The Latest in Lymphedema

Lymphatic system
Map of Lymphatic System: Old (left) and New (right)
The lymphatic system is a crucial component of the immune system.  The immune system helps protect the body from viruses, foreign particles, and foreign bodies (referred to as antigens).  Bone marrow produces lymphocytes, the active portion of lymph nodes which destroy foreign organisms thereby protecting the body. Interstitial fluid is filtered by lymph nodes prior to returning to the heart through lymph trunks.

Until recently, many believed that the central nervous system (brain and spinal cord) lacked lymphatic structures (and, by extension, the added immunity and protective mechanism enjoyed by the peripheral nervous system due to its connection to the lymphatic system).  However, recent research performed at the University of Virginia School of Medicine has revealed that the brain is directly associated with the immune system via lymphatic vessels which have somehow slipped under the radar until recently.  Apparently, the scientists who originally mapped the lymphatic system were unable to detect the vessels located within the brain’s meninges.  This discovery was made by Antoine Louveau, PhD, a postdoctoral fellow whose recent dissection will call for the re-writing of scientific textbooks (link to article’s abstract).

The implications of this groundbreaking research are manifold.  The presence of lymphatic vessels and its protective benefits in the central nervous system open a Pandora’s Box of possibility regarding future advances in treatment of neurological diseases.  Conditions such as Alzheimer’s disease, autism, and multiple sclerosis, to name a few, may be treatable through mechanisms never previously dreamed possible due to lack of knowledge about anatomy and physiology.  The future of neuroimmunology is an open book, and we are yet to see where the research will take us.

As a Certified Lymphedema Therapist, I am eager to see where Louveau’s exciting research will lead, and I look forward to learning new techniques in order to best treat my patients.  I also look forward to purchasing the latest edition of the Lymphedema mapping poster, because the one hanging on my wall is outdated!  If you or someone you know may benefit from manual lymphatic drainage to treat lymphedema, please contact me at Revitalize Physical Therapy.  I look forward to the opportunity to help.

Water, Water Everywhere…But Perhaps Too Much to Drink?

Drop of water
How Much Water is Too Much Water?
Everyone knows from Phys Ed 101 that it’s important to drink water while exercising to offset the fluid loss that occurs while sweating.  But, how much water is the appropriate amount?  Is there such a thing as hydrating TOO MUCH?

Traditionally, most athletes and personal trainers promote the concept of more is better.  Drink before, during, and after workouts, regardless of what thirst dictates.  However, in a recent article in The Washington Post, author Ariana Eunjung Cha (July 1, 2015, refer to link) encourages readers to challenge their previous assumptions in light of important recent research.

Exercise-associated hyponatremia is a dangerous condition that may develop up to 24 hours after a heavy workout.  It is characterized by decreased sodium ion concentration in the blood due to hyperhydration.  Sodium is an electrolyte which helps maintain the proper amount of water in the blood and cells.  Excessive water intake can shift the delicate fluid balance and create an environment where, relatively speaking, there are fewer (“hypo-“) sodium ions (“natremia”).  If the kidneys are unable to restore homeostasis through healthy mechanisms (such as urinating or sweating) the excess water can result in swelling throughout the body, including the brain (which in turn can result in seizures, coma, or death).

Too much of ANYTHING is not good- In fact, studies have shown that hyponatremia can occur even if one’s beverage of choice is a sports drink (as opposed to water)[i].  Drinking any fluid simply for the sake of “playing it safe” puts an individual at risk of developing exercise associated hyponatremia (EAH).  In a 2013 study that analyzed ultramarathoners in Northern California, researchers discovered that 15.1% of participants demonstrated EAH and 18.5% of marathon finishers were dehydrated at the finish line compared to 34.9% who were overhydrated[ii].

For those of you who recall from chemistry class that the formula for salt is NaCl (sodium chloride), you may be thinking that an appropriate solution to combat hyponatremia would be to ingest large amounts of salty food prior to a marathon.  While I applaud your creativity and knowledge, research has shown that this, unfortunately, is not an appropriate preventative measure against EAH.  However, “early recognition and field management with oral hypertonic saline (salt water) in combination with fluid restriction can be effective treatment for mild EAH[iii].”  Therefore, the best advice I could offer you, dear reader, is advice that I find myself telling patients regularly.  TRUST YOUR BODY.  Follow your internal regulatory drives.  When your hypothalamus is telling you that you are thirsty, THAT is the appropriate time to drink.  By respecting your innate needs and listening to the messages that your body is sending you, you can help maintain fluid balance which will enable you to exercise in health.


[i] Almond CS, Shin AY, Fortescue EB et al. (April 2005). Hyponatremia among runners in the Boston MarathonN. Engl. J. Med. 352 (15): 1550–6.

[ii] Hoffman MD, Hew-Butler T, Stuempfle KJ. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exerc. 45 (4): 784-91.

[iii] Hoffman MD, Myers TM. Symptomatic exercise-associated hyponatremia in an endurance runner despite sodium supplementation. Int J Sports Nutr Exerc Metab. June 9, 2015.