Lymphedema is a combination of two words: Lymph (a natural body fluid) and Edema (swelling)-literally, it means "swelling caused by lymph." This is a chronic disorder in which lymph fails to circulate properly and, as a result, accumulates in the tissues of a limb or otherpart of the body. It's symptoms can include pain, numbness, a loss of mobility, a loss of skin elasticity, hardening of the skin, increased susceptibility to infection, chronic ulceration of the skin, and swelling that can make an arm, leg, or other body part as much as two, three, four, or even more times it's normal size. Once the onset of lymphedema takes place, it affects every facet of your life-and it never goes away. If untreated, the damage it causes is irreversible and progressive. In order to understand this condition, it is first necessary to understand how the body's circulatory systems work, and also to understand the role of the immune system. As you will see, these systems are separate, yet intrinsically related.

In order to understand this condition, it is first necessary to understand how the body's circulatory systems work, and also to understand the role of the immune system. As you will see, these systems are separate, yet intrinsically related.

When we think of circulation, we tend to think of blood and the blood vessels. But the body has another circulatory system that works in concert with the blood system. This is the lymphatic system. The lymphatic system is a mechanism for removing excess blood protein and water from the spaces around the cells and returning them to the blood system.

When fluid diffuses out of the capillaries, it joins the interstitial fluid, which is found in spaces between the body's cells and tissues. It is the interstitialfluid that bathes all the cells of the body and serves as an exchange medium for the netrients carried in the blood. From this fluid, oxygen and nutrients enter the cells. In turn, the cells release carbon dioxide and other cellular waste products and eliminate them through the circulatory system. The blood is returned to the heart by means of the veins and the journey begins all over again.

As blood passes through the capillaries in the tissues, there is a continual exchange of its plasma portion(the liquid and nutrients, including protien molecules, that are needed by the cells for the maintenance of life) and the interstitial fluid. Normally, the amount of fluid thatexits the capillaries for the interstitial fluid is roughly equal to the amount of fluid that reenters the capillaries from the interstitial fluid. However, a small percentage of the fluid is left behind. It is this fluidthat must rejoin the blood circulation by means of the lymphatic system.

The lymphatic system consists of the lymph, lymphatic vessels, and lymph nodes. It is responsible for returning excess fluid and blood protein from the tissues to the blood circulation, and also plays an important role in protecting the body aginst illness.

Lymph is a clear, colorless fluid composed of water, protein, salts, glucose, and urea, plus white blood cells. Basically, lymph is interstitial fluid that has left the tissue spaces and entered the lymphatic capillaries. Unlike the blood vessels, which are closed (that is, the blood is always contained within the blood vessels), the lymphatic system's capillaries are open at one end. It is through these openings that the interstitial fluid enters the capillaries to become lymph. At the other end, lymphatic capillaries join with other lymphatic capillaries to form the lymphatic vessels.

These vessels act as channels through which lymph is moved through the body, back toward the blood circulation. The lymph is as thick as honey or syrup and it moves rather slowly, its movement powered by the contractions of skeletal muscles and the motion of breathing. An amazingly efficient system of one-way valves within the lymphatic vessels prevents the fluid from flowing backward toward the tissues again. Lymphatic vessels also absorb most of the digested fats that drain from the intestines, and transport these to the bloodstream as well. This intestinal lymphatic fluid is called chyle and often appears whitish because of its fat content.

As lymph is transported through the body, it passes through structures called lymph nodes, which are located along the lymphatic vessels in various regions of the body. These round or kidney-shaped nodes, roughly the size of a lima beans, are found in the head and neck, armpits, groin, abdomen, pelvis, and chest, either deep in the body or near to the surface, where they can be detected through manual examination. There are between 500 and 1,500 lymph nodes in the body.

The lymph nodes have two main functions. First, they produce lymphocytes, which are white blood cells that combat infection by producing antibodies to fight bacteria and viruses. Second, they filter the lymph, destroying and removing dead cells and waste materials, as well as bacteria, viruses, and other potential disease-causing pathogens. In essence,the node catch and annihilate these toxins, preventing them from entering the bloodstream and wreaking havoc there. When the lymph nodes have performed their detoxifying function, the lymphati fluid is ready to be returned to the blood.

This duct begins in the area of the lower spine, collecting the lymph from all the lymphatic vessels of the lowerlimbs, pelvis, abdomen, and lower chest. The fluid is then transported up to the chest, where it empties into the central blood circulation through a vein at the base of the left side of the neck. The right lymphatic duct collects lymph from the right side of the neck, the right chest area, and the right arm, and empties into a vein in the right side of the neck.

As we have seen, the circlatory systems are central to nourishing the tissues, removing wastes, and maintaining the body's critical fluid balance. That is not their only role, however. They also are important components of the immune system.

The body fights against the bacterial and viral invaders that threaten to undermine our health and well-being. To be sure, our bodies have other ways of warding off infections and diseases. Among them are the skin, which covers and protects the entire body; the mucous membranes that line our breathing passages and snare or sweep away minute organisms; our temperature-regulating mechanism, which elevates body temperature to destroy organisms that cannot withstand the heat; and even our sticky earwax, salty tears, and acidic stomach juices, all of which protect aganist and can destroy or retard the growth of microorganisms.

But if these defenceses fail to ward off bacterial or viral invasion, the body depends on its second line of defence: blood and lymph. At the first sign of foreidn invasion, blood and lymph containing infectionfighting white blood cells rush to the affected tissues in an attempt to lymphatic vessels and lymph nodes are found throughout the body, but tend tobe concentrated in certain areas.

If the lymphatic system is damaged, it's normal functions are compromised. If the nodes are injured, they cannot filter toxins from the system or produce the lymphocytes that fight infection; if the nodes are removed, this leaves the body with fewer nodes to fight disease and also disrupts the pat ways by which lymph is normally drained from the tissues; if the vessels are injured, they can no longer transport lymph through the system as they should. Put simply, a damaged lymphatic systems works inefficiently, giving rise to symptoms that demand treatment.

Both blood plasma and interstitial fluid contain protein, but plasma normally contains about 7 percent protein, whereas interstitial fluid contains approximately 2 percent. Biochemically, this results in most plasma protein being held in the lymphatic circulatory system. If some leaks out, it is returned to the blood by the lymphatic circulation. However, if the lymphatic system is damaged, a concentration of protein eventually accumlates in the tissues. This protein further interferes with the flow of the tissue fluid into the lymphatic capillaries and, ultimately, the blood. The result of edema, or swelling.

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