Dear Doctor: My 36-year-old son has recently been diagnosed with primary lymphedema. He has developed open wounds on both of his legs and is in a lot of pain. The condition limits his movement, and he has become depressed. Can you provide information about treatment, and where to seek it?

Dear Reader: Lymphedema is chronic and progressive swelling that occurs because the lymphatic system, which is part of the immune system, isn’t working properly.

The lymphatic system is made up of a network of minute, thin-walled tubes known as lymphatic vessels, and by hundreds of lymph nodes, which work together to carry and filter lymph throughout the body. Lymph is a clear fluid, rich in white blood cells, which helps fight infection and transport waste, toxins and debris. If you’ve ever had a scrape and seen a clear, watery fluid seep out of the wound, that was lymph. Unlike the blood circulatory system, which uses the force of the heartbeat to propel blood, the lymph system is largely dependent on muscle movement to keep things flowing. When either the lymph vessels or the lymph nodes become damaged, lymph begins to back up in that part of the body and causes swelling.

Swelling that arises due to lymphatic injury or obstruction is called secondary lymphedema. It’s often seen in cancer patients whose treatment involved the surgical removal of lymph nodes. Swelling that occurs independent of surgery or other damage, as in your son’s case, is known as primary lymphedema. It’s a rare inherited condition in which the lymphatic vessels are not properly formed and can’t carry out their task.

There is no cure for lymphedema at this time. Instead, the focus is on managing the condition. This includes specialized massage to help with drainage, the use of compression garments, light exercise focusing on muscle contraction to encourage lymph movement, limb elevation and pneumatic compression.

An effective treatment approach known as complete decongestive therapy, or CDT, which originated in Europe and Australia, is now becoming popular in the U.S. It combines a number of lymphedema therapies into a comprehensive program that focuses on swelling reduction, maintenance and self-care. Although your son will benefit from lymphedema treatment, your first priority is helping him get appropriate wound care. Due to swelling and skin tension, patients with lymphedema are at high risk of having a nick or a scratch develop into an open wound. If there’s a wound clinic in your area, the health care providers there can initiate treatment and teach you and your son how to care for the wounds at home. Your family doctor can help as well.

Lymphedema is a complex and challenging condition, so it’s important to seek out someone with expertise in the condition. Most cancer centers and hospital-based cancer programs offer lymphedema support or therapy, and can often provide referrals. Two organizations, the National Lymphedema Network (NLN) and the Lymphology Association of North America (LANA), oversee certification programs for lymphedema therapists. They also offer excellent resources, including directories of therapists. You can find them at lymphnet.org and clt-lana.org.

(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: My husband and I ate more junk food than usual during the coronavirus lockdown, and we both gained a few pounds. We’re trying for a healthier diet, with more fresh fruit and vegetables, but now I’m getting bloated after meals. What causes that? How can I make it stop?

Dear Reader: Whether it’s due to stress, boredom or simply experimenting in the kitchen to help pass the time, many people during the lockdown began taking in more fuel than their bodies were burning. At the same time, physical activities that had been hardwired into our daily routines were suddenly absent. Visits to the gym, the two-block walk from the parking space to the office, the staircase you choose rather than taking the elevator, those quick, darting runs as you chase a toddler through the park -- they all add up. For many, the increase in food and the loss of activity have resulted in what has been dubbed the “quarantine 15.” And as you have experienced, dietary changes to address the weight gain can lead to abdominal bloating.

Although bloating can be a symptom of gastrointestinal disorders, including irritable bowel syndrome, Crohn’s disease and ulcerative colitis, more often, the condition is associated with a buildup of excess gas in the digestive tract. Symptoms can include a feeling of fullness that causes discomfort or pain, and which can cause the stomach to become distended. This is often accompanied by an increase in belching or passing gas and rumbling sounds in the stomach or bowels. If bloating leads to nausea, diarrhea, fever or blood in the stool, it’s important to seek medical care.

One of the most common reasons for a sudden onset of bloating is a change to the diet. For people who are lactose intolerant, even a small amount of a dairy product can set off an episode. Unfortunately, many of the foods we turn to when cleaning up our diets are notorious for causing gas. Cauliflower, kale, broccoli, Brussels sprouts and other cruciferous vegetables contain a sugar known as raffinose. It gets digested by the bacteria in your gut, which produce gas as a byproduct of their meal. Beans, legumes and certain grains also contain indigestible fiber and sugars that feed our gut bacteria and earn us a bout of bloating.

With a bit of detective work in the form of an elimination diet, it’s possible to pinpoint the foods causing your episodes of bloating. Remove all suspect foods from your diet for a few days. Then, day by day, reintroduce one of the suspected culprits. You can then either skip the difficult food altogether, or reintroduce it very gradually and see if your body adjusts. Some people who can’t tolerate raw broccoli or kale find that breaking it down through cooking helps mitigate the aftereffects.

Carbonated beverages, eating too much or too quickly, and meals high in salt and fat can also contribute to bloating, so be aware of your behaviors as well. And if the bloating continues or gets worse, please check in with your doctor to eliminate other potential causes.

(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: My wife is 77 and has spinal stenosis. She’s often in pain. We read about a new procedure called “minimally invasive lumbar decompression,” which we are hoping might help. She really wants to avoid surgery. What can you tell us about it?

Dear Reader: To understand spinal stenosis and its treatment, we should start with the structure of the spinal column, or backbone. It’s a collection of 33 bones, known as vertebrae, which enclose and protect the spinal cord, along with the fluid that surrounds it. It also includes the muscles, tendons and other tissues that provide support and allow movement. The spinal column rises from the coccyx, or tailbone, and runs the length of the back to the base of the skull. The spinal cord, which serves as the master communications pathway between the brain and the body, houses 31 pairs of spinal nerves. These connect to the spinal cord and enter and exit the spinal column at various points, depending on their function. In between the vertebrae are discs, rubbery pads that provide additional space and cushioning.

In people who develop spinal stenosis, the spaces within the spine become constricted. (The word "stenosis" refers to the abnormal narrowing of a passage within the body.) This is often due to osteoarthritis, which damages the joints and discs in the neck and lower back, and may cause the growth of bone spurs. This results in pressure on the nerves in the region of the narrowing, which can cause symptoms such as a tingling sensation or numbness, muscle weakness and cramping, and pain in the lower back, buttocks and legs that can become severe. If nerve compression lasts long enough, numbness, weakness and, in more serious cases, even paralysis can become permanent.

Spinal stenosis usually occurs in the lumbar region, which is the lower portion of the spine. It’s typically treated with nonsurgical pain management, or with surgery such as laminectomy or discectomy. These are procedures that, in different ways, surgically excavate additional space within the spinal column. As with all surgeries, they carry a certain degree of risk.

However, as you mention in your letter, there is now a new approach to correcting spinal stenosis. Known as minimally invasive lumbar decompression, it uses a small implanted device that acts as a lift to create additional space within the spinal column. The device, which doesn’t use connecting hardware, is implanted via a small incision. The bone and tissue removal associated with traditional back surgery is usually not necessary. The procedure takes from 45 to 90 minutes and is often performed under local anesthesia. Patients may be asked to participate in physical therapy following the procedure and will have follow-up visits to assess progress. Many return to normal activities two to six weeks after receiving the implant.

Factors such as bone density and the degree of spinal stability play a role in whether this approach is appropriate. Complications can include fracture or tissue tears at the site of the implant. Unfortunately, studies regarding success rates aren’t yet available.

(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.)