How to treat lymphoedema of legs?

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. Thelymphatics are thousands of fine tubules, much like veins but thinner, thatcarry clear fluid from the tissues to the blood stream. The usual cause ofblock in lymphatics in India is filarial infection. The infection causes ablock in the lymphatics, usually at the groin, resulting in drainagedifficulties for the lymphatics in the legs. Once the lymphatics swell, theyget repeatedly infected by streptococcus germs (lymphatic infection iscalled lymphangitis), and more and more lymphatics block off. The patientsdevelop increasing leg swelling with time. Since tissue fluid is generatedduring walking, patients tend to have a slight increase in swelling anddiscomfort by the evening.Treatment depends upon the following:1. Treatment for filarial infection: you should take this, although thiswill not reverse your lymphoedema;2. Prevention of repeated attacks of lymphangitis: by suitable antibiotics.Usually 3-weekly injections of penicillin, but preventive tablets ofco-amoxyclav (Clavam, Augmentin) or other anti-streptococcal drug should doas 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 verylarge lymphoedemas, it may be possible to substantially decrease the size.Treatment for swelling is best carried out by compression therapy. The legis inserted into a pressure chamber for prolonged periods, and after severaldays 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 bedebarred.