Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Editor's Note: The information contained in this article is intended for informational purposes only. Working in this field must be done within scope of practice, in Western medical partnership, and with adequate education and training.

As cancer becomes increasingly prevalent in our society, the likelihood of encountering a client with cancer or desiring to work specifically with this illness is growing in the massage therapy field. Being aware of massage therapy's risks, protocols and preferred modalities for a person living with a cancer diagnosis is crucial before interfacing with this disease.

Massage's Risks
The primary risk of working with cancer is the possible encouragement of its spread. Since medical technology cannot yet accurately predict when, how or why it occurs, the spreading of malignancy takes place at any time, and could potentially be blamed on any therapeutic intervention. Massage poses such a risk because metastasizing cancer cells are believed to utilize the body's circulatory system to spread. As massage therapy generally increases local and systemic circulation, it is easy to see why bodyworkers are cautioned against working with individuals harboring malignancies.

In addition to the risk of metastasis, people undergoing Western medical treatment for cancer are likely to be very weak. Aside from surgical intervention, the two primary treatments for cancer include chemotherapy and radiation. While chemotherapy is more systemic and radiation therapy is more localized, both kill just about everything in its path, making the body's immune system virtually defenseless.

· White blood cells are destroyed along with cancerous cells during traditional cancer therapies. A person with an extremely low white blood cell count will be unable to protect themselves from any external pathogens. Until these individuals' immunity recovers, the slightest introduction of germs can have devastating consequences. Extreme attention to hygiene must be practiced in this situation.

· In addition to cancerous cells, cancer therapies also eliminate blood platelets. Without platelets, anything more than light pressure will not only result in severe bruising, but could also lead to uncontrolled internal bleeding. Obviously, a person with low blood platelets must only receive the lightest of touch therapy.

· Weakness and fatigue are often the most encountered symptoms during cancer treatment. Talking on the phone or walking across the room can be exhausting feats a person in this situation hopes to accomplish. A normal-length bodywork session can sap the person of what little amount of energy they have, as it is too much for a body fighting cancer to handle. Very short sessions, less than 10 minutes, are a more realistic goal for those who are extremely weak.

· Traditional cancer therapies can be very drying to the body, which explains the typical presence of an IV. Considering the lack of fluids to escort out any toxins released from bodywork, a massage that is too intense can easily maximize the stress on the liver and kidneys, and can push the client into a toxic reaction. Again, short and light bodywork can circumvent this complication.

Protocol
There are four critical elements of massage therapy protocol for people in cancer treatment, and they are very straightforward.

1. The first is obtaining physician permission. Only the client's doctor has the authority to clear them for massage. Be prepared to discuss your plans with the physician and request permission in writing. A person in a clinical trial will likely not receive the okay from their physician, as it may skew the results.

2. The second is communicating with your client. Judging if the work is too intense for your client is most accurate when you communicate freely with the recipient. Make certain they inform you if feeling dizzy, nauseous, suddenly exhausted or otherwise unwell.

3. The third is documentation. Documenting your work in the traditional style of SOAP notes will protect you and your client from accusations or legal action. Additionally, it may provide enlightenment when the patient recovers quickly.

4. The fourth is compassion. Working with this population is not only demanding and dramatic, but requires unremitting compassion. Most professionals in the massage therapy field are overflowing with this quality, but it is essential in working with cancer.

Preferred Modalities
As dictated by the risks, the preferred massage modalities for a person in cancer treatment center on being gentle. Enhancing muscular, blood or lymph circulation is much too aggressive for a person battling cancer. Styles that incorporate a light touch and focus on energy healing are the safest and most effective for clients in such a vulnerable state.

Therapeutic Touch Therapy is the most effective, well-known alternative therapy for individuals in cancer treatment. In fact, there is so much research on its efficacy that many registered nurses administer Therapeutic Touch to cancer patients. Reports on this type of gentle energy work claim that for people with cancer, it decreases pain, improves vitality, increases physical functioning and benefits their mood.

As our understanding of the benefits of touch therapy for cancer broadens, practitioners working with this population will become increasingly in demand. If you decide (with physician permission) to work with a client in therapy for a cancerous condition, make certain you are aware of the risks, protocols and best method of bodywork administration. Armed with the permission and knowledge necessary, compassion is the remaining ingredient to bringing the wonders of touch to a person who could really use it.

Earn continuing education credit for this article contained in our Cancer & Massage series. Click here to enroll.

Recommended Study:
Healing Energy and Touch

References:
Hubbard, Ariel, Energywork: A Powerful Complement to Massage, Massage Today, June 2005.

Massage and Healing Touch Ease Cancer Symptoms, Massage Magazine, May/June, 2004.

Healing Touch Augments Radiation Therapy, Massage Magazine, November/December 2004.

Post-White, Janice, RN, PhD, FAAN, Therapeutic Massage and Healing Touch Improve Symptoms in Cancer, Integrative Cancer Therapies, Vol. 2 No. 4, 2003.

www.school-for-champions.com, Basis of Therapeutic Touch and Healing Touch, Ron Kurtus, Kurtus Technologies and The School for Champions, 2005.

by Nicole Cutler, L.Ac.

The ancient Chinese art of design, Feng Shui, extends well beyond home decorating. Based on the premise that our environment can profoundly affect our physical, emotional and spiritual well being, many factors contribute to this style of design. First used to help farmers decide where to plant their rice fields and build their houses, Feng Shui’s principles today are used to design both interior and exterior spaces where people feel comfortable interacting with one another. Creating a space that makes you feel good includes its directional orientation, arrangement of items, spatial layout of furniture and placement of objects, as well as the source, intensity, location and direction of the room’s lighting.

Well-known to Feng Shui practitioners, lighting can dramatically transform any space. Dependant upon how it is lit, a room can be perceived as cool and sterile, small and cramped, or warm and cozy. “How a space feels,” says Feng Shui consultant and lecturer Linda Varone, RN, MA, CFS, “affects how people respond at a conscious and unconscious level. While some spaces just don’t feel right and people want to leave right away, other spaces invite people to relax and talk comfortably about personal concerns.”

Yin and Yang
Feng Shui is based on the principle of yin interplaying with yang. In Chinese philosophy, yin and yang represent the two cosmic, opposing forces of the universe. Yin is the receptive, passive, solid and cold force, while yang is the aggressive, energizing, moving and warm force. As such, light is perceived as a yang element. Using bright light within a space or shining it on an object increases the active energy of that location.

To encourage the restfulness and inactivity typically desired as part of a massage session, reducing the amount of light is favored. However, this concept does not encourage complete darkness, as achieving balance always remains the goal in Chinese-driven philosophies. The well-known yin-yang symbol represents such equilibrium, illustrating darkness following light, while each retains a small component of the other.

Effective Feng Shui occurs when yin and yang are harmoniously balanced. For example, a room with no windows, very little light and dark walls is exceedingly yin in nature, and needs a yang force to balance it. In this example, bringing in yang with appropriate lighting will stimulate the energy and transform this room into a pleasant space.

In the physical realm, light is radiant, electromagnetic energy. When light strikes the retina, it creates visual sensations, stimulating a neurological response in the brain. Revealing shape, size, texture, color, depth and location, light encourages brain activity. Desired during a massage session, a hiatus from conscious brain activity leads to increased relaxation. On the other hand, an overly darkened room can transmit feelings of depression and suffocation. Once again, finding a balance between light and dark is conducive to healing.

Flicker
Most institutionalized healthcare settings use florescent lights that function by flickering on and off up to 60 times per second. While this is too rapid for the eye to see, this flicker is noticed on a subliminal level and can cause fatigue. To counter this effect, lamps using incandescent bulbs or windows bringing in natural sunlight reduce the impact of a flicker. Although relaxation is desired in bodywork, causing fatigue from over-stimulation of the eye runs contrary to a healer’s purpose.

Hard and Soft
When choosing lighting for a massage space, it is important to consider the difference between hard and soft lighting.

Hard lighting equates to a brightly lit area, and is best suited for areas requiring attention or concentration. Hard lighting makes hallways, landings and porches safe and can help spaces seem wider. For vulnerable individuals, prolonged exposure to hard lighting creates feelings of stress. Hard lighting includes:

· Direct light (ex: spotlight)
· Fluorescent light
· High wattage bulbs

Soft lighting reduces brightness, encouraging relaxation. Also called ambient lighting, this illumination is ideal in the actual room where massage therapy is administered. Ambient lighting comes from an indirect light source that throws light against a wall or ceiling, creating soft illumination through reflection. Ambient lighting creates a relaxing, inviting atmosphere with:

· Indirect light (ex: sconces)
· Floor torchieres or uplights
· Lamp shades
· Yellow or pink lighting
· Dimmed lighting or low wattage bulbs

Diffuse, indirect, soft and low lighting are a bodyworker’s best bet in creating a relaxing, comforting and healing environment. By using the principles of Feng Shui in lighting up your massage space, you are adding another dimension to your services. Careful consideration of the type of illumination you use and how it will affect your clients is a relatively small detail that can make a big difference in your practice.

References:

www.altreligion.about.com, Yin Yang, Jennifer Emick, About Inc., 2006.

www.associatedcontent.com, Feng Shui Balancing Tools Including Color and Light, Kathy Browning, Associated Content, Inc., 2006.

www.fengshui.about.com, Feng Shui Cures, About, Inc., 2006.

www.fengshui.com,au, Lighting, Gayle Atherton, 2002.

www.feng-shui-tips.net, Fantastic Fixtures, Sally Fretwell, 2006.

www.healthliteracy.com, In Other Words…Using Feng Shui to Improve Healthcare Communication, Helen Osborne, MEd, OTR/L, Boston Globe's On Call Magazine, May 2001.

www.qi-journal.com, Feng Shui: Light and Lighting, Sally Fretwell, Qi Journal 2006.

www.strang-inc.com, Integrated Lighting Design Boosts Performance, Strang, 2006.

Anatomy
The nasal cavity contains a high proportion of blood vessels for the relative size of this facial structure. The septum is the tissue that divides the nose into two passages. There are two general locations of injuries to the nasal septum that causes nosebleeds:

1. The anterior nasal septum is the more common area for a nosebleed. This is a result of injury to the frontal portion of the nose and typically causes blood to flow out of the nostrils.

2. The posterior nasal septum is a less common location for a nosebleed. In posterior epistaxis, there is injury to the upper, rear portion of the nose and typically causes blood to backflow towards the back of the mouth and throat.

Causes
The following are the most common reasons why a nose would bleed:

Dryness – The most common cause of a nosebleed is drying of the nasal membranes. This frequently occurs in the winter months, when many people breathe the dry, warm air produced by artificial heat.

Trauma – An obvious cause of epistaxis, nose trauma can be a result of nose picking, foreign bodies in the nose, forceful nose blowing or sneezing and receiving a hard impact to the nose or head.

Irritant Inhalation – Repeatedly inhaling an irritant such as ammonia, sulfuric acid, medicated nasal sprays or cocaine is a cause of epistaxis.

Hypertension - Uncontrolled high blood pressure makes highly vascularized areas (including the nose) prone to bleeding.

Inflammation – An inflamed and irritated nose due to an upper respiratory infection, allergies or sinus irritation can result in epistaxis.

Tumor – While not a common cause, a benign or malignant tumor of the nose or sinuses may cause a nosebleed.

Medications – Medications that interfere with blood clotting, such as anticoagulants and non-steroidal anti-inflammatory drugs can make it easy for a nose to bleed.

Other systemic conditions – Some conditions make a person more susceptible to nosebleeds such as HIV/AIDS, pregnancy, leukemia, liver disease and hemophilia.

What to do?
If you or your client experiences a nosebleed, the symptoms can likely be stopped in your office. If epistaxis occurs in your massage space, make certain to follow universal precautions regarding contact with blood. These precautions include using gloves, proper hand washing, laundering, and disposal procedures.

Most anterior nosebleeds stop within 20 minutes without the need for professional medical intervention. Experts recommend the following steps be taken:

Remain calm. Anxiety around a nosebleed will upset the bleeder, possibly encouraging further bleeding.

Sit upright. The bleeder should sit up and lean forward with the mouth open. In this position, they can spit out any blood instead of swallowing it. Swallowing blood may cause nausea and vomiting.

Remove any objects. If possible, check to see if there is an object inside the bleeder’s nose, and remove it as necessary.

Pinch the nose. Pinch the soft part of the nose together between the thumb and index finger for at least five minutes. Repeat as necessary until the bleeding stops.

Apply ice. Crush ice and place in a plastic bag or washcloth before applying to the nose and cheeks.

Be gentle. Once the bleeding stops, refrain from picking or blowing the nose. Breathe through the mouth for a while and avoid straining, bending or lifting.

Epistaxis Prevention
If you or any of your clients are prone to nosebleeds, there are some preventative measures that can reduce their recurrence:

· Open your mouth when sneezing so air can escape through the mouth instead of the nose.

· To moisturize dryness, use a humidifier for the air and petroleum jelly or vitamin E oil on the inside of the nose.

· Avoid nose picking.

· Avoid lifting heavy items.

· Avoid straining during a bowel movement.

· If hypertension is the culprit, work with a physician to control it.

Seeking Help
While a massage therapist can typically handle nosebleeds, it is important to know when a physician’s referral is required. Seek a physician’s help immediately when:

· The nosebleed continues after 20 minutes of continuous pressure application.

· There are unexplained bruises on other parts of the body.

· The nosebleed is accompanied by nausea and/or vomiting.

· The nosebleed is accompanied by weakness, dizziness or excessive perspiration.

· The nosebleed is accompanied by chest pain or shortness of breath.

· The nosebleed is accompanied by syncope (fainting), or feeling like syncope could occur.

Being informed and prepared to handle the common winter occurrence of nosebleeds will boost your confidence when this situation arises. Additionally, your client’s trust in you will continue to deepen as you demonstrate a firm and calm command of the body’s nuances.

Recommended Study:
Anatomy and Pathology
Infectious Disease: HIV
Infectious Disease: Hepatitis C

References:

www.medindia.net, Nose Bleed/Epistaxis, Medindia, 2006.

www.med.nyu.edu, Nosebleed, NYU Medical Center, Debra Wood, RN, 2006.

www.sportsinjuryclinic.net, Facial Injuries, Sports Injury Clinic, 2005.

www.thecountrydoctor.com, Winter Epistaxis, John G. Hipps, MD, The Country Doctor, 2006.

www.tipsofallsorts.com, Nosebleed, tipsofallsorts.com, 2006.