PODCAST INTRO: Hey, beautiful soul, and welcome to Dear body, I'm Listening. The podcast for women navigating chronic symptoms, invisible illness, and that daily dance between hope and exhaustion. If you've ever been told, it's all in your head. Well, this podcast is for you, because your body is not lying, and neither are you.
Hi, I'm Donna Piper, movement therapist, body instructor and chronic illness navigator. After years of being dismissed, misdiagnosed and doing everything, quote, unquote right, but still getting sicker, I created this space to tell our truth. Here, we talk about swelling, brain fog, nervous system crashes, and the kind of symptoms that don't always show up on lab results. We're going to explore lymph, breath movement, self trust, latest research books, relationships, basically everything, all from a place of compassion and honesty. This isn't about fixing your body. It's about finally being heard, and getting some answers.
________________
Donna Piper: Hey, beautiful soul, welcome back to Dear Body. I'm Listening. Today, we're talking about lymph. The most underrated system in your whole body. If you're new here, the lymphatic system is like your body's drainage and detox crew, but hardly anyone gets taught about it, even in medical school. And yet, for those of us with lipedema, lymphedema, chronic illness or post surgical healing, lymph health is everything. So I brought in a powerhouse guest, Tina Shin. Tina is LANA Certified Lymphedema Therapist with a clinical doctorate in occupational therapy. She completed her residency at the Keck Medical Center of USC in Los Angeles, where she eventually served as the lead lymphedema therapist for several years. In 2021, she also opened her own private practice, OC Lymphatics, where she provides mobile lymphatic services throughout Orange County. She specializes in lymphedema, lipedema, oncology, Peri surgical care, and helping patients who suffer from chronic conditions. So without any further ado, here's Tina. I'm so excited to have you, so welcome, welcome, welcome.
Tina Shin: Thank you. I am so excited to be here. Thank you so much for having me.
Donna Piper: Yes. You're just a wealth of knowledge and full disclosure, Tina does my parent technique. She also does my MLD treatment, and I have learned a lot from her, both how to navigate the system, what to ask for, and really what to do in my conservative care for lipedema, but also all my other chronic illnesses. So I think she's a little angel, so I just couldn't wait for her to get on and talk about the lymphatic system, and her hands on real life experience with a lot of different bodies to really see the real world of what goes on. So I gave you your intro. Is there anything you want to add to it? Tell us about yourself today. You don't have to, but I just want to make sure.
Tina Shin: No, I feel like that was very thorough.
Donna Piper: So let's just start. Keep it simple. So anyone out there that hasn't heard of the word lymphatic or has heard is just hearing it now for the first time. Tina, how would you explain what the lymphatic system is? Why does it matter? I know you're good at really explaining these things, these very complex systems, very simply. So what would you have to say if someone's like, oh, lymphatic, what is that? I don't even know what it is. How do you explain it to patients?
Tina Shin: The lymphatic system is an incredibly important system, but it is greatly underappreciated. It is said that if our lymphatic system were to fail, we would die within about 24 to 48 hours. So it's incredibly important. And like you mentioned, it does a lot. It's a system that regulates our fluid, balances it, cleans and flushes out bad things that we don't want circulating around bacteria, viruses, pathogens, or even just our metabolic waste. But it also helps us to kind of transport and absorb good things that we do want, like nutrients and fats. So the easiest way to highlight how it works, a lot of us use this analogy is that it's like a highway, right? So you have these highways, things are constantly getting on and getting off, or coming in and going out for the lymphatic system. And as they travel along these pathways, the fluid is going through checkpoints, like a toll road, or like a security check where our lymph nodes then are kind of checking what's going on and saying, okay, is there anything bad here that we don't want? Okay, let's take care of that. Anything good that we do want? Go ahead and pass. Our lymphatic system plays a huge role. And when it does these checks, if something is out of whack, it can kind of trigger an immune response. And so that's when it kind of catches our attention a lot of times.
Donna Piper: So basically, how you described it is that it's a very complex system that is compatible with getting things all over our body, but also eliminating a lot of things that we don't want, especially viruses, bacteria. I know for me, for other women and everyone, once that emptying system gets backed up, I guess if the garbage men don't take the trash out--
Tina Shin: Then everything gets backed up. Everything gets piled up.
Donna Piper: Piled up, gets a little smelly. There's some issues. Because it's so important, why is it so under-educated, or under-reported, or talked about in the medical side of things like you see that all the time. You see tons of doctors, if you have any insight, or just your thoughts how it can be more integrated into.
Tina Shin: So when I started jumping into all of this, which was about a decade ago. I think at that time, I heard that in medical school, medical students were getting about 15 minutes on the lymphatic system. And now, don't quote me on this, but I've heard that, I think it's about 45 minutes to an hour. 45 minutes to an hour in four years of medical school. A lot of times, it's in the context of oncology, right? Related to cancer, that's usually when they're educating these medical students on it. So that's what got me intrigued about this when I first started learning about the lymphatic system is, why don't more people in the medical field know about this mysterious system? But I think part of it is that it's a very difficult system to study. For one, the lymphatic vessels are very small. They're very thin. When we die, they just kind of collapse, and they're very hard to visualize. So when you look at cadavers, a lot of times after death, you can't really see the lymphatic vessels. But now, they have come up with these iodine containing chemicals that now allow us to trace the lymphatics.
And so now, they're able to inject these dyes, and use them as tracers with imaging where we can visualize the lymphatics, and study them a little better. But until they did that, it was really hard to study the lymphatics, and it's also just an intertwined system with so many other systems. When you study the lymphatics, a lot of times, it's kind of hard, it's difficult to parse out. Well, is this a lymphatic issue? Or your liver, or your kidneys, or your cardiac system, because it just intertwines with everything. So if you think about it, that's why we don't have any lymph specializing doctors. There's no doctor that specializes in lymph. We have cardiologists that specialize in the heart. We have vascular doctors. We have neurologists, but there's no lymph doctor. We do have micro surgeons who can do amazing surgeries on the lymphatic vessels to make improvements to things like lymphedema. But there's no lymph doctor. And I think, it is really just because it's such a difficult system to study, or it has been up until more recently. But it's getting better. With advances, with technology, with more awareness, with more advocacy, with more and more people getting educated, it's definitely getting better. So hopefully, it will continue to get better.
Donna Piper: Which is really interesting. Because in the vernacular, you might know someone with cancer, especially women with breast cancer, and breast cancer has been a lot of advocacy since the 80s, 90s. All kinds of cancers. But typically when women have breast cancer surgery, they usually take out their lymph nodes, either as a conservative treatment or not. So I know before I actually had any sort of MLD or any sort of treatment, which I'm definitely not like an expert on, I think you're going to explain that a little bit later, the differences. But my grandfather died of lymphoma. And my doctor that diagnosed me, she had the same thing, but in her groin. She's had her whole lymph nodes removed. He died in the 80s. She was diagnosed, I think, in the 90s. So it's not like when you're in the community, you may know someone that has something with their lymph nodes, right? I know a ton of women that have gotten cancer, especially breast cancer. They always say, we're gonna keep the lymphatic in place. But let's just take it out, just in case. That's a lot of what I hear, and you can maybe speak a little bit more. So you would think that by this time, that's the 80s, 90s, and 2000s, that there would be a specialty in doctors with the lymphatic system, because they do tend to talk about it as something to remove in a conservative care, or they've found cancers in that system, right? So isn't that a little bit like--
Tina Shin: I think a lot of doctors do study it within the context of their specialty. So when you look at oncologists, or surgical oncologists, you look at the surgical techniques, and even those have really evolved. So for example, the breast cancer patient right before they just kind of took everything, or most everything, all the breast tissue, a great majority of the lymph nodes, just take it all, and get the cancer out. But as they have studied the lymphatics more, and studied the effects of what could happen when you do that, even the surgeries have evolved. So now, they do mapping where they will inject that dye, and they will map to the first 1, 2, 3 lymph nodes that that dye goes to, which are called the Sentinel Lymph Nodes, and they take those. And if those are clear, no need to really go farther or to dissect more lymph nodes than that because they've learned that there are consequences to just taking all the lymph nodes. Definitely, you're right. Within the context of certain specialties, I think doctors are becoming more aware of how that interplay between the lymphatics, and how to watch out for that within their specialty.
Donna Piper: Yeah. They know that it does something, and they know that if they take stuff out, that you would get lymphedema, which is a swelling unilaterally, typically in the area that is necessary. And sometimes, the onset is delayed, from my understanding. So you might have surgery, and you're like, oh, my arm didn't swell up, and I got my lymph. But like three, four years later, all of a sudden, that's not working. So hopefully with conversations like this, we're just putting it out there, that there are specialties with the lymphatic system. I'm sure the doctors, my grandfather, people that knew what that lymphatic system was, and maybe they could look at why there were cancers there right before just removing them. But for people like me that have all of these lymphatic issues, I have all these conditions, and one of their universal connections is the lymphatic system. And mine is also collagen. But the lymphatic system is really where my problems kind of exasperate. And so for those of you who listen, I have lipedema. But Tina, can you talk about the difference between lymphedema and lipedema?
Tina Shin: Yeah, that's a big area of confusion. I think because they sound so darn similar. I'm like, why do they have to make them sound so similar?
Donna Piper: I think I probably say the wrong thing all the time. But in my head, I think there's a difference.
Tina Shin: They are actually very quite different in what they are. So lymphedema is something that happens when you have actual dysfunction with your lymphatic system. So that might be something that happened where your lymphatic system got damaged because of surgery, or trauma, or radiation. Or it could be that you were born with a congenital defect with some part of your lymphatic system. But for whatever reason, there is a defect or a dysfunction within your actual lymphatic system. And so when you have that dysfunction, a lot of times, you'll get swelling in the area that kind of maps to the area that your area of dysfunction is. So for example, the breast cancer patient. Say, this patient has a bunch of lymph nodes removed from her armpit area, her axillary region to treat the breast cancer. Well, the area that drains to that particular set of lymph nodes, it's going to be that arm on that side, and the breast area and a portion of your trunk. So someone who has lymph nodes removed from your right armpit, you are at risk for getting lymphedema in your right arm, and kind of certain parts of your trunk and your right breast. You're typically not just going to get lymphedema in your left arm spontaneously. So there's kind of very distinct areas that correlate to the area of dysfunction where you have in your lymphatic system, right?
And so usually, the swelling or the visual things that you can see are asymmetrical. It can eventually become symmetrical with things like lower extremity lymphedema, if it's due to venous insufficiency or things like that. But generally, it's kind of more characterized as asymmetrical. It doesn't distinguish between men and women. It's like you have a man who gets a bunch of lymph nodes removed, you have a woman. They are both at risk for lymphedema, and they can both get lymphedema. Lipedema on the other hand, it's a medical condition that causes this kind of disproportionate, abnormal growth of subcutaneous fat. And usually, it grows in these kinds of standard, typical areas, usually like the legs, the hips, the buttocks. But of course, we also see it in the arms and the torso. But usually, it's much more symmetrical. It happens significantly more in women than in men. But where it gets tricky when you talk about lymphedema and lipedema is that people who have lipedema can eventually develop lymphedema because of the stress that gets put on the lymphatic system. You might find that eventually, women with lipedema evolve into what we call lipo-lymphedema, which is a combination of lipedema and lymphedema. But conversely, someone with lymphedema isn't going to get lipedema. Unless you were born with it, and we just didn't know. But it's not kind of related in that way.
Donna Piper: Okay. I think in Europe, they do L-I-P-O, and we just do L-I-P-E dema. And the lymph is part of the lymph nodes. So they're similar as far as, because there is fluid, and there's a dysfunction of the lymphatic system. but how it shows up is different. Meaning, if you don't have lymph nodes, your arm might swell with the swelling, and other things might happen. But IF you have lipedema, that also has that fat component, their marriage of what they do and how they make fibrosis and stuff like that, that's it's different. But do you treat them the same with the techniques, or the techniques different for each other?
Tina Shin: That's what can make it confusing too. A lot of times, the conservative treatment for both is very similar. For both of them, you're going to do the MLD, you're going to do some compression therapy, usually some exercise regimen. You factor in diet, nutrition, things like that for both.
Donna Piper: That makes it extra confusing. All these things aren't confusing enough. When I said MLD, if the listeners are new and not sure, well, I'll have you explain what it is like. Lymphatics on Tiktok, Instagram and everything have been much more, people are talking about the lymphatic system, good, bad or ugly, whatever. At least people are talking about it. But there's the wild, wild west in lymphatics. Once you explain what MLD is, can you talk about the different techniques that maybe you see online? I really like him, and maybe you might blow my mind with him today, and that's okay. You could break my heart if he's not the end all. But Dr. Perry Nicholson, he talks about how to clear certain larger ones and different ones before you do some of the other stuff. I've even gotten an MLD treatment, but it was much more aggressive than what you and I do. So take as long as you want to talk about all of these things. I asked a lot of questions, but I think they're kind of all related. If you can kind of explain it, and then debunk any myths. Or just start to tell us what we should look for, even learning what this MLD stuff is.
Tina Shin: Yeah. That's a great question, because you're right. It has gotten so trendy. It almost seemed like overnight. It was like, why is everyone talking about the lymphatics and lymphatic drainage, which is good. Like you said, it's getting recognition that we wanted. But there is some misinformation out there with what we call MLD or Manual Lymphatic Drainage. A lot of times, that refers to this Vodder style. You might have heard of Water Vodder Style lymphatic drainage, and that's where it all originated. So Dr. Emil Vodder, back in the 1930s, discovered that these people with chronic illnesses, sinus infections and things like that would have swollen lymph nodes. And he noticed that when he gently massaged them, they would get better. And so it kind of morphed into his whole Vodder technique that he went on to study, teach and expand on. So from that, there have been some offshoots that are just as valid, they're excellent, great techniques, but the foundation is usually still in these Vodder techniques. It's a very specific sequence. Like you said, even the Big 6 that Dr. Perry Nicholson does. I watched that program. I've gone through it, and I'm like, okay, it lines up with Vodder. So with the Vodder technique, you're using these very gentle, rhythmic light movements where you are pushing that lymph along very specific pathways, usually towards the groups of lymph nodes that you're trying to send that fluid to. If we go back to that kind of highway analogy, like you said, if there's a backup, if there's traffic up ahead at your exit, well, you don't want to start pushing stuff from way down below. You need to clear out the congested areas before you can start working on other areas. So that's why it's kind of a very specific pattern that you do when you do this with Vodder. The goal of all this is to boost your immune system, to improve swelling, or kind of help with fluid balances in the body. You're trying to promote relaxation by activating the parasympathetic nervous system. And the vessels that you're targeting are the superficial lymphatic vessels, which are right underneath the surface of the skin. So that's why it's so light and gentle. Because really, if you push too hard, you're just kind of smooshing those vessels. And it's counterproductive. You're not really doing what you're trying to do.
On the other hand, a lot of these other techniques that you might see that are much more aggressive, much harder, faster, firmer, a lot of those are the Brazilian Lymphatic Techniques. It's kind of marketed more for sculpting or contouring. And a lot of what that's doing is getting rid of water bloat. It's kind of just kind of clearing the bloat. And when you look at the esthetics results of it, it can be pretty compelling, pretty significant. But it is pretty temporary. And the main thing with the Brazilian techniques is that there just isn't a lot of research on it. So when you look at the actual research, and when you're looking at studies that show the efficacy of manual lymphatic drainage, or what it can do for people, most of the time, it's Vodder-style lymphatic drainage that they're studying in these studies. So that's just one thing to note with the Brazilian. Nothing against it. But if you were gonna do post surgery recovery, or if you're looking to do this for wellness, for any kind of medical condition like lymphedema, lipedema, you really want to go with the Vodder. If you just kind of want this quick temporary, I have an event, I want to sculpt. You could go with the Brazilian. With both, though a lot of times like on social media, what you see might be neither of them, because I don't know what people are doing out there. Sometimes I see them doing these things, and it's like they're pushing in the wrong direction. They're pushing against the direction that lymph would flow. They're really being way too aggressive. You see people after surgery, and these therapists, quote, unquote, are reopening incisions and pushing fluid out. That is not lymphatic drainage of any sort. I don't know what they're doing.
Donna Piper: That sounds a little a little scary to push this stuff out. I get it. If you think that you have fluid and you want it out, and that would help, but there is definitely a way. So I know for me, trying to find and navigate to get a specialist that does MLD on lipedema is a little challenging. Because I've been on with different things, have been a little archaic and things like that, but I know there's more things that people can use. Chat GPT is better, you can search it in there. So what are some of the things that you would recommend people to look for? If they say, hey, I'm a CLT, which I believe is Certified Lymphatic Therapist/Certified Lymphedema Therapist. So if you're brand new and you live in a small town, or a medium sized city, how do you go about finding a therapist? What are some of the things that you would want people to check on even before they work on them, or whatever? Do you have any recommendations about how to find a really good MLD, CLT?
Tina Shin: I will say it is hard. So it can be frustrating because there aren't enough of us out there for one thing. But to vet someone, so first and foremost, whoever you're working with has to have a license to touch. So just to be able to put hands on any type of body, not just anyone can do that. You need to be a physician, a nurse, occupational therapist, physical therapist, a massage therapist, acupuncturist. So you need that first. You need a license to be able to touch people first. First of all, beyond that basic licensure, there is additional training and education that you would want them to have. So ideally in a perfect world, if you could find a CLT, a Certified Lymphedema Therapist, that means that they have gone through a very specific program where they've undergone about 135 hours of extra training and education, most of which is hands-on. But there are only a handful of programs in the US that actually do this. You want to make sure that it is one of those few programs that do this beyond the CLT. You can find someone who has extra training, LANA Certification. So LANA stands for the Lymphology Association of North America. It just means that the therapist has also passed a rigorous test. And that hopefully, they're kind of staying on top of things, because you do need to recertify so often. So that would be kind of, if you could just get what you would want.
Donna Piper: That's a good place to start though, having initials like CLT, and then association like LANA, and then we also talked about Vodder. Is there any other sort of Vodder ish, or another school that is good that we could throw out there and maybe put in the notes?
Tina Shin: So the main schools in North America are KLOSE, Norton, Vodder I think is more European. I'm not sure. But I do think they have some courses in the US. There's Coles. There's a couple more that I am not remembering, but it's really like five or six schools that really certify. But that's for the CLT. Most of the same schools also can certify you just to do MLD. So if you can't find someone who is a CLT, there's also a certification just in MLD where they're learning the same Vodder based techniques. It's just that they haven't quite gotten the education on how to work with someone with a compromised lymphatic system. So they're not necessarily going to be trained in how to do compression bandaging, compression wrapping, knowing compression things for someone with lymphedema, or maybe someone with lipedema. But for someone with a generally intact lymphatic system, you can go with someone with the MLD certification to just do MLD.
Donna Piper: Okay. You don't need to know the answer to this question, but I'm kind of putting you on the spot. Do most people have a normal lymphatic system? Or does everyone have something that is compromised? Or most people have a healthy lymphatic system, and there's only a smaller percentage like, if you have lipedema, or you have cancer or stuff like that, is it common or not common to have a compromised lymphatic system?
Tina Shin: Most younger, quote, unquote, healthy, pretty well functioning lymphatic systems, our bodies are very dynamic. So even if it gets thrown off, it has a way of balancing itself. Once you've had any kind of surgery, trauma, anything like that, your lymphatic system is disrupted, but it can regrow, it can reconnect, it can regenerate. It can do amazing things. As we age, everything falls apart a little bit. But there are also a lot of lifestyle things that can impact your lymphatic system to maybe not work as optimally. Obviously diet, your activity levels are a big cause of lymphedema that people don't realize. Because most people think it's from cancer, it is actually obesity. So once we get to these obesity stages, it can put a lot of strain on your lymphatic system, and that's when we'll start to see the swelling in the lower extremities that kind of start off as just a little bit of swelling. And if left unchecked can progress into lymphedema. So it's a little hard to answer. I would say that most people have pretty well functioning lymphatic systems, but they can get abused. So it kind of depends.
Donna Piper: Especially to have that kind of knowledge, if you know someone, or you're listening and you have it yourself, you know what to look for because I felt like I was swollen. I felt like it was edema. All I know is edema swelling, and it wasn't like water retention. It wasn't going to be like, take some water pills or whatever they do for that. And it just felt like sausages. There was a different feeling. So if I would have had more understanding with the lymphatic system myself, or actually, who treats it? So to look at either words like MLD or CLT, and because I didn't have cancer, I wasn't going to get to refer to someone in the oncology world, to go that route, right? And then nothing against any of the practitioners. But typically, people see and associate, and therapists will see like, oh, I see people that have had breast cancer, some sort of cancer somehow, they may have had cancer somewhere else, but they had radiation. And that either chemotherapy or radiation has damaged somehow, and so they would get transferred. So in my situation, my legs feel heavy and hurt. It just didn't even dawn on me that I would seek someone like that. Maybe if I pushed for it, therapists that you have seen both, and I could have gotten some other treatment sooner, or at least referred.
I'm really just saying this because if you feel like you have something that you might need, there's something with your lymph or swelling to seek out a therapist. Or from that way, at least you could get some good information on what to do. Because you mentioned decongestive therapy. Even though my doctor is amazing, she and I weren't in her program. I paid out of pocket to see my doctor to get me a diagnosis inside of my own healthcare program and stuff. You helped me know what to ask my primary care physician so I could get a referral to their PT department. Because I didn't realize that a lot of this is done occupational therapy, which you did. I guess they don't overlap, but sometimes they put it in their PT world. But by saying these words, can I get a referral for lymphedema to treat lipedema to my primary care physician to get decongestive, whatever you say the words therapy, I was able to then get that treatment done, and then also get into their system so I can get flat neck compression, and potentially a pump or other things that I might need for long term conservative care. I said a lot, but what are some magic words to have people tell their primary care, even if their primary care is like, I've never heard of lipedema. I don't know what you're talking about. What are some inside scoop words to say too. Because when dealing with medical care, you always have to know the magic phrasing keywords.
Tina Shin: You touched on the whole PT thing that can get confusing too, because what you're looking for is basically a lymphedema clinic or a Certified Lymphedema Therapist. But that can be an OT or a PT, it's just because it's extra training above their licensure, right? So that's one thing. So you want to find out whatever clinic that you want to go to in your area. You want to find out what they are, because when the doctor sends the referral, they will need to specify it's for PT lymphedema or OT lymphedema. And even though you might be going for lipedema, it's still lymphedema therapists who are going to be the ones to treat you. So that's one thing. And then with the whole thing that you mentioned about getting in and what they can do there, depending on what stage of lipedema you're in and how you're presenting, you might not need all the components of it. Some women with lipedema have swelling. Some women with lipedema don't have swelling. So depending on where you're at, it might be a very simple treatment plan. Others might be more extensive and sensitive.
When we talk about complete decongestive therapy, that might involve some compression bandaging. But really, that's more if you have a pretty extensive swelling, notable swelling. But regardless, there are things that everyone can benefit from like the compression garments, like the pneumatic compression pumps. So if you can get into a clinic, even if you don't need all the things that they might have to offer, you can likely benefit from some of those things. And for someone who may potentially be considering surgery down the line, if you go get this treatment, at least you have it all documented. A lot of times, if you are going through insurance, they want to see that you've tried all the conservative things. And for some people doing the conservative things ends up being enough, and they're like, you know what? I don't need surgery. This is fine. I'm just going to stick with my compression garments. Keep doing some MLD, use my pump, and that's good. So I feel like it's a really good starting place. Not a lot of doctors. They may not know about these clinics, so you might have to provide some education and do a bit of research on your own to find some in your area. But if you can, and if you can get that referral and kind of advocate for yourself, then there are some real benefits that you can get out of it.
Donna Piper: It was eye opening, because I would have only looked for places in my Google search looking for these specialties. And it really is not that it's hidden, but it is kind of hidden within the system. So my particular one I went to is associated with their cancer center, but they have a different PT for pelvic disorders and things. So it's not like the therapist really needs to be cancer or not cancer. I guess it's just how they figure they do their structure. And I think everyone's insurance is a little bit different. And because lipedema is not yet considered a, what is the code?
Tina Shin: ICD-10 code. There's no official code for it here in the US, hopefully soon.
Donna Piper: So that kind of adds to the extra nuance. And then you brought up surgery. You know that I want to get surgery, and I know that you also see a lot of clients that have done post surgery, whether it was in your oncology, whether it was other surgeries. Because other surgeries, if you're cutting through the skin, when you're saying that, potentially, any surgery that you get could affect your lymphatic system. And I'm thinking, if you're a mom and you had a C section, there's a lot of lymphatics in your abdominal area. So any of that, if it's cutting through a system, a highway, you're just like chopping some of it off. So I would think anyone has the potential to potentially have swelling.
Tina Shin: With any surgery, we see swelling. You get knee surgery, you get swelling. You get a hysterectomy, whatever it is, any surgery, you're going to get swelling with it. And that's because those lymphatic vessels get disrupted.
Donna Piper: And then if you have more complications, look for a CLT, or Manual Lymphatic Drainage, or to get a referral to your PT. Because I know everything I've researched and what we've talked about is that post-op care is important after surgery. So obviously, whatever surgeon you go with, if you want to get lipedema reduction surgery, that's a whole other topic. But you pick your person, you get your surgery, they'll have their own protocol that you have to adhere to. But then beyond that, I do think there is still post-op care that has this conservative treatment where you still want to have a good relationship before and after with your therapist. Do you want to talk about any post-op, you're not a doctor, this is not medical advice, and you never go against your own doctor's advice, especially if you are listening to people like me and Tina that are just sharing information to get the word out. Because it's very complicated. But what are some of the general best practices for post-op care that you've seen generally. And again, I know I'm not asking you to give medical advice. This is not medical advice. This is just based on your experience.
Tina Shin: So based on my experience, the MLD, the lymphatic drainage can significantly help. Post surgical swelling, if done properly, should help speed up the whole recovery process. It should not cause more pain or discomfort, but it should decrease pain and discomfort. It should just help to facilitate the body to do what it would naturally, normally do, and just give it some support to do that. So the MLD is huge. Having the proper compression is also huge. You want to have compression garments, or whatever type of compression that you're using to fit properly, to give you compression in an appropriate gradient so that you are facilitating movement of that post-surgical edema in the correct direction. You don't want it bunching or tourniqueting anywhere. Because obviously, that's going to be counterproductive. So with the post-op care, the MLD, the compression is huge.
From what I see with working with a lot of my clients post surgically, the feedback that I get is, I think working with a qualified therapist, I think some of the value that it brings is just having another set of eyes on you. So you've gone through this surgery, any type of surgery is stressful. It's anxiety provoking. People always have questions like, is this normal? Am I healing? Does this look infected? And when you have surgery, you might see your surgeon one week post-op, and then you might not see them again for several weeks or months. Or maybe not again in person. It might be virtual if you're going out of town for surgery. So I think that just the reassurance that having a post-op specialist in your corner brings, a lot of times I hear that there's great value in that. I think with that, there are a lot of ups and downs, I think emotionally, that come with any surgery. Especially lipedema surgery. I try to just celebrate the highs with my people and try to help them work through the lows. I think there's just a lot of emotions that come up that aren't always expected. I think also having someone to just help you navigate that can be helpful for post-surgical recovery.
Donna Piper: I don't want to get us off on a totally different tangent, but if you can think of a few top of your head, what are some general things that you find? Because that is a big emotional part of healing. With lipedema and all of the populations that you work with, it takes a toll. It's not like you get an illness and you get better. There's usually years of all of these things, whether it's been cancer. There's a long process. What are some of these emotions that you see? Is it body dysmorphia? Is it depression? Is it like elation? Or do they regret their surgeries?
Tina Shin: I would say well for one, hormones can get out of whack. So sometimes, it's just random emotions. It's like, where's this coming from? So that's one thing. I would say one thing that comes up that kind of catches people off guard that I find is, at some point, I find a lot of women, they love their surgical outcomes, and they're happy with them. And they are so glad that they did this. But at the same time, I've seen so many women go through this period of life, I feel like I don't know my body anymore. This body that I was so used to almost had some, I don't know, anger or frustration.
Donna Piper: Oh, you could say it like hate and there's definitely a conflict in your body. I'll say it for you, because I have it. It functions, but not how I want to. And I can't get it to heal without extreme measures, which is very annoying, angry and frustrating.
Tina Shin: Despite living with those feelings for so long, and now they find that after surgery, it's no longer that body. It's better. I should be happy. Why am I not happy? Why do I feel like I have to get reacquainted with this new body? And that body that I hated, I feel like, I don't know, betrayed it, I guess. So that's something that I always found interesting that does come up. I should be happy. I'm happy with the way I look. But at the same time, there's this disconnect, and I don't know how to process these emotions. So that's one thing.
Donna Piper: That's huge, because that is something you're not expecting. But to know that you might have that, because that is like, you would think, oh, I have surgery. I have everything I want. My body doesn't hurt anymore. I can move, and I don't have pain. But there is still that, oh, my gosh, did I portray myself to it? There's a transitional time with lots of emotions. That's a big part, and that is a big part of you. There is compassionate support, as well as just the physical stuff. And that talks a lot about the compassion of finding a therapist to deal with it.
Tina Shin: And I think just letting them know that this does happen, it's common, and you're not the only one. Feeling these things can be reassuring. But aside from that, the more standard things that most people go through, I see a lot of people who undergo cosmetic surgery, and a lot of them go through the same thing where it's like this period of, what did I do? Oh, my God, people are gonna think I'm crazy. Why did I do this to my body? I'm uncomfortable. I'm in pain. Is it gonna be worth it? And inevitably, by the time we are done with their treatments, it's like, I kind of want to do this now. I always joke that it's kind of like giving birth, where you have a child and it's like, I'm never doing that again. Why would I put myself through this? And then sure enough after a year or so, kind of miss being pregnant. So you still come out of that with the post surgical recovery as well.
Donna Piper: That's really interesting, and that's some really good insight to kind of know that you will be on a little bit of a roller coaster as you heal. It's very typical, and that's very comforting. 100%, I could talk to you for hours and hours, but I do want to ask you just a couple more things. I know we talked about the technique, Vodder and everything, but how if you're just listening to this, what is the most common way a session should go? Once they had the technique, is it something they'd expect, or not? Because it is a lighter technique. It is different. There is a pulsation to it. So can you just give us a little peek behind the curtain of what it entails in a session with MLD?
Tina Shin: When you're first starting to work with someone, they should be getting a detailed medical history, information about your medical past, any other comorbidities that you have that might inform the way that they might adjust their treatment. So that's kind of the first thing. Getting a good idea of the person as a whole and their whole medical background. From there, the treatment itself, if you're talking about just the MLD, you will be unclothed, generally, but draped. You can keep underwear on. But really, the more access that the therapist has to skin because you want that skin on skin contact, the better. The therapist should start with those major important areas. It's basically the big six, right? So a really important area is right above your collarbone. That's the area where all of your lymphatic fluid eventually comes up and dumps into your venous system. So that is a crucial point, and that's usually where most Vodder trained therapists are going to start. You will have some element of deep breathing, or diaphragmatic breathing work. They'll target the major lymph nodes. And then from there, they'll start to direct that fluid where they're trying to get it to go.
And what you're really trying to get with the massage, they call it a massage, but really, you're going for a skin stretch. And without going into too much of the anatomy and the physiology, but it's that stretch that opens the valves and the the panels, or whatever you want to call them up, lymphatic vessels, that allow them to open, bring fluid and things in, and then close. So you're going for this opening closing effect of the vessels, and you do that by putting this stretch on the skin. So for true lymphatic drainage, you really don't use oil or lotion. Occasionally, I will use a little bit. If my hands are too dry and I'm just kind of sliding, I'll use it to get a little bit of grip. But it's none of this lathering of oil or lotion that you see sometimes on the Brazilian techniques, because you really want to get that skin stretched. Like you said, it's gentle, it's light, it's rhythmic, it's very intentional with where you're sending that fluid. Other than that, in a typical session, there's also going to be a lot of education. There's going to be education on things that you can do to kind of optimize your lymphatic system. Things that, if it's post surgical, you can do to optimize your recovery. If your doctor hasn't gone over any long term maintenance, then your therapist might talk about transitioning to longer term compression, or just things that you can help to facilitate long term recovery and maintenance.
Donna Piper: And is the rhythm of it, is it because the lymphatic system does not have a pump, your heart has pumps. Your blood, does it have a pump? Or does the lymphatic system do its own thing with gravity?
Tina Shin: It doesn't necessarily have a pump. A lot of it goes off of the muscle pump, which is why my movement is so great. So for people who aren't even mobile, even in bed, you can do muscle contractions. That will help kind of pump that fluid. The lymphatic vessels themselves do have these motor capabilities. So it does this peristalsis, but it doesn't necessarily have a pump, like your heart would normally pump.
Donna Piper: What's your go to muscle pumping thing? If someone is chair bound, or if you just feel really stagnant, what do you suggest to your patients that they do for an exercise to get that?
Tina Shin: So one thing that you can do, if you can do any movements that move the joints where a lot of your lymph nodes are, for the arms, it would be your armpit. So moving your shoulder, doing big shoulder circles, that's great. For your legs, your groin area, just opening and closing your legs, doing circles with your legs. And then for actual muscle pump, just anything that will contract those muscles. So a lot of times, if you have swelling in the legs, you could do ankle pumps. So you're kind of acting like you're pushing on a gas pedal up and down, doing circles. You're just trying to get those calf muscles to engage. And any of these things, if you can do it in positions where gravity is helping you. So if you have swelling in your legs, if you are on your back, elevate your legs, and then do those muscle pumping actions so that gravity pulls that fluid down, because you're always trying to direct the fluid basically towards your heart. Or in your arms. If you have swelling in your arms, you can lift your arms up, and then you open and close your fist, you can bend and extend your elbow, basically anything that's really going to get those muscles contracting in a gravity assisted position.
Donna Piper: You mentioned something really important, that if you're dry brushing, even using tools, the direction is important. So as you said, anything towards the heart. So that means if it's your head, gently go down. Arms go up towards the armpit, to the heart, legs, front, back. Even on your back, everything goes up. I know there's some central lymphatic things, right? When you go through the stomach, it's different. But if you're just kind of willy nilly with tools, that's probably the best one sentence advice. If you're using tools and you're not really sure because it's not going back and forth, right? You're not like, right, right. It's not like a massage back and forth.
Tina Shin: Correct. If you just want a quick and dirty easy guideline, just go towards the heart.
Donna Piper: I've gotten so many tools, and there's something in your brain when you have stuff you think you want to push it away. Especially the thighs and stuff pushed down, but it's really the goalie up.
Tina Shin: You're not really pushing it to the heart, you're pushing it to the inguinal lymph nodes, which are at your groin. So when you're at your legs, as long as you're pushing it up, it's going towards those groin lymph nodes that is what you're doing. And when you're at your arm, pushing it towards your heart, you're really sending it to your axillary lymph nodes. But to make it simple, bring everything central.
Donna Piper: And then they're going to the termini, right? They have their own pathways.
Tina Shin: And that's why we'll then eventually go there.
Donna Piper: Into the venous system. Because I think that's important, especially when you see different videos or use different tools. Like what you said, if you're cool and you have a good lymphatic system, I'm sure it's not going to do anything. But if you already have a little bit clogged up lymphatic system, or you have lipedema or lymphedema, or a chronic illness that deals with the lymph, that does matter because you could push stuff in a way that's not clear. I know probably 10 years ago dry brushing. Dry brushing has always been around in the very granola area where I've always lived of like, what's out there in health world? Because I was always seeking, what's the healthiest food? How can I lose weight?Maybe I need a healthier food? But there's a little bit of going up, but no one really talked about clearing all those points. And for me, I knew when I would do it. Everyone like, oh, I feel 10 pounds lighter when I dry brush. But for me, I always felt like more swelling. So mine was the opposite. And then now, fast forward 10 years, I've had these diseases forever. Oh, my lymph was already clogged, and I have lipedema. So whatever the lymph was doing in there wasn't really working, so I was just pushing more stuff into a place where I can't handle it.
I used to live in LA. We're in Orange County now, but think of the Carmageddon they had for a long time. But there's even morning traffic at the 101 and the 405, it's kind of like that. So I think it's just important when people see things or tools. There's lots of different tools, like massage guns and stuff. Not that they're not amazing, but be educated about direction, probably. Because it's a lighter system, if you know you have some compromised lymph, talk to your therapist about that. I'm a gadget gal. I love the newest gadget and stuff, but a lot of these two, they don't have a lot of research. Or maybe they have some, but you can do, which I'm sure they're not. I'm sure my lymph nodes are very compromised. I'm okay with that. My veins are probably very stretched out, and I probably will always have to deal with some swelling. But now being educated by you, I probably won't get the cool arm tool or leg tool that does all the swirly stuff, because that might be too much for me. I don't want to go into that fibrotic issue. Again, I said I was going to ask you just two questions, but just briefly with lipedema and the lymphatic system, I think Dr. Perrin talks about it too. Can you say when it gets, I guess disease, the fat doesn't leave because of the molecules and then fibrosis, can you talk about how it does get dysfunction and you get fibrosis in your body?
Tina Shin: There are different kinds of fibrosis. So when you talk to a lymphedema surgeon, they might talk about fibrotic tissue that is difficult for them to kind of work through when they're doing their surgery and working through the cannula. But there's also lymphostatic fibrosis, which a lot of us lymphatic therapists deal with. And so when you have swelling for so long, and the swelling just kind of sits there, and the swelling that you have from lymphatic dysfunction is different from an acute swelling that you might just get because you twist your ankle, that's more of a fluid swelling, whereas this chronic type swelling, it's protein rich. So it has all these proteins. And when it sits there too long, it just thickens over time, and it gets thicker and thicker. So now, you're turning from a liquidy substance to like a gelatin. And eventually to like a Play Doh, and eventually like clay, and eventually like a tabletop. I have felt fibrosis that's like a tabletop. So it's really difficult to work with, as you can imagine. Because if you're doing any kind of work, whether it's MLD or surgery, you gotta get that fibrosis to soften and loosen before you can really do anything with that lymphatic fluid. You need to get that fluid to soften.
Donna Piper: It's interesting, because that is the protection for your body, and your body is trying to survive. Amazingly, it adjusts so much when you have compromised systems if you think about what it's supposed to be doing, and your body's dealing with a lot of stuff that needs to leave, and then the proteins can't leave. And then they bring their friends, the fibrosis people, and they can't leave. So then it gets all congealed and hardened, but your body is still trying to help you eliminate that to go along the right pathway. And so it's kind of amazing. When I talk about all my stuff to people, I'm like, wow, even though I'm kind of bitchy towards my body, why don't you do this? I should look at it as like, wow, you're surviving. You're still breathing with all of your force. All the obstacles your body's going through just to survive is pretty amazing. But that fibrosis is a big part of it. Because when you said you have to get that lymph to move, and if it's a solid, and it should be a liquid, that's a lot of work. But also, when you take these treatments, you need to have some realistic expectations too. It's just because you do a few MLD sessions, and you're like, oh, I don't feel anything. Sometimes, you really have to stay with it in order to see the benefits long term. Because you just can't snap your fingers and make hard fibrotic material.
Tina Shin: And I will throw in that when you get to that kind of state of texture when you're dealing with fibrosis, just the standard MLD alone is not usually going to work. You need to do more. That's when you will find more aggressive, harder, firmer, deeper techniques to break up that fibrosis. And if you are undergoing the bandaging, that's when the therapist will use different layers of foams and foams of different textures and densities, depending on how you present with your fibrosis to kind of break that up, and really target it.
Donna Piper: Oh, that's good information too. Because that's probably a whole other topic. I could talk to you forever and ever, but I think you gave really good information. You're really your MLD, your OT, your PT, whoever does this is really your partner. It really is like a big support. I'm really grateful that you do the work, and that you're out here sharing about it, because there's so many components when you just say words like compression and a massage technique to help. I got those intellectually, but really, once you get into it, it's very confusing until you go through the weeds of it. You've very much cleared a lot of it up, so I really appreciate that. And then my last question is, it could be personal, it could be professional. It could be about lymphatic works, your work or anything. But I always like to ask, what was one thing that you know now that you wish you had would have known earlier? Something that would have made the path gentler, faster. Or if you just want to give some advice to anyone out there that will maybe make their journey a little bit faster, it could be anything that's a good one.
Tina Shin: I think what comes to mind is the patients and the clients that I work with. When you ask, what might make their journey a little easier? So normally, I am a firm believer in medicine, in our doctors, in our healthcare providers. I have great respect for everyone within that field, but there are things that we just still are researching and learning, and don't know a whole lot about. And when it comes to the lymphatics, that's one of those things. So if you are a person who is kind of going through a struggle with lymphedema, lipedema, whatever it is that is related to your lymphatic system, I would say, don't be afraid to do your own research and be your own advocate. People hate Dr. Google. But with something like this, you have to find good resources. Find some good resources with some good information. Look up, peer, review journal articles. Find some professionals that do know about this. Get the information. Get as much information as you can. Take it to your primary care physician, or take it to the physician that you're seeing to help you navigate your journey. And I would say, don't be afraid to buck what some of them might be saying, because there's still a lot of education and growth that needs to be done in this particular area. So I would say, be your own advocate. I think, like I said earlier, we're coming along. We've made some good strides, but there's definitely more work to be done. I think Donna is a great example of this. With all the things that you've been navigating, I think at one point, I joked that you have attained so much information you need to do something with it. And look at you. You are the perfect example. This is what people need to do. Really, just educate yourself and educate others. Just keep moving this forward.
Donna Piper: And I love that you said that because you are steeped in allopathic medicine, if I'm saying it correctly. Our doctors are important, and they do know a lot. You need to be in that relationship with them to get a lot of the things you need done. But also, everyone could be educated. Things are evolving all the time. And when you do get the gaslighting that goes on or like, oh, that's your age, you're just always in pain, or this and that, blow off stuff even though it's annoying, it could be very dismissive. But even if you're saying you've been in the healthcare world, you've seen it all, but don't give up. Get in there with your research, and educate them until they listen to you to get referrals to these things, to get you on your way. Because that's the only way that it's going to open up to having even more people to be OTs, PTs, CLTs with MLD. Because it's a field where one in nine women worldwide have these conditions with lipedema. The practitioners that help them are sorely under source. Well again, thank you so much. I know I kept on asking you questions. I'm going to stop, but I really appreciate you being here and sharing all your wisdom. So where can people find you if they want to connect with you, just to kind of follow you, learn more about you. Do you have a website? Online stuff?
Tina Shin: I have my website. It's just oclymphatics.com. I have my socials at oclymphatics, Instagram and Facebook, I'm on those. No Tiktok. You can find my phone number, you can text, you can call, you can email. I'm always open.
Donna Piper: Oh, great. I just love it. And thank you. So everyone listening, if this episode has sparked something in you, or someone that has these conditions, any sort of lymph swelling, any sort of lymphatic information, please share this information. I will leave all of Tina's contact information in the show notes to make it easy, so you could just pop on there and check her out. And again, thank you so much for listening. Thank you so much, Tina, for being here, and learning about what you need to do to be your own self advocate, and what really are these lymphatic massage techniques that are beneficial, and how to really find one in your area. So again, thank you so much.
________________
PODCAST OUTRO: If this episode made you feel even more seen, brought you clarity or reminded you that you're not alone, please take a moment to rate, review, and send it to someone who needs that same reminder. You can find more tools, blog posts, and support over at donnapiper.com. And hey, don't forget to subscribe so you never miss an episode. Got a question for me? Every month, I do a listener coaching episode, and I'd love to hear from you. Send your questions, stories or flare up confessions to [email protected]. You just might hear your answer on the show. Until next time, Dear Body, I'm Listening. I am so glad that you are here.
