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A diagnosis of lymphedema, edema, or lipedema can be overwhelming. The good news is treatment by a certified lymphedema specialist can reduce symptoms and improve quality of life. While the general rehabilitation plan for these three conditions are similar, actual treatment plans and therapy takes into account their differing complexities, nuances, and health of the patient.

It’s not just cancer patients that suffer from arm or leg swelling. Vascular issues can cause edema and lipedema, which is an excess accumulation of fat, may have an underlying vascular component, but is generally an issue of excess fat and is often hereditary. Both are primarily treated through advanced lymphedema protocols.

Kim Marshall, DPT, CLT has more than 15 years of experience in this highly-specialized field. She is a certified lymphedema specialist, a certified in oncology rehabilitation, and is a member of the oncology section of the American Physical Therapy Association, the National Lymphedema Network, and LE&RN (Lymphatic Education & Research Network).

Her success stems from combining her vast clinical experience with evidence-based science to generate results for her patients with customized treatment plans. No where is this more evident than her recent efforts to develop pre- and post-surgical treatment protocols for the pioneering lymphovenous bypass and vascularized lymph node transfer procedures.


The umbrella name for swelling caused by excess fluid trapped in your body’s tissue is called edema. It is most common in hands, arms, feet, ankles, and legs. This type of edema results from venous insufficiency, cardiac conditions, kidney failure, or other inflammatory processes.

Edema happens when your small blood vessels leak fluid into nearby tissues. That extra fluid builds up, which makes the tissue swell. It can happen almost anywhere in the body.

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It’s very important to see your healthcare provider if you experience edema or swelling in your body. Edema can stretch your skin and if not treated, swelling could increase and cause serious health problems.

Edema can be a short-term or long-term condition, depending on its cause. Treatment is available to help you manage any underlying conditions that might cause edema or you can make simple lifestyle changes to reduce swelling and fluid buildup in your body.

No matter what the cause of edema, any swollen area of the body should be protected from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns in areas that have edema take much longer to heal and are more likely to get infected.


The lymphatic system collects lymph (excess fluid, proteins, and other substances) from the body tissues and carries them back to the bloodstream. Lymph is moved slowly through lymphatic vessels and is passed through the lymph nodes. Swelling (“edema”) may occur when the lymph increases in the body tissues. Lymphedema occurs when the normal drainage of fluid is disrupted by a blockage or a cut in the lymph nodes in the armpit or groin area. Lymphedema can be a hereditary condition, but it’s most commonly the result of blockages caused by infection, cancer, and scar tissue from radiation therapy or the surgical removal of lymph nodes.

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According to the American Cancer Society, the early stages of lymphedema are often reversible, while the later stages (stages 2 and 3) can me more difficult to treat and manage. That is why, it’s very important to see your health care provider as soon as you notice any concerning symptoms.

For women undergoing breast cancer surgery, we strongly recommend an evaluation prior to surgery to establish baseline measurements should any post-surgical swelling occur. In addition, by accessing your risk for developing lymphedema, we can provide information to help you monitor your recovery and offer piece of mind should you experience the early signs of developing lymphedema.


Lipedema is a condition that mainly affects women and is characterized by a painful swelling in the legs, thighs and buttocks and sometimes the arms. It occurs because of the abnormal accumulation of fat under the skin. Lipedema can often be misdiagnosed as obesity or other lymphedema. Lipedema is its own distinct condition, and a non-trivial one. Lipedema is a chronic and chronically misunderstood disorder with unique health implications  An early, accurate diagnosis is crucial to receive appropriate treatment.

If you have lipedema your legs become swollen, bruise easily, are tender and feel painful and uncomfortable. Lipedema may occur because of changes in female hormones.

Symptoms of lipedema include:

  • Legs appearing symmetrically swollen – swelling can occur from the hips down to the ankles and your legs appear column-like; the feet are not usually affected
  • A “spongy” feeling of the affected areas  areas feel that may feel cool and the skin is generally soft and subtle
  • Easy bruising in the affected areasSmall varicose or spider veins in the affected areas
  • Legs and other affected areas are sensitive to touch
  • Legs and other affected areas hurt and feel uncomfortable – swelling may become worse in the afternoon, evening, after activity or in hot weather.

Because lipedema is not well known, getting a correct diagnosis can be challenging, that is why awareness of the symptoms is important. A good example is a larger lower half and column-like legs, which are often tender and bruise easily. For example, the top half of your body may be a size 8, but the bottom half may be a size 16.

Seeking treatment and care:

Regardless of your diagnosis we are here to help. Help you understand your condition. Help you reduce pain and improve quality of life. Help and teach you how to manage your symptoms at home. Help and support you in the rehabilitation process. Unfortunately, with lymphedema, edema, and lipedema, there are no easy fixes, but there is hope and there is improvement. We will listen and support you every step of the way.

Below are the general treatment therapies that we use:

  • Screening & Education Prior to Surgery
  • Complete Decongestive Therapy/Manual Lymph Drainage
  • ASTYM Soft Tissue Treatment for Scar Tissue and Fibrosis
  • Post Surgical Care for Lipectomy
  • Pre/Post Op LVA Management
  • Wound & Skin Care Management
  • Bandaging and Compression Garment Fitting
  • Home Exercise Programs
  • Pain Management
  • Education on Home Self Care

We are Here to Help

Our lymphedema, edema, and lipodema program are offered exclusively in our Garden Grove Clinic that is conveniently located by the 22/5/57 Freeways. Contact us at 714.643.9012 to schedule an evaluation.

Photo Credits:

“Edema of the leg” By Ryaninuk – Own work (CC BY-SA 4.0) via Commons Wikimedia

“Upper Arm Lymphedema” By DocHealer – Own work (CC BY-SA 4.0) via Commons Wikimedia

“Lower Limb Lipedema” By Borgardottir – Own work (CC BY-SA 4.0) via Commons Wikimedia

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