DEAR DR. DONOHUE: My friend was operated on for uterine cancer. Lymph nodes were also removed. Now her right leg is swollen. At first, the doctors thought it was an infection and treated her with antibiotics. Her surgeon said this wasn’t an infection but was lymphedema and walked out of the room without any explanation. How can she get the swelling down? – B.

ANSWER: Lymphedema is swelling of tissue due to disruption of lymph vessels. Lymph is fluid that seeps out of blood vessels to bathe and nourish body cells. It is suctioned into delicate lymph vessels that return it to the circulation.

In surgery where lymph nodes are removed, lymph vessels are unavoidably also removed. Sometimes that results in swelling. Many women who have had radical breast surgery with lymph-node removal have a swollen arm after the operation because lymph vessels have been severed. They drain into lymph nodes. Removal of lymph nodes interrupts the return of lymph to the circulation. Therefore, the fluid remains in the arm.

This is what happened to the lymph vessels that drained your friend’s right leg. The operation that entailed lymph-node removal also removed lymph vessels. Enough were removed to cause her subsequent leg swelling.

She should not take hot baths or showers. She should keep her leg elevated above heart level as often as she can and for as long as she can, day and night. Elastic compression stockings for her right leg will help rid the leg of fluid.

DEAR DR. DONOHUE: My 15-year-old son suffers from tics, both vocal and physical, due to Tourette’s syndrome. I read about success stories with near elimination of tics from using Nystatin to kill intestinal yeasts. What are your thoughts? – W.B.

ANSWER: My thoughts are of extreme skepticism. Personally, I don’t believe that yeasts cause Tourette’s syndrome or any tics.

Tourette’s usually begins around age 12, and it can bring on an array of tics. The mouth might twitch or the eyelids blink rapidly. Constant throat-clearing is another common tic. Some suffer more striking tics, like jumping, twirling or rapid head jerks. Tourette’s patients might suppress the tic or tics for a short time, but they inevitably come back. When they interfere with normal living, there are medicines that can be prescribed to aid in controlling them.

DEAR DR. DONOHUE: I have a shaking head that is getting so bad, it affects my walking. My doctor calls it a nerve tremor. Can you tell me what a nerve tremor is and what can be done for it? – A.B.

ANSWER: Most head tremors result from what’s called essential tremor – also known as familial tremor, since it runs in families. It usually affects the hands, but it can affect the head. It can also affect the voice box to give the voice a tremulous quality.

Inderal (propranolol) and Mysoline (primidone) are two medicines that are often successfully prescribed for essential tremor. If you’re taking medicine, you might need a dose adjustment.

Botox injections into the neck muscles have helped some patients who do not respond to medicine. In desperate cases, deep-brain stimulation can be effective. Wires are positioned in the movement center of the brain and connected to a battery. The electric current generated suppresses the tremor for many people.

DEAR DR. DONOHUE: My worry is about an elevated alkaline-phosphatase enzyme. My doctor feels it’s coming from my bones and not my liver. He said it could be from a number of bone diseases. All doctors seem to do is lament this problem. What are they looking for? What kind of specialist should I see to get some answers? – A.O.

ANSWER: Enzymes are proteins found in all body cells. They keep cell chemistry perking along at optimum rates. Injury to cells releases their enzymes into the blood and raises the blood levels of those enzymes. Some cells and organs have unique enzymes. When blood levels of those unique enzymes rise, that indicates trouble in the cells and organs that have those specific enzymes.

The alkaline-phosphatase enzyme is found in many places, but the two most common ones are liver and bone. Injuries to the liver cause the release of other enzymes, so when there’s a rise only in alkaline phosphatase, the liver is not the likely source. In such cases, bone is the more likely site of trouble.

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.