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My Experience at Manual Lymphatic Drainage (MLD) Bootcamp!

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It was not like any other course or form of study I have known, from the first minute I was scrambling, my brain didn’t compute, I am thinking I am in the wrong course surrounded by well educated nurses, occupational therapists, physiotherapists and the like. Then there was our teacher Jan who is like no other person in this world I have met, she knew it all, a walking encyclopedia of all things in the human body her passion and knowledge of the lymphatic system is phenomenal. Class days were combined of theory and practical sequences, the day started early and finished late, coming home consisted of a quick shower, quick bite to eat and then straight back into study. For fifteen unrelenting days I was immersed in all things lymphatic, immune and cardiovascular systems plus everything in-between.

Here is a very short summary of what I learnt:-

Functions of the lymphatic system are to primarily support the immune system, assist in maintaining blood volume, act to remove organic and inorganic materials, waste products, cells and cellular debris, removal of proteins and lipid molecules too large to enter blood capillaries and the removal of fluid leaked by capillaries into connective tissue spaces.

Anatomically the lymphatic system is beyond complex being made up of interconnecting cells, fibers, pre-collectors, vessels, nodes, trunks, ducts and veins and yes I can now tell you how and why it all flows together! That would ofcourse take much longer than you or I have right now so here is a summary of the basic things you need to know in relation to your treatments with me:-
The first part of the lymphatic system is the Initial lymphatic vessels (ILV) they sit just under the first few layers of skin, the job of the ILV is to gather all of the lymph obligatory load (LOL). LOL is compromised of all of the matter that the blood can not process, major components being Water, Proteins, Cells and Lipids. Minor components include but not limited to Dusts, Dyes, Pathogens and Cellular debris, the lymphatic vascular system (LVS) can be likened to a vacuum cleaner. Nobody needs all of that ‘junk’ hanging in their body (in the loose connective tissue) which is why we need to activate our vacuum cleaner. The ILV are so very important, just think for a minute, it is the head of your vacuum cleaner, explore how very delicate your skin is, if the entry point of your lymphatic system is only just under the first few layers of skin then it makes sense that we need to treat it with an extremely delicate touch so as to promote it to flow and not inhibit its function.

The LOL (lymph obligatory load) after being ‘sucked’ in from the ILV (initial lymph vessels) then passes into pre-collectors which in turn move into lymphatic collector vessels (LCV), it is the movement of the LCV that takes the LOL into the lymphatic nodes. We have nodes all over our body (anywhere from 700 – 1400, approximately 1/3 of these are located around our neck).

Lymphatic nodes have a really specific job when it comes to the regulation of blood and the immune system. It is at the lymph node that 50% of the water that has been collected by the LCV (lymph collector vessels) is returned directly into the blood supply, leaving the remaining concentrated 50% for the lymph node to process. The lymph node is a big production and filtering factory whose main job is to filter organic and inorganic substances and debris, pathogen removal and isolation, it performs as a storage site for lymphocytes and macrophages (immune cells), encapsulates inorganic material so it is not circulated back into the body and reproduces lymphocytes for immune defense. Here’s the bottom line, if you want a healthy immune system, you need a healthy lymphatic system.

Structurally there is a superficial and deep level of the lymphatic system, the superficial flows into the deep on its way back into the heart, this week I learnt how to work with both the superficial and deep structures of the lymphatic system.
I guess you may be thinking this is all really interesting Michelle but HOW do I get to improve my lymphatic system?
1 – Relax – when we are stressed we constrict blood and lymphatic vessels, muscles and all other intrinsic and extrinsic activities that help to stimulate lymphatic flow in the body, when we relax the blood capillary sphincter dilates which increases the velocity of blood through the capillary reducing the amount of fluid that leaks out of the cardiovascular system and into the connective tissue, this reduces the amount of lymph obligatory load that the lymphatic vascular system has to process ensuring that it is working within its maximum transport capacity, i.e. your vacuum cleaner is not getting blocked up.
2- Drink – when you are dehydrated everything slows down, the lymphatic system needs fluid to keep it moving through, remember it is like a river, more water = greater flow, every person has a unique amount of water that is ideal for their own bodies it is a good idea to chat to your healthcare provider about this if you are confused.
3 – Move – when we move we enable the stretch receptor reflex to pump the lymphatic collector vessels, we create more suction through the vacuum cleaner. Avoid lying down for long periods; the automyogenic process that is always present in the lymphatic smooth muscle only moves the lymph 6/7 times per minute which is why sometimes it is hard to get moving after a long period of sitting, standing or lying.
4- Breathe – I am talking deep belly breathing, the biggest area of lymphatic formation is around the middle of the abdomen, it is called the cisterna chyli (pronounced Kylie) this is where all of the lymph moves from the lower part of the body, the intestines, the reproductive system and the digestive system, breathing helps to enable the stretch receptor reflexes just like exercise does pumping that lymph further up the lymphatic chain and creating more suction.
5 – Clothing – the looser the better, tight restrictive clothing acts like a tourniquet to “cut off” the flow of lymphatic fluid, if it leaves a red line or a mark on your body forget it, bras, underpants and socks seem to be the major contributors that I see.
6 – Temperature – keeping yourself too cool slows down your flow, staying warm allows your lymphatic and cardiovascular system to keep moving, keep yourself at a comfortable temperature and listen to your body.
7 – ManualLymphaticDrainage – MLD – enables the pumping capability of the lymphatic vascular system to increase to 27/30 times per minute, just like hitting turbo on your vacuum cleaner, increased lymph flow may affect immunological process, reduce chronic inflammation, increase wound healing and relieve arthritic conditions. MLD has an analgesic effect by inhibiting pain pathways reducing migraines, headaches, neuralgia and chronic regional pain syndrome. Calming the nervous system assists in recuperation, stress and sleep disorders.

In light of this new found MLD technique and the enormity of the information regarding the lymphatic system that now lives in my brain you have some new options open to you at your next appointment with me, what you might notice -
You have an option to have NO music (whhaattt)! Yes music has been shown to increase sympathetic tonus which you have just read has the opposite effect on what we want to achieve.
I will encourage you to NOT talk – again we are trying to reduce sympathetic tonus so that the blood capillary sphincter dilates, more velocity of blood flows reducing the amount of LOL (lymph obligatory load) in the connective tissue.
Reducing the sympathetic tonus also reduces the neural pain receptors in the brain, meaning that you will experience less pain as we reduce the inflammatory load in the tissues.
The touch will be much lighter to what you are used to – remembering that we want to encourage the ILV (initial lymph vessels) to vacuum up as much LOL (lymph obligatory load) as possible.
Perhaps you might want to consider having a sample of MLD at the end of your remedial massage, remembering that MLD reduces inflammation and often regular massage is increasing inflammation.
In the deeper work that I studied we learnt how to treat injury, burns, breaks and much more using MLD, if you have had a chronic injury and have had a lot of treatment on it but still it remains perhaps there is some trapped inflammation that MLD can assist to move?
You may now have a lot of questions about your own health and how MLD can help you to improve ie, lymphoedema, cancer, injury, inflammation, auto-immune condition, lipoedema, post surgery recovery, plastic surgery recovery etc. I am going to be writing some more in-depth articles on these subjects.
I am sure after reading this you want less inflammation, a better immune system, healthier tissues, speedy removal of pathogens, virus and cellular debris, reduction in the appearance of your cellulite, cleaner blood, better digestion and bowel motions? What are you waiting for? Get breathing, get moving and get some Manual Lymphatic Drainage today!

See you on the table!

Michelle

Abstract

To ascertain the level and rate of olfactory dysfunction in patients with leprosy and to determine whether olfactory bulb volume is affected by the pathophysiology. Olfactory bulb (OB) volume, measured using magnetic resonance imaging (MRI), was compared in 15 patients with leprosy and 15 healthy controls. All of the participants were evaluated using a detailed history to identify the probable causes of the smell dysfunction. Those who had a disease other than leprosy that may have caused the smell dysfunction were excluded from the study. OB volumes were calculated by manually tracing the OB on coronal sections. Orthonasal olfaction testing was used to assess smell function. The orthonasal olfaction testing indicated that all patients with leprosy were anosmic or severely hyposmic. The smell function test indicated that the OB volume of the patient group was significantly lower than that of the control group. No within-group difference was detected between right and left OB volume in either group. The patients in the leprosy group were severely hyposmic or anosmic and their olfactory bulb volume was significantly lower than that of the control group. To our knowledge, this study is the first to show a reduction in olfactory bulb volume among leprosy patients.

Introduction

Leprosy, also known as Hansen’s disease, is a chronic granulomatous infection caused by Mycobacterium leprae [1]. M. leprae, primarily affects the skin, eyes, peripheral nerves, and testes and tends to spread to the ears, nose, upper aerodigestive system, hands, and feet [2]. The incidence of leprosy has decreased; but it remains a significant cause of neuropathy worldwide as a result of peripheral nerve involvement [3], and it is endemic in developing countries [4]. Leprosy causes hearing, vision, and taste dysfunction [5–7]. The olfactory nerve is specialized and carries only sensory information. Capitalism lab pc game. The olfactory system consists of the olfactory epithelium, bulb, and tract and is connected to the cortical olfactory area known as the rhinencephalon.

The olfactory bulb (OB) is a relay station between the peripheral olfactory receptors and cortical structures. The OB size changes with afferent neural activity and is plastic throughout life [8] consequently, the OB volume reflects the degree of olfactory function.

Volume measurement using magnetic resonance imaging (MRI) is a reliable technique for measuring the OB volume and has been used to study post-traumatic olfactory dysfunction, congenital anosmia, neurodegenerative diseases, and the sense of smell in individuals who have no dysfunction [9–13]. Htc desire 530 software update.

Upper respiratory tract impairment has been reported in the majority of leprosy patients, but personal safety issues, such as the inability to detect smoke or other dangerous odor signals, have not been addressed. Few studies of olfactory dysfunction in leprosy have been published in the English medical literature [1, 14–16]. Furthermore, the number of patients who lose the function of smell is not known. Chaturvedi et al. [14] reported olfactory dysfunction in approximately 40% of patients with leprosy, Ozturan et al. [16] reported that the rate was 91%, and Mishra et al. [1] observed olfactory dysfunction in all leprosy cases.

Therefore, this study ascertained the level and rate of olfactory dysfunction in patients with leprosy and determined whether olfactory bulb volume is affected by the pathophysiology.

Materials and Methods

This prospective study was conducted by the First Ear-Nose-Throat Clinic, Head and Neck Surgery Clinic, and Radiology Clinic of the Haseki Training and Research Hospital. The study was performed in accordance with the Helsinki Declaration (WMA 1997) and was approved by the hospital ethics committee. Written informed consent was obtained from the patients and healthy subjects.

Fifteen randomly chosen patients with lepromatous leprosy (seven men and eight women) were included in the study. Their mean age was 68.6 years (range 53–82) and the mean disease duration was 48.4 years (range 30–65; Table 1). The Ridley-Jopling classification system [15] was used to confirm the diagnosis of lepromatous leprosy. Septal perforation was observed in 11 (73%) patients during the examination.

Table 1

Patients who had a condition other than leprosy that could cause olfactory dysfunction were excluded from the study. Routine ear, nose, and throat (ENT) examinations, orthonasal olfaction testing, computed tomography of the paranasal sinus, and MRI to measure OB volume were carried out. A complete neurological examination and mini-mental test assessment was performed in all patients to exclude possible cognitive dysfunction and neurodegenerative disease.

The control group consisted of 15 subjects (10 men and five women) who had normal olfactory function. Their mean age was 67.7 years and ranged from 61 to 74 years (Table 1).

Orthonasal olfaction testing, developed by the Connecticut Chemosensory Clinical Research Center (CCCRC) and modified by Leon, were administrated to the subjects in both groups [16–19]. The CCCRC orthonasal test scores were classified as follows: 0–1.75, anosmia; 2.00–3.75, severe hyposmia; 4.00–4.75, moderate hyposmia; 5.00–5.75, mild hyposmia; and 6.00–7.00, normosmia (Table 2).

Table 2

Results of orthonasal olfactory testing by category

All data are reported as number of patients

The OB volume was measured using MRI (Fig. 1). All of the measurements were taken from 3-mm consecutive T2-weighted (T2 W) turbo spin echo (TSE) images using the Philips Achieva 1.5-T MRI system (Philips Healthcare, Andover, MA, USA). An experienced radiologist measured OB size by manually tracing the OB on the MRI coronal T2 W sections. The radiologist measured the right and left OB separately and was blinded to the patient and control groups.

T2-Weighted coronal image showing reduced olfactory bulb volume (arrows)

Patients were excluded from the study if MRI T2 W gradient echo (GRE) imaging revealed post-traumatic, parenchymal, or meningeal hemosiderin retention in brain tissue. In addition, patients were excluded if the T2 W TSE images revealed other organic brain disorders.

Statistical Analysis

The data were evaluated using MedCalc statistical software v11.1.1. The Wilcoxon signed-rank test was used to compare repeated measures variables and the Mann–Whitney U test was used to test between-group differences. The data are expressed as the mean ± standard deviation. P < 0.05 was deemed to be statistically significant.

Results

The OB volume varied widely in the patient group. The mean left OB volume was 31.6 ± 11.35 mm³ (range 17–55); the mean right OB volume was 30.26 mm³ ± 10.58 (range 17–57); and the mean total OB volume was 30.93 ± 10.55 mm³ (range 20–55; Table 1).

For the control group, the mean right and left OB volumes were 71.73 ± 10.97 mm³ (range 56–91) and 75.06 ± 13.11 mm³ (range 57–104), respectively, and the mean total OB volume was 73.33 ± 11.17 mm³ (range 60–96; Table 1).

No within-group differences between the right and left OB volumes were detected (patient group, P = 0.4212; control group, P = 0.2524).

The OB volume of the patient group was significantly reduced compared with that of the control group (P < 0.0001; Fig. 2).

Box plots showing the distribution of olfactory bulb volume measurements in the patient and control groups

Table 2 summarizes the orthonasal olfactory test results. On a seven-point scale for the butanol threshold and identification test, the leprosy group scored 1.41 ± 0.38 (range 0.75–2.75) and the control group scored 5.73 ± 0.5 (range 4.25–6.75). According to the CCCRC scoring system, the leprosy group was anosmic and the control group was hyposmic.

The orthonasal test detected olfactory dysfunction in all of the patients: 12 were anosmic and three were severely hyposmic. In the control group, two subjects were moderately hyposmic, five were mildly hyposmic, and eight were normal.

Orthonasal olfactory function was significantly reduced in the leprosy group compared with the control group (P < 0.0001). There was a significant cross-correlation between the orthonasal score and OB volumes in both groups (P < 0.0001).

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Discussion

The OB is a neuroplastic structure and its size may change in relation the level of afferent neural activity [1]. Although nasal pathology is common in leprosy, few studies have examined changes to the sense of smell in this patient group [1, 16]. Olfactory system dysfunction and anosmia have been observed in all types of leprosy, but no study has investigated the underlying physiopathology.

This study is the first to evaluate olfactory bulb volume changes caused by loss of the sense of smell in patients who have leprosy. Animal studies have shown that one of the most critical effects of olfactory deprivation is a reduction in OB size as a result of hypoplasia [20]. Bulbar neuroplasticity is associated with the stimulation from the olfactory receptor neurons [21].

Chaturvedi et al. [14] observed olfactory loss in 41.7% of 225 patients with leprosy, and Ozturan et al. [16] reported that 91% of their patients had olfactory loss. Mishra et al. [1] reported that all of their patients with leprosy suffered olfactory loss, but that medical treatment improved their olfactory test scores. However, the improvement was smaller in patients who had lepromatous leprosy, the more severe form of leprosy. All of the patients in our study had lepromatous leprosy and our finding that all had severe olfactory dysfunction concurred with that of Mishra et al. [1]. Although other studies have examined olfactory function in patients with leprosy, to our knowledge, our study is the first to investigate involvement at the level of the OB.

Mishra et al. [1] suggested that impairment of the olfactory receptors and OB developed in the early stages of the disease; however, no study was conducted to test this theory. It has been established that the non-myelinated axons of the olfactory receptor cells are the initial target of toxic agents and viruses [22]. M. leprae, which is spread through droplet infection, may infect the olfactory receptors and OB. Other changes affecting olfactory function occur in later stages of the disease. M. lepra causes edema, swelling, ulceration, septic perforation, and collapse at the upper respiratory tract [23]. Peripheral neuron infiltration, motor and sensorial abnormalities, autonomic nerve dysfunction, and ganglion infiltration have been reported in people who have leprosy [24]. Liu and Qiu [25] suggested that the infection reaches the nerves through the blood, lymph, or by direct exposure. Primary atrophic rhinitis is caused by thinning nasal membranes that are the result of the regional effects of leprosy, such as defects in mucosal innervation and olfactory nerve end damage. Furthermore, leprosy is known to cause secondary atrophic rhinitis [1].

Conclusions

To our knowledge, this study is the first to report olfactory bulb volume reduction in patients with leprosy. Olfactory dysfunction and a significant reduction in OB volume were observed in all of our patients. We believe that the OB dysfunction in patients with leprosy is the result of a primary or secondary rhinitis in the upper respiratory tract where the sense of smell originates. The rhinitis causes the peripheral neuropathy that leads to loss of the sense of smell and a subsequent reduction in OB volume.

Conflict of Interest

References

Manual Lymphatic Drainage Face

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