Lymphatic and Immune Pathophysiology

Lymphatic and Immune Pathophysiology
Tarrant County College District Massage Therapy Program Pathology 2014 Roberta L. Wolff, Instructor Lymphatic and Immune Pathophysiology 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

DIFFERENT TYPES OF IMMUNOLOGIC REACTIONS.
ANATOMIC STRUCTURES AND PHYSIOLOGIC PROCESSES RELATED TO THE LYMPHATIC SYSTEM. DIFFERENT TYPES OF IMMUNOLOGIC REACTIONS. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphatic System Overview
Composed of: Lymph Lymphocytes Lymphatic vessels Lymph nodes Organs and glands containing lymphoid tissue The image on the slide located in the lower left hand corner features the areas drained by the two main lymphatic trunks. These are the thoracic duct (blue area) and the right lymphatic duct (green area). ● The lymphatic system and immunity are major protectors from disease. ● Lymphocytes are specialized leukocytes. ● Organs and glands containing lymphoid tissue include bone marrow, the thymus and spleen, and areas in the intestinal mucosae. The latter is collectively called mucosal associated lymphoid tissue or M.A.L.T. ● The image on the slide located in the lower left hand corner features the areas drained by the two main lymphatic trunks. These are the thoracic duct (blue area) and the right lymphatic duct (green area). 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphatic system important for massage therapists Asymmetrical; functions with circulatory and immune systems Lymph system structure Interstitial fluid (ISF) originates at capillary exchange sites Medium for diffusion - ISF taken up by lymph system (open tubes) - Cleaned, neutralized in nodes - Put back in circulatory system at subclavian veins - Starling equilibrium: the amount of fluid squeezed out of circulatory capillaries should be almost equal to the amount being drawn into lymphatic capillaries, with about 10% left over to become interstitial fluid 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphatic System Overview (cont’d.)
Lymphatic system functions: Drains excess interstitial fluid Transports dietary lipids and lipid-soluble vitamins from digestive tract to the blood Carries out immune functions Lipids and lipid-soluble vitamins are too large to fit into blood capillaries. Thus when they are absorbed from the digestive tract, they move into the larger-diameter lymphatic capillaries instead, entering the blood when lymph drains back into the bloodstream. Lipids and lipid-soluble vitamins are too large to fit into blood capillaries. Thus when they are absorbed from the digestive tract, they move into the larger-diameter lymphatic capillaries instead, entering the blood when lymph drains back into the bloodstream. Lymph system function What moves lymph? Gravity Muscle contraction Alternating hot and cold Breathing Massage Deep, light 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

TASKS: Draining excess interstitial fluid - Enters lymphatic capillaries; drains into larger vessels Lymph nodes situated along lymphatic vessels; these filter out pathogens and debris Lymph finally drains into subclavian veins 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphatic circulation pathways ● This fluid is then transported to progressively larger lymphatic vessels, culminating in the right lymphatic duct (for lymph from the right upper body) and the thoracic duct (for the rest of the body). These ducts drain into the circulatory system at the right and left subclavian veins. ● Lymphatic flow is maintained by contraction of skeletal muscles and by intrinsic contraction mechanisms within the larger collection vessels. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Immunity – Anatomic and physiologic defense reactions to invading organisms Key components are: Lymphocytes White blood Cells Structures such as skin and chemicals (i.e., digestive enzymes) are also involved Immunology is studied in the lymphatic system because lymphoid tissue is the anatomical component of the immune system. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Immunity; two types: Natural: nonspecific responses to invading pathogens (i.e., physical barriers of the skin, chemical barriers of enzymes, fever, and inflammation) Acquired: diverse but specific responses to invaders involving lymphocytes; two types of lymphocytes B cells T cells Natural immunity protects a person from a wide range of pathogens. Defenses that qualify as part of the body’s natural immunity include the physical barriers of skin, mucosa and cilia; the chemical barriers of digestive enzymes, perspiration, vaginal secretions, and the skin’s acid mantel; complement proteins found in blood that attack foreign agents; phagocytes such as neutrophils and macrophages; fever; and inflammation. ● What is acquired immunity? Acquired immunity develops in response to the activation of the lymphatic system after pathogens penetrate the body’s natural immunity defenses. Once the immune system is able to recognize a specific pathogen, white blood cells develop the ability to recognize and destroy that pathogen. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

T and B cells both form in red bone marrow B cells mature in red bone marrow T cells mature in the thymus Mature T and B cells then travel to lymphatic tissues 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Immune response T and B cells activate when they come into contact with pathogens T cells leave lymphatic tissue to kill pathogens directly B cells produce antibodies antibodies leave lymphatic tissue to circulate in body fluids antibodies inactivate pathogens as they come across them In order for T cells and B cells to mount an immune response, they need to come in contact with the pathogen. What are the three ways in which this can happen? The pathogen can travel through the lymph into a lymph node; the pathogen can travel through the blood to the lymphatic tissue in the spleen; or the pathogen can come into contact with the embedded lymphatic nodules in the mucous membranes. ● The large-scale cloning of the B cells and T cells accounts for the presence of swollen lymph nodes when the body is fighting off an infection. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Immune response (cont’d.) Autoimmune diseases T and B cells unable to distinguish body’s own tissues from something foreign to body T and B cells then attack the tissues ● What are some common autoimmune diseases? Arthritis, lupus, multiple sclerosis, psoriasis, scleroderma, and type 1 diabetes are all examples of autoimmune disorders. Autoimmune disorders result when the immune system attacks the body’s own cells, mistaking them for pathogens. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

CONDITIONS OF THE LYMPHATIC SYSTEM
- appropriate massage considerations - emergency measures for anaphylaxis. Box 9-1 on page 263 for general manifestations of lymphatic and immunologic diseases. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Conditions of the Lymphatic System
Lymphedema and Edema Lymphangitis Lymphadenopathy and Lymphadenitis ● The lymphatic system involved in all inflammatory, circulatory, and neoplastic diseases. There are few diseases limited to just the lymphatic system. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphedema and Edema Lymphedema
Abnormal accumulation of fluids caused by obstruction in lymph flow causing swelling Primary: due to lymph vessel or nodal malformation; rare Secondary: due to a condition or medical procedure Edema Abnormal accumulation of fluids from a sluggish or overloaded lymph transport system causing swelling ● Lymphedema and edema are conditions that involve swelling, but they have very different causes. ● What are some of the possible causes of lymphedema and edema? Some possible causes include the following: inflammation, obstruction of lymph flow, removal of lymph channels, physical trauma, high blood pressure, or damaged blood vessels. Edema can be aggravated by pregnancy, obesity, and prolonged standing. Signs and Symptoms Depends on source, duration, affected area Soft, puffy, boggy texture Hot with recent injury, infection Cool if longstanding, from poor circulation Pitting edema: Fig. 6.2 Massage Most types contraindicate massage, especially pitting edema Lymphatic work appropriate with care, no infection 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

FORMS OF EDEMA Inflammatory: mechanism: vessel permeability, hyperemia
ex: acute inflammation Hydrostatic: contraindication mechanism: increased arterial pressure, increased venous backpressure ex: hypertension, heart failure Oncotic: contraindication mechanism: a. hypoproteinemia, increased protein loss, b. decreased protein synthesis ex: a –nephrotic syndrome, b - cirrhosis of the liver Obstructive: mechanism: lymphatic obstruction ex: lymphatic blockage (e.g. tumor) Edemas that contraindicate circulatory massage Heart problems Kidney problems Liver problems Local infection Blockage Indicated edemas Post acute musculoskeletal injury Some cases of immobility Risk of blood clots, deep vein thrombosis (DVT ) Hypovolemic: with caution mechanism: retention of sodium ex: hyperaldosteronism 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

MASSAGE THERAPY CAUTIONS AND RECOMMENDATION
MORE ON EDEMA MASSAGE THERAPY CAUTIONS AND RECOMMENDATION KALYANI PREMKUMAR, M.D., LMT The development of edema in your client is often the harbinger of something very serious. Please read Dr. Premkumars cautions. Before planning a session, take a detailed history and possibly have a consultation with client’s physician to establish the cause of edema. Generalized edema is usually due to chronic cardiac, kidney, or liver problems, and massage can be detrimental to such clients. If the edema is due to other causes, massage can be beneficial. In edema of the limbs following the removal of lymph nodes, the lib is hard, tender and painful due to lymphatic fluid congestion. The joints are stiff, and the joint movements are painful. In the case of the arm, swelling may be seen in front of the chest or behind the shoulders. The purpose of massage in these clients is to help lymphatic drainage by promoting the flow of the fluid back into the capillaries. This helps the body make new drainage pathways. Next page 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

MORE ON EDEMA, cont’d SPECIAL TECHNIQUES:
Position of the client with so the edematous limbs is supported and elevated. If you can get the client to maintain the position for 10 minutes before the massage, gravity will help with drainage. Manual lymphatic drainage techniques are appropriate (special training required). Use slow, deep effleurage and kneading strokes to the proximal area and then the distal areas, thus emptying the proximal lymphatic vessels before forcing the lump from the distal vessels through them. Use friction movement around the joints. The client will have relief even there might not be a visual reduction in size. Make sure that the strokes follow the lymph movement directions of the area. Upper arms, perform strokes toward the axilla. The chest: movement should be toward the neck and axilla on the affected side. Legs, toward the inguinal region. Use passive and active joint movements after the massage to assist both venous and lymphatic flow. In clients with chronic edema, organization of the proteins in the interstitial spaces results in fibrosis and thickening of the skin and connective tissue. In such clients, adnesion have to be stretched, using gentle friction. If pain or swelling increases, stop the session, refer to physician. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphedema and Edema (cont'd.)
Primary lymphedema ● In this slide, the child was born with the lymphatic vessel malformation, which caused left leg swelling. ● The woman on the slide had a surgical procedure to remove her right breast. The procedure included removal of her axillary lymph nodes. This caused swelling in her right arm. Secondary lymphedema 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Peripheral edema – Edema of an extremity Dependent edema – Type of peripheral edema found in gravity-dependant areas of the lower extremity Angioedema – Edema seen in allergic reactions Pitting edema – Edema that leaves a pit or dent in skin once compressed and released Non-pitting edema – Does not leave a dent after skin is compressed and released ● These are terms used when describing both lymphedema and edema. ● Pitting edema is more common in lymphedema than edema. Non-pitting is more common in edema. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

● Which three kinds of edema are shown in this slide? Dependant edema, angioedema, and pitting edema. ● Edema distribution is often linked to its cause; edema of lower extremities is typical of heart failure; edema of the abdomen is typical of liver cirrhosis; edema that is diffuse is typical of kidney failure. Be sure to consider these and other medical conditions in the treatment plan. From Frazier MS, Drzymkowski J: Essentials of human diseases and conditions, ed 3, 2004, St. Louis, Saunders; Callen JP et al: Color atlas of dermatology, ed 2, Philadelphia, 2000, Saunders; and Bloom A, Ireland J: Color atlas of diabetes, ed 2, London, 1992, Mosby-Wolfe 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

IN MASSAGE: 1. Avoid vigorous massage in affected areas 2. Avoid all forms of thermotherapy 3. During massage, elevate affected areas 4. Massage proximal to affected areas if located on the extremities ● Why is vigorous massage contraindicated? Because this may cause inflammation, which contributes to the closing of dysfunctional vessels, which in turn worsens swelling. ● Gentle superficial gliding strokes applied centripetally are beneficial. The edematous limb should be supported and elevated during the massage. ● Therapists trained in advanced techniques of manual lymphatic drainage may follow appropriate protocols. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

LYMPHANGITIS Treatment Antibiotic therapy ASAP Massage
Contraindicates massage Take good care of hands to prevent picking up infection 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphangitis Infection of lymphatic vessels; usually an indication that a primary infection is spreading Local contraindication From Stone DR, Gorbach SL: Atlas of infectious diseases, Philadelphia, 2000, WB Saunders. Etiology - Lymph capillaries are infected, usually with - - -Streptococcus pyogenes - Usually starts at skin lesion - In lymph nodes: lymphadenitis ● What are the symptoms of lymphangitis? Some symptoms of lymphangitis include enlarged local lymph nodes along with red streaks extending from the infected area. The person usually has chills, fever, fatigue, loss of appetite, and headaches. ● Because of comparable local signs and symptoms, lymphangitis of the lower extremity may be confused with thrombophlebitis. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphadenopathy and Lymphadenitis
Lymphadenopathy – Enlarged lymph nodes Lymphadenitis – Infected lymph nodes Local contraindication; absolute Contraindication if systemic disease is present ● Lymphadenitis denotes infection within the lymph nodes. Lymphadenopathy may be indicative of an underlying disease, while lymphadenitis is caused by bacteria, virus, parasites, or protozoa. ● What are the symptoms of lymphadenopathy? Some symptoms of lymphadenopathy include the following: enlargement of lymph nodes with possible bilateral involvement; lymph nodes feel hard; skin may be red or hot and edema may be present; there may be symptoms of systemic infection such as fever; chills; fatigue; loss of appetite; and headaches. ● If enlarged lymph nodes accompany a systemic disease, massage is postponed until the disease has resolved OR until medical clearance is obtained. Courtesy Dr. A.R. Kagan, Los Angeles. In Del Regato JA, Spjut HJ, Cox JD: Ackerman and del Regato’s cancer, ed 2, St. Louis, 1985, Mosby. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Conditions of Immune System
Allergy Chronic fatigue syndrome Systemic lupus erythematosus Acquired immunodeficiency syndrome ● Immune disorders are usually a malfunction of immune system. ● These malfunctions may generate hypersensitive reactions, autoimmune diseases, or immunodeficiency disorders. ● Scleroderma is discussed with dermatologic pathologies and multiple myeloma is discussed with types of cancer. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Allergy - Over-reaction of immune system to otherwise harmless agents; also called a hypersensitivity reaction Type I - Anaphylaxis is the least common, but most perilous reaction Caused by insect sting, ingestion of nuts or shellfish, or drug reaction - Ascertain and avoid allergens during massage Definition - Immune system reactions against stimuli that are not inherently hazardous Demographics - 50 million people in the United States - Hygiene hypothesis - Repeated exposures - Multiple chemical sensitivity: exposure to toxic substances leading to extreme reactions to other substances ● Table 9-1 on page 267 discusses types of hypersensitivities. Note that SLE is classified as Type III. ● The term allergy was originally used to denoted both aspects of the immune response, immunity (which is beneficial) and hypersensitivity (which is harmful). Now, the term allergy is used to denote harmful effects of the immune system, and immunity is the term to indicate its protective effects. ● An allergen is a substance that promotes allergic reactions. What are some examples? Pet dander, lubricants that contain nut oils, and latex gloves are all possible allergens. The therapist should ask clients with known allergies to review the ingredients list before applying a massage lubricant. ● Massage can be performed as long as the client is not experiencing any acute allergic reaction and/or difficulty breathing. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Angioedema Rapid onset of local swelling
Skin, genitals, extremities, gastrointestinal (GI) tract At tongue, larynx, pharynx: may interfere with breathing Triggers: nuts, chocolate, fish, eggs, aspirin, angiotensin-converting enzyme (ACE) inhibitors, poison ivy, etc. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Emergency Measures for Anaphylaxis
Call 911 - Calmly reassure the person - Check for special medications, such as injectable epinephrine; administer medication - Have person lie flat; elevate feet 12 inches - Cover person with coat or blanket; loosen tight clothing Cautions: - Do not give anything to drink - If person is vomiting or bleeding from mouth, place on side to prevent choking - Perform CPR if person is not breathing or does not have a pulse ● What are the symptoms of anaphylaxis? Choking, wheezing and shortness of breath, rapid pulse, dizziness, and loss of consciousness are all symptoms of anaphylaxis. Anaphylaxis Acute, severe, systemic Massive histamine release Drop in blood pressure; edema; can interfere with breathing Triggers: antibiotics, blood products, diagnostic imaging dye; latex, wasp stings, ants, honeybees; nuts First exposure may not cause significant reaction; repeated exposures cause more antibody activity Occurs at site of exposure and systemically; can be medical emergency (500 deaths/year) 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Emergency Measures for Anaphylaxis (cont’d.)
Treatment Antihistamines to interrupt inflammatory process Epinephrine and oxygen if necessary EpiPen Desensitization Massage Contraindicated while acute Use hypoallergenic lubricant, avoid perfumes, oils, etc. ● Box 9-2 on page 268 discusses these emergency measures. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Chronic Fatigue Syndrome
Disease characterized by prolonged and severe tiredness and disabling fatigue; this fatigue is not relieved by rest and may worsen with physical or mental activity Reduce treatment time and pressure if client is overly fatigued Treatment - Make supportive lifestyle choices Avoid stress Minimize stimulants and depressants Take careful exercise - Education, some medications Massage - Indicated to stimulate parasympathetic response, improve tissue nutrition, relieve muscle and joint pain ● CFS is often accompanied by flulike symptoms such as low-grade fever, sore throat, headaches, unexplained muscle soreness, joint pain, and lymph node tenderness. ● Depression is a frequent complaint. ● What type of massage is indicated for clients with chronic fatigue syndrome? A gentle massage is best as it can soothe the nervous system, relieve muscle and joint pain, and give the client a chance to rest. Because the client’s symptoms vary daily, it is important to ask about current symptoms and adjust the massage accordingly. It is also helpful to ask how the client responded to the previous massage, making appropriate treatment modifications. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Systemic Lupus Erythematous
Chronic inflammatory disease affecting skin, bones and joints, nervous system, kidneys, lungs, and other organs Massage is contraindicated during flare-ups; otherwise, reduce treatment time and pressure if client is overly fatigued; avoid skin rashes ● There are three main types of lupus, with systemic lupus erythematosus being the most common. The two other types are discoid lupus erythematosus and drug-induced. ● Skin rash is present in SLE. The photographs here show the butterfly rash and a skin rash on sun exposed areas of skin. ● Box 9-2 on page 272 features disease manifestations of SLE. ● During periods of remission, what sort of massage is indicated? A gentle full body massage is indicated. Special care should be exercised when performing stretches and joint mobilizations. Be sure to treat enlarged lymph nodes as a local contraindication. , Courtesy the Department of Dermatology, University of North Carolina at Chapel Hill. In Goldstein BJ, Goldstein AO: Practical dermatology, ed 2, St. Louis, 1997, Mosby. B, from Hill MJ: Skin disorders—Mosby’s clinical nursing series, St. Louis, 1994, Mosby. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

ANY MANIFESTATION OF ILLNESS THAT INCLUDES A FEVER:
DEFINITION: body temperature of over 100 degrees farhrenheit. If the client has a temperature - - - Massage: Fever systemically contraindicates massage Energetic techniques may be helpful 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Acquired Immunodeficiency Syndrome (AIDS)
Viral disease causing progressive impairment of immune system AIDS is the final stage (Stage IV) of HIV infection ● The person is considered HIV-positive when blood test positive for viral antibodies. The same person has AIDS when the immune system has weakened to the point where he or she has had at least three opportunistic diseases, or T cell blood count below 200 (normal range is between ). ● Box 9-3 on p. 273 of the textbook lists the staging criteria for HIV infection. (Review box in class.) ● The person is considered HIV-positive when blood test positive for viral antibodies. The same person has AIDS when the immune system has weakened to the point where he or she has had at least three opportunistic diseases, or T cell blood count below 200 (normal range is between ). From Salvo S: Massage therapy: principles and practice, ed 2, Philadelphia, 2003, WB Saunders 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

HIV/AIDS Demographics, Worldwide: 40.3 million = HIV+
2.3 million < 15 years 5 million new infections/year; 14,000/day 3.1 million deaths/year 90% of infections from heterosexual activity Demographics, United States: 950,000 = HIV+ (240,000 don’t know) 40,000 new infections/year 70% in men, 30% in women 20,000 deaths/year Most common in racial minorities: Blacks 7x > whites Hispanics 3x > whites See notes 40% new infections from sexual activity between men 26% from shared needles 4% from some combination of homosexual activity and shared needle use 28% from heterosexual activity 2% from no identified risk 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Acquired Immunodeficiency Syndrome (cont’d.)
● Antibodies against HIV appear rapidly after infection through blood (within 2-10 weeks). When the virus is transmitted by sexual activity, antibodies may not appear for 6-14 months. The time period between infection and the appearance of antibodies is called the window. This creates an opportunity of an infected person to transmit the virus unknowingly. The presence of antibodies helps determine diagnosis. ● Clinical stage 1 marks a period of asymptomatic infection, which can last from 2 wks to 20 yrs. During this period, the virus is replicating in lymph nodes. During clinical stage 2 and 3, the person presents more general symptoms of HIV infection such as unexplained weight loss, diarrhea, fatigue, night sweats, and enlarged lymph nodes. ● As the disease progresses, immunodeficiency is more evident and marked by frequent, or opportunistic, infections (any listed in the image on the prior slide). T cell count plummets; the person enters the final stage of infection called AIDS. Progression Phase 1 New infection; pools in WBCs Tests are negative, no symptoms Communicable Lasts 3 weeks to 6 months for sexually transmitted infections Phase 2 Acute primary HIV: antibodies become detectable 70% have fatigue, swollen glands, fever; looks like flu or mono Phase 3 Asymptomatic period Virus replicates; immune system keeps up Medication works to prolong this phase 1–20+ years; average is 10 years Phase 4 HIV+ → AIDS T cells drop < 200 cells/mL of blood (normal is 800–1,000) Opportunistic diseases develop HIV Resistance Long-term nonprogressors: three major factors Host resistance Fewer CD4 sites; harder for virus to attach Immune system response Immune system is more aggressive, responsive to viral signals Virulence of the virus Virus may be weakened by other factors 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

HIV/AIDS Signs and Symptoms Depend on the stage of infection
Communicability Exchange of intimate fluids Not sweat, saliva, tears Unstable outside a host Can’t use insect or other vectors Diagnosis May take 6 months for accurate test ELISA (enzyme-linked immunosorbent assay) test Western blot test Centers for Disease control (CDC) recommends screening for all adults and teens; may reduce spread Treatment Virus constantly changes during replication Combination of drugs to anticipate mutations (can be toxic) Highly active antiretroviral therapy (HAART) can slow progression; can’t access virus in dormant T cells Challenge: when is it best to initiate therapy? 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Acquired Immunodeficiency Syndrome (cont’d.)
Massage Take care for health of client Indicated for asymptomatic clients; may improve T-cell count For clients with AIDS, stay within tolerance and resilience Reduce treatment time and pressure if client is overly fatigued Inquire about and avoid skins lesions, enlarged lymph nodes, and area of most recent site of blood work Avoid or administer joint mobilizations and compressions carefully when condition is advanced ● When massaging a client who is HIV+ or who has AIDS, inquire about the client’s activities of daily living before every massage. When appropriate, reduce treatment time to 30 minutes and use lighter pressure. In general, individuals who are HIV+ can typically tolerate a more vigorous massage, and individuals with AIDS cannot. ● Because the immune system of the HIV-infected client is not fully functional, the client is more susceptible to contacting infections through simple exposure. The therapist is a greater health hazard to the HIV-infected client than the infected client is to the therapist. 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphoma Definition Demographics Cancer of lymph nodes, spleen
Delineations between lymphoma and lymphocytic leukemia becoming hazy Hodgkin lymphoma (HL) Non-Hodgkin lymphoma (NHL) Demographics 67,000 diagnoses/year in the United States 8,000 HL 59,000 NHL 519,000 lymphoma patients alive today Diagnosis rates are climbing; incidence up 80% since 1973 Better screening, early diagnosis Aging population Survivors of immuno-compromising conditions HIV, organ transplants, etc. HL mostly 15–34 years old or >55 NHL mostly 60–70 years old 20,500 deaths/year 19,000 NHL 1,500 HL Types of lymphoma Hodgkin lymphoma B cells mutate into large, malignant multinucleate Reed Sternberg cells Usually submandibular nodes, can be axillary, inguinal Growths metastasize to liver, bone marrow Progress is usually organized, predictable Non-Hodgkin lymphoma Mutation of lymphocytes into indolent or aggressive cancer cells 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphoma Prognosis - Depends on type, stage, age, etc.
- 5-year survival for HL > 86% (children > 95%) - NHL: 63% Massage - Rigorous circulatory massage inappropriate for malfunctioning lymph tissue - Noncirculatory work can be supportive - Work to ameliorate problems with chemotherapy, radiation therapy, other treatments 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

GOOD -BYE 9/17/2018 Tarrant County College District Massage Therapy Program, Pathology2014 Lymph/immune

Lymphatic and Immune Pathophysiology

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