Q: I am a 13 year old female resident of Chennai and am suffering from Lymphoedema grade 1 which has been diagnosed after a lymphoscintigraphy. The report states that there is no distal obstruction in right limb. I have been debarred from all physical activity and feel very sad as I am a very athletic girl. I have also been advised to wear stockings all day long. I have been very recently informed that there is a surgery available for my congenital problem. Could you please advise me about this surgery as I want permanent relief from this problem? I represent my state in Yatching and Tennis and do not want to give this up. Also, where would this treatment be available. I am willing to get this treatment even if I need to go overseas.

A:Lymphoedema is a swelling of tissues caused by a block in lymphatics. The lymphatics are thousands of fine tubules, much like veins but thinner, that carry clear fluid from the tissues to the blood stream. The usual cause of block in lymphatics in India is filarial infection. The infection causes a block in the lymphatics, usually at the groin, resulting in drainage difficulties for the lymphatics in the legs. Once the lymphatics swell, they get repeatedly infected by streptococcus germs (lymphatic infection is called lymphangitis), and more and more lymphatics block off. The patients develop increasing leg swelling with time. Since tissue fluid is generated during walking, patients tend to have a slight increase in swelling and discomfort by the evening. Treatment depends upon the following: 1. Treatment for filarial infection: you should take this, although this will not reverse your lymphoedema; 2. Prevention of repeated attacks of lymphangitis: by suitable antibiotics. Usually 3-weekly injections of penicillin, but preventive tablets of co-amoxyclav (Clavam, Augmentin) or other anti-streptococcal drug should do as well; 3. Increasing comfort, by prevention of swelling of the legs after walking: for this a pressure stocking is required; 4. Getting rid of existing swelling, so that the leg size returns to normal. This is difficult. The leg size does not revert to normal, although for very large lymphoedemas, it may be possible to substantially decrease the size. Treatment for swelling is best carried out by compression therapy. The leg is inserted into a pressure chamber for prolonged periods, and after several days of therapy the leg size decreases. To summarise, you should: 1. Take a course of anti-filarial medicines; 2. Take preventive co-amoxyclav or similar medicine; 3. Consider compression therapy after consulting an expert; Surgery is used for massive lymphoedema, and is not suitable in your case. If you can play games with compression stockings, I think you should not be debarred.