I have always had a propensity for the unique and uncommon, which has continued to be true in my career as a physical therapist. We learn the basics of the lymphatic system as bright-eyed bushy tailed graduate students, memorizing the anatomy and potential pathologies to pass our histology tests. We may refresh our knowledge briefly while studying for the national board examination, but then typically forget about the lymphatic system before we even begin treating patients. I'm willing to bet that most physicians have had a similar experience. The lymphatic system simply isn't emphasized in American medical training, and as a result, there is a huge lack of available care for patients who suffer from lymphedema. Medical practitioners don't know much about it and rarely know how to appropriately treat it. So naturally, I became a Certified Lymphedema Therapist in 2015 and I have been shouting about it from my soapbox ever since.
What is lymphatic system in the first place, and why should I care?
The lymphatic system is a network of vessels, lymph nodes, and ducts which are closely associated with our circulatory system. In fact, lymphatic vessels are found in all areas where there is a blood supply.
Cells, proteins, and fat travel constantly through our blood vessels. Occasionally, these things are pushed from our arteries and veins and are unable to re-enter. This collection of escaped "stuff" is called lymph fluid. The lymphatic system works to channel lymph fluid, filter it, and return it to our heart for circulation. A healthy lymphatic system will return an average of three liters of fluid to the heart per day. That's a lot of fluid! This process is essential for supporting an optimal blood pressure, normal circulation, and a strong immune system.
When the lymphatic system malfunctions or is injured, lymph fluid cannot be properly removed from our tissues. Think back to high school biology...remember the principles of osmosis? Lymph fluid is rich in protein, therefore if it is not properly reabsorbed by our lymphatic system it will continue to draw water and fluid towards it. Soon, lymph fluid will begin to accumulate excessively outside of our blood vessels. When the nearby body part begins to appear enlarged and/or swollen, we call this lymphedema.
Lymphedema is NOT swelling, or edema. Swelling is what happens when your roll your ankle and it gets fat for a day or two. Swelling is what happens when your forehead walks into the side of the refrigerator while in search of a midnight snack (yes, speaking from personal experience). Swelling is a natural response to an acute injury and goes away with rest and time verses getting bigger and bigger and bigger.
Swelling looks like this:
While lymphedema looks like this:
Woah! Now you have my attention...So what causes lymphedema?
Lymphedema can occur without a known cause (called primary lymphedema) or by a known cause (called secondary lymphedema). Surgery for removal of a cancerous tumor is the most common cause of secondary lymphedema in the United States. Unfortunately, development of lymphedema post mastectomy occurs extremely often.
Obesity, cardiovascular illness, delayed wound healing, radiation, and repetitive activity can increase one's risk of developing lymphedema.
I'm pretty sure I don't have cancer, so why should I keep reading?
Well first of all, you insensitive ass, nearly 1 out of 3 people will be diagnosed with cancer at one point during their lifetime. This means that, by virtue of your blog reading habits, you could help a friend or loved one identify the signs and symptoms of lymphedema before they progress. Given the lack of medical knowledge and expertise in this area, this is a very real possibility.
Second of all-
"repetitive activity can increase one's risk of developing lymphedema"
One of the things I disliked the most about Lance Armstrong, before it was cool to hate on Lance Armstrong, was that he quoted himself in one of his It's Not About The Bike books. I see why that is so convenient now. My bad Lance, my bad.
Are you a long distance runner, biker, swimmer, tap dancer, gardener, etc? Do you think repetitive activity isn't a risk factor for you because you are a big bad athlete? Other than the toe nails that will obviously die, what do you notice about this ultra runner after successful completion of a 100 mile race?
Sadly, this athlete did not recover with some ice, some time off, and a few beers. It plagued their year, disrupted their athletic plans, and gave them regular pain with their favorite hobbies. The runner's lymph system had been damaged and overwhelmed beyond capacity during extensive athletic activity. Luckily, the runner was very healthy at baseline and was able to recover after quite some time. However, it is my professional opinion that with manual lymph drainage and a compression garment the runner's recovery would have been greatly hastened.
That sh#t is real, folks. Lymph nodes and vessels can grow or diminish in size, but they cannot regenerate! Therefore an injury to the lymphatic system should be taken very seriously.
Um...is there any good news? How is lymphedema treated?
There are three components to a successful treatment program: therapeutic exercise, tailored compression bandaging or garment wear, and manual lymph drainage. Manual lymph drainage is not massage; it is a type of hands-on therapy which re-routes fluid and increases contraction of the lymphatic vessels by stretching the skin in a specific pattern. Manual lymph drainage serves to “open” healthy areas of the lymphatic system while redirecting lymph fluid away from non-functioning areas. It is very similar to re-routing water away from a clogged drain towards a clear one.
Manual lymph drainage is essential for treating an injured lymphatic system. What is more, it can also reduce recovery time after hard workout efforts for individuals whose lymphatic system is healthy and fully functioning.
If you or your loved one would like more information on lymphedema, I have included some helpful links
As always, knowledge is power. Share the wealth.