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Module 3: The Lymphatic System NB: This lesson initially covers information you learnt as part of Anatomy & Physiology II. The primary function of the lymphatic system is to protect the body against infection and environmental hazards. Lymphocytes are produced and stored in lymphatic tissues and organs ( tonsils, spleen, thymus) and distributed throughout the body via lymphatic vessels. The lymphatic system also: Collects and redistribute the excess fluid from peripheral tissues Absorb and distribute fat soluble nutrients. Lymph is initially collected in lymphatic capillaries. The walls of lymphatic capillaries allow the movement of fluid and solutes into the vessels, but not out of, facilitating the collection of excess fluid. Cellular debris, viruses and bacteria are also collected by lymphatic capillaries. Lymphatic capillaries are generally found with blood vessels. As the lymph flows towards the trunk, the lymph flows into small lymphatic vessels. These vessels have valves similar to those found in veins, this preventing the backflow of lymph. Small lymphatic vessels are generally colocated with blood vessels, but are distinctive from blood vessels in colour (pale golden) size (smaller) and have a branching pattern. Superficial lymphatics collect lymphatic fluid from deep within the skin, mucous membranes lining the digestive tract, and serous membrane lining the pleural, pericardial and peritoneal cavities. Larger lymphatic vessels (deep lymphatics) co-located with deep arteries and veins associated with other organs, the walls of visceral organs, neck, limbs and trunk. Cisterna chili – a small collecting vessel for lymph prior to it entering the left lymphatic duct. It is deep in the abdomen, just above the navel. Lymphatic ducts collect the lymph from the superficial and deep lymphatics. A smaller, right lymphatic duct collects lymph from the right side of the body superior to the diaphragm, while the larger thoracic duct collects lymph from the rest of the body. From these ducts, lymph is dumped back into the circulatory system. Lymphoid tissue contains lymphocytes densely packed into a lymphatic nodule. Lymphatic tissue is found in the digestive system (mucosarelated lymphoid tissue, Peyer’s patches, and in the walls of the appendix. The tonsils and adenoids are also lymphatic tissue. Lymphoid organs include the spleen and thymus. These differ from lymphatic tissue in that they are encapsulated in fibrous connective tissue. Lymph nodes are distributed throughout the body and vary in size form 1-25mm. Lymph nodes are found in the neck (cervical lymph nodes), axillary area, lingual area, and in breast tissue. Lymph flows through lymph nodes and removes up to 99% of antigens, which are then processed by macrophages. Lymph nodes also provide an early warning system to the presence of infection or other abnormality in peripheral tissue. A pale yellow fluid called lymph flows through the lymphatic system. Lymph is similar in composition to blood plasma, except that it has slightly lower levels of protein and cholesterol. The excess fluid which leaks out of the cardio-vascular system at the arterial end but does not get reabsorbed at the venous end is picked up by the lymphatic vessels, and now forms the lymph fluid of the lymphatic system. When the lymphatic system is working efficiently, the lymph that finally enters the bloodstream has been cleared of about 99% of the impurities collected along its journey around the body. The lymphatic system does not have a pump, so is circulated via muscular compression and general body activity. Lymphoedema Lymphoedema occurs when lymphatic fluids accumulates in a limb, generally the lower leg, causing the limb to become swollen. Because the lymphatic fluids are not moving (stagnant), pathogens are not being filtered out and, if the condition persists, infection may occur. Tight clothing and shoes can cause temporary lymphoedama, which is quickly fixed by removing the tight clothing/shoes. Some people experience a mild form of lymphoedema on long haul flights and car trips. Lymphoedema can occur when lymphatic tissue is removed, e.g breast cancer surgery, or from some infections e.g filariasis, causing scarring of lymphatic vessels, which leads to blockages. Lymphatic Congestion Lymphatic congestion occurs when the lymphatic system is not functioning as well as it should, causing it to be sluggish or stagnant. This lymphatic congestion could be caused by a number of things. Pockets of congestion can occur in the lymph vessels if the fibrinogen and leukocytes in the lymph fluid clot, and then adhere to the walls of the lymph vessels. There could also be too much protein in the lymphatic channels. The protein builds up in the lymphatic channels if it is not being reabsorbed effectively into the venous capillaries at the changeover point between the venous capillaries and the arterial capillaries. When the lymphatic system is functioning well there is a pressure gradient that pushes the proteins into the interstitial spaces, and then the proteins are reabsorbed into the venous capillaries (the proteins transport things in the blood, including essential oils). However, if these proteins are not efficiently reabsorbed, they may be too numerous to be absorbed into the lymphatic vessels and cleared away. Thus they may cause a blockage or congestion in the lymphatic vessels. So the ‘drains’ are blocked, and the fluid builds up, causing lymphoedema. Waste products from cell metabolism (and any other toxins) can build up and cause problems. While the lymphatic system is not one of the 5 organs of elimination (skin, lungs, kidneys, liver, large intestine), it does provide movement of toxins to these organs for elimination. Aromatherapy and the Lymphatic System Aromatherapists, are able to combine essential oils with massage, or other application methods, to stimulate lymphatic function. Many essential oils have a beneficial action on the lymphatic system through being diuretic, detoxifying, lymphatic stimulants, or circulatory stimulants. Grapefruit, juniper berry and geranium are 3 essential oils which will aid lymphatic circulation. There are other essential oils which are beneficial to the lymphatic system. Always select essential oils with care and attention to contra-indications and the usual care considerations associated with using essential oils. Generally a 2½% blend of essential oils in carrier oil is suitable, but this can be reduced or increased to suit the client’s needs. Care may be needed not to over-stimulate the system. Contra-indications to using Essential Oils to Stimulate the Lymphatic System Contra-indications will depend on the relative condition of the client or the condition of the area you are planning to treat. In some cases it may be advisable for the client to get clearance from their medical practitioner beforehand. Cancer or any malignancies, or clients undergoing chemotherapy and radiotherapy. Advisable for the client to get clearance from their medical practitioner beforehand. High blood pressure that is due to major heart problems. Major heart problems such as acute angina or cardiac oedema. Low blood pressure Acute inflammatory illness such as acute tonsillitis, colds, flu, viral or bacterial infection, urinary tract infection, acute bronchitis, and allergic reactions Thrombosis –medical clearance is essential. Phlebitis – inflammation of the wall of a vein. Any other severe medical problem (unless recommended by the client’s doctor). Varicose veins - work very lightly over the area, provided there is no pain or inflammation, and the client is comfortable with this. After abdominal surgery – apply your usual post-surgery guidelines. Acute illness and/or infection Burns, fresh scars, skin problems, or bruises Kidney problems such as renal insufficiency or haemodialysis. Gynaecological infections such as ovarian cysts or uterus conditions When to use the Essential Oils to Stimulate the Lymphatic System Essential oils can be used to: Stimulate a sluggish lymphatic system. Address lymphoedemas - primary or secondary. Improve lymph flow through scar tissue, and to soften scar tissue Ease pain such as arthritis and rheumatism, and sports injuries – not in the acute immediately after the injury is sustained. Reduce cellulite Ease toxicity - this would best be achieved with a review of diet and increased water intake. Oedema during pregnancy - keep your contra-indications in mind when selecting the essential oils you use for this treatment. Other Information It is VERY important that you let your client know that they must drink at least 1.5 to 3 litres of water a day for at least one day following a treatment aimed at the lymphatic system. This is water, not softdrink, fruit juice, tea, coffee, alcohol or other beverages. It is plain water. If a client is not used to consuming this amount of water, set them realizable targets e.g 1 x 200ml glass every 2-3 hours from waking in the morning to going back bed at night. Explain that this may mean that they urinate more. You also need to advise your client that a little light exercise is necessary following the treatment. If the client does not drink adequate water or have enough exercise there is an increased risk of side effects such as general flu like symptoms, nausea, headaches or in extreme circumstances even vomiting. You will need to explain why it is important to work on certain “sensitive” areas of the body, such as the groin, armpits and near the breasts You should not proceed in these areas unless your client has consented to you touching that area – informed consent. You may choose to ask them to sign a consent form.