It wasn’t too many years ago that Lillian Swafford’s days began and ended with a hike of Thumb Butte in Prescott.  

“I was on the trail by six every morning and sometimes back before sunset to do it again,” Swafford says. “Even if it was snowing, I got my hike in.”  

Swafford’s daily treks of Thumb Butte ended quickly when her lower extremities, especially her ankles, began to swell. Soon, her legs were aching constantly. The swelling worsened and as it did, the skin around her ankles tightened.  

“Walking felt like I was wearing ankle weights,” says Swafford. “The pain was relentless. By the time I got home from work, all I could do was sit.” 

I have lymphedema? 

Swafford was surprised when a physician diagnosed lymphedema. “I had never heard the word until then.” 

She’s not alone. The National Cancer Institute calls lymphedema a poorly understood condition, even though an estimated three to five million Americans suffer from it.  

Getting help for lymphedema at YRMC 

Fortunately for Swafford, a physician recognized the condition and referred her to Debbie Kooiman, MOTR/L, CLT, a Dignity Health Yavapai Regional Medical Center (YRMC) certified lymphedema specialist and occupational therapist.  

“Most lymphedema is triggered by trauma to the body,” Kooiman says. “That trauma can slow or damage the lymphatic system, which prevents it from moving the lymph fluid in your body. This is what leads to swelling.” 

Lymphedema may be caused by: 

  • cancer 
  • heredity 
  • infection 
  • infrequent leg elevation  
  • heart disease 
  • kidney disease 
  • lack of exercise 
  • non-healing wounds 
  • obesity  
  • radiation treatment for cancer (lymphedema symptoms can appear from three months to 20 years after treatment) 
  • surgery (lymph node removal or joint replacement, for example) 
  • trauma 
  • venous insufficiency (a vein condition) 

Life with lymphedema  

Swelling that persists three months or more may be lymphedema. And while there’s no cure for the condition, there are treatments. Therapies include compression wrapping, manual lymphatic drainage, decongestive exercises, and use of a pneumatic pump to move fluid.  

“Decongestive exercises activate the sluggish lymph nodes and help clear the lymphatic pathways,” explains Kooiman. “We combine that with lymph massage and compression to help push the fluid through the open pathways. That’s something Lillian does on her own, too.”  

At the end of each therapy session, Kooiman wrapped Swafford’s legs in layers of bandages designed to reduce swelling. Kooiman also introduced Swafford to: 

  • techniques for cleaning, moisturizing, and protecting her skin from infection 
  • exercises that improve circulation  
  • low-sodium foods to fend off inflammation 

After three months of therapy, the swelling was down 18 inches in Swafford’s left leg and 11 inches in her right leg.  

“Lillian is dedicated to her therapy,” says Kooiman. “These awesome results show that.” 

Adds Swafford, “It’s a partnership. Debbie has taught me everything about managing lymphedema. She’s my miracle worker.” 

To learn more about lymphedema, talk to your physician or contact Advanced Wound Care at Dignity Health YRMC, (928) 771-4788. For information about other YRMC services, visit 


Submitted by Dignity Health Yavapai Regional Medical Center.