Question

I have had trouble with my right leg swelling. It started when I was 13. At that time they injected some dye, but said they couldn't find anything wrong. It has got worse over the years : now it's up into my thigh. It gets very uncomfortable, but it's not painful. I'm 47, and would like your advice.

Answer

It sounds as if you might have a form of lymphedema. This condition is an accumulation of lymphatic fluid in the soft tissues that causes swelling, most often in the legs or arms. Lymphedema can develop when lymphatic vessels are missing or impaired (primary lymphedema), or when they are damaged or the lymph nodes removed (secondary lymphedema). When the lymphatic fluid production exceeds the lymphatic transport capacity, an abnormal amount of this protein-rich fluid collects in the tissues. Left untreated, this stagnant fluid not only causes tissue channels to increase in size and number, but also reduces the oxygen availability, interfering with wound healing, and providing an ideal culture medium for bacteria, that can result in an infection (lymphangitis).

Lymphedema should not be confused with edema resulting from inadequate venous return due to something like varicose veins. However, untreated venous insufficiency can progress into a combined venous/lymphatic disorder that is treated in the same way as lymphedema.

Primary lymphedema can be present at birth, or develop later, from unknown causes; sometimes it's associated with other congenital conditions (e.g. Port-Wine Stain). Secondary, or acquired, lymphedema can develop as a result of surgery, radiation, infection or injury. If lymph nodes are removed at surgery, there is always a risk of developing lymphedema.

Depending on the severity of the lymphedema, and provided it is not caused by infection, the recommended treatment plan should be based on the Complex Decongestive Therapy (CDT) methods, which consist of:

a) manual lymphatic drainage (i.e. massage)

b) bandaging

c) proper skin care and diet

d) compression garments (sleeves, stockings, etc.)

e) remedial exercises

f) self-manual lymphatic drainage and bandaging

g) continued prophylactic measures at all times

Your doctor should formulate a treatment plan for you. It may be possible to remedy the condition, even after 34 years.