Could swollen leg be due to my knee replacement?

QI had my right knee replaced a few years ago and have never regretted it, as everything went well, and I can now walk again without pain. But over the last few weeks my right lower leg has become quite swollen. Initially my GP thought I had a DVT, but a scan ruled that out. All the blood tests have come back normal as well and now I’m waiting for further tests to see if I have blocked lymph vessels. Could this be related to my operation and can anything be done about it?

AThe lymphatic system is a network of channels that connects together at lymph nodes. It takes excess fluid away from body tissues and also plays a major part in transporting white blood cells around the body to fight infection.

The enlarged lymph nodes that you get when you have an infection, such as a nasty sore throat, are swollen with lots of white cells. If lymphatic vessels are damaged or blocked then fluid tends to accumulate in the tissues they drain, a condition known as lymphoedema.

This tends to occur most commonly in the arms or legs, although the most frequent cause is removing lymph nodes during cancer surgery, such as the armpit nodes for breast cancer. The lymph vessels can also be damaged during other types of surgery.

This means it is possible that your knee replacement surgery is to blame, although this is not common and it’s also unusual to occur several years later. Damage to lymph vessels can also happen if the vessels become inflamed by an infection.

The main symptom of lymphoedema is swelling, which in the legs tends to get better overnight and then worse during the day. The affected leg may also feel uncomfortable and heavy. In severe cases there may be leakage of clear fluid from the skin. The condition can be diagnosed with a special scan that shows the flow of fluid in lymph vessels.

If your lymph vessels have been surgically damaged, the condition cannot be cured but regular exercise can improve drainage through alternative channels, along with the use of compression stockings or bandages. A specialised form of massage can also boost lymphatic drainage.

Skin affected by lymphoedema is more prone to becoming infected, so take care to avoid damaging it – this may mean buying a larger sized shoe for your right foot and using an electric razor for shaving. You should also apply moisturiser every day which will help prevent the skin becoming dry and cracked.

QI developed a swelling in my neck and after a load of tests I’ve been diagnosed with Hashimoto’s disease. I’m on thyroxine tablets, but would it help to alter my diet or take supplements, such as iodine?

AIn Hashimoto’s the body’s immune system attacks the thyroid, causing inflammation, which may lead to a visible swelling in the front of the neck. It also affects the cells in the thyroid that produce the hormone thyroxine leading to low levels, as well as symptoms of underactive thyroid, such as tiredness, dry skin and hair, constipation and muscle weakness. Some people may also put on weight and in women, heavy, irregular periods may occur.

The reason the immune system attacks the gland is not known, but genes play a role as it can run in families. Changes in hormones may also be involved as it can occur after pregnancy. It is more common in people who have other auto-immune illnesses, such as Type 1 diabetes or rheumatoid arthritis.

Iodine is required to make thyroxine, and lack of it can lead to enlargement of the gland as it tries to make more thyroid hormone. Adults need 140micrograms a day, and this can easily be obtained from a healthy diet. Excessive intake of iodine can actually disrupt thyroid function and can trigger Hashimoto’s or make it worse, so you certainly should not take an iodine supplement.

It would be wise to avoid foods high in iodine, such as kelp or other types of seaweed.

However, it is important that you have an adequate intake of selenium, which is found in many foods, especially fish and Brazil nuts. Ensure you are also getting enough vitamin D by taking a daily supplement, particularly between October and April.

QMy left ear feels blocked and I can’t ‘pop’ it, but while it’s uncomfortable, it’s not painful. I also can’t hear properly in that ear. I’ve tried decongestants and inhalations but they haven’t made any difference. Do you have any suggestions?

AThe most common cause of a blocked sensation is a build-up of wax in the ear canal. The other is a narrowed or blocked eustachian tube, which connects the middle ear cavity to the back of the nose – this can occur following on from a cold or Covid. Treatment with decongestants and inhalations is usually helpful though but if you have tried these for several weeks and the problem has persisted, it’s important to exclude another cause.

Sometimes an ongoing ear or sinus infection is to blame, although this does usually cause pain as well. More rarely, the symptoms you describe can be due to an abnormal collection of skin cells deep inside the ear, a condition known as cholesteatoma.

I suggest you have a further discussion with your GP. For this type of ongoing problem, you do need to have your ear examined, so although I’m a great fan of telephone consultations, in this instance you will need to be seen in the surgery.

If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.