Patients with varicose veins often complain of swelling in their legs.  At Vein & Skin, we frequently do see swelling related to varicose veins (venous disease).  However, many times the   swelling is a result of a totally different problem called lymphedema.  Because there are multiple causes for swelling, it is important to receive a proper diagnosis.  The treatment and approach is different for venous disease and lymphodema.  Ignoring swelling and delaying treatment could create a bigger  problem if the swelling  is in fact caused by lymphedema.

lymphedema 1

Patients can have both venous edema and lymphedema at the same time.  Vein & Skin can diagnose the differences between the two, using history, physical exam and ultra sound studies.  It is very important to make the diagnosis of lymphedema for proper treatment. The patient needs to know the consequences of not treating the condition properly because it is a lifelong issue that worsens if not properly cared for.

The good news is that there is a way to control the swelling of lymphedema.   Diagnosis, patient education and proper treatment are all crucial in the control of lymphedema.    The importance of education cannot be over-emphasized because the treatment requires long-term management after the initial diagnosis. 

What is lymphedema?

Lymphedema is the collection of proteinaceous fluid in the body’s tissues because of dysfunction in the lymphatic drainage system.  The condition is not entirely correctable, but can be managed.  This first requires the proper diagnosis and then patient education and finally proper treatment.

Is treatment easily established?

Frequently the patient seeks medical advice but is not properly diagnosed. They usually have had symptoms for years.    Most lymphedema patients complain of swelling of the legs that is typically asymmetric.  They feel  that their legs are heavy and uncomfortable.   Since swelling and “heavy and uncomfortable” legs are also a symptom of varicose veins, they may have been advised to seek varicose vein treatment, which will not help the problem.  The patients may have been put on diuretics to get rid of fluid, but this is not effective with lymphedema.

Side effects or complications related to the disease.

Lymphedma patients frequently complain of having repeated infections in their legs.  This is often a red flag for the diagnosis.  A diagnostic physical finding called stemmers sign is frequently present in these patients.  Stemmers sign  is a swelling in the toes in which the skin cannot be pinched to create a skin fold because of skin fibrosis (skin thickening).  The skin in lymphedema   patients becomes thickened and hard in the affected areas.  There is also a size difference in the legs and nodular thickening of the skin.  In the early stages of lymphedema, there is also pitting edema of the tissues (swelling that leaves an indentation when pressed upon by a finger).

What is involved in treatment?

Education of the patient is a critical step in the treatment.    The patient needs to know that there are treatment options and that it will be a lifelong commitment to the proper control of the swelling.  This will require frequent visits for treatment and follow-up care with qualified care providers, and/or certified lymphatic therapists, which is usually covered by insurance policies.

What are the goals of treatment?

The main goals of treatment are #1 education,  #2 skin and nail care,  #3 supervised exercise routine,  #4 manual lymphatic drainage (massage), and #5 compression hose or bandaging.

#1 Education:  motivates the patient to do proper care and prevent further progression of the disease

#2  Skin and Nail Care:  skin care prevents infections which can cause further destruction of the lymphatic system, causing the problem to get progressively worse.  Frequently a combination of topical steroids and creams are needed to prevent infection.

#3 Supervised Exercise Routine:  allows the patient to keep the legs functional and mobile

#4   Manual  Lymphatic Drainage:  massage is needed to keep the fluid collection controlled; otherwise the condition will progress and worsen

#5  Compression bandaging:  sometimes needed to control swelling.  Then the patient is instructed on self care management, with includes leg elevation and compression stockings or other compression devices.


Vein & Skin has experts trained in properly diagnosing lymphedema and directing  proper steps for treatment.  You can be confident that you will receive the best care available from our board certified physicians.  Call today for your appointment at 404-508-4320.

















This post was written by Vein and Skin Laser Center | August 19, 2016


 My kids tease me about one summer when I was driving them home from camp or a sports tournament….I don’t remember now.  Doctor Daddy couldn’t come so it was Mommy and the kids.  Late at night, they were asleep in the back seat.  One of them tells the story of waking or half waking and hearing me humming along to music……CHRISTMAS music!  In August! 

Which leads me to….what am I up to now?  Trying to beat the heat and huddle indoors with the air conditioning?  Or just embrace the heat and go out and bake in it?  No,  my thoughts are far away…..two places……Africa….and Christmas.


You remember my writing about my trip to Swaziland this past January.  Well, now in Swaziland they are experiencing the worst drought in their history.  No rain in over a year.  Reservoirs are not just low; they are completely dry, with the ground cracking at the bottom of what once was a small lake/reservoir.   There is a plan for another water source, but it requires a significant amount of money.  How to get that water is always on my heart. 

The farming on Project Canaan is now dried up and over because there is no rain.  Primarily, Heart for Africa’s farm, Project Canaan, serves as home for 135 abandoned babies.  But the farming component was also a big part, providing food, jobs and an income source for the whole amazing operation and the surrounding communities.   


The jewelry making venture is now trying to pick up the slack.  People who were working in the fields are now being trained to make jewelry, stringing beads and bending wire, and I must say, doing a great job of it!  Just this week we received stateside thousands of these beautiful ornaments. 


What’s  on my mind these days?  How to sell 2,000 ornaments!  So I’m telling everyone I know about them.  The easiest way is to get 20 people to buy 100 ornaments ($12/each).  Can you do that?  Or could your business do that?

If you can’t buy 100, could you buy 10?  Or 20?   Or 50?  Come on, we all know we spend $10 here and $15 there to take care of gifting during the holidays.  Could you give these ornaments instead?  They look really cute draped over a wine bottle for a hostess gift or a gift for a good client or referral source.  Some people are enclosing them in their Christmas cards.  The blue ornament is perfect for Hanukkah too.  

I know its early and still HOT.  So hot, and every time I take a cool drink out of my water bottle, I think of my friends in Swaziland.  Even the animals are dying because of the drought….beautiful exotic Africa animals as well as the only goat a poor family may have had to stand between them and starvation. 

I will ask again, but I’m asking now so you can begin thinking how together we can make a difference.



I just discovered this and I give the Pioneer Woman all the credit, since I found it in her cookbook. 



 ½ seedless watermelon

Juice of 2 limes

1/3 cup sugar

Cut off the rind of the watermelon and chop into large chunks. 

Next slice 2 limes in half and squeeze the juice into a blender or Ninja. 

Add the sugar. 

Pack the blender as full of watermelon chunks as you can get it. 

Blend until totally pureed. 

Pour out about half the mixture into a bowl, then add the rest of the watermelon and blend it up. Pour second batch into bowl and mix up  

Pour the mixture into a large flat pan.  I used a large metal baking pan that is about 3 inches deep, because I thought the metal would make things freeze faster.


Place in the freezer for 2 to 3 hours.  Take out from the freezer and stir, so that the unfrozen part freezes and it stays slushy, rather than being frozen into one large block.  If you forget to stir, you CAN chop it all up, but its nicer if you stir it every hour or so. 

Serve in a pretty glass.  I used mine for my grown up daughter’s birthday dinner.


  And to quote the Pioneer Woman,

“Splash a small amount of cold wine or vodka over the granita if you’re into that kind of thing.”  

This post was written by Vein and Skin Laser Center | August 18, 2016