Roots

Women's Healing Through Therapeutic Touch

Archives for April 2017

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THE LYMPHATICS PRIMER

When I tell people that I do Manual Lymphatic Drainage, the reaction is normally one of intrigue and curiosity. Most people have a general idea of what the lymphatic system does, but its mechanisms and functions are still not well understood by the general public.  Many physicians do not make it a priority to educate their patients about the lymphatic system (unless they are specialists in fields like oncology or physical therapy, dealing with damaged lymphatic systems).  In the past few years, awareness of lymphedema, a condition resulting from the malfunctioning of the lymphatic system, has increased thanks in part to celebrities like Kathy Bates who speak publicly about their experience living with lymphedema.  However, lymph is hardly a household word.  My goal over the next two blog posts is to provide a very basic overview of how the lymphatic system works, what manual lymphatic drainage is and how it is beneficial not only to damaged lymphatic systems but also to support healthy systems.

 

The lymphatic system is a uni-directional filtration and transport network for fluids in the human body, responsible for maintaining fluid levels in balance.  The three main functions of the lymphatic system are:

  • Immunological function through response of lymphocytes and other white blood cells to microbes, viruses and bacteria
  • Uptake of protein molecules and water from the intercellular fluid, filtration, and delivery of protein-rich lymph into the cardiovascular system
  • Absorption of fats and fat-soluble vitamins from the small intestine

A very basic anatomical explanation of the lymphatic system is as follows:

Superficial lymph vessels originate in intercellular spaces just below the skin surface and form an extensive plexus throughout the body.  Fluid from the intercellular space, containing water, proteins, fats and other cells, is absorbed and transported along these pathways into regional lymph nodes.  (The proteins absorbed by the lymphatic system are large molecules which are too big to be absorbed directly into the circulatory system – this is one of the reasons why the lymphatic system is so important, as it delivers the protein necessary for cellular functioning back into the bloodstream.)  Deeper vessels transport lymph from the organs, and intestinal lymph vessels transport fluid called chyle from the intestines.  Unlike the circulatory system, the lymphatic system has no pump.  The fluid is moved along the vessels through intrinsic peristaltic contractions of lymphangions within the vessels themselves.  The lymph travels through lymph nodes and deeper networks called lymphatic trunks to eventually drain into veins on either side of the neck, delivering the protein-rich fluid into the bloodstream.

The lymph nodes from a very important part of this process. As the lymph is transported through the lymph nodes, it becomes more and more protein-rich as water is reabsorbed into the body.  In addition, lymphocytes and macrophages are stored in the lymph nodes, which are cells that engulf and expel bacteria, toxins and dead cells.  This is how we fight infection.  There are 600-700 lymph nodes in the human body, the majority of which are housed in the intestines, but the head and neck also contain a large concentration of lymph nodes.  The other important node stations are the axillary nodes (in the armpit area) and the inguinal nodes (in the front crease area where the trunk meets the legs).  In addition to the lymph nodes, the spleen, thymus and tonsils are also part of the lymphatic system, contributing important immunological functions.  The spleen stores white blood cells and filters the blood of aged red blood cells.  The thymus is particularly active in early development, as it stores immature lymphocytes, developing them to become T-cells which can later fight off pathogens and cancer.  The tonsils are made up of tissue similar to lymph nodes and also help fight infection.

It is clear that the lymphatic system plays a critical role in homeostasis and immunological function, but how exactly does it work?  Like most of the bodily systems, it has some very efficient features!  The substances being transported through the lymphatic system at any given time comprise the lymphatic load.  Lymph time volume describes how much of this load is transported over a period of time.  The transport capacity is the maximum amount of lymph which can be transported over a period of time.  The difference between the lymph time volume and the maximum transport capacity is the functional reserve, which normally provides the body a large amount of room for the lymphatic load to change, like a buffer.  The body also has something called a safety function, which means the body can respond to an increase in lymphatic load by increasing its lymph time volume.  In other words, if there is more fluid in the intercellular spaces, the body can respond by moving the fluid faster up until the transport capacity is reached.

There are several things which can increase the amount of fluid being transported, including exercise, heat, massage and inflammation (usually from infection).  Poor venous return or congestive heart failure can also cause an increase in the lymphatic load.  If several of these factors are at play, and the lymphatic load increases until the transport capacity is reached and exceeded, the result is swelling, or edema, from high output failure.  The excess fluid is generally low in protein.  For example, when I go running on a very hot day, sometimes my fingers swell.  This is an example of high output failure.  When the lymphatic system itself malfunctions, such as in the removal of lymph nodes or through oncological radiation, the transport capacity can decrease and eventually dip below the level of the lymph time volume.  In this case, it is called low output failure and the result is lymphedema, or an accumulation of protein-rich fluid in the body.  (Please check out a great blog on lymphedema by a woman living with the condition – https://thelymphielife.com/).

Having a well-functioning lymphatic system improves immune health, allergy resistance, vitality, and helps us to more efficiently detoxify the myriad of environmental pollutants that find residence in our bodies. In my next blog, I will explore how I use Manual Lymphatic Drainage to optimize the function of the lymphatic system.

 

Resources:

Textbook of Dr. Vodder’s Manual Lymph Drainage, vol. 1 and 2

klosetraining.com

 

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IS ARTIFICIAL LIGHT SABOTAGING YOUR SLEEP?

Sleep and the importance of sleep has been a hot topic for some time.  New studies are routinely published on the effects of insufficient sleep on human health.  Many of these studies focus on the damaging effects of even small amounts of artificial light exposure to our sleep quality, particularly blue light.  Limiting our exposure to artificial light after dark is a key component of sleep hygiene.  However, evidence suggests that the consequences of disrupting our circadian rhythms with light exposure are more systemic than we originally understood, resulting in detrimental effects on both physiology and behavior.  Upsetting the homeostatic photo-cycles can cause sleep disturbances, irritability, depression, lack of attention, weight gain, gastrointestinal problems and even the tendency to develop cancer.

Here is a very basic explanation of how our body systems interact with light:

The suprachiasmatic nucleus (SCN), located in the hypothalamus, functions as our “master clock”.  It works in conjunction with the endocrine system to regulate the hormones that signal our bodies to perform internal processes.  The SCN “coordinates daily sleep-wake cycles, metabolic processes, hormonal release, and in general the temporal order of all the body physiology.”  The SCN is stimulated by light.  Light enters the eye and activates neurons in the retina that convert the light particles to electrical signals, which travel to the SCN.  When it senses light, it signals the body to produce cortisol (a stress hormone) that warms the body and wakes it up.  When darkness falls, the SCN signals the body to produce the sleep hormone melatonin, which cools the body down, prepares it for rest and stimulates DNA repair.

During sleep, a series of physiological events occur which help the body recover and prepare for the next day.  Cellular regeneration and repair are activated by human growth hormones.  Leptin, insulin and ghrelin, our hunger hormones, are regulated during sleep, which is why we may find ourselves more hungry than normal after a poor night’s sleep.  Serotonin, a neurotransmitter believed to regulate mood and energy, decreases in levels during sleep.  Studies show that the circadian cycle controls from ten to fifteen percent of our genes, so it is clearly an important part of our bodies’ functioning.

However, the modern problem is that our hours of darkness are becoming fewer and fewer, thanks to artificial light.  The light intensity used for illuminating our interior spaces, particularly that of blue light, is sufficient to alter the biological clock and circadian rhythms.  Blue light is especially damaging because it causes oxidative stress without the counter-balancing effects of the near-infrared frequencies found in natural light.  Even just a few minutes of artificial light, including the light from mobile devices and computer screens, will suppress melatonin enough to inhibit sleep processes.  Recent studies show that a night-time light exposure will shut off melatonin production for four hours.  In other words, when our retinas are continually exposed to light after dark, our “off switch” is never really activated.  If indoor conditions more closely approximate the natural light rhythms, the melatonin takes over slowly and the body gradually begins the restorative process of sleep.  The same holds true for waking in the night during sleep: if you turn on the light during a trip to the bathroom, the light will activate your body’s waking processes.   (It is interesting to note that even too much natural light at night can be detrimental.  People who live in areas of the world like Siberia and Greenland where they experience prolonged periods of sunlight at night have high rates of suicide, depression and alcoholism).

Our circadian rhythms are synchronized to periods of light and dark, and they control systems that tend to cellular regeneration and recovery.  Getting enough sunlight is critical to our body’s energy production systems, but periods without light are equally critical for regeneration and recovery.  It follows that the more closely we synchronize our lives with natural sunlight cycles, the better our bodies can function.

 

”Endocrine Effects of Circadian Disruption”, Tracy A. Bedrosian, Laura K. Fonken, and Randy J. Nelson, Annual Review of Physiology, vol 78, February 2016.

“Disruption of Circadian Rhythms: A Crucial Factor in the Etiology of Depression”, Roberto Salgado-Delgado, Araceli Tapia Osorio, Nadia Saderi, and Carolina Escobar, Depression Research and Treatment, August 2011.

“Circadian Disruption Leads to Loss of Homeostasis and Disease”, Carolina Escobar, Roberto Salgado-Delgado, Eduardo Gonzalez-Guerra, Araceli Tapia Osorio, Manuel Angeles-Castellanos, and Ruud M Buijs, Sleep Disorders, 2012.

“How Blue LEDs Affect Sleep”, Alina Bradford, Live Science, February 26, 2016

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BODY IMAGE (pt 3)

I have been talking for two weeks about body image.  Here is my final installment on this series:  body image and exercise, what is the relationship?  How do these two concepts inform each other in your life?  For most people the relationship can get complicated.  As children, it’s easy:  exercise starts out as play.  It’s normally something we do naturally for fun, like chasing each other around, playing soccer or basketball, swimming in the summer, wrestling with siblings or climbing trees.  However, at some point in our lives, most of us start to worry about our body image.  This is the point where exercise can cease to become play and instead become work:  an obligatory hour spent in the gym trying to make our bodies look different than they do.  Even women who love exercise can manage to make it a chore by feeling intense guilt if they miss just one workout.  But what if by working on developing a more positive body image, our approach to exercise started to shift?  The less we worry about how our bodies look, the less exercise has to be work and the more it can once again be play.  Once exercise is fun again, we organically begin to incorporate more of it into our lives and our bodies and minds naturally begin to feel better.  However, it takes a little reframing of our focus in order to get there.

 

My relationship with exercise is long and problematic, or at least it used to be.  During my school age years, I spent summers in Panama with my grandmother.  Being a good Latina, she showed her love with food.  When I came back to the U.S. at the end of that first summer, all of a sudden, to the outside world I was fat.  My mother, seeing how upset I was at this realization, tried to be helpful.  She set me up with a yellow leotard with a cute gray belt and a Betamax copy of that now iconic Jane Fonda Workout.  This was the beginning of my life as an exercise junkie.  I was determined to make my body look different than the current unacceptable state it was in.  I was nine years old.

 

It took the next twenty years for me to realize that exercise is necessary for good health (not a “good body”), yet it does not have to be a chore.  There are a few ways we can arrive at this point, but they all involve making exercise about anything else but gaining or losing weight.  The first way to reframe exercise is to make it about performance.  Martial arts and team sports are great for this.  However, my first “a-ha” moment with exercise and performance came when I started running.  I didn’t become a runner until I was about thirty, so it was always about milestones, not about losing weight.  I would get excited for my morning runs because it was always an opportunity to improve my speed, distance or perceived effort.  When I started racing, I learned about goal-setting, planning and training tricks until I felt like a real athlete, conditioning myself to perform.  Running was about putting in effort and reaping rewards, and it had nothing to do with what my body looked like or how much I weighed.

 

When I injured my foot, running could no longer be about performance, at least for a while.  When I could run again, I was slow.  I couldn’t do long distances until I built my base back up, so running then became about a sort of meditative mindful time to myself.  I started running without my watch or runkeeper sometimes, just running by feel.  The freedom I felt not having to keep a certain pace was unbelievable, and I gave myself permission to stop and just feel the sun for a minute or take photos of flowers or cool cloud formations.  Making exercise about quiet time to unplug can also be accomplished by taking a hike in the greenbelt or even a walk around the neighborhood.  Yoga is another great way to find that mind-body connection, and there are so many different types that you can make it as vigorous or mellow as you want.  Again, these activities remind us that movement can be about enjoyment of a little mental downtime rather than how we look.

 

Exercise can also be about a sense of community and connectedness with others.  I was part of a bootcamp for a few years, and the group of women I met there were an integral part of my life. It was easy for all of us to show up for a 6:30am workout when we knew that all of our friends would be there.  I have heard this about CrossFit and other group training situations as well – you form a support network for one another that can extend far beyond the walls of the gym.  This concept works for just two people, too!  I had a running partner for a few years and together we trained much better than we would have individually, plus we had the benefit of “talk therapy” three times per week.

Finally, exercise can just be straight up FUN.  I haven’t tried it, but I have heard Zumba is so fun you forget you are doing exercise.  My mother swears by her Jazzercise.  I will admit I find lifting weights fun, provided I only do this once or twice a week and I listen to my “guilty pleasures” playlist (reserved exclusively for the gym).  However, my favorite fun workout is barre.  I was never the ballerina type growing up, and I got kicked out of modern dance class at the age of twenty-two for being an unconvincing snowflake.  Enjoying barre now is my chance to reframe those early disappointments.  I get to channel my inner ballerina and be graceful and strong and precise in my movements.  I just have fun with it because I can.  Plus it’s an incredibly hard workout, which always puts me in a great mood. I love going to classes, but when I’m on a budget I get the DVDs from the library and do it at home. The added bonus is that, whereas in class I have to pretend to be in my own world, at home I really can be.  My boyfriend even made me a ballet barre out of PVC pipe, so now it’s EXTRA fun to do it at home!*

The truth is our bodies function better when we move them, so developing a way to make exercise feel more like play again is key to getting in the movement we need.  I have suggested a few ways to do so, but the bottom line is to make the focus of our exercise activity anything EXCEPT gaining or losing weight.  This ALONE is not normally a good enough motivator to make regular exercise sustainable.  The 2.0:  if we can manage to be at peace with our body image, we won’t be putting pressure on ourselves to exercise to gain or lose weight in the first place.. exercise can instead just be a pleasurable part of our healthy lifestyles.

 

*the ballet barre is easy to make, and cheap!  http://www.toroidalsnark.net/barre.html

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Body Image (pt. 2)

 

A distorted body image can stop us from feeling like we belong in the world.  It’s as if, because our bodies are not perfect, we have no right to exist.  We are not deserving of anything:  not food, not touch, not confidence.  For many women, the self-loathing that accompanies a negative body image boils down to this:  because we are not perfect, we are not worthy of love.  These feelings can carry over into the massage experience. However, by simply changing our mindset going into a massage, the massage itself can become a transformative healing experience, helping us to develop a healthier relationship with our own body image.

 

A few years ago, I was in a negative self-perception spiral, but I had started to become aware that this cycle of harsh self-criticism needed to be reversed.  Enter Kristen Neff and self-compassion.  (If you have never seen her TED Talk, the link is at the bottom of the post.  Warning to those at your desks:  I still cry every time I watch it.)  The basic idea with self-compassion is to treat ourselves like we would a good friend:  to approach ourselves with encouragement, understanding, empathy and gentleness.  Self-compassion is about embracing our imperfections with kindness. After all, imperfection is one of the ways in which we are connected in a shared human experience.  Neff suggests nurturing ourselves in gentle ways when we are feeling down about ourselves as opposed to judging and criticizing.  She also notes that humans are programmed to respond to warmth and gentle touch, as part of our evolutionary biology.  Therefore, allowing ourselves soothing touch is a powerful way to send the message to our critical minds that we are deserving of comfort and healing… and ultimately, love.  In this way, massage (even self-massage) can play a vital part in fostering self-love and a more positive body image, healing the parts of us that we have unfairly judged.

 

Massage can be so powerful in healing that it is often used as part of the therapeutic process for survivors of trauma, including sexual assault.  Therapeutic touch helps reintegrate parts of the body that have been taken from us, loving back into existence parts of us that we have imbued with guilt and shame.  It is helpful for receivers of massage to realize that the client is in control of what happens to her body and how it is touched during a session.  In this way, massage builds a sense of safety and trust.*  The effects are just as beneficial for those of us who are our own attackers, constantly waging war against our own bodies with negative self-talk.  Massage fosters a sense of worthiness that can repair a distorted body image over time.

 

Here is how to get the most out of the massage experience (even if you start with self-massage!).  It is important to realize that as the receiver of massage, you are an instrumental part of your own healing.   Enter the massage space by leaving all judgements at the door.  The massage therapist will never be judging your body, so you are not allowed to, either.  (All bodies are magical to a massage therapist.)  Relax, tell yourself that you are in a safe space.  Remind yourself that you DESERVE to receive healing, to get relief from aches and pains, to feel the benefits of non-sexual touch.  Give your body full permission to receive and to enjoy, because you are worthy.  Feel free to fall asleep if you want or breathe audibly or make noise.  Feel good about the fact that you are taking care of yourself, and make sure to ask for exactly what you want.  Never endure unwanted pain or discomfort – the massage is for YOU.  I wish someone had told me this when I got my first real massage at the age of 20.  My particular struggle with body image was that I always thought I was fat, but insert “too skinny”, “lopsided”, “too old” or any other negative body image stereotype and the message is the same.  So my first massage: I went with two other girlfriends. The therapist was a younger man about my age, and I just knew he was thinking “I got the fat girl”.  I spent the entire massage tensing every muscle, worried that he was judging my body (when in reality the judgement was coming from my own inner voice).  Needless to say, I did not enjoy the massage.   Not only that, but I literally could not move for the next three days.  Years later, now that I have been on the giving end of massage, I want to make sure my clients experience the opposite of that massage, and it starts with the receiver getting into the right frame of mind.  My part as a giver is to make sure my feels safe while in my care, knowing that I will honor her body’s pace of healing.  I will feel privileged to be a part of her therapeutic process, whether it take the form of releasing lower back tension or encouraging a positive body image, or both.

 

 

*Touch for Trauma: Bodywork for Survivors, Bodysense Magazine, Jenny Lorant Grouf

http://www.bodysensemagazinedigital.com/i/801174-spring-2017