Read Part 1 here

The Unthinkable Happened

Then the unthinkable happened.  One day a coworker stopped Carol to say she had something running down the back of her leg & on her pants. In fact, it was on both legs. She had developed wounds and didn’t know it. She went to a wound care clinic who told her something she had never heard:  You have lymphedema. She went to a lymphedema therapist who provided massage and compression bandaging. At the end of treatment, Carol was fit with custom, flat-knit compression hose. However, because of the unusual leg shape common to Lipedema (a condition she wasn’t yet aware of), the hose bunched around her ankle & caused pain. So, the foot of the hose was removed under the manufacturer’s warranty, and she wore compression from her ankle to her knee. At the time, her shoes seemed to provide enough compression for her feet. Her wounds had healed, and she loved her compression.

She wore her hose until they began to fall apart. Carol needed new compression but her former therapist wasn’t available. Not having any help, she searched the web and found hose she thought would work. But she didn’t know anything about compression sizing, strength, what gradient pressure was – in short, she didn’t have guidance and the compression she bought didn’t work. Her legs got bigger, and she was worried she would end up with wounds again. She began looking online for help and came across me.

Symptoms of lipedema

When I met Carol, I immediately recognized her leg shape as suspect for lipolymphedema (lipedema and lymphedema). Her legs were grossly symmetrical (meaning both legs looked about the same) and her feet were swollen but smaller. She had a definitive cuff around her ankle and while she was likely obese, there was more to her appearance than that. I asked Carol if she had ever been diagnosed with lipedema. She had never heard of the condition. I asked a few questions about her family and medical history.

She was very healthy and had no heart or kidney issues. At some point, though, a doctor had put her on diuretics. The diuretics helped for at time & then seemed to stop working. While she didn’t feel she ever bruised easily, during her evaluation, I noticed a bruise on the back of her leg that she wasn’t aware of (and she wasn’t using a blood thinner).  In fact, she didn’t take any medications other than one for her thyroid.  She denied feeling hypersensitive but had never really paid attention (her legs were hypersensitive to mild touch during our assessment).  She had knee & hip pain (a common characteristic in lipedema due to stress put on the joints). The arthritis had become so bad, she had to start using a walker. She cried as she told me about the first day she went to work with the device. In Carol’s mind, a walker was something “old people” use. As we talked about her family history, something stood out. At first, she said her mom had always been tiny, but later she mentioned her being diagnosed with elephantiasis (stage III of lymphedema) after the birth of Carol’s sibling. (It’s highly unlikely her mom went from tiny to elephantiasis after childbirth. She likely had swelling for years but, as a child, Carol just hadn’t noticed.) Carol was always hyper-flexible (a trait some people with lipedema have), and she struggled with her weight since adolescence (a time of hormonal change).

Sisters

Carol’s sister happened to be visiting during the evaluation. She told me all of their siblings had leg swelling and used compression now, but no one had as much swelling as Carol. Not only was she physically declining, but she was worried about her sister’s emotional & psychological health. Carol was a people-person but since Covid, she had been confined to her home. She became depressed. Carol spoke up, “but I’m ready for change. I woke up one day with an epiphany that I needed to make a change. That’s when I started looking for help and found you.”

Learning about lipedema

After the evaluation, I sent Carol a link to a doctor who specializes in lipedema named Karen Herbst.  I also sent a link to the Lipedema Project film entitled, The Disease They Call Fat and asked her to see if it resonated. When I saw her the next session, she said she could absolutely relate. She had never heard of lipedema before. How come no one ever told her? I explained lymphedema isn’t well-know but medical professionals are becoming more aware of the term. Lipedema, however, is even less well-known. And it’s one of the causes of secondary lymphedema.

For more information about lipedema, visit the following links: Dr. Karen Herbst, Lipedema Foundation, The Lipedema Project, the Fat Disorders Resource Society, National Center for Advancing Translational Sciences and this article in the Plastics and Reconstructive Surgery Journal.

To be continued 7/01/21.

“You’re just fat.” “You need to eat less.” You need to exercise.” “You need to diet.”  “You’re lazy.” Words hurt, especially when you are already doing everything you know to do to lose weight. If you are someone who can lose weight but never as much as you want, this blog is for you. If you hit a “wall” with diets and exercise you cannot get past, this blog is for you!

Lipedema, Obesity and Swelling

I’ve written a few blogs about a condition called lipedema (you can find them here, here and here). I’ve treated patients with lipedema which can progress to a condition called lipolymphedema (lipedema and lymphedema). This blog is part one of a woman’s story who has lipolymphedema and obesity. Meet Carol.

Carol* struggled with her weight, particularly when she hit her teen years. She has two brothers and a sister who use compression hose as adults, but they never struggled with weight like she did. In her late teens, a doctor put her on diet pills. She also put herself on several diets to lose weight over the years, including a 500-calorie diet (an extreme and risky way to lose weight).¹ Her efforts would partially pay off.  She would lose some weight in the upper body but never much in the lower body. Commonly losing 35 pounds, weight loss would then plateau, and she could not lose any more.  Disappointed and frustrated, she felt bad about herself.  She would gain back the weight she lost and then some. Her sister commented she always looked good in her upper body. Her lower body was never proportioned to the rest of her body. As an adult, Carol even had a lap band procedure but with no subsequent weight loss.

From weight to swelling

Most of her career, Carol had a desk job & company policy required her to wear pantyhose. Around age 33, she fell & injured her left knee which resulted in arthroscopic surgery. Later, her work policy changed, and she no longer had to wear support hose.  She gladly got rid of them!  At some point later, she began noticing swelling around her ankles, particularly her left ankle.  She also began having swelling in her legs.  Because of the swelling and joint pain (her knees & hip hurt), she went to a doctor for help. This doctor said she needed to lose weight. She told him she had tried dieting and exercise. She was disciplined & strict in what she ate, but she wasn’t able to lose the weight. He didn’t believe her.

Doctor after doctor

She went to another orthopedist. She described this man sitting in his chair, twirling his glasses and saying, “I can’t do anything for you. You’re just too fat.” She went to three more doctors after that consult who told her the same thing: You’re fat. You need to lose weight.  She went to one more orthopedist and described how she felt she had been discounted and [she paused as she held back tears telling me the story] treated like somebody who was just not worth their time. Someone who [she began to cry] had no value.” She described feeling like she was looked at as a second-class citizen, like someone who didn’t try.  That doctor said he didn’t want to treat her that way, but there wasn’t anything he could do for her. At that point, she stopped going to doctors.  She felt hopeless.  “If the person you place your [trust and] well-being in can’t help you, then why am I going? Why am I spending my money?” Her sister who was present in our session interrupted, “She wasn’t just hopeless, she gave up hope because she didn’t go to another doctor for years after that — for years.”

For more information about lipedema and resources, visit the following links: Dr. Karen Herbst, Lipedema Foundation, The Lipedema Project and the Fat Disorders Resource Society.

To be continued 6/01/21.

¹ https://www.healthline.com/health/food-nutrition/500-calorie-diet

For the American Cancer Society

In 2020, I was searching for a deeper knowledge of how to best serve the needs of people with lymphedema. In the process, the American Cancer Society (the Dallas chapter) asked me to do a video. If you’ve had cancer and are seeking to better understand lymphedema, check out the below links. One video is in English and one video is in Spanish.

Video (in English) Video (in Spanish)

If you’d like to share about your lymphedema interests and needs, you can take this survey.  What would you like to see more of? What would you like to know more about? As content continues to be created, information you provide will be used to maximize the potential benefit of these resources.

March is Lymphedema Awareness Month. March 6th is World Lymphedema Day. How can you make people aware of lymphedema? Three suggestions:

• Contact your legislators
• Contact your doctor
• Print free infographics to hand out

Legislators

Did you know Medicare does not pay for lymphedema treatment supplies or compression? Ironically, the same government that runs Medicare passed a law called the “Women’s Health and Cancer Rights Act” requiring other insurance companies to pay for lymphedema supplies and compression due to mastectomy resulting from breast cancer.^{1, 2}  Yet Medicare isn’t held to the same requirement. Isn’t that a double standard? Part of the discrepancy may be a result of poor awareness.  You can do something to help! Support the Lymphedema Treatment Act. The LTA website makes it easy and provides an email and platform to contact your senators and representative(s) in just a few clicks.

Doctors

This week I had the pleasure of speaking with Dr. Wei Chen, a plastic surgeon who specializes in lymphatic surgery. He commented that patients had cried in his office before because he was the first doctor to understand their condition. In Facebook feeds and reports from my own patients, I hear time and again how people with lymphedema are misdiagnosed, undiagnosed or incorrectly treated. Why is that?

Years ago I had a personal mentor whose husband was a pediatric surgeon. As I sat across the dinner table one Easter, I asked how much training physicians get in school about lymphedema. He held his hand up, separated his index finger from his thumb slightly and said, “about this much.” He explained there is so much information to cover in med school, there just isn’t time. Most of what is learned relates to immunity. Another physician (head of the acute care dept in a major Dallas hospital) contacted me to ask about care for a relative. Frustrated, he said, “they don’t teach us this stuff in med school.”

You can help your doctor become more aware by giving them a fact sheet from the LTA website or this brochure from the Lymphatic Education and Research Network (LERN). More free educational resources from the International Lymphedema Framework can be found here. You can encourage interest by suggesting they can earn CMEs. Licensure requires they obtain 48 hours of continuing medical education hours (CMEs) every two years. Physicians can earn a free CME here until 02/24/2022. They can earn up to (7) CMEs online here.

Print free infographics to hand out

If you have lymphedema, you’re bound to be asked a question now and then. Don’t be offended. You have an opportunity to educate others! If you don’t want to talk, give the inquirer this infographic. You’ll be helping spread awareness for yourself and others.

References
¹ https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet
² https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/health-insurance-laws/womens-health-and-cancer-rights-act.html

In last month’s blog, we talked about infection prevention. One of the strategies was to use more acidic soaps & lotions. This month, let’s investigate the composition of your skin & why those products are better for preventing infection.

Skin is composed of two main layers: the epidermis and the dermis. The outside layer (epidermis) doesn’t have blood vessels but the next layer does.  (If a skin injury or wound causes bleeding, you know its depth is at least to the dermis.)  The outer layer (sometimes called the acid mantle or hydrolipid film) has special qualities that prevent water loss & make it a good barrier to infection.  One quality is being composed of lipids which reduces water loss and keeps your skin flexible.  As the name “acid mantle” suggests, another quality is having a lower pH (or being more acidic than neutral).  That’s a good trait because we carry around harmful bacteria all the time (including bacteria that cause common infection(s) in lymphedema: Staphylococcus & Streptococcus). The acidity comes from sebum lipids (of your sebaceous glands – or oil glands) & sweat that excrete a wax-like substance to a hair follicle. ^{1, 2, 4}

Because of the acidic-lipid properties, you need to use products that are similar to your skin – both in pH level & with characteristics that aid in reducing water evaporation. Because immunity is compromised in tissue with lymphedema, you need to take good care of your skin as it is the first line of defense. We’ll discuss product ingredients, causes of compromised skin & product recommendations in the upcoming course & ebook on lymphedema management. For now, ideal products should have a pH between 5-7, contain barrier-forming lipids (like ceramides) & possess moisturizing characteristics (such as urea). You can find additional information here.

Most soaps & lotions are more alkaline (pH of 10-11)¹ which can change the pH level & bacterial resistance of your skin. Alkaline products also reduce the thickness of your skin and break down the lipid coating.²

Besides soaps & lotions, other factors impact skin integrity. Some of these factors include: sun, hydration, nutrition, smoking, obesity, medications & age. So use sunscreen, drink water, eat healthy, don’t smoke, lose weight, be healthy — & stay young (let me know if you figure that one out!).

In February, we’ll answer the question: Why People with Lymphedema are Prone to Infection.

References
¹ Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 623-627. Germany: Urban and Fisher.
² Bryant, R. Nix, D. (2016) Acute & Chronic Wounds (5^th edition), p 40-41, 46-59. Elsevier Inc.
³ attribution: <a href=”http://www.freepik.com”>Designed by macrovector / Freepik</a>
⁴ https://www.britannica.com/science/lipid
⁵ attribution: <a href=”http://www.freepik.com”>Designed by brgfx / Freepik</a>

(How Your Lymphatic System Defends Your Body and Keeps You Safe)

Several years ago I came across my grandfather’s old Navy manual.  He enlisted in the Navy underage, determined to join, near the time of Pearl Harbor.  The attack against Pearl Harbor forced the United States into World War II.  His subsequent years saw a lot of action – events he would never talk about.  Only in reading his journal entries years later (in the front and back pages of his handbook) did I gain greater insight into what he experienced. He wrote of being attacked by bombers and torpedo planes in the early morning hours. “[A]bout two o’clock they dived at us just missed us with a torpedo.” He continued, “May our luck hold out and God watch over us in time of battle which is very often.”  I knew he had a fear of water but only understood why later: He had been knocked into the ocean during an enemy attack against his destroyer warship.  Ultimately, he was honorably discharged after developing post-traumatic stress disorder (PTSD).

Many times we go about our daily lives not giving thought to the sacrifices those in our military make (in order that we might remain free and live each day as we do). Their sacrifices include missing the comfort of home; separation from loved ones; missing birthdays, anniversaries and holidays; missing a child’s milestones; potentially sustaining lifelong mental, emotional and physical trauma; and, some even sacrifice their very life on our behalf.  May President Reagan’s words ring true this month (and every month), “We will always remember. We will always be proud. We will always be prepared so we may be always free.” ⁸

To all who have served (and presently serve) in our armed forces: Thank you.

In honor of Veterans Day, how does your lymphatic system play a role in defending your body and keeping you safe?

Men and women in the Air Force, Army, Navy, Marine Corps, Coast Guard, and recent Space Force as well as the National Guard preserve our freedom by securing our country, protecting our interests, preventing potential attacks and fighting on our behalf when we do go to war. We even have elite special operations forces (highly trained and skilled individuals with specialized knowledge). To best perform these functions, the military must be strong, healthy and able to respond swiftly. In his 1793 State of the Union Address, President George Washington said, “[I]f we desire to secure peace …it must be known that we are at all times ready for war.” ¹ The best way to prevent an opportunist from gaining a foothold is to always be strong, prepared, and willing to act, if necessary.

Your body’s defense system is similarly made up of various branches creating its own armed forces:  Your skin, stomach (acid) and digestive system, tears, mucus, cilia (hair-like projections), saliva and lymphatic system make up your “armed forces.”  The lymphatic system has structural components made of vessels and organs. These include:

• lymph vessels – lymph capillaries, precollectors, collectors (lymphangions) and trunks
• primary lymph organs – red bone marrow (housing stem cells that become lymphocytes) and the thymus gland
• secondary lymph organs – spleen, lymph nodes (such as tonsils) and mucosa-associated lymphatic tissue (membranes that line the GI tract like Peyer’s patches, respiratory airways, urinary tract and reproductive tract). ^3,4

Your body fends off attacks from an enemy such as a pathogen or microbe (like a virus or bacteria) by neutralizing it, repairing damage (from bumps, cuts, burns, chemicals, etc.) and eliminating abnormal or degenerative cells (like cancer).  The body provides two types of defense:

Nonspecific³ – A general protection against invasion by pathogens through physical barriers (skin and mucus membranes), production of antimicrobial chemicals to inhibit microbe growth, natural killer cells (a.k.a. white blood cells or lymphocytes), phagocytosis (ingesting a pathogen), fever and inflammation.

Examples: Thick mucus and cilia filter air and trap microbes, dust and pollutants. Tears bathe the eye surface, washing away microbes as you blink. Cells that get infected with a virus produce messages (proteins called interferons) that signal other cells of the invasion. Many lymphatic cells (macrophages, B and T lymphocytes) produce these proteins. Non-infected cells get the message and ready themselves for attack (i.e. they make proteins to inhibit their own invasion of a virus which replicates itself using the cell). The blood contains a group of soldiers (i.e. inactive proteins) that activate themselves to bolster defenses (by enhancing immune, allergic and inflammatory reactions). Some soldiers even combine forces to punch holes in the plasma membrane of a microbe (cytolysis) causing it to rupture. How awesome is that?

If physical barriers and antimicrobial chemicals don’t work, the next lines of defense are natural killer cells and phagocytes (WBCs or lymphocytes) which destroy intruders. Killer cells patrol the body, interacting with other cells (checking “ID cards”). If a cell doesn’t match up (like a cancer cell)? It’s “Hasta la vista, Baby.” ⁶  Some phagocytes also patrol the body while others remain stationed at a post (in tissue). They ingest (imprison) an invader, unleash chemicals to kill the microbe and digest the remains. What a rough way to go! Anything that can’t be degraded is contained in residual bodies (mini-prisons) which are expelled into the interstitial space and cleaned up by the lymph capillaries.

Finally, there is inflammation and fever.  If invaders have caused tissue damage, the body responds with an inflammatory response (a loud siren) resulting in widening of roads (enlarging blood vessels, a process called vasodilation) and more eagerly opening gates (increasing blood vessel permeability), to allow soldiers, clean up personnel and paramedics (antibodies, phagocytes and clot-forming chemicals in blood) to enter the trauma zone.

Specific³ – A specific, adapted defense response (immunity) to a particular pathogen (called an antigen) is launched by the lymphatic system (T and B lymphocytes) and is the most potent.⁵ This takes some smarts!  It is sort of like profiling (antigens are external molecular structures or characteristics that identify the pathogen).  The lymphatic system not only recognizes the invader but remembers it next time around and responds even faster. These are your “elite special operations forces.”  T and B cells develop in red bone marrow. B cells remain there while T cells migrate to the thymus to complete their training (development). Before either cell leaves their training base, it becomes highly trained and skilled with specialized knowledge (in the form of distinctive surface proteins) in order to recognize specific enemies. In fact, “[b]efore a particular antigen ever enters the body, T and B lymphocytes that can recognize and respond to that intruder are ready and waiting.”⁷ That kind of preparedness would make President George Washington proud!

When an antigen is recognized, B and T cells respond in two ways: cellular or humoral. In cellular, some T cells become killer cells and directly attack. This is sort of like a reconnaissance mission during which T cells scout the body for enemies and once identified, attack.  In humoral, B cells become plasma cells which make and secrete proteins (antibodies or immunoglobulins).  These bind to and inactivate a particular antigen. This is sort of like a reconnaissance mission during which B cells disable and neutralize the enemy.

How can your lymphatic system “always be strong, prepared, and willing to act?” By you following a healthy regimen:  Get plenty of rest. Eat healthy. Reduce stress. Practice good hygiene and wash your hands often. Exercise. Maintain a healthy weight. Don’t do unhealthy things (drinking too much, smoking, etc.). And, given that lymphatics slow down as we age (restricting the transport of antibodies), ² consider getting a manual lymph drainage massage from time to time.

¹https://avalon.law.yale.edu/18th_century/washs05.asp
²Verlag, K. (1998). Compendium of Dr. Vodder’s Manual Lymph Drainage, p. 22-23. Germany: Huthig GmbH.
³Tortora, G., Grabowski, S. (1996). Principles of Anatomy and Physiology (8^th ed.), p. 671-706. New York: HarperCollins College Publishers.
⁴Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 2-8. Germany: Urban and Fisher.
⁵https://biodifferences.com/difference-between-humoral-and-cell-mediated-immunity.html
⁶Cameron, J. (Producer, Director). 1991. Terminator 2: Judgment Day. United States: TriStar Pictures.
⁷Tortora, G., Grabowski, S. (1996). Principles of Anatomy and Physiology (8^th ed.), p. 688. New York: HarperCollins College Publishers.
⁸Reagan, Pres. Ronald. “Normandy Speech.” June 6, 1984.

In prior posts, I’ve talked about the difference between edema and lymphedema (click here & here to see those posts). Today, let’s take a look at conditions that begin as edema & can become lymphedema as the swelling persists.  How can that happen?

To understand how edema can become lymphedema, we need to revisit what lymphedema is.  By definition, true lymphedema is an accumulation of protein-rich fluid (tissue which has excess protein in it).  How does protein get into fluid?  You eat protein (like meat, eggs, etc.), but your body also makes proteins that play an essential role in bodily function.  I won’t get into the bio-physiology of proteins except to comment on one: a plasma (blood) protein called albumin.

Albumin helps regulates which way fluid goes, into the blood vessels or into the tissue to potentially cause swelling (known as “colloid osmotic pressure”). Albumin, which is made by the liver, accounts for 70% of the colloid osmotic pressure.^1,2  That’s huge!

Second, by definition, true lymphedema is the result of damage to the lymphatic system. How does the system get damaged? Genetic causes (called primary lymphedema) or trauma (called secondary lymphedema).  Trauma is the most common. Chronic edema can be considered trauma because it increases the amount of fluid the lymphatic system must transport out of your tissue & back to the heart over time (sort of like abusing the lymphatic system).

Your lymphatic system has a pump, little “hearts” called lymph angions. Just as your heart pumps blood, these angions pump lymph fluid. But while the heart is a closed, circulatory system, the lymphatic system carries fluid one way, from the tissue spaces (throughout the entire body) to the heart. Just as blood enters the heart, stretching the wall of the right atrium & causing it to contract, fluid enters a lymph angion, stretching its wall & causing it to contract. At rest, contractions are 6-10 times per minutes. When necessary, this pumping can increase up to 20 times per minute.⁴ However, just like with the heart, such endurance cannot be sustained indefinitely.  The lymph angion will fail & stop working. ⁵ When that happens, the lymphatic load remains in the tissue causing inflammation & scarring. This leads to an important point: 

Lymphedema is not reversible once damage has occurred because of the mechanical, structural changes that have taken place. Progression of the condition can be stopped & symptoms can be improved, but the anatomy cannot be like it was before the damage.

In acute injury or initial trauma, edema is present & the lymphatic system is pumping as hard as it can to remove the excess fluid.  The body usually recovers, the swelling inundation subsides & the lymphatics return to normal. But over time (such as with chronic edema), the lymph system becomes overwhelmed & eventually stops working.  When that happens, inflammation & scarring occur.  The system becomes mechanically & structurally damaged in the area of congestion.

Now that we’ve reviewed what lymphedema is, what are some causes of chronic edema & why can they cause secondary lymphedema?

Obesity, lipedema & other fat disorders

These conditions slow down the flow of lymphatic fluid. I often use the analogy of driving around a mountain. Because of the curves & narrow roads, you have to slow your speed. When there are several cars, congestion results. When lymphatic vessels must weave through fat tissue, lymph fluid can become sluggish & congestion results, creating a backup of fluid which can lead to scarring of the lymphatic vessels.

Additionally, fat (or adipose) causes inflammation itself & inflammation can cause more fat development. Inflammation is the body’s response to trauma which increases blood flow to the affected (which increases swelling in that area). The cycle continues.

Venous pressure

Venous pressure causes an increase in the lymphatic load.  Conditions such as chronic venous insufficiency or varicose veins are conditions which cause blood flow to regurgitate in the lower legs instead of efficiently making its way northward to the heart. 

Another source of increased venous pressure is positioning.  Feet remaining in a dependent position (hanging down) for extended periods such as jobs requiring long episodes of standing or sitting create significant pressure in the lower legs that must be overcome.  Both the amount and speed of blood flow decrease in the legs after 15 minutes of static, dependent positioning.⁶

Another source of venous pressure is inactivity or not contracting muscles (even if in a gravity neutral position) as is seen in paralysis after spinal cord injury or a stroke. The lymph system is not able to overcome the increased tissue pressure in these cases & eventually fails, leading to scarring.

Organ dysfunction

Conditions such as heart failure, kidney failure, thyroid impairment & liver disease all can create an excessive amount of fluid⁷ & an inability of the lymph system to keep up with the demands, resulting in fatigue & eventual scarring of lymphatic vessels.

Infection

Localized infection such as cellulitis (particularly when repeated infections occur) result in scarring of lymphatic vessels.

Diabetes

Diabetes causes changes in the smallest parts of your blood vessels (making up the capillary beds).  The capillary bed wall thickens & enlarges, allowing the exit of blood matter (water, proteins & other molecules) that would not otherwise exit. That creates an added burden for the lymphatic vessels to manage. ⁸ Additionally, in my own thinking, because this results in loss of blood flow to other areas, it may likely cause disease of lymphatic vessels themselves. Either case would eventually cause scarring.

One of roles of the lymphatic system includes maintaining homeostasis (preventing swelling). Anything that causes edema creates more work for the lymphatic system. And when you work, work, & work more without rest, you get tired. So does your lymphatic system. When the lymphatic system gets tired, the fluid, protein & other molecules it’s responsible for get left in the tissue. That causes an inflammatory response which creates a cascade of events that create a cycle of chronic inflammation & scarring called lymphedema. As the cycle continues, you begin to see the symptoms of lymphedema.  In all the cases mentioned above, lymphedema occurs as a result of structural, mechanical damage to the lymphatic vessels, rendering it ineffective as a result of being overtaxed.

Note: Check out this link to read more on what is being done to increase awareness of edema induced lymphedema (added 01/12/21)

What can you do to prevent lymphedema resulting from chronic edema? Manage your health condition &, if your doctor approves, get compression. Check out past blogs for posts on compression!

¹ https://www.ncbi.nlm.nih.gov/books/NBK531504/, https://en.wikipedia.org/wiki/Oncotic_pressure
² https://www.ncbi.nlm.nih.gov/books/NBK204/
³ https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487
⁴ Weissleder, H., Schuchhardt, C. (2008).  Lymphedema Diagnosis and Therapy (4^th ed.), p.36.  Germany: Viavital Verlag GmbH.
⁵ Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 201. Germany: Urban & Fisher.
⁶ Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 434. Germany: Urban & Fisher.
7 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2^nd ed.), p. 242-259, . Germany: Urban & Fisher.