QuickLink Menu Main Page ---------[Products]---------- ReidSleeve Classic OptiFlow RM OptiFlow EC OptiFlow SC OptiFlow Packs The Contour The ContourPlus The Opera TheCinch Precise Gauge LE Alertband VHS Video Precise TapeMeasure --------[Information]-------- Lymphedema Data F.A.Q./Forum Need A Referral? Insurance Billing Fitting Clinics Alterations Professional Cleaning Resizing Links About Us Contact Us Have A Question? -----------[Clinical]----------- Dr. Reid's Corner Clinical/Case Studies Online Surveys --------[Community]-------- eNews Online LE Chronicles LE Message Board -----[Online Services]----- Distributor's Corner EdemaCalc General Survey      Sammuella Pry overcame lymphedema through dedication and hard work and is now completing a degree as a social worker at UC Monterey. She is working on a Capstone project and hopes to bring increased understanding of lymphedema to the medical community. As someone who has suffered from lymphedema, her goal is to bring her special understanding of lymphedema together with her training in social work to further the understanding of the problems faced by people with lymphedema. The specific aim of her project is to obtain an understanding of how lymphedema affected your life and how you learn to cope with lymphedema. I think answering the questions can be of great benefit in several ways. Completing this survey will assist Sammi in the pursuit of her degree, but I think it will provide others, including physicians, with vital insights into the problem of lymphedema.      The purpose of this survey is to provide patients, therapists and physicians with valuable information that will help address further needs of Lymphedema patients. The information provided will be written up in a formal report addressing sociological effects of lymphedema. Statement of confidentiality: All information in this survey will be used as statistical data only. Any information that identifies an individual person will not be disclosed without prior written approval from the provider. Instructions: Please answer each question based on the standard answers to the best of your ability. If the question does not apply please proceed to the next question. Do you have Lymphedema? Yes No (If no, do not continue with survey.) Sex: Male Female Age: Age at diagnosis of Lymphedema: Education:  H.S.    Bachelors    Masters    Doctorate    Other   Occupation(If retired, previous occupation)? Was the Lymphedema caused by cancer, heart failure, prior surgery, or other? Please Explain: Did another event such as an infection or trauma trigger the Lymphedema? Please Explain: Describe your feelings at the time you were diagnosed with Lymphedema: How do you feel about your condition now: What information did you have available about Lymphedema at the time you were diagnosed: Is your condition controlled? Yes No What methods have you used to treat Lymphedema: Do you consider your Lymphedema: Very Mild Mild Moderate Severe How many times per month do you go out socially with family and friends: 1-3 4-6 7-10 10-13 14-17 17-20 greater then 20 What support system do you have? Family Friends Support Group Psychologist Other: Are you currently receiving treatment for Lymphedema? Explain: Have you had any infections? Yes No If you had any infections, how many: 1-3 4-7 8-10 Greater then 10 Which limbs are affected by Lymphedema: Arm Leg Both Arms Both Legs What are the measurements of the affected limb(s): Left / Right Left / Right Wrist Ankle Forearm Calf Upper arm Thigh What are the measurements of the unaffected limb: Left / Right Left / Right Wrist Ankle Forearm Calf Upper arm Thigh Do you have support within the medical setting? Psychologist Support Group Counseling Specialist Other: Do you have medical insurance? Yes No Type: Private Medicare Medi-Cal Other: Have you been treated for any psychological issues associated with Lymphedema? Yes No Type: Depression Anxiety Isolation Other: How far do you travel for treatment/physician: 1-10 10-20 20-30 30-40 40-50 50-60 60-70 70-80 80-90 Over 100 Was your original primary care physician familiar with Lymphedema and treatment of patients with Lymphedema? Yes No How long(in months) was it from onset to diagnosis? Did you or do you have trouble finding clothing and/or footwear due to your Lymphedema? Yes No Have you learned anything about Lymphedema that you think will help others who suffer from Lymphedema? Please Explain: (Optional) Name: E-mail: ReidSleeve® Classic OptiFlow® RM OptiFlow® EC OptiFlow® SC OptiFlow® Packs The Contour The ContourPlus The Opera TheCinch Precise Gauge FREE Lymphedema Alertband VHS Video Precise TapeMeasure Lymphedema Data F.A.Q./Forum Need A Referral? Insurance Billing Fitting Clinics Alterations Professional Cleaning Resizing Links About Us Contact Us Have A Question? Dr. Reid's Corner Clinical/Case Studies Online Surveys eNews Online LE Chronicles LE Message Board Distributor's Corner EdemaCalc