Dear Doctor: My best friend had a successful breast cancer surgery last spring. But the surgeon took out some lymph nodes, and now she’s getting lymphedema in her left arm. Is it true that there’s no cure?

Dear Reader: Lymphedema is the name for swelling that occurs when there is a blockage to the lymphatic system. Often, as in your friend’s case, it arises when lymph nodes are removed or damaged during cancer surgery or treatment. The condition can also be caused by infection, inflammation, injury or certain illnesses. Lymphedema is most common in the arms or legs, but it can occur anywhere in the body in which the lymphatic system is blocked. While there is no cure, recent developments in diagnostic tools offer hope for managing the condition.

The lymphatic system is a remarkable network of tissues, organs, ducts and nodes that collect and disperse lymph, or lymphatic fluid, throughout the body. If you’ve ever scraped yourself and noticed the clear fluid that seeps from the wound, that’s lymph. It’s made up of fats, proteins, white blood cells and cellular waste, and it is an integral part of the immune system.

The lymphatic vessels that transport lymph throughout the body have valves that keep the fluid moving in one direction. But unlike our circulatory system, which utilizes the heart to move blood through the body, the lymphatic system has no central pump. Instead, it relies largely on the movement of skeletal muscles to keep lymph moving. Lymph vessels carry the lymphatic fluid throughout the body and eventually to the lymph nodes -- hundreds of small, round structures that collect the fluid and filter out the waste and bacteria it carries. When enough lymph nodes are damaged or removed, that part of the lymph system is blocked. The result is that fluid collects and causes the swelling known as lymphedema.

The condition can be painful; it can result in tissue damage and infection, and often limits a person’s range of motion in the affected limb. At this time, treatment focuses on managing swelling and pain. This includes the use of compression garments, physical therapy and lymphatic massage, a technique performed by trained specialists to manually disperse the accumulated lymphatic fluid. Strides are also being made in microsurgery, including lymph node transfer and the repair of lymph vessels.

More recently, a diagnostic technique called bioimpedance spectroscopy, which uses an electric current to measure the buildup of extracellular fluid, is seen as a potential advance in the early detection of lymphedema. This is important because the sooner that patients begin lymphedema therapies, the better the condition can be controlled. Last year, small studies into the use of certain anti-inflammatories to manage swelling also showed promise.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: What’s the latest on the new children’s disease that’s kind of like polio? It’s been all over the news, and like a lot of the moms around here, I’m getting worried.

Dear Reader: You’re referring to a rare and serious neurological condition that, as you mention, bears some striking similarities to polio. Known as acute flaccid myelitis, or AFM, it has thus far been seen mostly in children. AFM results in extreme muscle weakness and even paralysis, mainly of the arms and legs. At this time, the leading suspect is a virus that attacks and causes damage to the spinal cord. Unlike polio, which is known to be caused by the poliovirus and for which we have an effective vaccine, the specific cause of AFM is not yet known, and there is no vaccine.

Acute flaccid myelitis is not a new condition, but it has been on the rise in recent years. Due to this steady increase in cases, the Centers for Disease Control and Prevention began tracking the illness in 2014. There have been 570 confirmed cases of the condition since that time, with an average patient age of 5 years. Last year, a total of 233 confirmed cases of AFM occurred in 41 states. This played a role in the CDC’s decision to release an update about the condition in early July, which has put acute flaccid myelitis back into the headlines. The timing of this newest update is due to the observation that AFM has a “season,” with the number of cases spiking in late summer and early fall.

Although cases of AFM are reported each year, outbreaks appear to surge every two years. The CDC reports that so far in 2019, which according to the previous pattern is an “off” year for the condition, 11 cases of acute flaccid myelitis have been reported. However, because awareness of AFM is relatively recent, it’s likely that undiagnosed cases have not made it into the official tallies.

The majority of cases begin with fever and respiratory symptoms similar to a cold or the flu. This is followed by neurological difficulties such as weakness in the arms or legs, a decrease in reflexes, facial weakness, drooping eyelids, difficulty moving the eyes, slurred speech and trouble with swallowing. Occasionally, numbness or pain may be present, and in some cases, patients experience trouble breathing.

A lab test to diagnose the condition has not yet been developed, which makes vigilance by parents and health care providers about potential cases all the more important. Because the later symptoms of the condition can mirror those of other neurological diseases, such as Guillain-Barre syndrome, AFM is difficult to diagnose. There is no known cure, so at this time, treatment focuses on physical and occupational therapy to restore movement.

If your child shows symptoms of AFM, seek medical help immediately. Health care providers whose patients show symptoms of AFM have been directed by the CDC to immediately alert their state or local health departments. They should collect biological specimens to help identify the causes for the condition.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I had a urinary tract infection that improved on the antibiotic Keflex, but lab tests showed the bacteria was actually resistant to the Keflex, so I had to switch to a different antibiotic. I don’t understand -- if the infection was resistant, why did the symptoms go away?

Dear Reader: Urinary tract infections, or UTIs, are one of the most common bacterial infections in the U.S. They occur when bacteria -- in the majority of cases it’s E. coli -- colonize any of the tissues or structures of the urinary system. This includes the kidneys, which filter waste and excess water from the blood to make urine; the ureters, which are the tubes through which urine leaves the kidneys; the bladder, where urine is stored; and the urethra, through which urine leaves the body.

Although both men and women can get a UTI, the condition is more common in women. According to some estimates, anywhere from 40% to 60% of women will have at least one UTI in their lifetime. Symptoms can include urine that is dark, cloudy, bloody or pungent, an urgent need to urinate that yields very little urine, pain or burning during urination, and abdominal pain. In the elderly, a UTI can present without any physical symptoms, but result in confusion or temporary cognitive impairment.

Unfortunately, as you have experienced firsthand, urinary tract infections are becoming increasingly challenging to treat. This is due to the growing problem of drug-resistant pathogens, which affect an estimated 2 million people in the United States every year. Antibiotic resistance happens when drugs are no longer effective at completely eradicating the bacteria and fungi that cause infection and disease. That means that although some of the bacteria or fungi may be killed by the drug, others aren’t. Those that are resistant to the drug will continue to grow and reproduce, causing the disease or condition to persist.

We suspect that in your case, the initial antibiotic killed enough of the bacteria that were causing your UTI for the symptoms to abate and afford you physical relief. However, because the infection included bacteria that were resistant to Keflex, the UTI was not being cured. Those bacteria that were resistant to Keflex were continuing to grow. Fortunately, your health care provider followed the current guidelines to send a urine sample out to test for antibiotic resistance. Using the results of those lab tests, you were prescribed a different and ideally more effective antibiotic. In some cases, it can take multiple attempts with different antibiotics to successfully vanquish a UTI. Whichever drug is prescribed, be sure to ask about potential interactions with food or other drugs, and to complete the regimen, even after symptoms go away.

Because of the risk of the infection moving to the kidneys, it’s important to make sure that a UTI is completely cleared up. Patients whose urinary tract infection is caused by a drug-resistant strain of bacteria should continue to be followed after antibiotic therapy is complete. We recommend at least one repeat urine test to “test for cure” and make sure that the UTI has been completely eradicated.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)