Robin Devine, RMT, CLT, LTI joins us this week to discuss the importance of your Lymphatic system and ways to support it for healthy detoxification.
Episode 51: Getting Ecstatic about Lymphatics
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[01:46] Cassy Price: Hello friends. Thank you for tuning into another episode of Supplementing Health. In light of our focus on the bodies detoxification organs and processes we will be discussing our lymphatic system today. For this conversation I have the pleasure of introducing a long-time friend of mine Robin Devine. Robin is a registered massage therapist, certified lymphedema therapist, lymphatic drainage instructor and the founder of the Lymph Balance Centre here in Calgary, Alberta. Hi Robyn. It’s great to be chatting with you today.
[02:09] Robin Devine: Hi. I’m so glad I was able to connect up and be able to join you today. So, it’s wonderful.
[02:15] Cassy Price: So, before we dive into the lymph system and why it is so important to our overall health, would you like to share a little bit about how you go into the field and the inspiration for your clinic?
[02:25] Robin Devine: Sure. Yes, so I have been a massage therapist for about 20 years. I absolutely love learning about human anatomy, physiology and what happens with pain and how people are able to recover. I kind of jumped into the lymphatic world by accident but it was wonderful. When I took the course, I thought “No one else is doing this or never really heard of this so maybe this will make me odd and unique.” It definitely did. So, yeah, I have been doing lymphatic work now for about15 years and when I initiated and started doing lymphatic work, I worked with a lot of people who had general immune issues. So, whether it was asthma or allergies, and I would work with sinus issues, really basics.
[03:12] Robin Devine: Then in 2015 I decided that I needed to go deeper so I stated working with lymphedema patients and situations where there is significant swelling and traditional medicine wasn’t helping. So, I jumped into that and have loved it ever since and very blessed that in the last three years I was able to open my clinic in Calgary, the Lymph Balance Centre, and I have an amazing team of 14 therapists who are almost as geeky as I am.
[03:43] Cassy Price: That’s fantastic. I love that you are having a geek off with your team.
[03:47] Robin Devine: All the time. All the time. We have way too many lymph jokes that nobody else on the planet would get but you know it’s what we do so I am very lucky that way.
[03:57] Cassy Price: So, many of us have probably been told by our practitioners at some point that our lymph nodes are swollen. So, do you want to share exactly what the lymphatic system is and why it is important to our health?
[04:09] Robin Devine: Absolutely. So, you’re right. One of the most common things that people go is “Well I know they can get swollen but I don’t know why.” So, the best way that I can describe it, this is the way I describe it to a lot of clients and my kids understand it, it is not a really difficult thing once you understand it, is that all of the cells in your body need oxygen, they need nutrients, they need water, and we give that to our cells by our blood stream which is great. Our cells also give off waste products. When they give off those waste products, when I was in high school, I was taught that it was picked up by the blood stream, but what it turns out is that the majority of all those waste products that our cells are giving off every second of your day, every day of your life, actually gets picked up by your lymphatic systems.
[04:57] I describe it like a vacuum system that cleans up all the waste and debris around your tissues. Anywhere in your body, it could be around your hair, it could be around your eyeball, it could be in your lungs, it could be in your big toe. We take all of these waste products and we need to take them to areas where we can clean it. We need to look at the waste and look at the debris and take the foreign cells like viruses or bacteria that might have gotten into this tissue and this fluid and we need to clean it. So, you have lymph nodes. Lymph nodes jobs are to filter and make sure that bad waste products that we’re neutralising it and maybe good things actually got into the waste that we can recover it as well. We take the waste products and all the cellular pieces and we put them through hundreds of lymph nodes to make sure that it is as clean as possible because eventually we take that, and we put that back into our blood stream.
[06:01] So, I love the lymphatic system because it is this amazing recycling water purification, sometimes we say water treatment plant kind of process, it is definitely not garbage. It’s your body’s ability to clean, purify, reuse what is can and eliminate what it doesn’t. So, when we get sick a lot more of the waste products are viruses or bacteria, so your lymph nodes get really overworked so they swell up and are tender and inflamed. So, that is the most common, when we go to the doctor and say we have a cold or not feeling good and they feel under your chin and say, “Oh yeah, your lymph nodes are totally swollen.” That’s because you have a respiratory- it came in through your nose and mouth, so yeah, the lymph nodes around there would be mad. They are processing viruses and that’s their job. It is such an important system that it is kind of painful to realise that not many people understand what it does. So, I love teaching people about the lymphatic system.
[07:11] Cassy Price: So, then obviously a key point of it working well is that things keep moving through it. So, what can cause the lymph system to become stagnant?
[07:21] Robin Devine: Yeah, so, there is a lot of things that we can look at that cause lymphatic stagnation. If we look at the physical structure, if we have really tight muscles and we get scar tissue or fascial adhesions it sort of creates like a beaver dam, like a physical barrier, and that can actually stop lymph from moving. We see that actually sometimes after injuries. Say you sprained your ankle. You sprained it hard enough that you have tissue that has become damaged as well so you have swelling, well the inflammation process should only be a day or two, why is there still fluid swollen there a month later? Maybe there was fascial restrictions or tight muscles and tissue that is preventing the fluid from moving.
[08:05] Robin Devine: Sometimes it might be the food that we are eating. Sometimes we eat foods that cause inflammation in our gut. Some people are very irritated by dairy or irritated by certain vegetables. When you get that inflammation in your abdomen that is more fluid than we are expecting our lymphatic system to move for us. If you’re having a high dairy, high fat, high sugar, high alcohol style diet that had to be processed by your lymphatic system as well as by your liver. Your liver is an amazing component of your lymphatic system. So, there is lots of reasons. That’s if you have a healthy system to start off with but there are lot of people who don’t have a perfect lymphatic system and they have had damage and so on and that can lead to even more issues.
[08:57] Cassy Price: So, which people would be more prone to lymphatic imbalances than others?
[09:03] Robin Devine: Well, we see people who are born with immunocompromised systems, right? We see people who don’t have the greatest lymphatics or maybe they have asthma, they have eczema, they have allergies and are already immunocompromised. So, they tend to have more congestion and irritation. Their immune system gets irritated faster, right? For example, I am totally fine around cats and dogs, it doesn’t bother me whatsoever, but my husband, oh my goodness, if there is a cat in the three block radius, he starts getting congested. That is his lymphatic system and his immune response, right? Anybody who has any kind of autoimmune or allergy that causes more imbalances. That can happen with food, with environmental toxins, allergies, smog, a whole bunch of things. It is getting harder because a lot of us do live in big city centres and so the pollution is higher and so on but it’s hard to say what exactly causes a lymphatic imbalance. It can be trauma. It could just be something that is in the air as well.
[10:13] Cassy Price: So, then pretty much any condition could be impacted due to lymphatic imbalances, it sounds like.
[10:20] Robin Devine: It could be. A lot of time when we look at the lymphatic system, we are looking at congestion and swelling, right? Anytime we are seeing conditions where there is fluid that is not moving, swelling in the joints or not moving as well, yeah absolutely it can be the lymphatic system. If its immune based and we are looking at either hyperirritability or sensitivities that is definitely immune system lymphatic based.
[10:49] Cassy Price: Okay, awesome. So, what are the treatment options for someone who is suffering from a lymphatic imbalance then?
[10:56] Robin Devine: Well because lymphatic imbalances tend to show up as swelling or congestion, if you were going to see a regular GP and we have a lot of swelling, one of the number of things that they will normally do is give you an anti-inflammatory or look at water pills. They might work for the short term but not always. So, there is the traditional stuff that we can do when it is swelling or congestion, we can elevate our limbs, we can put a compress on it. One of the things that we do is lymphatic drainage. What we are doing is we are physically working with the lymphatic system and we are working with it. We are not forcing it to do something that it doesn’t want to do. We are showing and helping it find the most effective pathways to get back into the blood stream and get that connection back to the beautiful cycle of recycling. So, it depends on the situation. It depends on if it’s a joint or if it’s the skin or if it’s an organ. A lot of the times it’s been the lymphatic drainage and it’s obviously why I do it for as much as I do because it just gives such great results.
[12:12] Cassy Price: What are the benefits that come from getting a lymphatic message rather than doing some of those traditional options?
[12:20] Robin Devine: Well, obviously you don’t have any medicinal side effects, right? It is a manual therapy. It is working directly with a therapist. One of the things that I emphasise right now, more than ever, is that you get physical contact with someone. I feel like everybody is going through this significant contact deprivation which is just exhausting. So, one of the things I rarely call it lymphatic massage. The reason for that is that it doesn’t feel anything like a massage. Massages most people think there is a lot of needing and getting the tissue and physically picking up the tissue and you get lots of circulation. Lymphatic work is extremely gentle. The reason why it’s so gentle is because approximately about 70% of all of the lymph in your entire body is right underneath the skin. So, because it is right underneath the skin, if I go too deep, if I go like I am doing a massage or even fascial work, I have actually gone past the lymphatic system.
[13:21] There is lymphatics everywhere you have blood but if I am going to have the most effect on moving them, the very most fluid with the least amount of contact and trying not to be invasive, staying within that very outer layer of the skin is very important. What we tend to see with receding lymphatic work is not only that the swelling with generally reduce, it’s extremely relaxing. It stimulates that part of your nervous system that really helps it mellow out. You go into that beautiful rest and digest parasympathetic part of your nervous system and it really does help with toning the entire body. So, I might just work on the arm, but it has an effect globally for the entire body. So, even if I am not touching the toes it still might have that moving the lymphatic system up and helping it drain. It is very gentle. It is never painful. It is extremely relaxing, and it really does boost how much fluid gets to move.
[14:30] We end up seeing that maybe on a regular day you and I move anywhere between 1.5 and 4 litres of lymph which in its own sounds like a huge amount but when we do lymphatic work, we can increase that by five or 10 times. It really can help move everything around so much more efficiently. One of the most common things though is that everybody has to pee so much later. That is one of the main ways that you get rid of it, right? So, the most common side effect is people going “I had to pee like all night long and I don’t know why.” It’s because you were processing.
[15:07] Cassy Price: Do you suggest people up their fluid intake before and after a treatment to help flush out those toxins?
[15:12] Robin Devine: Absolutely. When we have clients that book it’s what happens. They get sent an email saying, “we highly encourage that you drink two-four glasses more a day than you normally would” because, yeah, if you are dehydrated, I am going to move more fluid and detox you, your body could almost feel like it’s in a hangover the next day because you are even that much more dehydrated because I’m asking your body to process and to eliminate and if you are not well hydrated, you know. There are very few negative side effects post lymphatic drainage but one of the ones that is the hardest is the headaches and that sensation of being almost hungover the next day. So, yeah, you have to make sure that you are coming to the session well hydrated but also to continue that for a couple of days afterwards.
[16:01] Cassy Price: I always thought there were points where your main lymph nodes resided, like under your armpits or under your neck like you were saying where doctors feel. So, are there certain points that you work on for certain conditions or is it a full body thing every time?
[16:17] Robin Devine: So, in your body, I can’t tell you exactly how many lymph nodes you have because everybody is a little bit different. However, many lymph nodes you have, you are born with them and that’s what you have for life. You don’t grow new lymph nodes. You get what you get and that’s it. So, it’s true. If you were going to go in a foetal position like curled up on the floor, the majority of your lymph nodes would be protected because your body strategically placed your immune system and the lymphatic system into joints and into crevices so when you go into the foetal position you are protected. Some books will vary in what they say with numbers. We tend to see anywhere between 400 to 800 or sometimes 1,000 lymph nodes in a body. About half of them are just in your abdomen so if you think of having 500 lymph nodes in your abdomen alone, there are very few times I don’t work on the abdomen for a client.
[17:18] No matter where the congestion is, no matter where the problem is. If you don’t work the abdomen you are kind of missing out on a huge piece of what is the lymphatic system. Basically, yeah, we have large clusters in our armpits and in our groin, so where your thigh meets your trunk, in that crevice, almost what we would call the panty line. In those groin areas, as well as in the armpits, you have anywhere between 30 to 60 lymph nodes in each of those areas. You have them behind your knees. There are so many in your neck. Your body is strategic, and it tries to protect these nodes, they are very valuable. Without a lymphatic system you don’t survive so let’s make sure we tuck them into nice little crevices and areas where they will be protected. So, absolutely. If somebody came in with carpel tunnel, I am looking more at the forearm and hand, I am probably going to do more of the armpit nodes. I might not need to go down to the groin, right? It doesn’t have a direct correlation with those nodes. So, it is all about learning where the nodes are and what tissues they drain and how we can make their pathways more efficient.
[18:34] Cassy Price: Are there certain situations then when you would have lymph nodes surgically removed which could then influence the pathways and how the whole system works together?
[18:43] Robin Devine: Absolutely. That is actually one of the hardest things on your system is to have lymph nodes removed. In my experience, the most common reason that we see lymph nodes removed is obviously because of cancer. So, if there is breast cancer or if there is prostrate cancer or colon cancer, they will generally when they remove that tissue, they will also remove a couple, if not more, of the lymph nodes in the region because they are worried that the cancer cells will have spread and they will spread to the lymphatic system. Once they are in the lymphatic system it is hard to control it because it spreads all over the body. That is one of the most common reasons why lymph nodes will get removed. The problem is that, as soon as you remove lymph nodes, it is going to effect, like you said, the exact pathway that that tissue would have drained towards. So, if we go back to, the number one cause of what we called lymphedema, lymphedema is swelling when the lymphatic system has been damaged.
[19:46] The most common we see in North America is breast cancer surgery. We will start to see a mass of fluid accumulation in the area that would have originally drained toward that cluster but now that cluster is compromised. It’s weak. It might be able to move all of the fluid and it can, some people are very lucky, and their system finds a new pathway on it’s own. I always joke, I tell people that if I could, I would want the lymph to go on the Deerfoot, I would want it to go on a major highway but just sometimes there is construction, or the road is blown up, and now we have to find these alternate pathways. I asked Siri and she’s like “You can’t take Deerfoot, you have to take these other routes.” It might take me longer to get to where I am trying to go, and I am lucky if I am able to figure out a way to get to my final destination and that is what lymph has to do. It is trying to get its way back to the blood stream. In our body, where that happens is that the base of our neck. So, if the lymph can’t get there, we start to see a lot of swelling and it’s very hard to correct.
[20:54] It is not comfortable. Fluid is heavy. Some limbs can feel like they are two to 10 times heavier than the opposite limb. It can make it extremely uncomfortable. What hit me really hard was when I started to think about all the people who I knew who had lymph nodes removed. Everybody I know who has had cancer, who had tissue removed, or lymph nodes removed. Sometimes lymph nodes, it is not a perfect situation, it is not clean and clear as much as we all want it to look like, right? We watch our Grey’s Anatomy, we watch our ER, we watch whatever and we think when you are doing surgery and you are removing tissue to know exactly, well sometimes lymph nodes get caught up in the dissection and sometimes in the fascia. Sometimes it is unintentional and sometimes it is the focus of the surgery. I have met people who have lymphedema, and it has nothing to do with cancer. It has to do with, they had a port put into their upper chest and when they removed it, unfortunately it pulled a lymph node out with it. So, I would love to say that it is always an intentional thing to remove lymph nodes but it’s not the case.
[22:13] Cassy Price: So, if lymphedema is caused by essentially the injury of these lymph nodes, can it be cured? Does the inflammation eventually go away or is it kind of a lifelong thing?
[22:27] Robin Devine: Well, so to answer the question I sort of have to backtrack a little bit. So, there are two different kinds of lymphedema. There’s lymphedema where you are born with an imperfect lymphatic system and that is called a primary lymphedema. So, some people are born with less nodes or very small lymphatic vessels or maybe even really big lymphatic vessels, but they are just not functional. So, that is called Primary. What happens is that anytime throughout their life something tips the scales, and their system goes “look, I can’t move this fluid.” Whether it was at birth and we have this congenital or conatal lymphedema which is where you see a baby that is born and it has one, two, three or four limbs that are really swollen and unfortunately, the thing is, is that lymphedema cannot be cured, as of right now, it has no cure. So, if you are born with lymphedema, that is your lot in life unfortunately. You are going to have to deal with that for the rest of your life.
[23:28] Primary can also be developed when you are a teenager and hormones start flushing. You can see it in adults, after the age of 35, they didn’t know they had lymphedema but they are 50 and they decided to do a world trip on an aeroplane, not obviously now, but something happens and their body produces more fluid and their system goes “I can’t handle this.” When we look at where the lymphatic system is damaged that is secondary lymphedema. It can be damaged because of a really bad car accident. It could be damaged from a surgery, whether it was removing nodes or not. I have seen lymphedemas because of gall bladders being removed. Of course, everywhere you have blood you have lymph, so organs are extremely vascularised. They have a lot of lymph and there are lots of lymph nodes in our abdomen. So, you look at women who have had hysterectomies, who have had parts of their stomachs stapled, they’ve had stomach sleeves, that’s another one. There are just so many conditions where the lymphatic systems could get damaged and once it is damaged lymphatic vessels can heal themselves which I love.
[24:40] We have all had surgeries and I don’t have massive amounts of swelling. It’s because my lymphatic vessels could heal themselves and they do it in like two weeks, it’s beautiful. Lymph nodes, you get what you get, and you don’t get to make any more. If you damage a lymph node it’s gone, and it is very difficult. There is a lot of supportive treatment we can do in reduction of the fluid but as of right now there is no official cure. There are lots of surgeries they are looking at where they are connecting the lymphatic system directly to the veins, the lymphovenous surgery, which is amazing. They are injecting the framework of a lymph node into stem cells and trying to get new stem cells and create new lymph nodes. They have also had lymph node transplants where they have taken a lymph node from one part of your body to help move the excess fluid which they have had some really great successes with.
[25:40] So, they are working on ways to work with the excess fluid and to move the fluid, but I haven’t seen anything that has cured it yet. One of the things is that when people go and type lymphedema into Google or search and they will see these horrifically huge limbs, where one limb is just massive like seven to 10 times bigger than the other one. That is the unfortunate reality if it goes untreated. There are technically four stages to lymphedema. We have a stage zero which is when you have had your lymphatic system damaged, but you have no swelling. You have stage one where you get a little bit of swelling but then it goes away and then it comes back and then it goes away. It sort of fluctuates and you’re like “It can’t be that big of a problem if it keeps going away.” Stage two is when you get swelling and it just stays. It doesn’t leave anymore. If that is left untreated you get to stage three. Stage three is also known as elephantiasis and that is when that leg is so gargantuan it has that elephant like largeness, but the skin also starts to change, and it gets really thick, and it can feel like elephant skin.
[26:54] I didn’t believe it for the longest time and then I was in Thailand and I got to touch an elephant for the first time, and I was like “Oh my gosh that feels like elephantiasis skin.” So, not only does the limb get so excessively huge which is really heavy, and you think one leg being that heavy, you think about your muscles in your lower back, your sciatic nerve, you think of how imbalanced your body is going to be. How do you move? How do you go upstairs? How do you get in and out of a car, right? Then you think about, well if that tissue is not getting lots of oxygen and nutrients, how easy is it to get an infection in that tissue? If somebody has a massively huge leg and they get a scratch, their skin is very delicate, if they get a scratch and they get an infection it will spread and it is very common we will see cellulitis with individuals who have lymphedema. That can be very serious and can be very dangerous. We will see things like that as well as fungal infections. You see toe fungus gets really bad. It causes a lot of discomfort and it affects you socially in such a level that is hard to understand.
[28:13] Cassy Price: The other thing I was curious about, you mentioned that the lymph system is very much connected to your gall bladder, your liver, and a lot of your organs. So, if you suffer from kidney stones, gall stones, any of that sort of stuff, can it be due to damage of the lymph system? How does the lymph system play a role in those conditions?
[28:36] Robin Devine: It depends on the person. It is really hard because you look at somebody’s health history and you start breaking it down, it can diet induced, it can be a lot of things. Could it be because the lymphatics are very congested in that organ which is preventing them from detoxifying? Absolutely. It depends on the person. When we see a very congested liver that can be correlated to alcoholism. It can be associated with hepatitis. By doing lymphatics, we can help move the fluid and take that sluggishness and make it more free flowing and make it more balanced as a system. Whether it is from damage to the lymphatics is to be seen. It depends. Normally we would see wither a lot of swelling the abdomen, a lot of scar tissue etc. They can be correlated. We look at leaky gut. We look at Chron’s and colitis. It is all inflammatory based. Our lymphatic system needs to detoxify and move all that extra fluid, so it makes it interesting to know which one comes first, is it because of the organ being unhappy or is it the lymphatic system that is leading to the organ being unhappy? It depends on the person.
[29:57] Cassy Price: How long do lymph treatments take on average?
[30:01] Robin Devine: That again depends on how much you are trying to work. If somebody comes in with just sinus issues or let’s say acne on their nose, I don’t need more than 20 minutes. If I am looking at someone whose both legs are massively swollen, we might be closer to an hour. What we do here at the clinic is we ensure that first time patients don’t get overtreated. Like I said, if you’re dehydrated and then you get overtreated you could end up getting some very negative side effects and we definitely don’t want to cause any negative side effects if we can from our treatments. So, here at the clinic first time patients don’t receive more than 30 minutes unless they have had treatment somewhere else, they know what lymphatic treatment feels like, they know what their body is going to do. We like to keep it to just 30minutes.
[30:52] That gives us the ability to do follow up and make sure that they are feeling well afterwards and make sure that they are not feeling overwhelmed and that their system was able to recover, they did not have the negative side effects. Then depending on what the situation is, if they have lots of swelling, I might have to see them three to four times a week for the first couple of weeks. If I am dealing with lymphedema, definitely more frequently when we first start treatment to when the point is that we are also using compression garments and we are using wrapping tools and exercises and skin care. That again is going to add more time to it, verses, again, if you come in for acne which lymphatics is beneficial for, or sinus issues or shoulder joint issues, we might just have to do one session this week and I will see you in a couple. We try to keep it very individualised because your lymphatic system is extremely unique compared to everybody else’s. How you respond to it will be unique as well.
[31:52] Cassy Price: If you’re working to attain optimised health, it is never a perfect equation, right? We are all unique and have unique genetics and unique body makeups and diets and experiences and everything. It all plays into it. I think personalising treatments is part of that personalised health and reaching that optimal goal. It makes sense that there is no perfect canned answer.
[32:15] Robin Devine: No, and we try really hard to create a treatment plan. Of course, it has to be something that works, and it has to be something that the patient can afford and have time for. It is not a perfect world. Right now, with limited work and cost of living and all the not beautiful things that are happening it is not easy to make those choices. Luckily here it is hands on. It is able to be covered as massage therapy with most insurance plans but depending on where you are in the world it might not. So, we are lucky here for that reason.
[32:51] Cassy Price: Now that so many people have sedentary jobs, we get home and we end up watching Netflix, because what else is there to do right now? We are sitting and reading or whatever it is. I think people have probably become a lot more sedentary, especially through the winter while it has been so cold and snowy. Can that have a detrimental effect to the lymph system then?
[33:11] Robin Devine: It can. What we are seeing a lot with desk jobs is that especially if you are sitting at a chair where your knees or your hips are at 90 degrees what happens is the fluid from your legs can have a hard time making it from your foot past the big bend in the knee, past the big bend in the hip and move up. What we are seeing is more clients coming in with swollen ankles. That is the hard part right now. We can take it the opposite. In the summer when it is really hot that causes a lot of fluid accumulation as well. Here in Canada, depending on where you are, can be decent weather. I have a lot of friends who are down in Florida and they hate summer because they just swell, and they can’t do anything. They can’t wear compression because they are really hot. Sedentary, heat, a lot of things come into play.
[34:15] If we take it one step further and even look at atmospheric pressure. That’s where aeroplanes really can be exhausting for the lymphatic system because we have less atmospheric pressure when we go up into an aeroplane so if you can recognise when you start getting those little warning signs, your lymphatic system is trying to talk to you. It is trying to tell you it can’t handle the stress of moving that fluid. When you start getting swelling, it is trying to communicate. If you can take care and wear compression and exercise and move your limbs and maybe get supportive treatments etc, you are less likely to have those horrible varicose veins when you get older. You are less likely to have these really thick ankles and have to wear horrible compression as you get older. It doesn’t get any more fun. I am not going to lie.
[35:08] Cassy Price: So, if our listeners want to work with you and your team, what is the best way for them to get a hold of you?
[35:14] Robin Devine: Well, I always love it when people get a chance to check out the website first. It answers so many great questions and it really helps to give a good base of information, so you are walking into this educated right off the bat. So, that would be lymphbalance.com. It is great. I love my support team at the front. They are great at answering questions. They are very educated, more than any receptionist on the planet that I have met. So, most times when people want to call and chat a little bit, they will be able to get a lot of answers from the front. That’s why we also do consults, and we do phone consults. I love doing that. It prevents people from coming in when they might not need it or can’t receive it. There are sometimes where it is not safe to receive treatment. So, we have to be cautious of some of those things as well. As light of a touch as it is, it is an extremely powerful technique. We take a lot of time. We do a lot of initial consult. We make sure that everything is as safe as possible.
[36:24] Cassy Price: Fantastic. Thank you so much. I really appreciate you taking the time to chat with me and educate me on this. I know it is definitely something I have been curious about for a while and you read a little bit here and there, but it is nice to get the chance to have all the questions answered at once, so I appreciate you joining me today. I hope our listeners can get a lot out of it as well.
[36:46] Robin Devine: Well, there’s so many people, when you look for them and you start looking for those people who are geeky about the lymphatic system, they are there.
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