DEAR DR. DONOHUE: During a 1997 operation for cancer in my right breast, all the nodes were removed from under my right arm. I wore a compression sleeve on my right arm because it started to swell after the operation. Because of a misunderstanding, I quit wearing the sleeve in 1998, and the arm swelled. I had intensive therapy, and the arm is back to normal again. How long do I have to wear the sleeve? I have been doing so for seven years. – V.G.

ANSWER: The swelling comes from lymph, a fluid that seeps out of the circulation to bathe all cells and tissues. Lymphatic vessels suction up lymph and return it to the circulation.

Disruption of lymph channels and lymph nodes makes it difficult for lymph fluid to find its way back into the circulation. The area of the body where the lymph channels are missing swells with retained fluid. That is often the consequence in breast surgery when lymph nodes and lymph channels under the arm have to be removed.

Concerted effort must be made to keep the swelling to a minimum. A swollen arm is prone to infection, and the swelling impairs arm function. Furthermore, the retained fluid irritates tissues and leads to scar formation, which can make mobilization of the fluid next to impossible.

Elevation of the affected limb, for as long as possible and for as many times during the day as possible, lessens swelling. So do compression garments – in your case a sleeve that is specially fitted to your arm. Since lymphedema, as this condition is called, doesn’t go away, the garment must often be a lifelong proposition.

If your doctor ever agrees to a trial of disuse, then you and the doctor have to carefully watch for any signs that fluid is starting to accumulate again. At the first sign that it is, the sleeve must go back on.

There are other therapies for lymphedema. Massage by specially trained therapists is most helpful, and there are compression pumps that can mechanically push the retained fluid back into the circulation.

Lymphedema is discussed, along with edema, the more common form of fluid retention, in the booklet with their names. Readers can order a copy by writing: Dr. Donohue – No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Why shouldn’t men with liver problems take Cialis? Is it because the drug damages the liver, or is it because an impaired liver doesn’t metabolize the drug properly? What about Viagra and Levitra? – R.L.

ANSWER: It’s the second reason you gave.

Cialis (tadalafil), one of the new erectile-dysfunction drugs, is metabolized by the liver. Without a properly functioning liver, blood levels of the drug would rise too high and stay elevated for too long. Men with cirrhosis, therefore, should not take it. Men with a lesser degree of liver impairment have to reduce the dose, if they use it at all.

The same warnings go for the other two erectile-dysfunction drugs, Viagra (sildenafil) and Levitra (vardenafil).

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.