All Aboard!!!
A brief lesson on lymphatic anatomy and physiology
I think that the lymphatic system is absolutely fascinating. It runs throughout our whole body as an intricate network of vessels and nodes running along our arteries and veins filtering and deep cleaning our body to put it simply. So as a first post, I’d like to share my approach to lymphatic anatomy and biology and bring you on a little journey. We will first discuss a healthy functioning system and then dive a bit more into how things can go “off the rails.” It is always important to know WHAT the lymphatic system is and HOW it works to understand WHY lymphatic dysfunction can come about.
A few summers ago, my family had the joy of traveling to Scotland to take the iconic Jacobian train along the Western Coast. As we rounded the bend at the Glenfinnan Viaduct, my children imagined themselves as their favorite Hogwarts student. People stood in the rolling green hills waving at us and snapping pictures. What do trains have to do with the lymphatic system you ask? Well, it is a great way to explain the structure of the circulatory system.
THE ANATOMY OF IT ALL
Photo Credit: socratic.org
The Circulatory System is made up of your heart ❤️ (hometown station), arteries (train tracks going to the lungs or body regions), veins (train tracks returning to the heart), and of course, the lymphatics (the sewer system, although much more complex than that). Fluids (blood, particles, nutrients, oxygen) travel along like train cars filled with all the things your body needs to survive and thrive. The tracks start wide like a big highway in a big city and get narrower and narrower as they move away into the countryside and eventually stop in the depot called the capillary beds.
Photo Credit: socratic.org
All of the things your body needs to function get off the train and move into the body to do their jobs. The empty train returns to the heart via the veins to pick up more passengers and cargo at the home base. Thus, the Primary Loop of the Circulatory System. However (insert ominous music), there are times that there are unwanted or defective caro that gets on the train and get transported around the body (think bacteria, viruses, toxins, cancer cells…) They are a harmful threat so our immune system kicks in to do its job by fighting or destroying. Once dealt with along with all other cellular remnants, waste too large to fit back in the tiny veins, and water, the lymphatic system acts as an alternate set of tracks with a special ultrafiltration - the Secondary Loop.
Picture Credit: Google
The lymphatic fluid (made up of large proteins, fats, water, waste products, large cells, and coagulation factors) moves along deep lymphatic vessels in the lymphatic system. It further gets processed and broken down along the way in ultrafiltration stations called the lymph nodes before finally returning to the Primary Loop in an area just below the neck and above the heart.
Photo Credit: Google
WHEN THINGS BREAK DOWN
What happens when there is dysfunction in the lymphatic system? That’s what we call lymphedema. It comes about one of two ways:
#1. You are born with a defective system - the vessels, the nodes, or both. This is called Primary Lymphedema. Onset before the age of 35 is Lymphedema Praecox, and after Lymphedema Tarda. What’s so special about the age of 35? I think scientists assume that most folks are at the peak of their body development (building and growing) before the great descension towards death. Also, since many hereditary lymphedema cases coincide with other genetic disorders or abnormalities, perhaps 35 is the age by which most of those have been identified. I am not sure as to why 35 and am just taking a huge guess here.
#2. Your lymphatic system has been damaged. This is called Secondary Lymphedema or Acquired Lymphedema. The most common cause is through surgery (removal of parts of the lymphatic system) or radiation (deep scarring), as seen with cancer treatment. Lymphedema can also develop when the lymphatic system (Secondary Loop) is stressed by a dysfunctional or damaged Primary Loop by other diseases (venous insufficiency, morbid obesity, rare fat disorders, cardiac or kidney problems, to name a few.)
Photo Credit: Google
When there is too much lymphatic fluid backed up in between the tissues because the system is defective or damaged, we get lymphedema. Lymphedema is the slow build-up of lymphatic fluid in a body region, leading to inflammation and, eventually, a special kind of scar tissue called fibrosis. This swelling cannot go away on its own like swelling from a sprained ankle, but requires the skills of a Certified Lymphedema Therapist to work alongside you for optimal management.
If you have lymphedema or suspect you may have lymphedema, please reach out to your healthcare provider to do a formal evaluation and if appropriate, refer you to a Certified Lymphedema Therapist (CLT) for treatment. Just as it is important to see your Primary Care physician yearly for check-ups, those with a lymphedema diagnosis should also have at least yearly assessments with their CLT to make sure they are staying on track!
Where do I you find a CLT? There are great resources out there:
Lymphology Association of North America (LANA)
National Lymphedema Network (NLN)
Lymphatic Education and Research Network (LE&RN)
Many local hospitals may have a CLT on staff, so that is a great place to start. Feel free to reach out to me if you are an Indiana resident.
Remember, it’s swell to not swell! Education is empowerment towards thriving in life.
Please note: This is a very simplified explanation of the lymphatic system and lymphedema, as it is intended for readers who do not have extensive anatomy and physiology education. Always be mindful that if you suspect you may have lymphatic dysfunction, it is important to get worked up by a lymphatic specialist. I highly discourage self-diagnosis in these realms when there are professionals out there who have done a lot of extensive schooling and continuing education to help you sort out the weeds.