Last month, a consultation with a new patient en-graved itself within my memory. The clinical presentation of his medical problem was not particularly unusual within the scope of my practice, but the circumstances surrounding his visit were striking. This retired gentleman had flown thousands of miles because, as he said,‘‘You are my last hope.’’The patient recounted a nearly lifelong history of hereditary lymphedema, in itself not a rare disorder. In recent years, his medical problem had intensified with the advent of persistent chylous ascites that necessitated multiple therapeutic paracenteses each month. He traveled to Stanford with his wife, exhausted and desperate. Why was this patient so memorable? It was the paradox surrounding his need for consultation with me. He did not have a rare or undiagnosed condition, and he did not come to me from some isolated medical backwater; rather, he had been receiving his medical care within a highly regarded, tertiary care multispecialty clinic. Nevertheless, he had been subjected to surgeries where conservative options had not been explored. When diagnostic imaging became indicated, his physicians opted for the highly invasive approach of lymphangiography when the gold standard, radionuclide lymphoscintigraphy, might certainly have sufficed. Ultimately, his doctors said, quite frankly,‘‘We are failing you. You have to find another answer.’’They left it to the patient to find his own solution. Not only were they unable to provide the relatively simple, nonprocedural therapies indicated here, they were not even able to guide the patient to an appropriate resource for further evaluation and treatment. Sadly, this patient is not alone in feeling abandoned by the medical community. How has this deplorable lymphatic ignorance arisen? It strikes me that the current level of lymphatic ignorance would not be predictable from the known course of medical history. Indeed, Aselli recognized the existence of the visceral lymphatic circulation a scant fifty years after William Harvey described the blood vasculature. 1 In fact, if we search even farther back in medical history, we learn that the Father of Medicine, Hippocrates, not only recognized the lymphatic vessels as ‘‘white blood,’’2 he even created the name chyle. Ironically, Hippocrates seems to have had fundamental insights that seem to be absent in the prior medical care delivered to my patient for his recurrent chylous ascites. In stark contrast to these auspicious historical beginnings, the evolution of modern medical practice has not been kind to the lymphatic patient. Despite the heavy emphasis placed upon the functional importance of the lymphatics in Guyton’s Textbook of Medical Physiology, 3 studied by generations of medical students, the translation of this preclinical curriculum into the practice of medicine is quite faulty. It is disheartening to learn that the average American medical school graduate receives an exposure to the lymphatic curriculum for less than 30 minutes within a four-year medical education. 4 Small wonder that so many lymphatic patients discover that their health care providers are ill-equipped to provide the care and solace that they seek. These inequities are especially tragic when the patient is a child whose diagnosis and indicated treatment is not available during critical formative years.

Unfortunately, the problems extend far beyond health care practitioners. While it has been incontrovertibly established that the progression of lymphedema and other lymphatic diseases can be halted or significantly slowed through treatment, our health care system denies access to these beneficial modalities to large numbers of affected Americans. The proper …