Dear Doctor: I have Stage 1 lymphedema in my left leg, which causes pain and swelling. I do self-massages every morning, but it's not enough. Can anything reverse this? I've heard that lymph node replacement hasn't been very successful.

Dear Reader: First, let me acknowledge the frustration you must feel, not to mention the pain. This can be a difficult condition to treat.

Here's what happens: The lymphatic system is part of the circulatory system of the body -- only instead of circulating blood, it circulates lymph, a clear fluid that contains waste products from proteins; cells, including white blood cells; and sometimes bacteria. Lymph nodes filter the lymph of infection and possible cancer cells. The lymph eventually drains upward toward the heart, where it returns into the bloodstream. When the lymphatic system is disrupted, it leads to lymphedema, the swelling of an arm or leg caused by stagnant fluid within the limb.

Such disruptions can occur due to infection or cancer in the lymph nodes; radiation therapy or node removal as part of cancer treatment; or sometimes, due to none of these causes. The latter is termed primary lymphedema. The condition is often inherited; is more likely to occur in the legs; and is more common in women.

Stage 1 lymphedema, with which you have been diagnosed, is characterized by swelling that can subside if the limb is kept elevated for up to 24 hours. If not treated properly, Stage 1 lymphedema can develop into Stage 2 or Stage 3, causing inflammation, infections and scarring of the dermis, the thick layer of skin below its surface. In Stages 2 and 3, lymph can't return to the heart, even with elevation of the legs.

My first suggestion is to keep your legs elevated as much as possible and to avoid positions that put more pressure on the lymphatic system, such as prolonged standing, sitting or resting cross-legged. Second, keep your weight down, because obesity can worsen lymphedema. Third, watch for signs of infection and help prevent infection by keeping skin moist to prevent small breaks in it.

The type of massage that you do, called lymphatic drainage, helps move lymphatic fluid upward. Physical therapists trained in manual lymphatic drainage can accentuate this upward movement, as can the daytime use of compression stockings.

The node-replacement procedure you reference is called vascularized lymph node transfer (VLNT), in which a lymph node is transferred from one part of the body to another to help lymphatic drainage. It's sometimes used for breast cancer patients who develop lymphedema in the arm after having lymph nodes removed from the armpit. In those cases, a lymph node is transferred from the groin and connected to the lymphatic system in the armpit.

A 2016 study of 305 VLNT patients found a noted reduction in limb swelling and a decreased rate of infection of the affected limb. However, this procedure was predominantly done on patients without primary lymphedema, so it may not be applicable to you.

The T-cell inhibitor tacrolimus has shown an ability to prevent inflammation and scarring of the dermis in animal studies of lymphedema, but human research is needed.

In summary, use compression stockings, keep doing the massage techniques and seek out a physical therapist for lymphatic drainage. But most important, don't give up. You don't want the lymphedema to progress further.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My 10-year-old grandchild gets a bath only three times a week, and sometimes it's only twice a week. Is this normal? I thought that children should be bathed every day.

Dear Reader: While it's true that the ritual of a child's nightly bath has fixed itself into the popular culture, the reality of what's best is actually somewhat different. Back in the days before indoor plumbing and central heating, bathing was generally performed weekly in the United States. It was a family affair often performed on Saturday night, so that everyone would be their sweet-smelling best for church on Sunday.

As technological advances gave each house a furnace in the basement and hot running water in the bathroom, taking a bath was no longer a laborious chore. Add in the revolution wrought by understanding how infections are transmitted, and the link between physical cleanliness and good health was formed.

However, the zero tolerance of the medical environment doesn't transfer to the home. According to guidelines developed by the American Academy of Dermatology, your grandchild is perfectly fine with those three or even two baths per week. The reasoning is twofold.

First, unless he or she is playing in mud, crawling through public sandboxes or helping out with messy tasks, the average kid just doesn't get dirty enough to require a bath every day. The other consideration is something known as the skin barrier. That's the protective film of cells and lipids that make up the outermost layer of your skin. Sometimes called the lipid barrier, it's meant to keep your skin hydrated by preventing water and electrolytes from evaporating.

In children, the skin barrier is not yet fully developed. Too much soap and scrubbing and they run the risk of irritation, even infection. In addition, the skin is home to certain microbes and bacteria that are an important part of our immune systems. Daily washing diminishes their numbers.

So how often should your child be bathing?

With babies, three times a week is plenty. What's important is being vigilant about keeping the face, neck and diaper areas clean and -- this is just as important -- dry. If bath time is something your baby enjoys and you'd like to do it more often, go with just warm water and no soap.

Children between the ages of 6 and 11 should bathe at least once or twice a week. If they want to bathe more often, that's fine. Are they smelly or visibly dirty? Then they need a bath. Once kids hit puberty, dermatologists say daily bathing is a good idea.

To get off on the right foot with personal hygiene habits, make the activities fun. This includes teeth brushing, hair brushing, hand-washing and bathing. Toys, story times, charts with stickers or stars -- all can turn a daily chore into an enjoyable moment.

And while daily bathing up until adolescence is optional, proper hand-washing is not. From the time they're old enough to understand, be sure to teach your kids to wash their hands before eating, after using the bathroom, after blowing their noses and, of course, when they're just plain dirty.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I have a lot of urinary tract infections. My doctor told me not to drink anything with caffeine, but surely there must be something else I can do. Are there foods I should eat? Not eat?

Dear Reader: First, let me say that you have my sympathies. Urinary tract infections, though they have no outward signs, can be quite painful. Such infections are common, especially in women, who have a short urethra compared to men, meaning bacteria don't have far to travel in order to cause a problem. The majority of bacteria that cause these infections reside in the colon. These bacteria can colonize the area at the exit of a woman's urethra and, from there, move up the urinary tract to cause infections in the upper urethra, bladder or even kidney. These infections usually require antibiotics.

In younger women, sexual intercourse is a substantial risk factor for urinary tract infections, or UTIs, as are spermicide use and having a new sexual partner. Genetics likely play a role as well; daughters born to mothers with a history of UTIs have a greater likelihood of such infections. Further, those who have a UTI before age 15 have a greater chance of recurrent infections later in life.

After menopause, problems with bladder emptying, incontinence and bladder position increase the risk of UTIs. For post-menopausal women, vaginal estrogen can reduce infections, because it improves the natural bacterial flora in the vaginal area and decreases colonization of harmful bacteria. If you develop UTIs after sexual activity, urinating and increasing fluid intake after intercourse may decrease your chances of infection because these actions help flush the bacteria from the urethra.

If these measures -- not proven by any study -- don't reduce intercourse-related UTIs, a dose of antibiotics after intercourse might be warranted. But take care: With increased exposure comes a greater likelihood of bacterial resistance to that antibiotic.

Another alternative is the use of the probiotic Lactobacillus, which helps protect the vaginal area from the bacteria associated with urinary tract infections. It's not as effective as prophylactic antibiotics, but it can decrease infection frequency.

Cranberry extracts have shown an ability in the laboratory to stop bacteria from attaching to urinary tract cells, but studies of cranberry juice and tablets have been mixed. A combined study in 2012 did show a reduced risk of UTIs among women taking cranberry products, but many studies within the larger study showed no benefit.

Studies on caffeine intake and UTIs have been limited. Although caffeine does cause bladder irritability and may worsen the symptoms of urinary frequency and urgency that are seen with a UTI, the polyphenols in tea and coffee may create antibacterial activity within the urine.

A 2003 Finnish study showed that women who had a higher intake of yogurt containing probiotics and berry juice, like cranberry juice, had a lower rate of urinary tract infections. But the data have not been replicated, and the study did not adjust for confounding factors.

Overall, although some people advise women to avoid alcohol, sodas, spicy foods or citrus, I'm afraid there is no good research on specific diets to help stop recurrent UTIs. The best that science can support is cranberry extract tablets; probiotics or yogurt with Lactobacillus; some of the behavioral changes mentioned above; and doses of antibiotics.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)