The Effectiveness of Treatment of the Lymphatic System on a Patient with Congestive Heart Failure and Emphysema

Authors: Adrienne Kramer PT and Susan Morrison DC

Abstract: The purpose of this study is to demonstrate the effectiveness of treatment of the lymphatic system on a patient with congestive heart failure and emphysema.

Key Words:Congestive Heart Failure, Lymphatic System, Emphysema

Introduction: The purpose of this study is to demonstrate the effectiveness of treatment of the lymphatic system on a patient with congestive heart failure (CHF) and emphysema. The goal of treatment is to decrease extracellular fluid volume to allow increased ease of oxygenated blood in reaching the tissues. Another desired outcome is to decrease chronic infections and strengthen the immune response.

Typically these diagnoses are treated with multiple medications, antibiotics for frequent infections, and oxygen therapy. For COPD the survival rate after the first episode of respiratory failure is 25%. With CHF, annual mortality ranges from 10% in stable patients with mild symptoms to greater then 50% in symptomatic patients with advanced disease¹. It is important to find another modality of treatment to improve the quality and length of life in these people.

Case Description: Y.R. is a 60 year old Caucasian female with a history of emphysema for the past 2 years and CHF for one year. She presents with neck and back pain, bilateral shoulder pain, chest pain, difficulty breathing, and depression. She is on 2 L/min demand oxygen and 4 L/min oxygen with activity. She maintains an O2 saturation of 88% or greater with activity. Other pertinent medical history includes appendectomy in 1995, 3 miscarriages, high blood pressure and asthma. Medications at onset of treatment include: Combivent, Serevent, Flovent, Lotensin, Cardizem, and Zoloft. The patient’s goals included: increase energy level and be able to discontinue the oxygen. Upon intake, the client reported a susceptibility to stress and poor memory.

Evaluation: The patient’s height is 4’ 11" with a weight of 175 lbs. Standing posture shows a forward head and neck, decreased thoracic kyphosis, bilateral shoulder protraction, left depressed shoulder, clavicle, scapula, and rib cage, and a hyperlordosis of lumbar spine. The patient presents with hypomobility at C2-C5, T3-T12, and L4-L5. In addition, the patient presented with edema throughout her head, face, neck, trunk, and all extremities. Range of motion was measured without deviation or compensation. See Tables 1 and 2 for pre and post range of motion tests. See Table 3 for pre and post measurements.

Treatment: YR was treated for 3 days with 6 hours of treatment per day. Measurements were taken at the end of the first day and during the last hour on the 3^rd day. The main resource for treatment was Integrative Manual Therapy Lymphatic System Congestion Therapy. The following techniques were used: Advanced Strain and Counterstrain for the diaphragms, superior vena cava, inferior vena cava, and aorta; Lymphatic Therapy Level One-- Regeneration of Cardiac-Lymph Functional Output; Advanced Strain and Counterstrain for face lymph nodes, head lymph nodes, neck lymph nodes, chest / thorax lymph nodes, abdomen lymph nodes, low back lymph nodes, pelvic region lymph nodes, upper quadrant bilateral lymph nodes, bilateral leg lymph nodes; Myofascial Release to all areas with nodes; Advanced Strain and Counterstrain to all the lymph vessels in these areas; Abdominal Compression Syndrome for the cistern chyle, thoracic duct and mediastinal lymph node; Thoracic Diaphragm Compression Syndromes; Liver Compression Syndromes; Immune Deficiency Motility (IDM) and Disruption of Membrane Technique (DOM) to the anterior and posterior aspects of the left lung; Bone Bruise Technique (BB) to ribs 3,4,5, posterior; Superior Vena Cava Restriction Release; Inferior Vena Cava Syndrome; Portal Vein and Hepatic Vein Drainage Techniques performed simultaneously with DOM and IDM. The order of treatment was determined by Myofascial Mapping, 5 Point Longitudinal Pressure Scan, and Longitudinal Pressure Cavity Scan. YR was given Neurofascial Process to do at home every night from the areas that were treated to the ureters.

Outcomes: Following completion of treatment, the patient presented with significant improvements in range of motion. The ranges of motion were measured without deviation or compensation. Measurements are a percentage of normal range of motion. The patient also presented with decreased edema that are evident in the post treatment girth measurements.

 

Table 1- Cervical ROM	Pre-test	Post-test
Flexion	10%	50%
Extension	50%	50%
Left Lateral Flexion	20%	30%
Right Lateral Flexion	20%	40%
Left Rotation	25%	40%
Right Rotation	30%	30%

Table 2- Trunk ROM	Pre-test	Post-test
Flexion	25%	60%
Extension	25%	40%
Left Lateral Flexion	20%	40%
Right Lateral Flexion	30%	30%
Left Rotation	10%	25%
Right Rotation	10%	40%

Measurements were as follows ( in inches):

TABLE 3
Locataion	Pre	Post	Difference
Base of neck	16 ¾	14 ½	-2 ¼
Under chin	18 ½	17	-1 ½
R Axilla	20 ½	20 ½	0
L axilla	18 ½	18 ½	0
Chest at axilla	40 ¾	38 ¼	-2 ½
R elbow	12	11 ½	-1/2
L elbow	13	12 ¾	-1/4
R wrist	7 ¾	7 ½	-1/4
L wrist	8 ¼	6 ¾	-1 ½
Iliac crest	38 ¼	37 ½	-3/4
Umbilicus	43 ½	38 ½	-5
L thigh	29 ¾	28	-1 ¾
R thigh	30 ¾	29	-1 ¾

Discussion: Increased range of motion was apparently due to a decrease of tissue edema and repair of Disruptions of Membrane as no biomechanical corrections were performed in these hours of treatment. The significant decrease in body measurements appears to be a result of a more efficient and effective lymphatic system. With the decreased fluid load YR reported an easier time breathing so much so that she forgot to wear her O2 for 10 minutes, which had never happened before. YR reports decreased back and shoulder pain. YR will continue to receive IMT treatment with a focus on improving the health of her heart and lungs in order to reach her long-term goal of getting off the supplemental oxygen.