LIVING WITH LYMPHEDEMA
Green KY Daily News - Thanks Dean for sending this to us
Living with lymphedema
Malfunction of lymphatic system doesn’t have to be the end of normal life
By Alyssa Harvey, firstname.lastname@example.org
Clinton Lewis/Daily News Carolyn Matthews of Glasgow has her arm wrapped by her husband, Billy, as a therapy for her lymphedema, a condition that causes swelling in her left arm.
After Carolyn Matthews had lymph nodes removed from her left underarm area following a bout with breast cancer in January 2002, she thought her battle was done.
Then the swelling began.
“In the middle of the year – about July – I noticed the swelling,” the Glasgow woman said. “It was in my right arm, my ankles and especially in my left arm where I had the surgery. It kept getting puffy.”
At first, she didn’t think about it much.
“I had just had a granddaughter born and had just finished chemotherapy,” she said. “I thought the swelling would go down.”
Eventually a doctor diagnosed her with lymphedema, an incurable swelling caused by a dysfunction of the lymphatic system, said Annette Runyon, rehabilitation area manager and occupational therapist at Bluegrass Outpatient Clinic. There are two types of lymphedema – primary, in which the lymph nodes are missing or aren’t working properly because of unknown causes, and secondary, which can occur because of cancer treatments.
“The secondary type is the one that happens most often,” Runyon said. “It’s common with post-mastectomy.”
Lymphedema often affects the legs and arms and – more rarely – the face and genital area, depending on where a patient had surgery, Runyon said.
“I have some patients that have no pain and others that have extreme pain,” she said. “It’s devastating. It affects function.”
According to the American Cancer Society, the following are signs of lymphedema: a full or heavy feeling in an arm or leg; a tight feeling in the skin on the arm or leg; less movement or flexibility in a hand, wrist or ankle; difficulty fitting into clothing in one specific area such as the sleeve of a jacket or socks being tight; a ring, watch or bracelet feels tight with no weight gain.
There are ways to help ease the effects of lymphedema, Runyon said. One way is letting a therapist who specializes in lymphedema do manual lymphatic drainage followed by wrapping the affected area in a bandage.
“It’s important to find someone who’s trained in lymphedema,” she said. “Someone who’s not trained can make it worse.”
Matthews agreed. After learning she had the ailment, she went to therapist after therapist and did research to find someone who could help ease her symptoms.
“It was a frustrating experience for me the whole year I was looking for treatment,” she said. “I should have been trying to find treatment at the first sign of swelling.”
After a visit to one therapist, she knew she had to find someone who specialized in treating lymphedema patients because that therapist did not know what to do.
“Any physical therapist will try to treat lymphedema, but it takes special training to prevent further damage,” she said. “It’s like a light massage.”
The first week of therapy is sometimes intense for new patients, Runyon said.
“The first week of therapy I see patients daily to get the swelling down as much as possible,” she said. “Then we order them a custom-made compression garment. It feels tighter than support hose.”
The heat from summer often aggravates the condition, Runyon said. Injuries also affect lymphedema, so patients must learn methods of self-management to keep the ailment under control.
“People with lymphedema heal slower,” she said. “Infections can cause more swelling. Paper cuts, bug bites ... they can flare it up. They can never get their blood pressure taken on that side. Flying can also increase the swelling.”
Matthews said her life has been affected by her condition.
“My arm gets aggravated during the summer because of the heat. The special sleeve I wear is hot, but that’s better than having my arm huge,” she said. “Even carrying a purse is hard sometimes. There are so many things that you do that can aggravate it.”
Getting treatment for lymphedema is important, Runyon said.
“The swelling doesn’t go away. It can get bigger and bigger,” she said. “There can be more cancerous situations and infection (can develop) if it goes untreated. It’s important that people understand that it can be treated and they can learn how to maintain themselves.”
“It’s best to get it treated,” she said. “Learn about it and educate yourself. At the earliest sign, you need to get help.”
Matthews has learned how to take care of herself. She goes to therapy regularly at Bluegrass Outpatient Clinic and wears her custom-made sleeve at other times.
“I’m learning to live with it now,” she said.
http://www.bgdailynews.com/cgi-bin/view.cgi?/200312/01 lymphedema20031201_top-feature.html 20031201 top-feature
To Your Health: Managing and living with lymphedema
Palo Alto Weekly Online Edition
Publication Date: Wednesday Dec 10, 1997
I had a mastectomy for breast cancer four years ago, and although I had no complications at the time, I have suddenly developed a very swollen arm that my doctor tells me is lymphedema. Do you have any information on this condition? My doctor tells me I'll just have to live with it......
Living with Lymphedema
Sabrina S. Selim, BA, Francine Manuel, RPT, Cheryl Ewing, MD, Ernest H. Rosenbaum, MD
The good news for Julia Gibson was that her cancer was long gone. The bad news was the unexplained swelling in her arm years after her radiation treatments.
The lump was gone. The cancer was gone. But five years later, the surgery and treatments she'd had were instigators of a new problem in her life.
Julia Gibson, 62, stood with her arms raised in front of a mirror. She compared arms. Scrutinized her right, and noted, "I have no elbow."
It looked swollen. And lately, she'd been having trouble fitting it into the sleeve of her blouses.
Her right arm was unusually big. Bigger than her left. And growing. She was worried because it was on the same side as the breast cancer she'd had back in 2000. She'd had the lump removed as well as some lymph nodes under her arm, which later tested positive for cancer.
After that, she had eight months of chemotherapy and five weeks of radiation.
When she first noticed her arm swelling, she put up with it for awhile. Then it got bigger, from her wrist way on up to her shoulder. It felt heavy and uncomfortable and it made her back ache. Then it started to hurt too much to do the things in life she enjoys, such as knitting, sewing and painting.
She remembers going to a quilt show with her sister. Her arm was so sore and swollen, she made herself a sling so she could rest it while she walked. Having her arm hang down all day would have been unbearable.
Even in the sling it hurt.
Then it got infected. Her arm turned red and felt hot. The Port Colborne woman had a fever and felt sick and tired all the time. Her arms shook so much she couldn't hold a glass of water. Her doctor prescribed antibiotics, but it always came back.
Some days, she was too sick to enjoy her three grandchildren. And she worried that might lose her arm.
She told her oncologist who realized the problem right away: lymphedema.
Simply put, it's a chronic swelling in one part of the body, caused by a problem with the lymphatic system.
Think of the lymph network as a sort of waste disposal system. The network runs alongside blood vessels. Its job is to remove impurities.
Primary lymphedema happens at birth or any time in life, for unknown reasons that relate to a malformation of the lymphatic system.
Secondary lymphedema is triggered by a trauma, surgery or treatment such as radiation. But often it happens months, even years, afterwards.
There hasn't been a lot of research done, so it's not understood why some people who had surgery and radiation develop lymphedema while others never do, says Anna Kennedy, executive director of the Lymphovenous Association of Ontario.
Nonetheless, it begins when the lymph nodes are either damaged or removed.
Think of lymph nodes as traffic lights that direct the flow of lymph fluid. If nodes are damaged or removed - most commonly through cancer surgery and treatments - then the traffic doesn't flow as well.
It's like four lanes of traffic getting reduced down to two. All you need is one accident (something as simple as a scratch that triggers an infection) and everything starts to back up, says Kennedy.
There is traffic chaos. Lymph fluid doesn't know where to go.
"It just sits under the tissue and can't move," says Kennedy.
Fluid backs up and causes swelling. And if that swelling isn't treated, it can cause problems that range from an infection called cellulitis (red, blotchy skin with sudden fever and chills) to hardening of the skin, delayed wound healing, pain from heaviness and psychological distress.
Trouble is, few family doctors even recognize the signs, says Kennedy.
Herself a lymphedema patient, she woke up one morning with a grossly swollen leg. It had been five years since her surgery for cervical cancer.
It took about three months to get a diagnosis, after ruling out blood clots, tumours and other blockages. One night she typed the words "swollen leg post cancer" into her computer search engine and read the word "lymphedema" for the first time.
"I hear the same story on our help line," she says.
"I got cancer X number of years ago. I had treatment, radiation and then I get this swelling and nobody knew what it was, until I read an article on it ..."
But even once diagnosed, the story doesn't get much better.
There is no cure for lymphedema. But it can be successfully managed by a treatment called Combined Decongestive Therapy (CDT).
Across Ontario, there are only about 60 people trained in CDT, says Kennedy.
Typically, they include registered massage therapists, physiotherapists, occupational therapists and registered nurses.
In Niagara, there are two. Cindy Schultz from St. Catharines and John Mulligan in Welland are both registered massage therapists trained in CDT.
Simply put, CDT consists of an intensive phase to reduce the swelling as much as possible and a longterm maintenance phase to keep the swelling down.
It involves several therapies that include manual lymph drainage, compression bandaging and garments, exercises and skin care.
Manual lymph drainage is like massage but not, says Schultz. It's a much lighter touch and involves moving fluid to areas of the body that have enough lymph nodes to drain it.
Schultz gently twists, pulls and stretches the surface of the skin, where the network of lymph vessels lie. The idea is to manually get rid of excess fluid.
After that, the limb is bandaged tightly to replace skin pressure lost from lymphedema and prevent the swelling from returning.
Every day for just over a week, Gibson's bandage was adjusted. As she lost fluid, it was made smaller, so it stayed tight.
After one massage treatment and bandaging, her skin was so wrinkled they figured she'd lost about a cup of fluid.
Mulligan says people are often skeptical at first. "That doesn't last long," he says.
"There's a dramatic difference after the first treatment.
"It gives their life back to them."
They can once again buy clothes off the shelf. They can walk and care for themselves. They don't suffer repeated infections. And they feel more confident, he says.
"It makes them feel more whole."
In addition to people with lymphedema, the treatment seems to help people with sprains, post-surgical swelling, women who are pregnant with swollen ankles, people with skin conditions such as acne or rosacea, or with head colds or ear problems, he says.
Eventually, Gibson's treatments were reduced to once a month. And instead of a tight bandage, she wears a compression sleeve. It's custom-made in Germany and costs just over $500.
She only takes it off at night.
Gibson also uses special skin care cream to keep her arm soft and prevent cracking and infections.
And even though the compression sleeve is hot in the summer and is a reminder of the cancer she once had, she's not complaining.
"You know what? I'll take it," she says.
"I feel blessed that I have a solution to my problem."
"I'm living. I'm enjoying my life."
That includes her three grandchildren, all her hobbies and volunteer work with her church.
She wants to let other people know, so they can find treatment.
Tom Kutlesa wishes he knew.
Back in 2006, he was in a car accident that left him with multiple injuries including a crushed right leg. He was a passenger in a car being driven on the QEW in St. Catharines, that flipped several times before stopping.
Part of his injuries included damaged veins and lymph vessels.
But it would take a year and a half for the 25-year-old to finally receive appropriate treatment for the lymphedema that had developed. Problem was, no one identified it as lymphedema.
"People said, live with it. It takes time," he says.
"It was out of control for a long time. I didn't know what to do," he says.
For months, he suffered from a grossly swollen ankle and a wound near that area that grew and changed, but never really healed. One doctor even suggested he might have to consider amputation if it didn't get better.
Along the way, he was treated by a nurse practitioner who put his leg in a compression cast, then a compression stocking. Soon, it was noticeably better. But eventually, the wound started to reappear and Kutlesa was left once again searching for answers.
Eventually, he saw a wound specialist in Dundas, who put his leg in an even tighter stocking and suggested manual lymphatic drainage.
That's when his life changed.
Nearly a year and a half after the accident, in September 2007, Kutlesa met up with Cindy Schultz, the registered massage therapist who had helped Gibson's swollen arm.
"When I left her office, I felt like I had a new leg," he says.
There was less swelling. And he could move his ankle.
He's in the process of getting a custom-made stocking from Germany to replace the one he currently wears.
He, too, wants people to know about lymphedema so they can find help quicker.
"A lot of people told me, Tom, relax. Nothing's wrong. Trust the doctors," he says.
"They were putting bandages over the top.
"I found a way to heal this from the inside out."
Two registered massage therapists in Niagara offer Combined Decongestive Therapy, including Manual Lymph Drainage:
Cindy Schultz, Port Health Clinic 600 Ontario St., in the Port Plaza. 905-684-6066.
John Mulligan, B Elliott and Associated Medical Massage Therapy Clinic at 706 East Main St. in Welland. 905-788-3214.
For more information:
Lymphovenous Association of Ontario, www.lymphontario.org.
Lymphedema Association of Quebec, www.infolympho.ca.
The National Lymphedema Network, www.lymphnet.org.
Early warning signs of Lymphedema
Swelling that occurs gradually or suddenly.
Feeling of heaviness and/or limited flexibility.
Tightness, hardness or indenting of the skin when pressed.
Achiness or bursting or shooting pain.
More swelling on hot, humid days or after exertion.
Infection (cellulitis) in the affected area.
Complications if left untreated
Infection, called cellulitis, is the greatest danger and requires antibiotic treatment. Signs of cellulitis include: red blotch or rash that may be itchy; increased swelling; increased temperature of the skin; sudden onset of high fever and chills.
Fibrosis or hardening of the tissues.
Delayed wound healing.
Pain from heaviness or reduced mobility.
Difficulty carrying out daily tasks.
Source: Lymphedema Association of Quebec.
From: The Standard
queen Street, St. Catherines, Canada905-684-7251
Living with lymphedema
three months after undergoing surgery and radiation for breast cancer,
noticed an uncomfortable tightness and fullness around her left
side on which the cancer had occurred. She was having difficulty
and wearing a watch, and within days her arm had swollen to three times
normal size. Alarmed, she saw her doctor, who told her it was
Lymphedema is a painless swelling of an arm or leg that occurs when lymph, a natural body fluid, is unable to drain properly. Most of the 2.5 million lymphedema cases in the U.S. are the result of cancer treatments, especially those involving the breast, the reproductive organs, the prostate and melanomas of the arms or legs.
reason: Surgical removal of lymph nodes or radiation therapy that
vessels can disrupt lymph flow, causing it to back up into the arms or
That’s when the swelling occurs.
can’t be cured, but it can be treated. The most effective approach is
complete, or complex, decongestive physiotherapy. It has four steps:
the limb reaches normal size, most patients will have to continue
limb overnight and wearing elastic support sleeves during the day.
also recommend taking steps to prevent infection, such as wearing
gardening and cooking, using thimbles when sewing, wearing water shoes
swimming and avoiding extreme hot or cold. In addition, some
that eating a low-fat, low-sodium diet and maintaining a healthy weight
keep lymphedema under control.
Wednesday, April 2, 2008
At Adventist Rehabilitation Hospital of Maryland, women suffering from chronic pain are moving toward healthier bodies and minds with the help of bubbles, boas and bands of yellow stretchy rubber.The Rockville hospital offers classes in the Lebed Method, a light dance-inspired physical therapy regimen. The therapy is used by those whose movements are limited by lymphedema, a chronic and incurable condition common among breast cancer patients that causes swelling in the limbs and elsewhere in the body.
‘‘It brings fun and silliness. It makes people forget about their fears and concerns for an hour a week,” said occupational therapist Vicki Ralph, a certified Lebed instructor who recommends that her lymphedema patients attend Adventist classes to supplement regular treatments, which involve massage and compression of the affected limbs. Attendance at the weekly class has more than doubled since she began teaching it in the fall, and the five original students remain among the 12 currently enrolled.
Participants use props to aid them in light stretching and gentle movements, such as raising and lowering a feather boa and blowing soap bubbles to help with breathing. The exercises can be done sitting or standing, and can be beneficial for people with chronic fatigue, multiple sclerosis, arthritis or other conditions that make movement difficult, Ralph said.
‘‘It’s activity, but it’s not too strenuous,” said Susie Sabatano, 36, of Silver Spring, who was diagnosed with breast cancer when she was 28 and developed lymphedema a year later. She found out about the class last fall from Ralph, an acquaintance she met through church. ‘‘It’s not like an aerobics class where you’re trying to get your heart rate up,” she said.
Exercise is recommended for people with lymphedema, a condition in which the lymphatic fluids that help the body fight infection build up in the limbs or elsewhere, because it moves accumulated fluid out of swollen areas, according to Ralph. However, physical activity can be difficult for those with severe swelling.
‘‘It puts you in a good mood and gives you energy that you didn’t have before,” said LaQuita Hunteman, 66, of Germantown, who was unable to lift her left arm above her ahead until she began the exercises. She has worn a custom-made compression bandage extending from her hand to her elbow 24 hours a day, seven days a week for the last six years to reduce the swelling.
Hunteman, a breast cancer survivor, developed lymphedema after she had 26 lymph nodes removed in 2001. Breast cancer often first spreads to the lymph nodes near the armpits, according to the non-profit breastcancer.org.
The Lebed Method was developed in 2000 by Sherry Lebed Davis, a professional dancer who was diagnosed with breast cancer in 1996. The Adventist classes, which also serve as a kind of support group, feature music such as ‘‘(You Make Me Feel Like) A Natural Woman” and ‘‘I Believe I Can Fly” and plenty of water breaks for socializing.
‘‘You start talking about your cancer and then you start talking about where your family lives,” said Hunteman, who exercises at home and plays the piano for an hour a day to keep her fingers moving.
Ralph agreed. ‘‘Some people don’t connect with a support group,” she said. ‘‘This is more upbeat.”
Kim McColl and her husband Dale Neil used to spend six-months each winter in Florida, from November to April.
Then in December 2006 McColl discovered lumps under her arm that she had never noticed before.
McColl says she always valued the Canadian health care system but now she is more appreciative of what we have here because of the tribulations she experienced in Florida.
The day that she discovered the lumps she tried to make an appointment at a primary care practitioner she had visited in the past.
She was refused after explaining her situation and was told the office would not accept cash paying patients.
Even though she was there the previous year and had paid with the couple’s insurance policy.
McColl suspects that the particular clinic she went to that day only accepts insurance from one company.
Fortunately McColl was able to locate a second general practitioner who was willing to take cash.
The doctor got her in to Manatee Memorial Hospital in Bradenton, Florida where she was administered a diagnostic mammogram and an ultrasound.
The tests found nothing, which McColl later learned could have been caused because the cancer had metastasized.
“At the time I did not realize the gravity of the situation,” said McColl thinking like many who have a cancer scare, that it will probably end up being nothing.
insurance policy covered her for emergency procedures only, the tests at approximately $2000 each were paid out of pocket.
The doctor in Florida recommended that she have a fine needle biopsy next but with the medical costs adding up and the possibility of more tests McColl and her husband decided to cut short their Florida trip and return to Napanee.
Prior to returning Neil called their family doctor in Napanee to set up an appointment, the family doctor told them that 80 per cent of lumps can be drained.
McColl saw her doctor within days of returning in February of 2007 and had the fine needle biopsy at Lennox & Addington County General Hospital the next day.
For the next month McColl was submitted to a barrage of tests, “CATscan, MRI, bone scan, endoscopy, colonoscopy they were trying to find the source of the cancer,” recalls McColl, everything happened very quickly.
“This was an education we did not want,” says McColl, “it was discovered that the cancer was without a primary source.”
On March 27 McColl had 12 lymph nodes removed and and a prophylactic mastectomy.
Chemotherapy began for McColl in May but she only made it through the first five treatments, skipping the final treatment because she says it would have finished her.
“My body rejected it,” says McColl, “I have an honorary degree in throwing up.”
The next complication came in the form of lymphedema or swelling of the limbs caused by a blockage in the lymphatic system.
The swelling meant that McColl could not raise her arm above her head so they could localize the radiation therapy.
During the summer and fall of 2006 McColl underwent physiotherapy and massage therapy to control the lymphedema.
Finally in November of 2007 McColl began the first of 25 radiation treatments that lasted through December.
McColl began herceptin treatments in February which will last for a year. The treatments are administered every three weeks in Kingston. A volunteer driver from the Canadian Cancer Society picks her up for her treatment, a service McColl is grateful for.
“The Cancer Society has been an invaluable resource,” says McColl, “I have had many different drivers some of whom are cancer survivors.”
McColl describes her medical journey as a 26-month ordeal, she still has 10 months of herceptin treatments but is very optimistic about the road to recovery.
“I am still on the road, but the main thing is that I am on the road,” says McColl, “all this effort will not go to waste.”
McColl plans on attending the wedding of her nephew this summer and maybe down the road heading back to Florida for a holiday.
Check 12: Lymphedema
By: Christy Hendricks
CAPE GIRARDEAU, Mo. - Breast cancer affects one in eight women in a lifetime. Not only do patients have to deal with treatment of the cancer, other health problems can develop from the treatment.
Patients who have mastectomies often develop lymphedema. It happens many times after lymph nodes are removed during surgery and fluid builds up in the arm. While there's no cure for lyphedema there is treatment.
"After I finished with all the surgery and all the chemo and everything that took all of my time and energy, I noticed that my arm continued to hurt," said Connie Eichhorn. She was diagnosed with breast cancer two years ago.
Eichhorn says after 23 lymph nodes were removed from her arm during a mastectomy, she could barely buckle her seat belt and couldn't sleep through the night.
After hearing about lymphedema through a support group, she sought treatment from physical therapist Paula Stout.
"The treatment of choice for lymphedema is manual lymph drainage. It's not massage. It's a treatment by which we stimulate the lymph vessels to reroute the fluid around that area that's been removed," said Stout.
"Like the very first treatment I went home and I think I slept all night which I hadn't done in probably six months," Eichhorn said.
Connie receives the manual lymph drainage treatment every week.
She also wears a compression sleeve several hours a day to reduce swelling.
"Lymphedema is aggravating and it takes a lot of time and it's painful, but compared to the other things that I went through in that year, probably, it's really a much easier thing to deal with," Eichhorn said.
Stout says anyone who's had lymph nodes removed probably have a little bit of lymphedema.
If left untreated, it could cause infections and hardening of the skin.
What is lymphedema?
Primary lymphedema is caused by a malformation of the lymphatic system.
Secondary lymphedema is often caused by surgery removal of lymph nodes, injury, scarring, or radiation therapy. Many breast cancer patients develop lymphedema.
Swelling, pain, joint immobility, feeling of heaviness, repeated infections, skin thickening
Manual lymph drainage - manual treatment technique which improves the activity of the lymph vessels and re-routes the lymph flow around the area of blockage.
Compresson therapy - special compression garments are applied to the arm or limb to reduce swelling.
Skin and nail care - helps prevent bacterial and fungal growth. Use a low pH lotion to maintain moisture and reduce the chance of an infection.
Therapeutic exercise - exercises done while wearing the compression garments to promote the flow of lymph and improve range of motion.
Site for more information on lymphedema:
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
Lymphedema People / Advocates for Lymphedema
For information about Lymphedema
For Information about Lymphedema Complications
For Lymphedema Personal Stories
For information about How to Treat a Lymphedema Wound
For information about Lymphedema Treatment
For information about Exercises for Lymphedema
For information on Infections Associated with Lymphedema
For information on Lymphedema in Children
Lymphedema People - Support Groups
The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.
No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.
Come join, be a part of the family!
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved one with lymphedema who you are trying
and understand come join us and discover what it is to be the master
the sufferer of lymphedema.
Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.
Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.
Lymphedema People New Wiki Pages
you seen our new
“Wiki” pages yet? Listed
are just a sample of the more than 140 pages now listed in our Wiki
are also working on hundred more.
and take a stroll!
are not for
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
to Treat a Lymphedema
para-aortic lymph node dissection (EPLND)
Needle Biopsy - Fine Needle Aspiration
Lymphedema Gene VEGFC
Lymphedema Gene SOX18
Home page: Lymphedema People
Page Updated: Dec. 14, 2011