Lymphatic Circulation

The human circulatory system is made up of two interacting but closed systems: the arterial-venous blood system and the lymphatic system. Blood Plasma pumped from the heart to tissues leaks through the thin walls of the capillaries into the interstitial space of the skin. This leaked blood plasma is then called interstitial or extracellular fluid that carries with it nutrients for the tissue cells.  Most of this fluid seeps immediately back into the bloodstream but a percentage is taken up by a network of lymph capillaries.  The interstitial fluid along with debris enters the lymph vessels; it is then referred to as ‘lymph fluid’.

Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

The lymph fluid containing cellular debris, proteins, fats, fluids and other toxins as well as bacteria, and viruses drains into larger vessels called lymphatics via lymph nodes that remove foreign materials such as infectious microorganisms from the lymph fluid filtering through them. 

In this way, the role of the lymphatic system is to direct lymph fluid from distant tissues (skin, muscles, visceral organs, lung, and intestine) to the lymph nodes thus preventing a fluid imbalance that would result in the organism’s death and as the first line of defence for the immune system.

Major lymph node-bearing areas include the neck, chest, abdomen and, importantly, the axilla (underarm) and groin. When the lymphatic system is damaged, then swelling (edema) or lymphedema results from an accumulation of the protein- and particle-rich fluid within the body’s tissues

The larger vessels (lymphatics) converge to form one of two larger vessels called lymphatic trunks which are connected to veins at the base of the neck where the lymph fluid is separated for either recycling back into the blood system or for elimination from the body.

The right lymphatic duct drains lymph from the upper right quadrant (dark blue) of the body into the right subclavian vein. The thoracic duct drains lymph from the rest of the body (yellow) into the left subclavian vein. The lymphatic fluid is thus returned to the systemic blood just before entering the heart.

Lymph Transport

Interstitial or Extracellular fluid enters the lymph capillaries via gill like openings. Once within the lymphatic system the fluid that is now called lymph, drains into larger vessels called the lymphatics.  These vessels converge to form one of two large vessels call lymphatic trunks, which are connected to veins at the base of the neck

The Lymph in the Head and Neck are assisted by gravity to drain whereas lymph fluid in the arms, legs and abdomen travel through the non-return valve lymph vessels via 5 mechanisms

  • Skeletal muscle contraction

  • Valves to prevent backflow

  • Peristaltic contraction of smooth muscle in walls of lymphatics

  • Respiratory pump

  • Pulsations of nearby arteries

Firstly, skeletal muscles push against the lymph vessels pushing open the upstream end of the lymph valve forcing the fluid into the next chamber.  The valve then closes back up preventing the fluid from flowing backwards. 

Flow of Lymph toward the Lymphatic or Thoracic Duct

Valve (closed)

Skeletal

muscle

Valve (open)

The lymph fluid then travels via lymph capillaries into larger lymph vessels called lymphatics where smooth muscles add to the force of the skeletal muscles pushing the fluid through each chamber in the larger lymph vessels.  This action of the smooth muscles is called peristalsis.  The larger lymph vessels travel deeper to the underside of the armpit lymph nodes and on the inner side of the leg travelling to the groin nodes.

As lymph flows through your lymphatic vessels, it passes through lymph nodes. There are about 600 of these small, bean-shaped organs scattered strategically throughout your body. In the lymph nodes, lymph is filtered for bacteria, cancer cells, and other potentially threatening agents.

The fourth way is via thoracic pressure.  Located just inferior to the respiratory diaphragm is the Cisterna chyli, a sac like structure that fills with fluid, through deep breathing, expanding and contracting the diaphragm, from the abdominal region into the thoracic duct. The respiratory diaphragm puts the Cisterna chyli under the influence of the volume and pressure changes of the respiratory system so as you inhale increasing the thoracic cage Cisterna chyli experiences the changes of pressure drawing lymph up from your lower extremities back toward the thoracic cavity.

Located just inferior to the respiratory diaphragm the Cisterna chyli is put under the influence of the volume and pressure changes of the respiratory system so as you inhale increasing the thoracic cage Cisterna chyli experiences the changes of pressure drawing lymph up from your lower extremities up back toward the thoracic cavity.  This is accomplished through deep breathing.

As lymph capillaries are in close proximity to veins and arteries it is thought that the pulsating action has an effect on the flow of lymph fluid

Lymphatic system transports fluid much slower than the circulatory system.  It takes 24 hours to return 3 litres of lymph back into the blood whereas the circulatory system circulates 5 litres every minute. As Lymph fluid is being transported it is also being cleaned up along the way slowing down the transportation.

The Lymph vessels on the right upper body, the right arm & right side of the face (depicted in Green) drain into the right lymphatic duct.  Whereas the lymph vessels on the left side of the body, abdomen & right leg drain to the Thoracic Duct (depicted in Red).

Lymph Composition

Blood Plasma (the liquid portion of blood) that is pumped from the heart to tissues, leaks through the thin walls of the capillaries into the interstitial space of the skin. This leaked blood plasma is then called interstitial or extracellular fluid and carries with it nutrients for the tissue cells.  Once the interstitial fluid enters the lymph capillaries it becomes Lymph fluid. There is between 3-4 litres of lymphatic fluid produced by an average adult every day.

What substances make up Lymph Fluid?  Depending on where in the body Lymph originates depends on its composition.  Lymph found in the arms and legs is clear & transparent; it is a similar composition to blood plasma without the red blood cells and with less protein. It contains a variety of substances, including proteins, salts, glucose, fats, water, and white blood cells.

Human lymph, obtained from thoracic duct

The lymph returning from your intestines is milky, owing to the presence of fatty acids absorbed from your diet. This mixture of fats and lymph is drained into a dilated sac - the cisterna chyli (meaning 'reservoir for chyle') - at the lower end of the thoracic duct. The thoracic duct then conveys the chyle to your bloodstream, where the fats it carries can be processed for energy or storage.

The lymphatic system also regulates immune responses by transporting bacteria, foreign antigens, particulate matter, exosomes, and immune cells to regional lymph nodes and lymphoid structures.

Role In Immunity

The Immune system is the body’s defence against invaders, such as viruses, bacteria and foreign bodies. The immune system is comprised of special organs, cells and chemicals that fight infection.  The main parts that actively fight infection are white blood cells, antibodies, the complement system, the lymphatic system, the spleen, the thymus and the bone marrow.

In addition to regulating the body fluid balance, the lymphatic system also regulates immune responses by transporting bacteria, foreign antigens, particulate matter, and immune cells to regional lymph nodes and lymphoid structures. White Blood Cells called Lymphocytes include natural killer cells, T and B cells are the main type of cell found in lymph fluid.  T & B cells identify an invader & generate specific responses that are tailored to eliminate infected cells.  Natural Killer cells release cell-killing granules which destroy altered cells.

Although lymphocytes are distributed throughout the body, it is within the lymphatic system that they are most likely to encounter foreign microorganisms.

A paper published by PubMed on Regulation of Immune Function by the Lymphatic System in Lymphedema states: -

“Prolonged T helper 2 biased immune responses in lymphedema regulate the pathology of this disease by promoting tissue fibrosis, inhibiting formation of collateral lymphatics, decreasing lymphatic vessel pumping capacity, and increasing lymphatic leakiness.  Treg infiltration following lymphatic injury results from proliferation of natural Tregs and suppresses innate and adaptive immune responses.” https://www.ncbi.nlm.nih.gov/pubmed/30936872

In other words, if lymph fluid is not continually moved & is allowed to stagnate, the bodies immune response becomes suppressed resulting in thickening & slowing down of fluid through the lymphatic system and inflammatory conditions ensue.

Lymphoedema

Lymphoedema is a progressive condition.  Having an understanding of how the Lymphatic System works is a great start to understanding how lymphoedema develops. 

When lymph nodes are either removed or damaged as a result of surgery or injury a blockage occurs.  Initially a drain is put in place around the wound site to drain off the lymph fluid and blood collecting in the site of the operation.  When the flow of fluid slows down, the drain is usually removed, which means, the ends of the lymph vessels are closing up and scar tissue is forming.  When this happens, the fluid is no longer able to flow through its normal path to lymph nodes.  The blood circulatory system continues to deliver nutrients & fluid to site of the operation which can cause swelling around that site.

As the lymphatic system is a network of vessels travelling all over the body, the fluid trapped in the blocked lymph capillaries & the additional fluid being delivered by the blood circulatory system, has to be encouraged to either find another pathway or move out of the blocked lymph capillaries so that the fluid can be taken up by other lymph capillaries.  This allows the lymph fluid to travel to a lymph node where it can be reabsorbed or eliminated from the body. 

If the lymph vessels around the site of the blockage are not encouraged to move the lymph fluid builds up in those vessels and over time becomes thicker backing up the system, all the way down the lymph vessels path down a limb.

Once the lymph capillaries are full of lymph fluid the system essentially becomes blocked preventing more fluid entering the system.  The interstitial fluid builds up and swelling begins to occur. Often the swelling goes undetected initially until the limb (leg/arm) or feet/ankles/hand swells up, even though you may have been experienced pain from the full, tight lymph vessels.  Gravity also assists in the pooling of fluid in the interstitial space at the body’s extremities.

If lymph fluid is not moved around the blockage, along the lymph pathway and the interstitial space, patients with lymphedema develop progressive fibroadipose deposition (tough fibrous, fatty tissue) in the affected limb and have an increased risk of developing infections and secondary malignancies. These pathologic changes cause significant morbidity and decrease quality of life.

Manual Lymphatic Drainage

There are many YouTube videos showing self-massage for lymphatic drainage for upper, lower and neck lymphoedema.  What I have found however is that a lot of videos concentrate on moving the lymphatic fluid through the lymph vessels to lymph nodes which is fine if you have them.  If not, then you have to move the fluid around the area where the lymph nodes have been removed as well, which is where abdominal compressions & deep breathing are important.  Slow compressions of lymph vessels helps to encourage the fluid from one vessel to the next. (see Lymph Transport section) When clearing of the lymph vessels occur upstream, lymph fluid can then flow from the interstitial space into the lymph capillaries then lymph vessels.  Excess interstitial fluid can be moved through dry brushing toward the abdomen around the blockage to areas where it can be taken up by other lymph capillaries/vessels, together with deep breathing & exercise.

Example

Self-Massage for Upper Extremity Lymphedema

https://www.youtube.com/watch?v=Up_sIKnZ-_g

Self Manual Lymph Drainage of the Leg

https://www.youtube.com/watch?v=CTGqYOKOvfU

The same clearing techniques of the lymphatic and thoracic duct and the throat lymph nodes are used for facial or neck lymphoedema.  YouTube videos for facial and neck lymphatic drainage do not necessary state that they are for lymphoedema but the same techniques are used.

Whatever method you use that works for you is the one to do. But, the following sequence should be followed:-

Sequence

  1. Clear right lymphatic duct and left thoracic duct

  2. Clear lymph nodes under arms

  3. Deep Breathe

  4. Clear abdominal area

Lower Body

  1. Clear abdominal area

  2. Clear Groin

  3. Clear Upper leg working your way down to your knee

  4. Clear lower leg working your way down to your feet

  5. Clear feet

Upper Body

  1. Clear neck

  2. Clear shoulders & upper arm down to elbow

  3. Clear lower arm down to hands

  4. Clear hand

Repeat

Remember gravity helps drainage so it is best to have the affected limb raised in a position where gravity can help.  For upper body this means raising your arm or at least resting it on a pillow that elevates it above your shoulder.  For lower limbs this means elevating your legs.  I know that most instructions just say to put pillows or specially designed foam shapes under your legs but personally I prefer to raise my bottom as well.  Reason being, if your blockage is in your groin area then all the fluid is being directed to that area.  Whereas, if your bottom is also elevated the fluid can continue along its path to the abdominal area.

Hope you get the picture -  Whether you do self-massage, or someone does it for you, use a pump or just elevate your legs try to get your bottom up so gravity becomes your friend and Fluid doesn’t pool in your groin area.

Pooling of interstitial fluid

Pooling of interstitial fluid

Gravity

Gravity

I also sleep with the bottom of my bed elevated.  It does not have to be a lot; I use a brick at each bottom corner which just gives a slight angle that I barely notice & no one else knows.

When I elevate like this and do my self-drainage massage (dry brushing), I hear the sweetest sound.  It’s like gurgling in my tummy which I have learnt is the sound of fluid being sucked up past my diaphragm. Kind of sounds like, you are hungry, but you’re not.

Exercise and deep breathing become a vital part of managing lymphoedema for both upper and lower lymphatic conditions.  For lower lymphoedema, whatever method you use to draw the fluid up to the abdominal area you still need to get the fluid above the diaphragm into the thoracic duct for either recycling back into the venous system or elimination out of the body.  For upper lymphoedema, interstitial fluid that is not taken up by the lymphatic system can via gravity move into the abdominal area where it can be drawn into the lymph vessels back up into the thoracic duct.

IMPORTANCE OF EXERCISE & DEEP BREATHING

When fluid fills the abdominal cavity, you can feel very blotted, this is when deep breathing is required to get the fluid up past the diaphragm for either recycling or elimination.

The best type of exercise for lymphedema patients is swimming and other water exercises because the water provides tissue counter pressure on the skin lymphatics and the muscular exercise helps the lymph to flow.

http://www.thedoctorwillseeyounow.com/content/womens_health/art2092.html

Aqua Aerobics exercise has a double advantage.  When you carry out vigorous exercise in the water that gets you breathing deeply thus drawing lymph fluid up into the thoracic duct, the action of the water against your body acts like a massage.  Pushing your body through the water applies pressure against the skin along with the pressure of your muscles against the lymph vessels encourages lymph fluid to move through the lymphatic system.

If you prefer to do Aqua separately & not in a class, I recommend Aqua on Demand with Christine England which gives you expert training sessions privately.  Great to get your heart & lymphatic system pumping as well as releasing endorphins to make you feel good.

Early intervention is essential to encourage the lymph fluid to move around the site of the blockage, which assists in creating new pathways to a site where the fluid can be processed.  Ongoing management then ensures a continual flow.

Yoga is also excellent for lymphoedema, not just for muscle movement but also deep breathing and elevation of the limbs.  Remember gravity is your friend as long as you use it that way.

BREATHING

For many people, deep breathing is no longer instinctive, instead, many of us have become shallow chest, or thoracic breathers – inhaling through our mouth, holding our breath and taking in less air.

We don’t breathe as nature designed it.  Your breathing at any time falls in one of four patterns:

  1. Chest breathing, when breathing is primarily occurring in the chest:

  2. Belly breathing, when breathing is primarily occurring in the belly;

  3. Pelvic breathing, when breathing is more active in the pelvic area and

  4. Full breathing, when breathing involves the entire torso, from collarbones to the perineum.

You should breathe in through the nose for one count, hold for four counts, and exhale through the mouth for two counts.  In other words, if you inhaled for five seconds, you’d hold for twenty, and exhale for ten.  The numbers can change as long as the rations stays the same.  Why exhale for twice as long as you inhale?  That’s when you’re eliminating toxins via your lymphatic system.  And holding for four times as long allows you to fully oxygenate the blood and activate your lymph system.  You should breathe like this in three sessions of at least ten breaths per session.

How should I breathe?

When you INHALE fully and exactly as nature designed it, you may experience the following:

As the breath goes downward, the chest expands, the rib cage elevates, diaphragm goes down and the belly comes out.  The area between sternum, navel and perineum stretches.  The upper back widens, and the lumbar arch slightly deepens.

When you EXHALE fully and completely as nature designed, you may experience the following:

Diaphragm relaxes, chest shrinks, ribcage sinks, the belly goes in, perineum to navel and navel to the sternum region stretches and the lumbar arch slightly flattens.

Some make a distinction between “belly breathing” and diaphragm breathing.”  Belly breathing is more diffuse and occurs in the entire abdomen, in diaphragm breathing, the mid-section of the dividing line between the abdominal cavity and the chest cavity expands to its full capacity.

When you commit fully to exercise, in other words, give it your all, deep dynamic breathing comes naturally.  Even if that exercise is Yoga provided you focus on your breath.  Personally, I have found that I need the dynamic breathing that I get in exercise when I do my regular MLD.  The reason I feel I need it is because of the extra volume of fluid that needs to be sucked up into the thoracic duct as not all of the fluid is able to be processed further down the line like it would if I did not have my lymph nodes removed.

Do’s & Don’ts

I remember my oncologist giving me a long list of don’ts.  The one that really struck me down was ‘don’t walk on grass’.  In that moment I felt my live was over, there was nothing I could do any more.  Seeing my depressed anxiety his next words washed over me with ecstatic relief ‘it’s about the infection’.  I got it, it doesn’t mean you CAN’T do these things it just simply means be careful, take precautions and if you get cut or bitten, treat it immediately to prevent any kind of infection getting in.

Being a major part of your immune system, it is important to note that if your body is fighting off an infection or illness of some kind your lymphatic system can slow down so it is always necessary to be diligent in maintaining a healthy lymphatic system.  Likewise, it is essential that any cuts, bites etc are kept clean & treated with antibacterial wash or lotion.  What I have found is that these wounds take a little longer to heal than normal which makes it more important to be proactive in preventing any possible infection.

Gravity does not assist in lymph flow when standing or sitting with your feet on the floor for long periods of time or restricted movements of your arm like sitting at a computer.  So whenever possible walk around, do some arm & hand exercises, leg & ankle exercises as well as elevate your legs or arm to encourage the movement of lymph fluid. I would often sit with my legs raised up on a box under my desk to avoid pooling of fluid around my ankles. And some deep breathing exercises.

There is absolutely nothing that you cannot do particularly if it makes you happy, just use some common sense and look after yourself.  Find ways that help you, be proactive.

SKIN CARE

Your skin is your first barrier preventing invaders from entering your body.  Dry, cracked skin is more open to foreign invaders than moist supple skin. So skin care is important consideration in the management of lymphoedema.  Keeping your skin moist and healthy through the application of moisturisers and dry brushing.  I have found the best methods are often the simplest and cheapest.  Applying glycerine (readily available at the local supermarket) or coconut oil straight after you shower while you are still wet.  A wet body allows for more even spread and you don’t have to use as much. Pat dry with a towel, they both dry quickly on the skin and don’t transfer onto your clothes.  Also, if you have an aloe vera plant, removing the jell and rubbing that into your skin is very effective.

Dry skin brushing.  I tend to use this as part of my manual lymphatic drainage routine.  I simply use the dry brush in the same way you do a self MLD.  Starting at the proximal end, firstly deep breathing, clearing area around the blockage then moving slowing up the limb to the farthest extremity, brushing the lymph up the body.  As I have lower limb lymphoedema I usually lie with my whole body on a slope of approx. 30deg, so gravity can help the process.  I know a lot of people say to raise your legs only up but the way I see it is that you are pushing the interstitial fluid into your groin where it then has to change angle to move into your abdomen area.  I find it better to have a continual slope, so I just prop a pillow under my buttocks for a continuous even flow. See Manual Lymphatic Drainage section.

DRY BRUSHING VIDEO    https://www.youtube.com/watch?v=ZgPfpwyfndE

DRY BRUSHING

Light gentle massage and elevation will help to move the interstitial fluid to another area for processing however, a gentle slow pumping action is required on the lymph vessels, starting at the proximal end (around blockage) gently pumping your way down the central channel to the lower extremity to encourage lymph fluid through the lymph vessels and around the blockage. You have to clear the blocked end first then work your way down in order for the fluid to move through the non-return valve system – in other words you empty the vessel upstream first so the downstream fluid can move into the upstream vessel.

Laughter & Lymphoedema

I’m sure everyone is aware of the endorphins that are released during laughter which leave you with that happy relaxed feeling of wellbeing. 

 

Relieving the body from depression, anxiety, stress and worry.  But did you know that it can also have an effect on the lymphatic system. 

What does laughter have to do with the lymphatic system? The answer is so simple it is easy to miss:

Biophysical studies have shown that belly laughter accomplishes the diaphragmatic breathing necessary (diaphragm fluttering up and down at a very quick rate) to create a strong negative pressure within the thoracic duct (the largest lymphatic vessel in the body). Under negative pressure, the lymphatic fluid seeks an area of lesser pressure, thus shooting the lymph up and out through lymphatic vessels, increasing the speed and flow up to 10-15 times its normal rate of flow.

The increased flow of lymphatic fluid means more lymph is passing through lymph nodes, which itself means that more lymphocytes (t and b-cell lymphocytes, plus NK cells – the natural killer cells) are produced. Increased number of lymphocytes circulating in the blood means better immunity toward ALL diseases, especially cancer.

Any muscular movement will stimulate and increase the flow of lymphatic fluid, but laughter might prove to be one of the most painless and beneficial for accomplishing that goal.

When you laugh, the diaphragm becomes a powerful pump for your lymphatic circulation, much like your heart serves as the central pump that propels blood through your blood vessels. This assists the lymphatic vessels in carrying this fluid through your body and helps your lymph nodes to clean and filter this fluid, removing waste products, dead cells, and even unwanted microorganisms. Maintaining clean body fluids is important because these are necessary for you to be at your best. Increased lymphatic flow = an elevated, improved immune system just by the simple nature of more lymph flowing through the nodes, thus producing more lymphocytes, antibodies, etc.

More good news

 

Engaging the diaphragm with ANY type of deep breathing (laughter included), immediately engages the parasympathetic nervous system. The parasympathetic nervous system signals ALL body systems to SLOW down, thus producing “feel good” hormones (endorphins) that signal stress hormones to cool it. Once that signal is received, blood pressure drops, heart rate slows and an overall glow of “happiness in the moment” replaces anxiety/stress – the perfect “domino effect”.

Laughter is something I always seek when I am down or feeling caught up in a negative spiral.  Getting together with friends who I know will make me laugh or watching a funny movie/video/YouTube is a way for me to shift my mood.  But I also use another way when those things are not available to me and that is by letting other people’s (especially babies) infectious laughter infect me.  Here is a link to a YouTube video that may help you:

https://www.youtube.com/watch?v=AEDyZzZWq3w

If all else fails put on some of your favourite upbeat music and DANCE https://www.youtube.com/watch?v=VbD_kBJc_gI

What tickles your funny bone?

Here are some other Websites that may be of interest.

https://www.wonderslist.com/10-benefits-of-laughter/

https://laughteryoga.org/

Here is an article from the Laughter Online University that explains why.

 

The link between laughter and the lymphatic system Article by  - https://www.laughteronlineuniversity.com/

HEALTHY WEIGHT

Extreme Obesity Can Cause Lymphedema Independently of Surgery. Not only does obesity increase the risk of lymphedema in patients with lymphatic injury, recent studies have shown that superobese individuals can develop lymphedema even without antecedent surgery or injury.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393748/

A journal article from Frontiers in Immunology states “Similar changes in lymphatic function have been reported in obesity. For example, obesity results in structural and physiologic changes in the lymphatic system including increased lymphatic leakiness, decreased collecting vessel contractility, and decreased lymph node size and changes in lymph node architecture. Obese patients have decreased clearance of interstitial fluid as compared to lean individuals, obesity increases the risk of developing lymphedema after surgery, and severe obesity can lead to the spontaneous development of lymphedema. Interestingly, obesity induced lymphatic abnormalities decrease adaptive immune responses and are reversible with treatments that promote lymphangiogenesis and increase lymphatic transport. These findings are important because they suggest that common comorbid conditions have significant effects on the lymphatic system and these changes in turn significantly modulate immune responses.

https://www.frontiersin.org/articles/10.3389/fimmu.2019.00470/full

Lymphedema and Weight Loss. If you're overweight, you're more likely to experience problems with lymphedema. The theory is that when your body has extra fat, those tissues require more blood vessels. ... Some studies have shown that losing weight can significantly improve lymphedema symptoms in people who are overweight.

https://www.breastcancer.org/treatment/lymphedema/treatments/weight_loss

Swelling results when gravity causes this extra fluid to settle in the feet, ankles and legs. Being overweight and sitting or standing for more than an hour or two can cause edema. ... If swelling occurs in just one leg, problems with veins in that particular leg, such as varicose veins, may be to blame.

http://www.healthcommunities.com/obesity/edema-swollen-ankles-feet.shtml

Lymphangiogenesis is the formation of lymphatic vessels from pre-existing lymphatic vessels in a method believed to be similar to angiogenesis (blood vessel development). Lymphangiogenesis plays an important physiological role in homeostasis, metabolism and immunity

In medicine, comorbidity is the presence of one or more additional conditions co-occurring with a primary condition; in the countable sense of the term, a comorbidity is each additional condition

UNDERSTANDING PAIN & REDNESS OF SWELLING

Swelling occurs when the remaining lymph nodes and vessels can’t keep up with the tissues’ need to get rid of extra fluid, proteins, and waste. With fewer lymph nodes, too, the proteins and wastes do not get filtered out of the lymph as efficiently as they once did. Very gradually, waste and fluid build-up in the tissues of the leg, foot, arm, hand, breast, chest, or trunk. One or more of these areas may be affected. The result is typically mild lymphedema, which can get worse if it’s not treated. At first, you might notice that your arm, leg, or chest feels a little bit different — tingly, uncomfortable, achy, or “full”— or that your bra, sleeve, pants, shoes, watch, or ring feels a little tight.

Personally, I noticed the tightness around my groin and pubic bone first.  The tightness is when the lymph vessels become full of fluid, pressure is being exerted onto the walls of the lymph vessel in order to push the fluid into the next chamber but there is a blockage.  As more lymph vessels fill up they resemble a cord like structure which is normally referred to as cording or axillary web syndrome.  Cording is painful, tight & feels like a string of lumps down the central channel from the lymph nodes.  When the large lymphatics and capillaries are full, unable to take on more Interstitial fluid and the remaining lymph nodes are not coping with the amount of lymph fluid swelling occurs.  The pressure on the lymphatic system and the tissue layers of the skin causes the pain associated with the swelling.  This is why clearing of the existing nodes, then the large lymphatics followed by the capillaries is vital in allowing more fluid to pass through the lymphatic system.  Excess Interstitial fluid can be brushed or encouraged to another area to allow take up by the lymphatic system in that area.  If the fluid is not moved through the lymphatic system or encouraged to another area where it can be processed, the fluid begins to thicken as proteins start to stick together & long term can become fibrous causing major disruption to the lymphatic system.  Fluid can be encouraged through & in some cases out of the lymphatics and capillaries through a gentle slow pumping action.  This action encourages the lymph fluid to find an alternate path around the blockage via the network of lymph capillaries.

Your bodies normal immune response to injury or infection

Mast cells in the interstitial layer release histamine as part of your first line of defence of the immune system, increasing blood flow resulting in redness & heat.  The heat makes it harder for bacteria/virus’s to spread.

Cells in the blood vessels enlarge allowing immune responders & extra fluid to pass through the cell wall into the interstitial fluid which causes the swelling.

Pain – when swelling occurs there is more pressure applied that tingles the many nerves in the skin causing the pain.

T-Cells (Tregs) act to suppress immune response, thereby regulating the immune system.

Lymphoedema – Immune system response.

The Lymphatic System is the drainage system of the body.  Lymph fluid contains a variety of substances, including proteins, salts, glucose, fats, water, and white blood cells taken up from the interstitial fluid. The lymphatic system also regulates immune responses by transporting bacteria, foreign antigens, particulate matter, exosomes, and immune cells to regional lymph nodes and lymphoid structures.

When the lymphatic system is blocked and the fluid in the lymphatic vessels has not been encouraged to move through the system and around the blockage fluid backs up until no more fluid can enter and swelling or pooling occurs.  If left untreated the fluid becomes stagnate. Bacteria, foreign antigens etc build up, collagen proteins begin to stick together causing the fluid to thicken and slow down the system.

Your body’s natural immune response then kicks in.  Mast cells release histamine causing heat. Cells in the blood vessels enlarge allowing immune responders & extra fluid to pass through cell walls help transport the stagnate fluid, causing the redness & swelling.  Resulting in tingling numbness, heaviness and pain.

Recent studies using animal models and clinical samples have established that immune function is significantly compromised in secondary lymphedema, and demonstrated that a variety of T-cell-related networks are up-regulated in this condition. Tregs, in particular, are increased in abundance in lymphedematous tissue and are thought to compromise immune function in this disease by promoting immunosuppression, although they can make a positive contribution by reducing the degree of inflammation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361763/

These changes may modulate the severity of the underlying condition and, in some cases, may promote the development of a vicious cycle of events.

https://www.frontiersin.org/articles/10.3389/fimmu.2019.00470/full

In other words, if T-cell (Tregs) are left to increase, the immune system can be compromised.  Hence, the importance to get the interstitial fluid into the lymph vessels to lymph nodes into the thoracic or lymphatic ducts for recycling or elimination out of the body.  Keep the circulation of lymphatic fluid moving.

Obviously if swelling/redness/pain continues to exist & do not reverse following treatment, medical attention is required to treat a possible underlying infection.

Effect of Radiation on Sweat Glands

In most cases, healing occurs by regenerative means; however, large radiation doses to the skin can cause permanent hair loss, damaged sebaceous and sweat glands, atrophy, fibrosis, decreased or increased skin pigmentation, and ulceration or necrosis of the exposed tissue. In some studies changes in sweat gland function can be detected and quantified in skin which may otherwise appear normal.

On the other hand, sweating and hot flushes can be a side effect of some drug treatments, including chemotherapy and morphine.

This is a very simplified version of events of a very complex and less understood response to the build-up of fluid resulting in lymphoedema.

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