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When Tucsonan Josette DePasse was in the sixth grade, she twisted her ankle playing soccer. Her foot swelled and swelled. It never went down.

DePasse and her mother went to countless doctors for help. No one offered a solution, other than telling her to lose weight. As time went on, the swelling continued.

She no longer could fit into most shoes. She rarely wore shorts, instead opting for long skirts, pants and dresses that hid her legs altogether. People would often stare at her swollen legs, which no longer showed any indentation for her knee or ankle.

Not only was she self-conscious, but by the time she was 29, DePasse found it difficult to walk.

"I was poked and prodded. I tried acupuncture," said DePasse, who has a doctorate in education and runs a local preschool. "I grew so tired of my legs."

Three years ago, she finally got a diagnosis: lymphedema. The condition arises from an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arms and legs.

"I burst out in tears," said DePasse, 33, recalling her diagnosis.

While she was relieved to know what was wrong, she also feels frustration and "what ifs." Had her condition been caught earlier, she might not be where she is today — managing severe, irreversible lymphedema.

If she could change anything, she'd like more people in the medical community to be aware of the condition.

A bonus would be more general awareness — then she might not get so many questions and stares from strangers, DePasse said.

Lymphedema can develop when lymphatic vessels are missing or damaged, or when lymph nodes have been removed.

If left untreated, the lymphedema can lead to a decrease or loss of functioning of the limbs, skin breakdown and chronic infections. In the most severe cases, it can develop into a rare form of lymphatic cancer.

The swollen tissue on DePasse's legs is now hard — fibrotic.

Once a week, DePasse goes to Andrea Morken, a local certified lymphatic specialist, for an hour-long session of manual lymphatic drainage. About 85 percent of Morken's business at Skin Hygienics is made up of lymphedema patients.

Morken compares the lymph system to the body's "garbage disposal," and in the case of a patient with lymphedema, the garbage — lymphatic fluid — backs up. Her job is encouraging the flow of lymph fluid out of the arm or leg.

Many lymphedema patients develop the condition after cancer surgery, particularly if they've had their lymph nodes removed.

Dolores Meyer, a local retiree and breast cancer survivor, noticed her lymphedema and got it diagnosed in part because of two friends who didn't.

"One of my friends died as a result. Her arm, everything was swollen from one end to the other," said Meyer, who is in her 70s.

"I am very happy I had a doctor who knew about lymph therapy," she added. "I have very little swelling, because I take care of it. I go every two weeks for therapy on my arm, and then I do my own therapy. I've been able to keep it under control."

Meyer began her therapy at the Arizona Cancer Center, and she now goes to Morken at Skin Hygienics. Like DePasse, Meyer has health insurance that doesn't cover her lymphedema.

In order to fit into a pair of high-heeled shoes for her best friend's wedding in 2007, DePasse had daily sessions with Morken and was extra-diligent about wrapping her legs in compressive stockings that promote drainage.

Most of the time she wears Crocs, shoes that are kinder to the bulges on her feet. She hasn't been able to get her feet into running shoes since she was in high school.

She drinks no soda and consumes nothing with caffeine. She's dropped 100 pounds and is trying to lose more weight. She does water aerobics and swimming, because these exercises put the least pressure on her legs.

"I've been to where I can't walk, but my career does not allow me to not be mobile," she said. "You have to commit (to therapy), or it's not going to get any better."