What Is the Glymphatic System?

The glymphatic system is the lymphatic system in the brain.
It was first named in 2012.
It cleans your brain, carries nutrients, and provides immune support for the brain.

How Does the Glymphatic System Work?

The glymphatic system is the combination of cerebral spinal fluid and interstitial fluid plus immune cells in the brain. It travels around the arteries and the veins and is regulated by the glial cells called astrocytes, and the aquaporins that live in their feet.
Glymphatic movement is influenced by the heartbeat, respiration, the tone of the vessels, macrophages, and the vagus nerve.

Why Is Sleep Important to the Glymphatic System?

The glymphatic system is 90% more active when we sleep.
It seems to be turned on by norepinephrin, which is stimulated by darkness.
It also works better when we are on our backs or sides.
Finally, the glial cells shrink when we sleep so moving fluid through the brain is easier when we sleep.

What Can Go Wrong With the Glymphatics?
Glymphatic function decreases as we age.
Poor glymphatic function is associated with neurodegenerative conditions such as Alzheimer’s and Parkinson’s.
If the astrocytes are damaged, it is hard for the glymphatic system to wash the brain and remove debris and carry nutrition to brain cells.

What Can Injure The Astrocytes and the Glymphatics?

• Neurodegenerative Disease
• Stroke
• Traumatic Brain Injury
• Poor Sleep
• Alcohol
• High or Low Blood Pressure
• Blood Sugar Dysregulation
• Toxins (including mycotoxins, biotoxins, heavy metals)

What You Can Do To Improve Glymphatic Function

• Experience Darkness – Lights out by 10pm
• Exercise Daily
• Eat anti-inflammatory foods like fruits, veges, clean fats, and clean proteins
• Check out chi gong for improving lymph flow
• Experience parasympathetic dominance – destress

How Dr. Caroline Can Help With Manual Hands-On Drainage of the Glymphatics
Dr. Caroline can help give the glymphatics a jump-start so your at-home care can be more effective.
She will start by opening the main drains of the lymphatic system – the subclavian veins – by the collar bones. Then she will work with the lymphatic vessels in the neck and the blood vessels in the head. She will check the bag that holds the brain and the movement of the bones in the head and the cerebral spinal fluid production and movement. Finally, she will work directly with the glymphatics to support their movement and the washing of the brain.

What Is Histamine?

Histamine is a neurotransmitter that is made out of the amino acid called histadine.

It affects many processes in the body including

• Autonomic function
• Energy/Arousal/Sleep
• Digestion
• Body Temperature
• Cognition
• Immune system

Histamine Has 5 Receptors

• H1 =Airways, blood vessels, skin, heart etc
• H2 =Gastric mucosa
• H3 = Central nervous system and other neurotransmitters
• H4 = Bone marrow

Histamine Is Broken Down By Two Pathways

• DAO – Diamino Oxidase – in the gut
• HNMT – Histamine-N-Methyltransferase – in the cell (50-80% of all histamine metabolism)

Food is only associated with about 5% of all the histamine in your body

That said, a low FODMAPS diet can still be super helpful for people with IBS and decrease gut mast cell activation.

To do a low histamine diet stay away from old food like fermented food, alcohol, dried fruit, aged cheese, processed meat, dried beans

Also stay away from foods that have sugars in them that can break down too easily and become old like garlic, onion, cruciferous vege, some nuts, some grains

How Does Histamine Relate to Depression?

H3 Histamine receptors regulate serotonin transport to ensure there is enough serotonin in the synapse.

Histamine kind of works like and SSRI in the central nervous system, but without the side effects.

H3 Histamine receptors also influence serotonin release.

Histamine and serotonin levels are inverse to each other. High histamine means low serotonin. So working to optimize histamine can also optimize serotonin.

Inflammation and Depression

Inflammation and depression are comorbid.
That means they occur together.

If you are inflamed you will have high levels of histamine and lower levels of serotonin.

If you have inflammation and high histamine, histamine will induce a breach of the blood brain barrier that will lead to more brain inflammation and affective disorders, foggy brain, and cognitive decline.

H1R – Histamine receptors 1 – in the prefrontal cortex and the frontal cortex and the cingulate gyrus are associated with depression

H3R – Histamine receptors 3 – hyperpolarize serotonin neurons and inhibit serotonin signalling. This can also be a pathway leading to depression

Mast Cell Function

Mast cells are messengers between the nervous system and the immune system.

They are associated with activation of pain fibers and transmission

Mast cells are a major producer of histamine and histamine provokes increased estrogen production.

Mast Cells Are Regulated by

• Vagus nerve
• Acetylcholine (parasympathetic neurotransmitter)
• Nitric oxide

Mast Cell Activation Syndrome (MCAS)

• Standard Allergy Symptoms (rash, itch, runny nose, sneeze etc)
• Pelvic pain/endometriosis/vulvodynia
• Bladder pain/overactive bladder
• Anxiety/depression
• Difficulty sleeping
• Fatigue
• Palpitations
• Constipation/diarrhea

Mast Cells and Estrogen

Mast cells have estrogen receptors, and high estrogen can cause mast cell degranulation.

Estradiol increases the number of mast cells

Dural mast cells are associated with menstrual migraines

Estrogen can decrease DAO

Endocrine disruptors like BPA (Bisphenol A) can bind to estrogen sites and activate a mast cell response.

Mast Cells and Progesterone

Mast cells also have progesterone receptors.

But progesterone can either help to stabilize mast cells, or induce histamine release.

Vitamin D & Short Chain Fatty Acids Also Stabilize Mast Cells

What Is Manual Muscle Testing?

Manual muscle testing is a type of functional neurology that checks to see what idea or things are distracting for the brain.

Your brain has an idea about how everything inside your body should work, and about how everything outside your body should work.

If something doesn’t meet up to the brain’s idea of what reality should be, for a second it is distracted and there is a delay in the muscle response.

Does Manual Muscle Testing Check for Truth?

No. There is no neurologic tract in the body for veracity.

The body is only able to perceive.

Sometimes we perceive correctly, sometimes we perceive incorrectly.

How Do You Use Manual Muscle Testing?

I use manual muscle testing several ways

1. As adjunctive care with other diagnostics like lab

Sometimes I will use muscle testing to determine which brand of supplement I might suggest or something like that

2. As a tool to determine perceived stress with the treatment modality neuroemotional technique (NET)

With NET we are looking at what emotions or situations are distracting for the brain.

We will have a weak muscle test when the brain is distracted because the person is experiencing stress over a situation.

Manual muscle testing is helpful for finding the stressor and then figuring out the best way to fix it.

3. As a distraction for the mental mind

I will sometimes use muscle testing to help me during energy work.

In this case, I feel like the muscle testing is a sort of automatism that helps to shift away from my mental mind into my third eye so I can see the relevant stories more quickly and more clearly. I don’t think it is necessary, but simply a teaching aid for me at this time of my development.

What Is Adenomyosis?

Adenomyosis is endometriosis of the uterus. It occurs when the endometrial glands grow into the myometrium in addition to being in the endometrium.

Adenomyosis is a type of chronic pelvic pain.

Who Gets Adenomyosis

People used to think that only women in their 40s and 50s who had already had a baby were at risk of adenomyosis.

Now, with the wide-spread use of ultrasound, gynecologists are checking the uterus for younger women with painful periods and noticing the uterus looks thicker and more globular like the adenomyosis uterus.

About 50% of women with adenomyosis also have fibroids.

What Are the Symptoms of Adenomyosis

• 1/3 women asymptomatic
• Heavy menstrual bleeding
• Irregular bleeding
• Pelvic pain with period
• Pain with sex
• Infertility

Cause of Adenomyosis

• Injury from cesarean, D&C, or pregnancy
• Altered lymph and venous drainage
• Abnormal initial development of the layers of the uterus

Hormones and Adenomyosis

Adenomyosis presents as an estrogen-dominant condition. However, generally women do not have higher levels of estrogen.

The issue is that there are more estrogen receptors, and the estrogen receptors are more sensitive, so the same amount of estrogen has a bigger effect.

There are also problems with estrogen metabolism so you have recirculation of estrogen.

Additionally, there is an excess of inflammatory prostaglandins with adenomyosis. This leads to painful periods and heavy bleeding.

How To Diagnose Adenomyosis

• 2 or 3 dimensional transvaginal ultrasound
• Pelvic MRI

Biomedical Treatment of Adenomyosis

• No FDA approved treatments
• NSAIDS
• Hormonal menstrual suppression
• Gonadotrophin-related drugs
• Hysterectomy (80%)

Natural Care for Adenomyosis

• Castor oil packs
• Visceral/vascular/lymphatic manipulation
• Improve estrogen metabolism – detox
• Down-regulate estrogen receptors with adaptogens
• Treat underlying conditions such as infection and inflammation
• Modify environmental exposures to estrogen

What Is Pudendal Neuralgia?

Pudendal neuralgia is pain experienced in the pelvic floor or external genitalia that is caused by microtrauma to the pudendal nerve.

Pudendal neuralgia is worse with sitting, and better with standing, laying down, or sitting on the toilet.

Why Do Some People Have Pudendal Neuralgia?

Trauma to the pudendal nerve most commonly can occur with childbirth, pelvic prolapse surgery, cycling, or excessive sitting.

If your pain has not resolved with decompression surgery or pelvic floor myofascial release, other causes of pudendal neuralgia include endometriosis, viral infections, venous congestion, diabetes, and autoimmune conditions.

How To Diagnose Pudendal Neuralgia

You will be diagnosed with pudendal neuralgia if all the following are true.

• Pain in the area of the pudendal nerve
• Pain primarily with sitting
• Pain is not worse at night
• No sensory loss
• No itching with pain
• Pain is not fleeting
• Imaging doesn’t identify a different reason for pain
• Pudendal nerve block relieves the pain

Biomedicine’s Approach to Pudendal Neuralgia

• Pain killers and muscle relaxants
• Myofascial pelvic floor therapy
• Pudendal nerve block
• Surgical decompression

My Holistic Approach to Pudendal Neuralgia

• Set up the drainage system of the body
• Optimize organ mobility (especially kidneys and uterus)
• Address fascial constraint
• Address ligamentous and joint imbalance
• Optimize posture, breathing mechanisms, and postural muscle strength/activation

What to Expect

I will not be exclusively treating the pelvic floor

I will be identifying all the structures that have a bearing on the function of the pudendal nerve and optimizing their function.

If there is an underlying process like a viral infection, diabetes, or an autoimmune condition, we will treat that, too.

• 20 hours of hands-on manual therapy
• 2 hours of exercise
• 1-4 hours internal medicine

I feel like patients get better faster if they get treatments close together in the beginning.

People usually do well with a minimum of 2 hours of care a week.

If you are coming in from out of town for care, we should be able to complete the care within 7-10 days.

What Is Pelvic Congestion Syndrome?

Pelvic congestion syndrome occurs when the veins that are supposed to drain the pelvis cannot do their job adequately. The vein that most commonly has problems is the left ovarian or testicular vein.

Women or men can experience this syndrome and is characterized by

• Pelvic pain of >6 months duration
• Possible external genitalia varicosities
• Possible lower extremity varicosities or insufficiency
• Pain after or during sex (most diagnostic symptom)
• Pain worse with standing and walking
• Bladder or rectum discomfort
• Painful menstruation
• Swelling of lower extremities

Risk factors for pelvic congestion syndrome include

• PCOS
• Having had at least one baby
• Obesity
• Varicose veins

Biomedical Treatment

• Blocking the incompetent veins by embolization or sclerotherapy is considered to be the best treatment.

My Natural Approach
I recommend a trial of conservative therapy for patients to are interested in, and able to, exercise. Passive care without exercise might not be enough to improve function
My approach includes

• Treating any underlying conditions (such as PCOS, which generally is related to insulin-resistance, so requires dietary and lifestyle changes)
• Visceral manipulation (left kidney is commonly involved, as is uterine retroversion, pelvic organ prolapse, and adhesions from prior surgeries)
• Vascular manipulation (draining the veins, opening up the main venous and lymphatic returns to optimize movement)
• Botanical support for strengthening vessels and mobilizing lymph, fish oil to thin the blood, nattokinase to prevent clots associated with venous congestion
• Homeopathic suppositories for hemorrhoids (which are varicose veins)
• Instruction on physiologic breathing
• Hydrotherapy such as sitz baths or cold plunges to reset veins and wring out pelvic congestion
• Instruction on core strengthening

What To Expect

• Approximately 20 hours of manual hands-on visceral and vascular and lymphatic manipulation
• Approximately 2 hours of internal medicine consults
• Approximately 2 hours of exercise practice

How Long Does the Treatment Last?

I find people do better if the initial treatment sessions are frequent and close together.

People who are not too inflamed do well with a minimum of 2 hours of manual hands-on therapy weekly, and commonly more.

If you are coming in from out of town, we can complete all the therapy within 7-10 days.

Because some of the underlying conditions such as PCOS can take 3-6 months to heal, the final improvements will not be fully appreciated until the underlying conditions have healed.