Know Your Nodes, Part II

By Riva Preil

Approximately 10% of water that exits the capillaries and enters the interstitial space at the arterial end of the capillary does NOT return at the venous end due to pressure related factors (refer to Starling’s Equation for more details).  This “extra” water (referred to as the lymphatic load) enters the lymphatic system at lymphatic capillaries to the venous angles (the junction of the left subclavian vein and the internal jugular vein).  The lymphatic system meets the circulatory system at the venous angles, and it is where the extra water is returned to the circulatory system.

Furthermore, certain molecules, including fats from the digestive system and certain large proteins, are TOO LARGE to travel through the narrow diameters of the circulatory vessels.  Instead, they travel through the larger lymphatic vessels along with the water.

Now, moving on to the title of this blog…It would be impossible to explain the lymphatic system without mention of our ever so crucial LYMPH NODES.  Lymph nodes are small oval shaped organs that contain white blood cells, T cells, and B cells which are responsible for fighting infection and are a component of the immune system).  All lymph fluid travels through a series of lymph nodes, which are also responsible for filtering the lymphatic fluid.  There are approximately 600 lymph nodes in the average adult human body.

Know Your Nodes, Part I

By Riva Preil

Can you believe that Labor Day has come and gone?  Yes, dear readers, summer is officially over.  But boy, was it an amazing and memorable summer!

Believe it or not, when asked about the highlight of my summer, I unequivocally and enthusiastically respond that it was my lymphedema certification course.  (#PTnerd.  And darn proud of it too).  Fortunately, I had the wonderful opportunity to return to class this summer and learn some pretty incredible, stimulating, and practical material. Touro College, right here in New York City, hosted a course taught by The Academy of Lymphatics, one of the highly recognized training centers in the world of lymphedema.  The course was an intensive nine day class which was three classes condensed into one.  In addition, each participant was required to complete seven modules which included extensive textbook reading. Each module contained a written online examination which we were required to complete prior to attending the class. I found this approach extremely beneficial, because it allowed me to begin with a strong foundation.

The course itself was fascinating!  The instructor, Marina Maduro, and her assistant, Kirat Shah, are excellent educators who were clearly well versed in the material and who explained difficult concepts well. I would be one to know; let’s just say I am not shy when it comes to asking questions, and I challenged them on many a concept that they clarified and explained clearly.

You are probably wondering, okay Riva, so what did you ACTUALLY learn, in a nutshell, in this course?  Let’s start off by first discussing the lymphatic system itself.  I like to call the lymphatic system “the secondary circulatory system.”  It is an OPEN system without a central pump. The primary circulatory system, which consists of the heart, blood vessels (arteries, veins, and capillaries), are responsible for transporting fluids, nutrients, gases, and waste products throughout the body.  It is a CLOSED system with a pump (the heart)…

To learn more, stay tuned for my next post!

Live (Yesterday) from New York!

By Riva Preil

Even if you snoozed, you DIDN’T lose your chance!  If you missed yesterday’s live episode of The Pelvic Messenger, May the Floors Force Be With You with Diane Lee, you can STILL listen to it and enjoy her knowledge and wisdom. I feel blessed to have had the opportunity to interview such a renowned clinician and educator, and I am pleased to share my reflections on the experience with you.

Diane opened the conversation with a description of her professional journey and telling us about her role models.  She then described the Integrated Systems Model and explained the difference between form closure, force closure, and motor control.

Diane also elaborated upon various postpartum issues that mothers may face, and she shared helpful hints with listeners regarding how to address those problems.  (I don’t want to spoiler alert y’all and ruin the excitement for you, but I WILL give you a hint: Baby Belly Belt. Listen to the show, link below, for more details!)

Diane proceeded to discuss some of her most rewarding experiences as a physical therapist, and she whet our appetite for her upcoming International Pelvic Pain Society presentation (October 22-26 in Chicago, Illinois).  She also described her upcoming exciting trip to South Africa, where she will work with other PTs to educate health care providers and treat underprivileged women. One of my favorite parts was when Diane extended a PERSONAL INVITATION to me to join her on her medical mission!

It was an honor and privilege to (virtually) meet one of MY role models, and I encourage you to sit back, relax, and enjoy the show.  Comments and feedback are warmly welcome- this was my first show (!) and I would love to hear your thoughts 🙂

P.S. The interview starts 1 minute and 13 seconds into the show, so don’t be alarmed if you don’t hear anything for the first minute or so. ENJOY!    

May the Floor’s Force Be With You! (Part 2)

By Riva Preil

The theory behind The Integrated Systems Model for Disability & Pain, an approach co-developed with L-J Lee, is an evidence-based whole body/person approach to help optimize function and performance.  This approach considers regional alignment, biomechanics and control during meaningful task analysis and determines something called the ‘primary driver’ when there are multiple sites failing to transfer load well during the task being analyzed.  The primary driver is the area of the body that when treated will have the biggest impact on function and performance of the rest of the body.

Diane treats, teaches, writes, and creates.  Her enormous contributions to the world of pelvic floor physical therapy are recognized and appreciated.  Please tune in to the show on July 22 at 3 PM to experience Diane’s brilliance and creativity first hand.  For those who can’t tune in live, the show will be archived and accessible at:

Can’t wait until July 22 and thirsty for knowledge TODAY?  Previous shows are available RIGHT NOW!  Check out the links below for incredible options:

May the Floor’s Force Be With You! (Part 1)

By Riva Preil

Last week, I encouraged you to “stay tuned for more details” regarding my upcoming blog talk radio show entitled May the Floor’s Force Be With You on The Pelvic Messenger. Thank you for waiting patiently and here they are!

On the next Pelvic Messenger, Diane Lee will discuss the forces that affect the pelvic floor and how to maintain pelvic floor health.

Diane Lee has been practicing physical therapy for almost 40 years, and she is the owner and senior Therapist at Diane Lee and Associates.  Diane has been a member of the Canadian Physiotherapist Association since 1976, and she has been a fellow of the Canadian Academy of Manipulative Therapy (FCAMPT) since 1981. In addition, she created the Com-pressor, a unique, patented sacroiliac support belt as well as the newly released Baby Belly Belt, a specialized pelvic support with broader applications.

Diane is internationally recognized as an expert in the field of thoracic, lumbar, sacroiliac, and pelvic disability and pain.  The fourth and latest edition of her popular book, The Pelvic Girdle, serves as a crucial guide for many practitioners.


Riva Speaks at Plaza College!

By Riva Preil

Riva, right, with Dean Marie Dolla, left.

Thanks to the help of Dean Marie Dolla, I had the pleasure of presenting a talk about pelvic floor physical therapy at Plaza College yesterday.  The goal of the presentation was to educate young women about the prevalence, signs, symptoms, and treatment of pelvic floor dysfunction.

Unfortunately, many women are unaware of the existence of pelvic floor physical therapy (or even of their pelvic floors altogether)!  When asked about my job, I respond that I am a pelvic floor physical therapist.  The follow up question I expect to receive (and almost always do) is “What is that?”

Many of us function on autopilot- when our bodies function as we expect them to, we don’t think twice.  We go about our business and don’t give too much thought to our bowel and bladder function. However, if, for whatever reason, the pelvic floor muscles cease to operate in the smooth manner that we often take for granted, symptoms such as urinary frequency, urgency, incontinence, constipation, and/or pelvic pain may develop.

Very often, these symptoms are associated with MUSCULOSKELETAL dysfunction in the pelvic floor.  When this is the case, pelvic floor physical therapy can help alleviate the aforementioned symptoms.  That was the goal of my talk–to raise awareness amongst a population of individuals who may be suffering in silence.  I am passionate about my job and strongly believe that is important to EDUCATE women about their bodies and their health so that they can pursue avenues directed towards improvement.  I long for the day when I will not have to explain my job to new people that I meet, because they will already know what pelvic floor physical therapy is.  By educating the 25 of women at Plaza College, I have taken another step along that journey.

An Interview with Alexandra Milspaw, Member of the Alliance for Pelvic Pain

By Riva Preil

amAlex is a licensed professional counselor (LPC) in the state of Pennsylvania.

Her recently released audio CD, “Guided Meditations for Mindful Living”, is now available on iTunes, CDbaby, and You may also order a copy directly from her by calling 610-868-0104, ext. 3.

Alex earned her Bachelors of Arts in Sociology, Anthropology and Women’s Studies as well as a Masters of Education in Counseling Psychology and Human Services from Lehigh University. She received her Masters of Education in Human Sexuality at Widener University. She is currently a doctoral candidate in the field of Human Sexuality at Widener University. Alex is certified as a Master Practitioner in NeuroLinguistic Programming, Emotional Freedom Techniques (EFT) and Mindfulness-Based Stress Reduction Trainer. She has been working with patients suffering from chronic pelvic and genital pain for two years, focusing on the counseling and education of mind/body relaxation for stress and pain management.  Alex has been running workshops for women for over 6 years.  Her private counseling practice specializes in depression, anxiety, trauma and sexual health.

  1. What was the goal in creating the Alliance?

Our main mission in creating the Alliance was to expand knowledge and care to the underserved population of female patients with chronic pelvic pain. We wanted to create an atmosphere where patients felt safe to be their authentic selves and felt comfortable in expressing their thoughts and feelings.  It was important to us to help these women meet each other in an effort to help them not only realize they are not alone in their experiences, but also to learn there are answers and reasons for their pain. Too often I hear from our patients I meet at Dr. Echenberg’s office that they have been to countless numbers of doctors without receiving any clear explanations for their pain and symptoms. In fact, many of them have been told that their pain is “all in their head”, which is a complete neglect and dismissal of their experience. Hearing these stories also lead to a main goal of the Alliance, which is to also expand knowledge to health care professionals around the country. We hope to hold educational retreats for professionals as well as patients in the near future.

  1. What were the highlights of the weekend in your opinion?

I think the entire weekend was a highlight! Beginning with Friday night’s “Meet and Greet”, the energy in the room was swirling with excitement and camaraderie as the participants began to meet each other and share stories.  The entire lobby of Hotel Bethlehem was buzzing with sounds such as, “Really? Me too!” and “Oh my gosh, I thought I was the only one.”  Watching the smiles on these women’s faces and hearing that this is the first time they have smiled and felt part of a community warmed my heart and expanded my energy for the upcoming weekend.

Another great highlight was when some of the participants gave us the idea to have a special lunch table for those under 30 years old. Watching the young women share stories and tears was sensational.

Another highlight was having the immense support of our sponsors, which provided us the ability to provide over 10 raffle baskets and generously filled guest bags for all participants. Having the “extras” always helps make an event more exciting and enjoyable! It was also great to be able to donate over $200 from the raffle to the Pelvic Messenger, which is a non-profit dedicated to educating the world on CPP.

Another highlight was the break-out sessions, which provided more one-on-one attention in practicing the techniques discussed in the lectures. Specifically, participants enjoyed the physical therapy workshops with the help of Dustienne Miller, who is a wonderful yoga teacher dedicated to the care of those coping with pelvic pain.

Finally, a highlight that was more “behind the scenes” was the opportunity to meet with one-on-one practitioners who specialized in a variety of areas, including nutrition, Emotional Freedom Techniques, One Brain, Sound Therapy, Qi Gong, Yoga, and Myofascial massage. We are so grateful for the providers who took their weekend to be available for individual sessions for the participants.

  1. What was some of the feedback you received from participants?

We have received very positive feedback overall, including the highlights listed above. Some constructive criticism we received revolved around the food available during the meals. While we tried our best to make the meals “IC friendly”, there were other additions and subtractions that we missed. However, all of those details are written in bold for the next retreat! Overall, feedback mainly revolved around the buzz of meeting others with shared experiences, knowing they are not alone and that there are answers to their symptoms, leaving with concrete techniques, resources, tools and treatment leads, and enjoying the dedication and passion of the Alliance presenters. According to all of the evaluations, we achieved all of our goals that we set out to accomplish! These goals included the following:

  • Participants will develop and practice self-healing techniques.

  • Participants will create a consolidation of self-care skills acquired during the therapies.

  • Participants will illustrate to themselves and others that progress can be made in managing their pain.

  • Participants will assess the cognitive, emotional, social, spiritual, and physical consequences of their chronic pelvic pain and how these influences are affected by the pain.

  • Participants will develop understanding of how CPP affects their sexuality.

  • Participants will develop an understanding of how CPP affects their relationships with friends, family, and themselves and will learn how to better navigate these relationships.

  • Participants will develop an understanding of multiple treatment approaches that they can explore within their own community.

  • Participants will learn how to reframe their sexuality as it relates to CPP.

  • Participants will have an opportunity to connect with others who share their experiences and feelings related to CPP.

  1. How did the Yoga sessions complement the lectures and workshops?

The yoga sessions helped guide participants through relaxation and stretching techniques to help release their pelvic floor muscles and surrounding muscles involved with CPP. It was fun to be able to first educate the participants on the muscles and ligaments that are involved, and then follow that with actual techniques on how to address these muscles through specific stretches and movements. Dustienne is also wonderful at talking them through relaxation breathing techniques, which complimented the mindfulness-based stress reduction lecture and workshop.

  1. Would you do this again? What do you look forward to incorporating into future Alliance retreats?

I absolutely plan on doing this again. I look forward to planning more break-out workshops and expanding the retreat to 3-4 days, rather than trying to squeeze it all in to 2 days. This will also for more one-on-one attention as well as more “free time” for participants to spend quality time together without being exhausted from a busy day. I will have more one-on-one treatment providers available on-site to not only offer sessions but also answer questions about the modality and how it helps with CPP. I also plan on having a “pre-retreat” training day for health care professionals that also offers continuing education credits (CEUs), which always helps practitioners attend! I would also like to incorporate more patient testimonials to help emphasize the importance of an integrative, multidisciplinary approach with all chronic pain disorders. It’s so hard for many to afford the multidisciplinary services because most are not covered by insurance. However, it is so important to the management and treatment of chronic pain and this must be understood and emphasized more by mainstream health care providers.