Defective lymph drainage leads to swelling
DEAR DR. DONOHUE: My granddaughter has been diagnosed by a lymph specialist at Stanford University in California as having Milroy’s disease. Her left hand and part of her forearm are affected. She was 2½ years old when she was diagnosed.
The doctor recommended massage therapy, a pressure bandage, a positive mental attitude and genetic testing for family members.
During my daughter’s pregnancy, she was ill almost every day. She had had four miscarriages in the two years prior to her latest pregnancy. She was monitored as a high-risk pregnancy at the Massachusetts General Hospital in Boston. The birth was uncomplicated, and the baby was born perfect except for a chubby left hand.
She is bright and loving. She has hit all her development markers — walking, talking early and toilet training; however, I am concerned about the future. How rare is Milroy’s? Are operations possible? — M.F.
ANSWER: Your daughter and granddaughter have been treated at two of America’s most prestigious medical centers. They have received the best in obstetrical care and in the care of Milroy’s. I can add nothing to what they’ve gotten and been told.
I can give you an understanding of what’s going on. Milroy’s is a very rare genetic condition, so rare that accurate statistics on it are hard to come by. For a child to come down with the disease, only one gene need be inherited, and it can come from the mother or the father. If neither parent has the gene, then a genetic mutation occurred at or soon after your granddaughter’s conception.
In Milroy’s, lymph vessels don’t develop properly. Lymph is a fluid that bathes all body cells, tissues and organs. It partly comes from the liquid part of blood and partly from cellular production. Lymph vessels vacuum it up and return it to the circulation. Your granddaughter’s problem is confined to a very small part of her body. Her growth and development should continue to be completely normal. Operations have been attempted but have not met with great success. She should live a long, healthy, productive and happy life.
DEAR DR. DONOHUE: I have had a hernia for almost two years. The swelling and discomfort are getting worse. I don’t have insurance, and can’t work because of this condition.
What are the long-term consequences of not getting treatment? I am a 61-year-old man. — G.M.
ANSWER: For an older man, not having a hernia immediately taken care of isn’t a health threat. If the hernia causes pain that makes it unable for you to carry out the tasks of daily life, if the pain suddenly intensifies or if you cannot push the hernia back into the abdomen, then you need immediate attention at the emergency department of a hospital. You cannot be turned away because of not having insurance.
This state of affairs might never occur. In the meantime, you can wear a truss over the hernia that keeps it in place. These devices are available at most drugstores.
Hernia surgery is outpatient surgery. If you do need surgery, you can make arrangements to pay the surgeon and hospital in small installments.
DEAR DR. DONOHUE: I must have bumped my ring finger. It is painful, and the top part is swollen on the side of the nail. I think some pus is forming. What can I soak it in? I cannot go to a doctor. — B.P.
ANSWER: You describe a paronychia (PAIR-uh-NICK-ee-uh), an infection of the skin and tissues bordering a fingernail. If the skin and tissues show only mild swelling, then frequent daily soaks in hot water can bring it to a head and cause it to drain. If it is quite swollen and painful, you’ll have to see a doctor. Try an emergency-department doctor. It has to be incised to permit drainage and antibiotics will be needed.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.