How the lymphatic system supports immunity and whole‑body health

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. Now, here are Carmenn Miles and Dr. Tamika Perry.

CARMENN MILES
Welcome, everybody. We're delighted to have you with us on Docs in a Pod, presented by WellMed. I'm Carmenn Miles alongside our co-host for today, Dr. Tamika Perry. You can find this award-winning show on any listening platform featuring podcast, and you can also find us on the radio in several Texas and Florida markets. Each week, we're here to just discuss health and wellness topics, especially those that impact our senior community. Our goal every week is just to really share practical information on how we can all live healthier, happier lives and maybe, in the long run, better manage some of the chronic conditions that arise as we age. We're super excited to have you listening in today. Thank you again for joining us. As I mentioned, our co-host today is none other than the Dr. Perry. Tamika Perry, that is. Dr. Perry is an associate medical director at WellMed in the DFW, Dallas-Fort Worth area. She oversees several large clinics in the Optum Care North Texas region. She's board certified in both family medicine and osteopathic treatment. Additionally, she earned a Master of Public Health from the University of North Texas Health Science Center. She says she was inspired to enter a career in medicine to help provide quality health care to the disenfranchised. She enjoys working with families and communities as a whole and building relationships with their patients. She's traveled the world quite a bit as a child in a military family, but she continues to enjoy traveling today. Dr. Perry, I got to ask, have you visited all of the continents yet? I know that has been a long time goal for you.

DR. TAMIKA PERRY
ItÕs a long term goal. Australia was thwarted by the pandemic, but it's going to be on the circle again list. So, it's Australia and Antarctica that I have left. Believe it or not, Carmenn, I turned 50 this year.

CARMENN MILES
And I believe that you will do it.

DR. TAMIKA PERRY
Yeah, not when I turned 50, but probably when I turned maybe 55 or 60, I will add Antarctica on the list. I didn't know it was so pricey to go to Antarctica, but Australia will be very cool.

CARMENN MILES
Very cool. Well, good. We will be watching you. We will be living vicariously through you as you make your way to these the other continents. Beatriz Cazares is a family nurse practitioner with more than 24 years of health care experience. She began her medical career as a certified nurse assistant, phlebotomist and medical assistant in Laredo, Texas, before she relocated to Corpus Christi, where she continued her education. Bea, as her family and friends and patients affectionately refer to her, completed her Bachelor of Science in nursing at Texas A&M University in Corpus Christi. She later went on to earn her Master of Science in Nursing as an advanced practice registered nurse and family nurse practitioner in 2018. She didn't stop there, guys. In 2021, she transitioned to wound care and she's now a lymphedema therapist, and she's achieved certified wound specialist status as of last year. Welcome to the show, Bea. How are you?

BEATRIZ CAZARES, NP
I'm doing good. Thank you so much for having me.

CARMENN MILES
Absolutely. Thanks for taking time out of your busy schedule to be with us. Today, we're talking about a body system that I almost never hear get mentioned, so I'm excited that we're talking about it today. I find that it's interesting that it's an essential system within our bodies. It's necessary for us to live healthy lives, but you don't hear about it much. So, today we're breaking it down. All medical jargon out the window, and we are going to discuss the lymphatic system, of which I know nothing about, so I'm excited to learn from the both of you today. Bea, I think it's important that we just start with the basics. Tell us, what is the lymphatic system?

BEATRIZ CAZARES, NP
Just like you mentioned, Carmenn, the most common systems that we usually refer to are your arterial and your venous. However, we do have a lymphatic system that is always overlooked, just like you mentioned. The lymphatic system absorbs interstitial fluid, which usually transports different kinds of protein, water, fat, waste, foreign subjects, and most importantly, different kinds of cells such as white blood cells, red blood cells and lymphatic cells. Basically, it's like our cleaning system of all these different fluids that need to be taken out of our system.

CARMENN MILES
Very good. Let's take a moment to welcome those who may have just joined us, you are listening to the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles, alongside co-host Dr. Tamika Perry and our guest for today's show, Miss Bea Cazares out of Corpus Christi, Texas. If this is your first time tuning in, our podcast is available wherever you listen to podcasts. You can also find us on the radio in several Texas and Florida markets. Today we are discussing the function of the lymphatic system. What I think I'm hearing you say Bea, when I think about it, the lymphatic system and its role within our body, it makes me think of our computers and our laptops. We have programs such as McAfee, if you will, that run in the background to kind of keep our computers and our laptops free of certain dangers. I feel like the lymphatic system kind of works quietly in the background of our bodies to help us in the same way. Am I on the right track?

BEATRIZ CAZARES, NP
Yes, ma'am. You are.

DR. TAMIKA PERRY
You're moving in the right direction. Bea did an excellent job of explaining how it gets rid of fluid and recirculates fluid in our body, but it's also important in infection. So, think about our lymphatic system as military bases in your body is the globe. And these little military bases allow the immune system in the lymph nodes in the lymphatics allow the soldiers of the immune system to come together and they'll talk. If you have a lymph node thatÕs swollen in your neck, thatÕs called your submandibular or your segmental lymph nodes, and it'll say, hey, there's infection somewhere. So, white cells, soldiers, y'all talk to each other and let's go attack that infection, whether it's in your ear or in your lower jaw. It's a communication system for your entire body that very much so works quietly in the background. Sometimes not so quietly when you have these lymph nodes that swell up and get really big, they give you a sign that, hey, something's going on with me. I mean, would you agree?

BEATRIZ CAZARES, NP
I agree, Dr. Perry. Another, very important thing to mention, just like you said, you sometimes feel the lymphatic node inflamed. The closer that lymphatic node is to an organ or to a site of your body, that kind of narrows down where the infection is happening since it's the closest to where we're having issues.

DR. TAMIKA PERRY
That is 100% correct. Remember, not only does fluid travel through the lymphatic system, but cancer can also travel through it. For example, when Bea and I are doing breast exams on women, we not only look at their actual breast tissue, but we'll feel above and below their collarbone and in their axillary area, which is just our underarms, because there are related lymph nodes there. So, if those lymph nodes are swollen during the breast exam and we may or may not fill a mass, we always want to look a little further with imaging just to make sure our body isn't telling us is there an infection? Is there inflammation? Or is there a bad villain there like cancer in that area?

CARMENN MILES
That's interesting. A lot of times as patients get a little nervous. What I'm hearing is that our lymph nodes are little security checkpoints within the lymphatic system, but when they swell or tend to swell when we're sick, we tend to think that's not a good thing. But doesn't it mean quite the opposite? Our immune system is actively working and filtering out some of the bad stuff?

DR. TAMIKA PERRY
Right. That's a warning sign to you, too. You go, okay, my throat is swollen and I have lymph nodes. Should I go see my PCP? Absolutely. Your immune system is doing its thing, but that does not mean you should not go see your PCP. Bea and I will never say that. Always go see your primary care physician. Let's just say your lymph nodes are swollen in your neck and underneath your chin, you could have streptococcal pharyngitis. If you have strep pharyngitis, you definitely want a penicillin like drug if you're not allergic to it because we don't want the negative stuff that can happen from strep to happen to you. You can get kidney disease from strep. You can get heart disease from it. So, there's quite a few things can happen. Not only is it a signal that the immune system is working, it's also a warning sign for you. You may need to take action.

CARMENN MILES
Absolutely. Do you want to add to that, Miss Bea?

BEATRIZ CAZARES, NP
Like Dr. Perry was saying, we will never say do not go and check. Because again, that is just a red flag for you. There's something going on in your body and it is our first warning sign. So, we always encourage, please go see your primary care because you just never know. Never take it for granted.

CARMENN MILES
Right.

BEATRIZ CAZARES, NP
For example, like she was saying, you have a patient that you're checking for breasts. If they've already had issues or had any type of procedures, those lymph nodes have already been damaged. So, we must be extra cautious on that and those types of patients.

DR. TAMIKA PERRY
Extra, extra cautious. Remember that one of the first things that Bea said was, it's a drainage system. So, we don't want that that drainage system to carry cancer to other places. So, if you've had breast cancer, for example, and then you had axillary nodes or under your arm, lymph nodes that were positive for cancer, we're not only going to remove that cancerous mass, we're also going to remove those lymph nodes because we don't want those lymph nodes making that cancer travel to other places. So therefore, you may see some women or even guys who have had breast cancer in particular, and the lymph nodes were removed, but that arm looks large all the time because it doesn't have adequate drainage now. So, they'll have effective lymphedema swelling from lack of the lymph nodes in that area. I'm sure you all have seen probably family members of friends or people at church, why is one arm and one hand bigger than the other one? ThereÕs a great possibility that person had breast cancer and we surgically removed those lymph nodes because we did not want it to spread anywhere.

BEATRIZ CAZARES, NP
That is very correct, Dr. Perry. That also goes back to nowadays having all these procedures, the young ladies that are doing procedures, we also need to realize that the lymphatic system is very superficial. So, any type of surgery, you run the risk of damaging your lymph nodes. Again, once your lymph node is damage, it cannot drain appropriately. That's where the fluid starts building up and developing the lymphedema.

DR. TAMIKA PERRY
The radical point that I hardly ever think about, we were talking about unnecessary surgery with the breast cancer, but with cosmetic surgery be very, very careful that you don't mess up something trying to be Instagram pretty.

CARMENN MILES
That's a good point and a good point to go out on as we take a brief break. We need to take just a quick break, but please stay with us as we continue learning about all the important functions of the lymphatic system. You're listening to Docs in a Pod presented by WellMed. WeÕll be right back.

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CARMENN MILES
We're back on Docs in a Pod. I'm Carmenn Miles alongside cohost Dr. Tamika Perry. Our guest today is family nurse practitioner Beatriz Cazares. Bea, as she is referred to by most is a lymphedema therapist and a certified wound specialist in Corpus Christi, Texas. Bea, just before the break, we talked about how the lymphatic system works to clean up and flush out the system for lack of better terms, and how to maintain good fluence balance in our bodies. Let's talk about that. What should a patient do if they feel like maybe they are having an issue with fluid balance that may mean that there is an issue with the lymphatic system? What would you recommend a patient do?

BEATRIZ CAZARES, NP
I would recommend for them to seek out referral to a lymphedema specialist or even as in the wound care center. Treatment is very, very important. There is a very invasive treatment that will help and be able to manage long term. But it goes back to patient wanting and having the desire to put in the work because there is work to be put into this type of diagnosis. Not only am I talking about progression, but it has also to do with skin hygiene to avoid any type of cellulitis. It also involves with the compression. What type of compression would be appropriate for the patient? The main thing is compression to help push up that lymphatic drainage that is not working appropriately.

DR. TAMIKA PERRY
I think people discount the importance of compression. The compression forces the lymph system to flow in the direction is supposed to flow, and it keeps the interstitial tissue tight. So basically, it keeps your flesh tight and forces not only the left to flow, but it also forces your venous system to flow. A lot of times what is accompanied by lymphedema or lymphatic congestion is also something called chronic venous insufficiency. This is just a state in which kind of happens with age. Our veins become a little lazy. So instead of fluid, when I say fluid, I mean blood, going back to the heart appropriately, in a timely manner. Some of the fluid part of the blood seeps into this tissue space, and it causes swelling, which is compounded against a lymphatic system that may be aging. Previous surgeries. When you have that compression, it forces those tissues to flow in the direction that it was meant to flow for better circulation and better elimination.

BEATRIZ CAZARES, NP
Yes, Dr. Perry, I agree. That's what we call lipo-lymphedema when we have issues with the venous insufficiency. Again, all these three lymphedemas, which is your regular lymphedema, your feeble lymphedema, your lymphoedema, all of them have to do with not appropriate drainage of some sort. Compression is the most important thing for all three of these. I can't emphasize to patients. One of their biggest complaints is that it's so tight it's hurting. I always tell them that's an alarm for you that your body's telling you it's time to elevate. The more you elevate, the more you use your lymphedema pump, that also helps. So, I always tell them don't see it as a negative. See it more of a positive. Your body's alerting you. You're starting to swell up. Put in the time. I can't emphasize enough the education part for patients so they could understand the whole concept.

DR. TAMIKA PERRY
When she says elevate, she's talking about gravity's either your friend or your enemy. So, if your legs are just dangling down or even your arms y'all think about it like this. When you go for a walk and your hands are dangling down and you're casually talking to your friend that you're walking with, when you get home, your fingers may be a little bit tight, right? Or it may be a little bit difficult to get the ring off, but if you hold your hands up after about 5 or 10 minutes, you can pull your ring off. That's because gravity, when your hands were dangling down, has kind of hindered the fluid from going back towards the heart. Now, when you put those hands up now, gravity helps it go back towards the heart. So, when Bea says elevation, when your legs are parallel to the ground, now you're neutral to gravity. But when you start to elevate them going toward your heart now gravity can help that fluid go back towards the heart and the kidneys, where it can either be redistributed or eliminated. So, gravity can either hinder or help you with lymphedema depending on the state that you're in. If you're swollen up, what my friend Bea say? She said elevate, elevate, elevate. She said wear those compression stockings. You can get you some really cute ones off of these online stores like Amazon, and I do not work for Amazon. So, just elevate, elevate, elevate. For my patient who ask me if fishnets count, no, ma'am. They do not count. They may be cute, but they do not count. Put them over your real compression stockings. In terms of treatment, remember compression elevation if you have a lymph issue. Bea, what role does exercise play? What do you recommend for your patients?

BEATRIZ CAZARES, NP
I always emphasize low impact such as water aerobics. Even just walking. Nothing strenuous. I emphasize that their calves are like a second part. Those calf muscles help pump that extra fluid from the lower extremities back up. So, when they say, I guess I can't walk, I say, yes, you can, because, and I'll explain why. The only bad part is one of their main concerns is my leg or my arm. It's too heavy. I canÕt do exercise, but I emphasize to them, if you do the exercise, that extra fluid that's built up will start moving. Then they understand. They put one and one together and they understand the process.

DR. TAMIKA PERRY
Right. It's like having stagnant water or do you have a circulating pump in the water. So, that exercise becomes a circulating pump that gets that water moving. We don't want to just become stagnant. There's also special massage that you can get called a lymphatic massage that will help. This is specialized. People have to be trained to do this, but it helps manually move that fluid from an external force. An external force in this case is a physical therapist who has been trained in it.

CARMENN MILES
Absolutely. One thing that surprised me in my little bit of research before the show, let's talk about fat absorption. Is this myth or is this it's true that the lymphatic system helps with fat absorption? Is that accurate?

DR. TAMIKA PERRY
It is accurate. Bea will cosign with me when I say that there are little fingers called the villi inside of your intestines that are part of the lymphatic system that absorb molecules that are too big for the blood system, particularly in the small intestine. So, fat molecules that are too large, as well as vitamins A, D, E and K, which happen to be fat soluble vitamins. So yes, most certainly it is important in the absorption of fat. She attested earlier that there is a type of lymphedema that has to do with fat distribution, right Bea?

BEATRIZ CAZARES, NP
Correct that that is called the lipedema. One of the biggest reasons why they start developing lipedema, there's many studies justifying it like hormonal changes, believe it or not. That's why it's a lot more common in women than in men because of our hormones. Especially, as we get older, our hormones change. When women get pregnant, they go ahead and go through that change as well. Menopause. We have now so many studies justifying earlier menopause starting as well. All those changes affect the hormones. That's one of the biggest reasons why the lipedema starts. But I agree, lipedema is one of the biggest things the distribution of that.

DR. TAMIKA PERRY
Just to kind of put it into terms where people can visualize is if youÕve ever seen people in their lower extremities and they have like dimpling or uneven distribution or not smooth fat distribution on their legs. So, it looks like it's dimpled or as I affectionately call it, like hail damage. On top of that, your calves are large. I'm not talking about anybody because somebody on this podcast has a significant amount of hail damage and her first name starts with a T and last name starts with a P. Treatment, weÕll exercise. Bea, she's already articulated very beautifully some of the other treatments for lipedema. Why does everything happen to us as women? Oh, goodness gracious.

CARMENN MILES
I don't know. But the good news is, even though there's no internal pump that regulates that, just getting out and moving a little bit every day helps. Muscle contraction helps with all those things. Your breathing, your posture. We got to give it a little help in order for it to be able to do what it needs to do. Any last thoughts? We're almost out of time.

DR. TAMIKA PERRY
Never discount the power of diet and exercise in any disease state, particularly in lymphatic diseases, especially lymphedema. Movement and the position of your body is essential.

BEATRIZ CAZARES, NP
I agree, Dr. Perry. Some physicians automatically tell patients, it's caused due to your obesity. But if you put in the time, like Dr. Perry said, doing exercise and watching your diet, you could at least have a step ahead of the doctor and say, I've already done this, and it's not improving. So yes, I agree, diet and exercise will also help.

CARMENN MILES
Well, thank you ladies. You've both been a wealth of information about something that's not discussed often. Our lymphatic system, which is absolutely essential for our bodies to operate and deliver the way they should. So, thank you for your time. Hopefully after today when people hear lymphatic system, they'll think essential, not something thatÕs obscure because it's quietly working for us every second of every day. That's all for today's episode of Docs in a Pod presented by WellMed. Thank you for joining us each week as we explore ways to live happier, healthier lives. Don't be a stranger. Subscribe to this podcast and you will never miss an episode. Sharing is caring. Share this podcast with your friends and loved ones who might also benefit from these conversations. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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