A knee that goes beyond its normal limits will typically illicit pain, and could possibly set up the joint for a future of subsequently related injuries. A client with a current knee hyperextension or a history of such a problem requires that his or her attending massage therapist be aware of several anatomical and physiological facts. When addressing a hyperextended knee, bodyworkers are most useful to their clients when they know what type of activities could exacerbate the knee's instability and which muscles benefit most from circulatory massage.

Most people are aware of how easily the knee can be injured from twisting. However, fewer realize that straightening the knee beyond a straight line is another type of misalignment that can pave the way for more serious knee injuries. Over time, knee hyperextension can:

· Strain or tear ligaments

· Degenerate local cartilage (including the meniscus)

· Cause arthritis of the knee joint or kneecap

· Fracture the tibia

In many of the body's joints, ligaments and tendons play a major role in preventing excessive motion. If those tissues become too loose, the joint can move in ways that cause damage or set the stage for injury. Known as a hypermobile joint, the knee is particularly vulnerable to this problem. Experts agree that keeping the knee stable requires balancing the knee-extending strength of the quadriceps with the knee-flexing strength of the hamstrings and other knee-flexing muscles.

Anatomy
Normally, the ligaments and tendons surrounding the knee pull taut and stop the femur and tibia at the point where they lie directly in line with each other. The tissues at risk of being overstretched causing knee hyperextension include:

· The cruciate ligaments deep inside the knee

· The medial and lateral collateral ligaments on the inner and outer surfaces of the knee

· The popliteal ligaments, which cross the back of the knee

· The hamstring tendons coming down from the back of the thigh

· The gastrocnemius tendons coming up from the calf

According to Tressa Gorman Crehan, associate director of the University at Buffalo dance department and a professor of anatomy and kinesiology for dancers, hyperextension "can cause trauma to the knee capsule and, eventually, depending on the severity, can cause tearing or strain on the ligaments in the back of the knee." The anterior cruciate ligament, which helps prevent the tibia from moving too far forward in relation to the femur, is particularly susceptible to injury.

Repeated hyperextension of the knee places high levels of stress on the lower leg as well, and can lead to shin splints. In more extreme cases, it can result in tibial fractures. Knee hyperextension can also tilt the top of the pelvis forward, which can stress the hip joints, overarch the lower back and disturb posture all the way up to the head.

Causes and Exacerbation
Hyperextended knees can develop at an early age, lending credence to the belief that some are genetically more prone than others. However, this over-straightening of the knee is a common result of posture and movement anomalies from certain types of activities, such as from volleyball, dance, gymnastics, soccer or yoga.

Because a tight soleus can pull the tibia back, activities that tighten this muscle may encourage knee hyperextension. Women who wear high heels are particularly prone to this misalignment because of the tension the foot's angle places on the soleus. Massage therapists working with knee hyperextension can work to enhance circulation and lengthen the soleus to reduce this vulnerability.

Several ballet forms and yoga poses encourage participants to "lock" their knees, a position that strains the knee joint's extension capacity. A "locked" knee relies on shortened quadriceps muscles. Thus, bodyworkers can provide relief by kneading this large muscle group to achieve quadriceps relaxation.

Bodyworkers can help those with knee hyperextension problems by advising clients to avoid exacerbating activities and by working on the tightened muscles encouraging the misalignment. Strengthening the thigh musculature, minimizing stress on the soleus, massaging the soleus, quadriceps and other local tightened muscles as well as avoiding locking the knees, can all help prevent future pathologies arising from chronic hyperextension of the knee.

Recommended Study:
Anatomy Review for Professionals
Sports Massage
Swedish Massage for Professionals

References:

Cole, Roger, Please Your Knees, Yoga Journal, February 2009; 101-04.

http://www.dance-teacher.com/sections/health/122, Hyperextension and Bowleggedness, Michelle Velucci, Retrieved February 15, 2009, DanceTeacher, MacFadden Performing Arts Media, 2009.

http://www.yogajournal.com/practice/997, The Hyperextended Knee, Julie Gudmestad, Retrieved February 15, 2009, Yoga Journal, 2009.

Infertility affects millions of couples around the world. Although there are a wide range of physiological reasons for infertility, medical treatment to foster conception can have many side effects and is typically very expensive. Because of its effectiveness, safety and relative low cost, Shiatsu is a favorable option for a growing number of men and women hoping to expand their family.

What Is Infertility?
Affecting 10 to 15 percent of American couples, most experts define infertility as not being able to get pregnant after at least one year of unprotected, sexual intercourse. Women who are able to get pregnant but then have repeat miscarriages are also considered infertile. Infertility may be due to a single cause in a man or woman, or a combination of factors that prevents a pregnancy from occurring or continuing.

A result of a complex sequence of events, the following four phases must occur for a woman to become pregnant:

1. Ovulation - A woman must release an egg from one of her ovaries.

2. Egg Travel - The egg must travel through a fallopian tube toward the woman's uterus.

3. Fertilization - A man's sperm must find and fertilize the egg.

4. Implantation - The fertilized egg must attach to the inside of the uterus.

Infertility can result from problems that interfere with any of these steps.

Traditional Chinese Medicine
Traditional Chinese medicine (TCM) considers infertility to be a reflection of an energetic blockage or imbalance. With the goal of unblocking and rebalancing the affected individual's energy flow, TCM treatments have demonstrated effectiveness in improving male and female reproductive function.

In the traditional literature of TCM, fertility is closely related to the health of the following channels: Kidney, Liver, Spleen, Governing Vessel and Conception Vessel.
More specifically, the following TCM patterns are known to interfere with conception:

· A deficiency in the Kidney and Liver energetic organs disrupts the endocrine system, resulting in a hormonal imbalance that can prevent ovulation or implantation.

· Stagnant energy and/or blood in any of the five channels (but especially in the Governing and Conception Vessels) can easily prohibit ovulation, egg travel, fertilization or implantation.

· Besides hampering sperm and egg production, damp heat in the Liver or Conception Vessel channels causes inflammation that can irritate the delicate tissues needed for reproduction - thus impeding their function.

According to experts, stimulating key points encourages the energy within these channels to flow in a smooth, healthy fashion - thus improving chances for conception.

Shiatsu
Based on TCM theory, Shiatsu is an ideal, non-invasive application to improve circulation in the Kidney, Liver, Spleen, Governing Vessel and Conception Vessel channels. After Shiatsu practitioners evaluate their clients and conclude which TCM pattern is most likely responsible for infertility, they can focus on stimulating the following points:

· Kidney and liver deficiency - Kidney 3, Conception Vessel 4 and Spleen 6

· Stagnant energy or blood - Liver 3, Spleen 8, Spleen 10, Spleen 6

· Damp heat inflammation - Spleen 6, Spleen 9, Stomach 40, Gallbladder 34

While carefully directed Shiatsu treatments can help resolve an imbalance that is prohibiting conception, practitioners must remember which points to steer clear of on women who might be pregnant. On pregnant (or potentially pregnant) women, avoid:

· Points on the sacrum and lower abdomen
· Spleen 6
· Large Intestine 4

Of particular interest is Spleen 6 - which is advised in all stages of fertility treatment, yet contraindicated during pregnancy. Thus, whenever working with clients trying to conceive (whether they are having trouble or not), Shiatsu therapists must know if there is any chance of a pregnancy.

When a couple's attempts to procreate have been unsuccessful, they are likely to explore their options within allopathic and alternative medical practices. Massage therapists with an understanding of reproductive health, TCM pattern differentiation and Shiatsu can help balance their clients' energetic channels to overcome their fertility challenges.

Recommended Study:
Advanced Anatomy and Physiology
Prenatal Massage Fundamentals
Shiatsu Anma Therapy

References:

http://www.acufinder.com/Acupuncture+Information/Detail/Acupuncture+Points+to+Avoid+During+Pregnancy, Acupuncture Points to Avoid During Pregnancy, Diane Joswick, L.Ac., MTOM, Retrieved April 12, 2009, Acufinder.com, 2009.

http://www.altmd.com/Articles/TCM-for-Infertility, Traditional Chinese Medicine (TCM) for Infertility, Retrieved April 11, 2009, altMD LLC, 2009.

http://www.associatedcontent.com/article/150987/acupuncture_acupressure_and_massage_pg2.html?cat=68, Acupuncture, Acupressure, and Massage All Help Infertility, Lea Barton, Retrieved April 11, 2009, Associated Content, Inc., 2009.

http://www.mayoclinic.com/health/infertility/ds00310, Infertility, Retrieved April, 11, 2009, Mayo Foundation for Medical Education and Research, 2009.

http://www.womenshealth.gov/faq/infertility.cfm#a, Infertility, Retrieved April 11, 2009, US Department of Health and Human Services, 2009.

Jin, Yu, MD, Handbook of Obstetrics & Gynecology in Chinese Medicine - An Integrated Approach, Eastland Press, Seattle, WA, 1998; 69-85.

Maciocia, Giovanni, The Foundations of Chinese Medicine, Churchill Livingstone, New York, NY, 1989; 223.

As part of their education, massage therapists learn which pathological conditions could render bodywork as potentially dangerous. However, the rising popularity of massage coupled with our increasingly unaffordable healthcare system means that many bodywork patrons have not visited a physician in a long while. Thus, medical problems often go undiagnosed. Although diagnosing is beyond their scope of practice, bodyworkers must be able to recognize ailments where massage would be unsafe. As such, reviewing the early indicators of appendicitis can help therapists identify and quickly refer out clients in danger of a ruptured appendix.

The Appendix
The vermiform appendix, commonly referred to simply as the appendix, is a 3½ inch long tube of tissue extending from the large intestine. Some doctors believe it serves as a reservoir for immune cells because a high concentration of lymph cells have been found in the appendix. However, those without an appendix don't appear to suffer any negative consequences. Therefore, most physicians believe it to be a non-functioning remnant of an earlier stage in human evolution. Normally found in the lower right abdomen, the appendix becomes inflamed in one of every 15 people.

About Appendicitis
An inflammation of the appendix, appendicitis is a medical emergency that requires prompt surgery for removing the organ. There is a debate regarding why people get appendicitis, but a blockage within the appendix is one of the more likely causes. Several of the suspected reasons for an appendix blockage include:

1. A buildup and hardening of mucus or stool
2. Cancerous tissue
3. A foreign body
4. A swelling of lymphatic tissue

An obstructed appendix leads to local distention, bacterial overgrowth, a lack of circulation and inflammation. Left untreated, an inflamed appendix will eventually burst and spill its infection into the abdominal cavity. The reason appendicitis is an emergency is because infection in the abdominal cavity (peritonitis) can be fatal.

Appendicitis Symptoms
Anytime appendicitis is suspected, immediate action must be taken because the appendix often ruptures within 24 hours of presenting symptoms. Thus, a massage therapist who recognizes the signs of appendicitis should cease massage immediately and arrange for swift emergency care. The most common six indicators of appendicitis include:

1. Pain beginning around the navel, then moving to the lower right quadrant of the abdomen

2. Pain that is sharp and severe

3. Pain that progressively worsens and intensifies with movement or coughing

4. Low-grade fever

5. Loss of appetite, nausea or vomiting

6. Inability to pass gas

While a physician employs many techniques for diagnosis, these four tests can guide a bodyworker to better identify appendicitis:

1. McBurney's Point Test - Rebound tenderness at the junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior iliac spine

2. Rovsing Sign - Pain felt in the right lower quadrant with palpation of the left lower quadrant of the abdomen

3. Psoas Sign - An increase in pain from passive extension of the right hip joint that stretches the iliopsoas muscle

4. Obturator Sign - Pain caused by passive internal rotation of the flexed thigh

Healthcare practitioners are usually weary of jumping to conclusions that would cause their clients to worry. Since appendicitis can be fatal if not addressed immediately, suspecting your client's appendix is inflamed should be disclosed without hesitation. By reviewing these symptoms and tests, massage therapists are best prepared to spot a possible case of undiagnosed appendicitis - and their quick action could end up saving a client's life.

Recommended Study:
Advanced Anatomy and Pathology
Anatomy Review for Professionals

References:

http://www.hcahouston.com/CustomPage.asp?guidcustomcontentid=13B48D6D-F0E9-4C4B-A2C6-300EA1AD74C8, How to Recognize Appendicitis, Retrieved April 18, 2009, HCA Houston, May 2001.

http://www.massagetoday.com/mpacms/mt/article.php?id=10341, How to Say "No" When Your Client Says "Yes," Part III, Ruth Werner, LMP, NCTMB, Retrieved April 19, 2009, Massage Today, October 2001.

http://www.medicinenet.com/appendicitis/article.htm#tocc, Appendicitis and Appendectomy, Retrieved April 19, 2009, MedicineNet Inc., 2009.

http://www.merck.com/mmpe/print/sec02/ch011/ch011e.html, Appendicitis, Retrieved April 19, 2009, Merck & Co., 2009.

http://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis, Appendicitis, Retrieved April 19, 2009, WebMD LLC, 2009.

http://www.wisegeek.com/what-is-the-vermiform-appendix.htm, What is the Vermiform Appendix?, Retrieved April 19, 2009, wisegeek, 2009.

According to the American Rhinologic Society, sinusitis is the most common chronic illness in America with an estimated 35 million people affected. Those with repeated bouts have likely tried a range of over-the-counter and prescription drugs for relieving their sinus discomfort. However, sufferers may not realize that a massage therapist could potentially be their greatest ally in their battle against sinusitis.

In the acute stage of infectious sinusitis, massage therapy is systemically contraindicated. However, massage is appropriate for chronic and non-infectious cases of sinusitis, provided the client is comfortable. In general, acute sinusitis lasts for about three weeks; but it can persist for as long as three months. Chronic sinusitis lasts longer than three months and may not immediately respond to conventional antibiotic treatment. Symptoms of chronic sinusitis are less severe than those of acute, but can last for years.

Sinusitis Symptoms
Depending on the stage and cause of sinusitis, the symptoms differ slightly. Sinus symptoms are common during a cold or the flu, but this usually resolves when the infection does. More than just a stuffy nose, sinusitis symptoms are associated with one or more of the following:

· Nasal congestion/discharge that typically is thick and is yellowish to yellow-green.

· Facial pain, pressure, congestion or fullness that is accompanied by other symptoms of sinusitis.

· Symptoms that continue for 10 days or more after the start of a cold or flu.

· Symptoms worsen after five to seven days, or return after initial improvement in a cold.

· Diminished sense of smell.

· Fever accompanied by other sinusitis symptoms.

Other symptoms of sinusitis that usually occur in adults may include:

· Red, bulging or painful eyes
· A persistent cough
· Ear pain, pressure or fullness
· Halitosis (bad breath)
· Dental pain
· Fatigue

Because of the sinus' proximity to the brain, there are some additional symptoms that constitute a medical emergency. These include:

· Eyelid swelling and drooping
· Loss of eye movement or vision changes
· Fixed and dilated pupils
· Severe headache with altered vision
· Mild personality or mental changes
· Soft swelling over a bony area in the face

Specific for a Massage Session
Massage therapists who are working with a client reporting sinusitis must first determine that it is not an acute, infectious case or a medical emergency. Once the client's history confirms this, massage therapists can formulate their session plan. The following four bodywork techniques are known to help sinusitis by breaking up congestion, increasing circulation within the sinuses, aiding the lymph in removing sinusoidal debris and strengthening the immune system:

1. Sinus Massage: To promote drainage and alleviate congestion, perform a sinus massage. You can use these directions as a guide - beginning from the midline, massage in small circles laterally on the forehead out to the temples, the base and sides of the nose out to the cheeks and ears and along the mandible from the chin out to the ears.

2. Acupressure: Utilize the wisdom of Traditional Chinese Medicine (TCM) by applying pressure to the following acupoints - Urinary Bladder 2, Stomach 3, Stomach 8, Stomach 40, Gallbladder 20, Large Intestine 4, Large Intestine 20, Bi Tong, Yin Tang, Triple Warmer 17 and Governing Vessel 24.

3. Cranial Sacral Therapy: Because it moves stagnant cerebrospinal fluid within the bones of the skull, cranial sacral techniques create an influx of circulation, which consequently eases sinus pressure. This technique is especially useful for head, jaw, eye and ear pain from chronic sinusitis.

4. Lymphatic Drainage Massage: Because this manual technique stimulates the movement of lymphatic fluid, it helps the body thin out mucus. Especially when applied to lymph vessels in the head and neck, properly applied lymphatic drainage massage can reduce congestion and sinus pressure.

Whenever a massage therapist is working with clients who have sinusitis, there should be awareness of the following issues:

· Since there is no way to be sure that a client's secretions are non-infectious, be extra vigilant about potential contagion by following universal precautions.

· Affected clients are likely to have difficulty breathing in the prone position. If your session involves back work, make sure it is brief and take steps for your client's comfort.

· Chronic sinusitis sufferers may have inflammation that makes local massage painful. Continually check in with your clients to make sure that sinus massage or acupressure is not causing them pain.

· Bodywork will increase circulation and break up sinus congestion. To help move those toxins out of the body, advise your client to drink plenty of water following the session.

After repeatedly trying to get a handle on their congestion and pain, many sufferers have succumbed to the discomforts of chronic sinusitis. They may be in for a pleasant surprise when massage therapy brings them more relief than their primary physician ever could! By customizing a session with sinus massage, acupressure, lymphatic drainage and cranial sacral therapy, massage therapists can be the most important practitioner a chronic sinusitis sufferer ever entrusts with his or her care.

Recommended Study:
Anatomy Review for Professionals
Cranial-Sacral Fundamentals
Lymphatic Drainage Massage
Shiatsu Anma Therapy

References:

Braun, Mary Beth, Stephanie J. Simonson, Introduction to Massage Therapy, Lippincott, Williams and Wilkins, 2nd Edition, Baltimore, MD, 2007: 183.

http://adam.about.com/care/allergy/allergy_sinusitis.html, Sinusitis, Retrieved August 22, 2009, About.com, 2009.

http://www.american-rhinologic.org/patientinfo.sinusitisqa.phtml, What is Sinusitis?, Retrieved August 22, 2009, American Rhinologic Society, 2009.

http://www.associatedcontent.com/article/191771/how_to_stop_sinus_congestion_now.html?cat=68, How to Stop Sinus Congestion Now, Deborah Dera, Retrieved August 21, 2009, Associated Content, Inc., April 2007.

http://www.chinese-holistic-health-exercises.com/natural-sinus-remedies.html, Natural Sinus Remedies & Sinus Massage Techniques, Retrieved August 21, 2009, Chinese Holistic Health Exercises, 2009.

http://www.firsthealthofandover.com/MBWCranioSacral_Sinusitis.htm, CranioSacral Therapy: Supportive Options for Sinusitis, Retrieved August 22, 2009, FirstHealthofAndover, 2009.

http://www.umm.edu/patiented/articles/what_symptoms_of_sinusitis_000062_4.htm, Sinusitis, Retrieved August 22, 2009, University of Maryland Medical Center, 2009.

Editor's Note: October is National Breast Cancer Awareness Month. Learn more about this important event by visiting: http://www.nbcam.org/

According to the American Cancer Society, breast cancer is second only to skin cancer as the most common cancer among American women. With a one in eight chance that women in the U.S. will develop invasive breast cancer, early detection has emerged as a life-saving practice. Although not particularly common, inflammatory breast cancer (IBC) is a type of breast cancer that often goes unrecognized until it is in the later stages.

Especially because an estimated 46 million Americans are living without healthcare coverage, there is a great need for educating the public on recognizing the early signs of cancer. While they may not have a primary physician to ask health-related questions of, many who are uninsured will receive a periodic massage. Thus, bodyworkers may be the only healthcare professional accessible to someone with symptoms that could potentially indicate cancer. Massage therapists are not qualified nor are they equipped to diagnose cancer. However, knowing what symptoms represent cancerous red flags can prompt an important referral.

When it comes to educating the public about detecting breast cancer early, great strides have been made. Scanning for lumps via a breast self-exam is the focus of the breast cancer awareness campaign; however, IBC is not characterized by a lump. If familiar with IBC's signs, a massage therapist could be the first to notice that a client is at risk. By advising clients that their breast tissue anomaly may be cause for concern, massage therapists could facilitate an IBC diagnosis at an earlier stage than would have occurred without their intervention.

About IBC
While it is rare, inflammatory breast cancer is a very aggressive type of breast cancer, in which the cancer cells block the breast's lymph vessels. Accounting for one to five percent of all breast cancer cases in the United States, IBC is usually diagnosed in women younger than non-IBC breast cancer.

An advanced and accelerated form of breast cancer usually not detected by mammograms or ultrasounds, IBC requires immediate aggressive treatment and is treated differently than more common types of breast cancer. Inflammatory breast cancer usually grows in nests or sheets, rather than as a confined, solid tumor and therefore can be diffused throughout the breast with no palpable mass.

IBC Symptoms
Because it can occur without a lump, practitioners should be familiar with the following symptoms typical of IBC:

· Heat - A breast that is warm or occasionally hot to the touch.

· Dimpled - The breast and its surrounding skin can take on a dimpled appearance, looking like an orange peel. This texture is not a result of being overweight.

· Nipple Inversion - A nipple that is flat or inverted can indicate IBC, except if an inverted nipple has existed since birth.

· Breast Discoloration - The skin of the breast may appear pink, reddish-purple or bruised.

Other symptoms that could indicate IBC include heaviness, burning, aching, increase in breast size or tenderness that persist throughout a woman's cycle.

Not a Breast Infection
Usually developing quickly, IBC's symptoms may lead people to guess they have a breast infection. Although IBC is commonly mistaken for a breast infection, its symptoms won't go away with antibiotics. Unfortunately, many women (especially those without health insurance) will forego medical assistance and use home remedies to try and quell the discomfort of an assumed breast infection. This is probably the most common reason that IBC goes undiagnosed for so long, making it a much harder cancer to treat.

By being familiar with the symptoms of IBC, massage therapists can serve as public health educators to their potentially affected clients. So, the next time a client asks if you do any kind of massage to help speed the healing of a breast infection, ask more questions. Clients who have self-diagnosed themselves with a breast infection or who have IBC symptoms that have not responded to antibiotics must be evaluated by a physician. Even if your clients do not have health insurance, make sure to share with them what you now know about IBC.

Recommended Study:
Advanced Anatomy and Pathology

References:

http://covertheuninsured.org/, Let's Get America Covered!, Retrieved November 21, 2008, covertheunisured.org.

http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_breast_cancer_5.asp, What Are the Key Statistics for Breast Cancer?, Retrieved November 22, 2008, American Cancer Society, 2008.

http://www.ibcresearch.org/, Home Page, Retrieved November 20, 2008, Inflammatory Breast Cancer Research Foundation, 2008.

http://www.nci.nih.gov/cancertopics/factsheet/sites-types/IBC, Inflammatory Breast Cancer: Questions and Answers, Retrieved November 20, 2008, National Cancer Institute, 2008.

Along with the popularity of massage therapy, the percentage of Americans who use complementary and alternative medicine (CAM) each year is growing. On the positive side of this trend, an increasing number of people are taking control of their health to live a better quality life. On the not so good side, many of those interested in CAM are mixing drugs and supplements without the guidance of a knowledgeable physician. Although bodyworkers don't prescribe medications, they may be the first healthcare professional to recognize that their client is dabbling with a risky combination of substances.

CAM Popularity
The likelihood of a person taking supplements without the guidance of his/her physician is steadily rising. In December 2008, the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) released new findings on Americans' use of CAM. According to NCCAM, approximately 38 percent of American adults are using some form of CAM. The most commonly used CAM therapy among adults is reported to be non-vitamin, non-mineral natural products. In addition, America's patronage of deep breathing exercises, meditation, massage therapy and yoga is progressively growing.

The Concern
The popularization of CAM modalities has been a major player in improving the public's quality of life. However, many mistakenly assume that its isolation outside of conventional medicine renders their therapy as completely safe. Extensively trained in the cautions and contraindications of their profession, massage therapists are well aware of this common misconception.

When it comes to non-vitamin, non-mineral supplementation (the most popular form of CAM), most Americans act without professional guidance. Published in a December 2008 edition of the Journal of the American Medical Association, a study conducted by the National Institutes of Health and University of Chicago found that at least two million older Americans are taking a combination of drugs or supplements that can be a risky mix. According to the researchers, older men are particularly prone, with one in ten taking potentially harmful combinations.

Study Details
Based on analysis of nearly 3,000 interviews of Americans aged 57 to 85, the older population is especially vulnerable to potential drug and supplement interactions, because their medication use is higher than their younger counterparts:

· Encompassing over 50 million people, 91 percent of older Americans use at least one medication.

· More than half of older Americans use at least five remedies, including prescriptions, over-the-counter medicines or supplements.

Unfortunately, mixing substances without discussing it with a knowledgeable physician or pharmacist could result in disastrous consequences. As a CAM practitioner, massage therapists must be aware of this huge lack of guidance for the general public - especially with their older clientele.

What to Look Out For
As part of the initial history taking process, massage therapists traditionally ask their clients about the medications and supplements they take. Since medications influence massage, this information is crucial to maximizing the session's safety and effectiveness. However, this also means that massage therapists may be the first practitioners to realize their client is dangerously mixing substances. Some common things to look out for include:

1. Blood Thinners With Garlic - Warfarin is a potent prescription clot-fighting drug. Garlic supplements are often taken to benefit the heart and prevent blood clots. However, when taken together, the risk of bleeding is magnified. Excessive bleeding could include bruising easily, hard-to-stop bleeding from the gums or cuts or blood in the urine.

2. Aspirin With Ginkgo - Aspirin also thins the blood and is commonly taken as a clot preventative. Ginkgo is usually taken to enhance memory but it also thins the blood. When taken together, the chance of excess bleeding is increased.

3. ACE Inhibitor With Potassium - Potassium is often taken to compensate for the effects of some blood pressure drugs. Lisinopril, an ACE inhibitor used to lower blood pressure, can cause abnormal heart rhythms when combined with potassium.

4. Statins With Niacin - Also known as niacin, Vitamin B3 is commonly taken to help lower cholesterol. When combined with the cholesterol lowering class of drugs known as statins, the risk for muscle damage is magnified.

5. Diabetes Medications With Ginseng - Ginseng is a popular supplement for reducing stress and boosting energy. However, ginseng may lower blood sugar, which can be dangerous when combined with certain diabetes medications.

6. St. John's Wort - While this supplement is popular to relieve mild depression, it can interfere with the metabolism of prescription antidepressants, birth control pills and anticoagulants.

As confirmed by the recent National Institutes of Health and University of Chicago study, the potential for a risky combination is even greater in people over the age of 57. Keeping this in mind, all healthcare practitioners should pay closer attention to this age group's medications.

By recognizing a potentially risky combination, massage therapists can voice their concerns and advise their clients to discuss their medication and supplement list with a physician or pharmacist. Some people may be aware of the potential for harm and are already being monitored by their doctor, but others may not know of the risks they are creating. As knowledgeable and trusted CAM practitioners, massage therapists are probably in the best position to uncover such risky combinations and make a potentially life-saving referral.

Recommended Study:
Medical Errors
Pharmacology for Massage

References:

http://nccam.nih.gov/news/camsurvey_fs1.htm, The Use of Complementary and Alternative Medicine in the United States, Retrieved December 27, 2008, National Institutes of Health, 2008.

http://news.yahoo.com/s/ap/20081224/ap_on_he_me/med_drug_interactions_2, Millions of older Americans use risky drug combos, Lindsey Tanner, Retrieved December 27, 2008, Yahoo! Inc., December 2008.

http://stayhealthymn.com/print_article.php?articleID=86, A bad mix? Drugs, alcohol and herbal supplements, Kelli Miller, PharmD, Retrieved December 27, 2008, Park Nicollet, 2008.

http://www.bcm.edu/news/item.cfm?newsID=346, Dangerous liaisons: Prescription drugs, certain foods don't mix, Meg Bolton, Retrieved December 27, 2008, Baylor College of Medicine, February 2005.

http://www.webmd.com/migraines-headaches/news/20060719/migraine-depression-drugs-risky-mix, Migraine, Depression Drugs Risky Mix, Miranda Hitti, December 27, 2008, WebMD, LLC, July 2006.

Because many of today's careers require constant motion of isolated muscle groups, repetitive motion injuries are one of the most common problems faced by healthcare workers. When such an injury involves the forearm, median nerve compression is a likely consequence. If entrapment of the median nerve is found to be responsible for arm or hand pain, tingling or numbness, a hypertonic pronator teres muscle could be the culprit. By applying several of Doug Alexander's nerve mobilization techniques, bodyworkers can bring surprisingly swift and effective relief to someone with a pronator teres overuse injury.

Pronator Teres Syndrome
Pronator teres syndrome (PTS) is a painful nerve entrapment condition where the median nerve is placed under abnormal pressure by the pronator teres muscle. Functioning to pronate the forearm, the pronator teres muscle attaches to both the humerus and ulna bones near the elbow and then diagonally cross to the radius bone. When stressed, this muscle's hypertonicity can apply pressure on the median nerve, especially where the nerve passes between the pronator teres' two heads.

Pain elicited from a tight pronator teres is usually located in the forearm, wrist and the thenar side of the palmar aspect of the hand. Similar to carpal tunnel syndrome (CTS), pronator teres syndrome typically squeezes the median nerve producing numbness or tingling in the palm, thumb, forefinger and middle finger. Since the well-known condition of CTS also involves compression of the median nerve, many cases of PTS are mistakenly diagnosed as carpal tunnel syndrome. Also occurring from median nerve compression, CTS results from compression of the carpal tunnel - the wrist's fibrous sheath that forms a passageway for the median nerve and hand tendons.

Since PTS typically results from repetitive motions that cause hypertonicity in the pronator teres, activities involving recurring pronation are often behind this problem. Some examples of these motions include:

· Hammering
· Cleaning fish
· Prolonged use of screw drivers or other hand tools
· Overhand motions in racquet sports

Assessing PTS
While PTS and CTS both affect the median nerve and have similar symptoms, there are several differences:

· PTS pain is exacerbated by repetitive elbow flexion, and symptoms arise in the forearm as well as the hand.

· CTS is aggravated by wrist movements, and pain is not experienced as much in the forearm.

· Due to prolonged wrist flexion during sleep, CTS often causes pain at night, while PTS usually does not. (Wrist flexion does not recruit the pronator teres muscle.)

Bodywork Techniques for the Pronator Teres
Overuse injuries from forearm or wrist pronation cause the pronator teres to shorten and become denser, thus increasing the likelihood of compressing the median nerve. Therefore, releasing and lengthening the pronator teres can ease median nerve pressure and relieve PTS symptoms.

In the Institute for Integrative Healthcare's Nerve Mobilization home study course, Doug Alexander cautions bodyworkers that treating the pronator teres can further aggravate an already irritated median nerve. To prevent this, Alexander advises putting the median nerve on slack in two ways:

· proximally via shoulder girdle elevation and slight elbow flexion
· distally via neutral wrist posture

After giving the median nerve some slack, several techniques can release the pronator teres. While step-by-step instructions are included in the Institute's Nerve Mobilization workbook, Alexander says the following three techniques usually unravel pronator teres tension:

1. Contact Inhibition - Inhibitory contact with the hypertonic parts of the muscle can drain pronator teres tension.

2. Post-Isometric Relaxation - Post-isometric relaxation further challenges stubborn pronator teres hypertonicity.

3. Sustained Stretching - Sustained stretching helps to lengthen a previously shortened pronator teres.

Nerve pain can be frustrating, especially for those misdiagnosed with carpal tunnel syndrome. By taking a little extra time to evaluate the pronator teres' involvement in median nerve compression, bodyworkers can provide more targeted, therapeutic treatment. If the pronator teres is hypertonic, protecting the median nerve while combining contact inhibition, post-isometric relaxation and sustained stretching will relieve a majority of PTS cases.

Recommended Study:
Advanced Anatomy and Pathology
Anatomy Review for Professionals
Clinical Massage Therapy
Nerve Mobilization

References:

Alexander, Doug, Nerve Mobilization Workbook, Natural Wellness, 2008.

http://www.chiroweb.com/mpacms/dc/article.php?id=40345, Pronator Syndrome: A Cause of Carpal Tunnel Syndrome, Warren Hammer, MS, DC, DABCO, Retrieved August 19, 2008, Dynamic Chiropractic, July 1995.

http://www.lydiasarticles.com/articledetail.php?artid=60876&catid=360&title=Pronator-Teres-Syndrome-And-Massage-Therapy, Pronator Teres Syndrome and Massage Therapy, Ben Crabtree, LMT, CNMT, Retreived August 19, 2008, 2008.

http://www.massagetherapy.com/articles/index.php/article_id/279, Conscious Bodywork: Unraveling Carpal Tunnel Syndrome, David Weinstock, Massage & Bodywork, October/November 2000.

http://www.massagetoday.com/mpacms/mt/article.php?id=13625, Pronator Teres Syndrome, Whitney Lowe, LMT, NCTMB, Retrieved August 18, 2008, Massage Today, May 2007.

There are a variety of physical and/or mental conditions that become apparent during childhood and cause certain limitations in ability. Among them are autism, cerebral palsy, epilepsy and mental retardation. Persons with developmental disorders may not learn very quickly or be able to express themselves clearly. They will often be unable to or have difficulty in taking care of themselves and have limited mobility.

The causes of the various limitations are many, and can occur before, during or after birth. They may be the result of genetic problems, poor prenatal care, exposure to toxic substances such as drugs or alcohol, lack of oxygen during the birth process or traumatic brain injury. Often the exact cause is unknown.

A History of Abuse and Neglect
Early in American history, those with developmental disabilities were generally grouped in a classification referred to as deviant. They were looked upon with suspicion and at times accused of witchcraft or of being possessed by the devil. If they survived at all, they were often housed together in correctional facilities along with prostitutes, beggars, paupers, convicted criminals and the criminally insane.

Until as recently as 30 - 40 years ago, many persons diagnosed with some form of developmental disability were treated and even officially classified as subhuman. Those who could not be cared for by a loving family were relegated to live in institutions, where they were routinely exposed to abuse and neglect. Personal needs or abilities were not recognized. Those who were institutionalized often shared clothing and were bathed en masse by being hosed down in a large shower room.

A Return to Dignity
Throughout history, while there has been mass abuse of this population, there have also been those who have fought hard for their rights as human beings, deserving of respect and entitled to decent housing, medical care, counseling and more.

Today there is far less abuse, and many who were formerly institutionalized now live in handicapped accessible group homes, where they share dining and general living areas, but have their own bedrooms. Care and supervision is personal and monitored throughout the day and a trained staff is present 24 hours a day. The residents of these homes have frequent interaction with physical therapists, occupational therapists, recreational therapists and social workers. They are treated to outings such as the occasional seasonal party or shopping days and have in-house activities such as music and art therapies.

As recently as September 2008, federal laws have been updated and expanded to improve the lives of those who may be unable to care for themselves.

How Can Massage Help?
Sometimes the benefits are obvious. A person with cerebral palsy might experience less tightness or spasming in his/her muscles after receiving massage. Someone who has restricted movement may experience greater flexibility through the application of massage and stretching. Often the benefits are subtle, yet profound for both the client and the therapist. A person with a history of being very docile or lethargic will, after a few massage therapy sessions, be more alert and reactive. Someone who has been, for the most part, non-verbal or non-communicative, will speak and interact with others.

Several forms of complementary therapies have been shown to be effective in treating the developmentally disabled. Among them are:

· Aromatherapy - The use of essential oils can be of great help when used with the developmentally disabled. Chamomile, jasmine, ylang ylang and rose are known for their calming properties, while marjoram, rose geranium and lavender are sometimes used to help those who have trouble sleeping. Precautions need to be observed, such as avoiding the use of scents that may be too stimulating. Many of the developmentally disabled take a lot of medications. It is vital that you know what they are taking if you use aromatherapy so as to avoid any unpleasant or possibly harmful reactions. For example, aniseed, dill, fennel, hyssop and sage should not be used if the person has epilepsy.

· Chair Massage - Knowing how to do chair massage can be of great help, as many of the developmentally disabled are wheelchair bound or simply unable to get onto a massage table. It is also generally not advised and often inappropriate to use their beds for a massage therapy session. While you may not be able to use a standard massage chair for the session, the skills you use for someone in a wheel chair can be easily transferred. A person who sits all day will benefit greatly from leg and foot massage, as well as massage on arms and hands that may ache from pushing the wheels.

· Lymphatic Drainage - Many of the developmentally disabled are in wheelchairs all day, or have limited physical activity because of impairment or physiological imbalance. The result can be lymphedema, or a buildup of fluids, especially in the legs and ankles. Lymphatic drainage massage uses very light pressure strokes to help eliminate this fluid and can reduce the discomfort cause by this condition

· Reflexology - Various physical or neurological disabilities may prevent the use of certain techniques, but reflexology can be used in some form on most persons. Used mostly on the feet, it can also be used on the hands, face or ears, depending on which system is used. These areas are rich in nerve endings, which correspond to reflex zones in the body. These, in turn, affect the various glands, organs and internal/external areas of the body.

These methods are safe, gentle and non-invasive, and can be used on children as well as adults. These and other forms of touch therapy help with proprioception and improvement in joint flexibility and mobility. Often there is some improvement in cognition and communication, which may be due in part to the one-to-one attention during the session.

While facing a challenging future, many with developmental disabilities can still lead full and active lives. Offering massage helps them integrate more fully into our society and receive a caring and compassionate hands-on therapy. Working with the developmentally disabled will not only improve their lives, but it will undoubtedly touch your heart and soul as well.

Recommended Study:
Aromatherapy Essentials
Chair Massage Fundamentals
Lymphatic Drainage Massage
Reflexology

Resources:

"Administration on Developmental Disabilities: ADD Fact Sheet." Administration for Children & Families. US Department of Health & Human Services. 18 Dec 2008 http://www.acf.hhs.gov/programs/add/Factsheet.html.

"Information and Technical Assistance on the ADA." Americans With Disabilities Act. US Dept. of Justice. 18 Dec 2008 http://www.ada.gov.

"NYS-OMRDD:FAQS." August 20, 2008. New York State Office of Mental Retardation & Developmental Disabilities. 18 Dec 2008 http://www.omr.state.ny.us/hp_faqs.jsp.

Wolfensberger, Wolf. "DHM: Library - The Origin and Nature of Our Institutional Models." (January 10, 1969) Disability History Museum. 18 Dec 2008 http://www.disabilitymuseum.org/lib/docs/1909.htm.

Many people live with vague yet persistent symptoms that, even when evaluated by a physician, seem to have no rhyme or reason. The under-diagnosed conditions of celiac sprue and gluten sensitivity are increasingly common culprits of a wide range of non-specific health complaints. While close to unheard of a decade ago, evidence of the rising prevalence of acknowledged gluten intolerance is confirmed by the sprawling gluten-free sections in most major supermarkets. If familiar with the patterns that could indicate an intolerance to gluten, healthcare professionals can advise clients who may be affected to consider testing for this escalating problem.

About Gluten and Celiac
A protein contained in the grains of wheat, barley, rye and oats, gluten's unique molecular structure lends a doughy/elastic consistency to flours derived from these grains. Because of gluten's ability to stretch, gluten-containing grains are used extensively in breads and other baked goods to form a light, airy texture.

Also known as celiac sprue, celiac disease is a genetically inherited autoimmune disorder causing inflammation in the small intestine from the gluten protein. Scientific studies demonstrate that people are born with a genetic predisposition to celiac, and any trauma to the body such as surgery, stress, pregnancy or viral infections can ignite it. Approximately one in 100 people have celiac disease, most of which remain undiagnosed.

Gluten Intolerance
Gluten intolerance is a broad term, which includes all kinds of sensitivity to gluten. An estimated one in four have sensitivity to gluten without celiac disease. Constituting a growing number of healthcare visits, the correct term for these people is Non-Celiac Gluten Sensitive (NCGS).

Once in the digestive tract, gluten is broken down into its components, including an amino acid chain called gliadin. For those living with celiac or NCGS, the following problematic events are likely to occur:

· The absorption of gliadin in the small intestine triggers an inflammatory response that damages or completely disables the villi.

· The lack of functioning villi interferes with the absorption of all nutrients, and typically causes malabsorption and malnutrition.

· The damaged small intestine walls allows for large molecules to leak into the bloodstream.

· Detected as foreign invaders, these misplaced particles prompt the immune system to launch an attack.

Symptoms
Depending on the severity of the inflammation and the extent of damage to the intestinal villi, gluten sensitivity can cause a host of problems ranging from mild to severe. While often thrown into the category of irritable bowel or leaky gut syndrome, gluten sensitivity typically results in some (or all) of the following:

· Abdominal pain
· Gas and bloating
· Diarrhea and/or constipation
· Lots of oily, foul smelling stools
· Anemia
· Depression
· Fatigue
· Brain fog
· Joint aches and pains
· Muscle cramps
· Nerve pain
· Skin conditions like eczema
· Headaches
· Gastric reflux or heartburn
· Changes in weight
· Other food allergies

For Bodyworkers
Several companies are actively searching for a drug or supplement to help those with gluten sensitivity. However, there is currently only one effective solution for those affected. Although it requires education and commitment, eliminating all foods containing gluten from the diet effectively stops symptoms and allows areas damaged by gluten to recover. Because a gluten sensitive person's immune system sees this protein as a threat, many experts believe that skin products containing gluten must also be avoided. Of particular interest to the massage therapist, massage mediums containing wheat germ or hops have the potential to irritate the skin of someone with gluten sensitivity.

Besides carefully choosing massage oil or lotion, therapists may encounter clients who have many symptoms of gluten intolerance - yet have not been evaluated for celiac sprue or NCGS. Thus, a supportive practitioner who suggests testing for gluten sensitivity could help direct his/her client towards finally finding the answer to all that ails them.

Recommended Study:
Advanced Anatomy and Physiology

References:

https://www.enterolab.com/StaticPages/Frame_Faq.htm#What_is, Frequently Asked Questions, Retrieved May 17, 2009, EnteroLab, 2009.

http://www.massagetoday.com/archives/2006/03/16.html, Celiac Disease, Part 1: What Is Going On Here?, Ruth Werner, LMP, NCTMB, Retrieved May 16, 2009, Massage Today, March 2006.

http://www.massagetoday.com/mpacms/mt/article.php?id=13424, Celiac Disease, Part 2: What Is Going on Here?, Ruth Werner, LMP, NCTMB, Retrieved May 16, 2009, Massage Today, May 2006.

http://www.prohealth.com/ME-CFS/library/showArticle.cfm?libid=14523&B1=EM050609C, The Gluten Syndrome: A neurological disease - Source: Medical Hypotheses, Rodney Philip Ford, Retrieved May 14, 2009, ProHealth, Inc., April 2009.

http://www.psychologytoday.com/articles/pto-19980301-000024.html, Gluten for Punishment, Richard Firshein, Retrieved May 17, 2009, Psychology Today, March/April 1998.

http://www.seattlewomanmagazine.com/articles/may08-4.htm, No Gluten, Please, Mary Jane Halligan, LMP, NTP, CT, Retrieved May 16, 2009, Caliope Publishing Company, May 2008.

In the late spring of 2008 I noticed a redness on my upper left shoulder. It looked more like an enlarged and slightly irritated mosquito bite more than anything else. But in three days it grew from the size of a nickel to a circular patch with a diameter of more than eight inches. On the fifth day I woke up to discover it covered close to one-quarter of the left side of my upper body, and large red splotches were appearing on my left leg as well. A trip to the doctor confirmed it was Lyme disease and three weeks of antibiotics ensued.

Despite my diligence, earlier this summer, I discovered that familiar bull's-eye circle on my left leg, behind my knee. I had removed a tick attached there about two weeks earlier, monitored it for about ten days and everything seemed fine. It was the Fourth of July weekend, and I waited until Monday to go to the ER - when once again I was diagnosed with Lyme disease.

I like to think that as a massage therapist with knowledge of pathology, a desire to maintain good health, as well as being a nature lover living in the woods, would mean I was up on the facts about preventing and recognizing Lyme disease. But it took this most recent bout to get me to read up on it and share the information with other massage therapists.

What Causes Lyme Disease?
Lyme disease is caused by a spiral shaped bacteria belonging to the genus Borrelia, which is carried by ticks belonging to the species of the genus Ixodes. The deer tick is responsible for Lyme in the Eastern United States, while the western black-legged tick is responsible for Lyme on the West Coast of the U.S. (Europe and China have other species of ticks that transmit diseases similar to Lyme.)

A tick itself is no larger than a poppy seed, which makes them very hard to detect. The bacteria transfers to humans via an infected tick, which is in either the nymph or female adult stage of development. The tick needs to be attached to the body for more than 24 hours to transmit Lyme.

Diagnosis
Diagnosing Lyme disease is tricky. Perhaps the most definitive diagnosis comes when you know you've been bit by a tick and then get the classic bull's-eye rash (erythema migrans). Most doctors won't even bother with a blood test if those two factors are evident. However, not everyone with Lyme knows he or she has been bit. And of those diagnosed with Lyme, only about 60% - 80% present the rash.

Even the typical blood tests given often show false positives, as well as false negatives. This means that Lyme could be either vastly over- or under-diagnosed. A person infected with Lyme may not show any symptoms for 30 days or more, or symptoms can manifest just a few days after the tick bite.

Some of the symptoms of Lyme disease, especially if there is no rash, can be confused with other pathologies including fibromyalgia and chronic fatigue syndrome, which are treated much differently than Lyme.

Who Is At Risk?
If you live in or near a wooded area, especially in the Northeastern United States, you are at risk for getting Lyme disease if bitten by a tick. Though living elsewhere is not a guarantee of safety. According to the Center For Disease Control (CDC), about 93% of all cases of Lyme disease come from the Northeast states and Minnesota though every state, as well as the District of Columbia, has reported cases. Depending on where you live, ticks can be active anywhere from mid-May to November and tend to thrive in moist, grassy areas.

Treatment
Lyme disease is typically treated with antibiotics with different ones used to treat children and adults. Doxycycline is generally prescribed for adults, amoxicillin for children and erythromycin for pregnant women.

In the past it was thought that only long-term use of antibiotics could totally rid the body of the Lyme causing bacteria. There is still some controversy over the use of long-term antibiotic treatment, though most doctors advise against it and the typical treatment now lasts three weeks. Long-term antibiotic use comes with a high price - including a depressed immune system and the development of drug resistant infections.

Stages
There are three stages of Lyme disease.

First Stage: The initial phase (7 - 10 days after the bite) may include the hot, itchy circular rash and typical flu-like symptoms such as high fever, swollen lymph nodes, headache, night sweats and fatigue. There may be overall achiness and stiffness as well. If there is no bull's-eye rash, this phase may be misdiagnosed as the flu, mononucleosis or even meningitis and so may be treated incorrectly.

Second Stage: If left untreated, the disease may progress to a second stage and result in cardiovascular problems including irregular heartbeat and dizziness, neurological problems such as Bell's Palsy, numbness, tingling, poor coordination and even forgetfulness. There can be a general malaise and debilitating fatigue as well.

Third Stage: The third stage is associated with inflammation of one or more large joints, most notably the knees. If left untreated it can cause permanent damage.

The second and third phase can occur weeks, months or even years after infection with Lyme causing bacteria. In later stages, if left untreated, the bacteria disseminate throughout the body and can cross the blood-brain barrier making the Lyme much more difficult to treat.

Can Massage Help?
Massage can't cure or treat Lyme, but it can help with the symptoms such as the aches and pains, and also help to boost the immune system. In the initial stages of Lyme, a person may be too uncomfortable to even want a massage - (I know I was) - and it often is not advisable to administer massage to a person on antibiotics. Massage can reduce the discomfort of later symptoms that may continue long after the completion of antibiotic use.

Deep tissue massage is not recommended in acute stages of the disease, but gentler modalities, such as lymphatic drainage, polarity therapy, reflexology can be helpful. Light Swedish massage and Shiatsu can also be effective as long as the massage therapist recognizes the client's tolerance level.

Complementary Treatments
In addition to massage there are some other natural remedies that can complement allopathic treatment.

· Probiotic supplements, such as Lactobacillus acidophilus, can help maintain gastrointestinal health by replacing good bacteria and offsetting some of the effects of the antibiotics, such as diarrhea and yeast infections. Look for live, active probiotics in foods like yogurt and kefir, or get them in supplement form at your local health food store.

· Herb teas, or dried extracts in the form of capsules, powders or tinctures can help because of their antioxidant, anti-inflammatory and immune support qualities. Try decaffeinated green tea, ginkgo biloba, cat's claw, reishi mushroom, olive leaf or garlic. Inform your doctor if you take any of these to avoid any possible interactions with prescribed drugs.

· Homeopathic remedies, prescribed by a professional homeopath, can reduce the effects of Lyme. They may include ledum, thuja or lac canimum among others, depending on the homeopath's evaluation.

· Acupuncture can help to relieve pain, increase mobility and reduce fatigue. As they are also schooled in Chinese herbal medicine they can also offer remedies that may help with other symptoms and side effects of Lyme.

· Essential oils can help to alleviate some of the symptoms. For example cinnamon, clove or ginger can reduce fatigue and keep you alert; chamomile, lavender or myrrh can help reduce inflammation; and bay laurel, clove bud or garlic are powerful antibacterial agents.

If You Think You Have Lyme
If you have found a tick attached to your body, or if you find a bull's-eye rash (particularly prone areas are back of the knee, inside of elbows, armpits, groin, under the breasts and on the back), go to a doctor for evaluation and treatment as soon as possible.

To get up-to-date information on Lyme disease, tick removal and tick identification contact your local department of health. 1-800-866-LYME (5963) is a 24-hour hotline provided by the Lyme Disease Foundation.

Recommended Study:
Advanced Anatomy & Pathology

Resources:

Cutler, Nicole, L.Ac. "Is a Tick Burying Itself In Your Client's Skin?." Integrative Healthcare. 16 Jul 2009 http://www.integrative-healthcare.org/mt/archives/2009/06is_a_tick_buryi.html.

Ehrlich, Steven D., NMD. "Lyme Disease." 15 June 2008. University of Maryland Medical Center. 14 Jul 2009 http://www.umm.edu/altmed.articles/lyme-disease-000102.htm.

"Lyme Disease." Lyme Disease Foundation, Inc., 14 Jul 2009 http://www.lyme.org/otherdis/ld.html.

"Lyme Disease - Fact Sheet." September 2008. New York State Department of Health. 16 Jul 2009 http://health.state.ny.us/diseases/communicable/lyme/lyme/fact_sheet.htm.

"Lyme Disease - Medications." 03 September 2008. WebMD. 14 Jul 2009 http://arthritis.webmd/tc/lyme-disease-medcations.

"Lyme Disease - Treatment Overview." 03 September 2008. WebMD. 14 Jul 2009 http://arthritis.webmd/tc/lyme-disease-treatment-overview.

"Lyme Disease." Wikipedia. 14 July 2009. Wikimedia Foundation, Inc., 14 Jul 2009 http://en.wikipedia.org/wiki/Lyme_disease.

Smith, Jenna. "Lyme Disease Resource - Essential Oils." 2006. Lyme Disease Resource. 16 Jul 2009 http://lymediseaseresource.com/Essential_Oils.html.

Werner, Ruth, LMPA Massage Therapist's Guide to Pathology [133-137]. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2008.

Considered by many healthcare practitioners to be one of the most challenging health conditions to work with, different forms of cancer are increasingly affecting the world's population. Although Western medicine has made great strides in treating cancer, many believe that alternative therapies play an important role in their healing process. Because of the caution that some treatments may encourage the spread of cancer cells, various alternative health practitioners have taken a hands-off approach to cancer in favor of safety. However, therapists trained in aromatherapy offer a predominantly safe method to help a person battling cancer.

Over the years, a bodyworker's role in working on people with cancer has shifted from a distinct prohibition to an emerging specialty. While no respectful practice should suggest that their healing method supersedes a physician's advice, pairing certain complementary health approaches with medical treatment can have tremendous positive benefits to the patient. As one of the more researched modalities, experts believe the ancient art of aromatherapy can be highly effective in helping manage the restlessness, anxiety and stress associated with conventional cancer treatment. However, as with anything of strong therapeutic value, there are some unique potential interactions between the use of essential oils and traditional cancer treatment.

When it comes to essential oils, Cherie Perez, a supervising research nurse in M. D. Anderson's Department of Genitourinary Medical Oncology who teaches aromatherapy to cancer patients, says they have been shown to have tremendous soothing and stress-relieving capabilities. According to Perez, "The most common complaint I have from [cancer] patients is with anxiety or sleeplessness." Perez has discovered that when patients are relaxed they sleep more comfortably, further enabling their bodies to heal.

Besides surgery, enduring either of the two prominent treatments for cancer - radiation or chemotherapy - is always a challenge. In fact, it is common for people receiving radiation and/or chemotherapy to have severe side effects and even long lasting health implications from these treatments. Although aromatherapy can be a soothing complement to cancer treatment, assuring it is safely applied must always be a practitioner's priority.

Chemotherapy
Aromatherapists Jane Buckle, Ann Percival and Pam Conrad are registered nurses who have studied the impact different essential oils have on those undergoing cancer treatment. These experts concluded that, because essential oils can compete with cell receptor sites utilized in chemotherapy, aromatherapy application should adhere to the following guidelines to ensure safety:

· Essential oils can be applied in massage up to two days before a chemotherapy treatment.

· Essential oils should be avoided for nine to ten days after chemotherapy administration.

· During a chemotherapy regimen, keep the dose of essential oils low by using only two drops per ounce of carrier oil or lotion.

· While inhalation to counteract nausea accompanying chemotherapy is acceptable, there are provisions for peppermint and ginger.

· Peppermint can be inhaled unless the client has cardiac problems or is on the chemotherapy drug 5FU, since peppermint enhances its absorption fourfold.

· Although ginger is another good essential oil choice for relieving nausea, it can reduce clotting time.

Radiation
Even though several clinical studies have failed to report any improvements by using aromatherapy during radiation therapy, there are still a substantial number of people who believe otherwise. Despite this discrepancy, several wellness centers across the U.S. employ the benefits of essential oils for those undergoing cancer treatments.

Since one of the prominent concerns about radiation therapy is excessive burning and skin problems, applying anything to the skin should be carefully evaluated. As is the case with aromatherapy, topical application of phototoxic oils can be detrimental to those doing radiation therapy or those with skin cancer.

Stedman's Medical Dictionary defines photosensitization as, "sensitization of the skin to light, usually due to the action of certain drugs, plants, or other substances." Phototoxic oils cause light-related irritation or darkening of the skin when exposed to certain types of light. For a person about to be exposed to the intense rays of radiation therapy, it is important to avoid phototoxic oils so that you do not worsen skin sensitivity. The more commonly known phototoxic oils include:

· Lemon
· Bergamot
· Angelica
· Lime
· Grapefruit
· Orange
· Mandarin
· Tagete
· Verbena

It may be possible to safely use citrus oils with a person undergoing radiation therapy. By choosing a steam-distilled oil, the phototoxic elements can be avoided. If unsure, check with the essential oil manufacturer about your chosen oil's phototoxicity.

In addition, certain essential oils can irritate or sensitize the skin regardless of light exposure. Commonly known sensitizing oils include:

· Cinnamon bark
· Fig leaf
· Verbena
· Caraway
· Dill seed
· Peppermint
· Ylang ylang

In addition to considering the phototoxicity and sensitivity to the previously listed oils, a good rule of thumb to follow for those receiving radiation therapy is as follows:

Keep the concentration of essential oils low by using only two drops per ounce of carrier oil or lotion.

The more we learn about aromatherapy, the more we realize how strong essential oils can be. Bodyworkers incorporating aromatherapy into their practice can offer people undergoing cancer treatment a better experience and may even improve their ability to defeat their cancer. While this prospect excites those destined to heal, make certain you are being safe with those undergoing chemotherapy or radiation therapy. Even though aromatherapy poses little risk to spreading cancer, it is a potent application - and safety should always be a practitioner's first therapeutic consideration.

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

Recommended Study:
Aromatherapy Essentials

References:

Enteen, Shellie, BA, LMT, Aromatherapy for Clients With Special Needs, Massage Today, January 2007.

Osborn, Carrie, Essential Oils Simply Complex, Massage and Bodywork, December/January 2006.

www.associatedcontent.com, Aromatherapy and Phototoxic Essential Oils, Associated Content Inc., 2008.

www.cancerwise.org, Aromatherapy Soothes Cancer Patients, The University of Texas M.D. Anderson Cancer Center, 2008.

www.cancerwise.org, Exercise Safety When Using Aromatherapy, The University of Texas M.D. Anderson Cancer Center, 2008.

One of the more enigmatic muscle groups in the human body, contracted scalenes are commonly found to be at the root of several pathologies. Due to their slightly hidden, highly innervated and vascularized locations, performing bodywork on these muscles requires extra care. Upon identifying contracted scalenes as problematic, carefully and thoroughly performing a sequence of massage techniques on these muscles can bring your client significant and seemingly miraculous relief.

Scalene Function and Dysfunction
Consisting of the scalenes anterior, scalenes medius and scalenes posterior, the scalene muscles originate from the transverse processes of cervical vertebrae two to seven and insert into the first and second ribs. Located on the lateral side of the neck, the scalenes serve two primary functions:

1. Neck movement by laterally flexing the head. In addition, the scalenes assist in rotating the head to the opposite side and flexing the cervical spine on the thoracic spine in an oblique direction.

2. Assist in respiration by raising the ribs. The scalenes are considered to be auxiliary respiratory muscles, becoming activated when more thoracic cavity space is required - usually occurring during exercise when a greater volume of air is needed to meet increased demands for oxygen.

Those who recruit neck muscles for everyday breathing are likely to develop trigger points in the scalenes. To learn more about the problems associated with apical breathing and how to correct it, read the article Diaphragm Strengthening for Neck and Shoulder Pain.

The scalenes are notorious for generating pain, both locally and distally. In addition to causing widespread pain in the neck, scalene trigger points can cause pain to refer to the:

· Chest
· Medial border of the scapula
· Shoulder
· Posterior and lateral sides of the arm to the thumb and index finger

The brachial plexus and the subclavian artery pass between the anterior and medial scalenes and the subclavian vein passes anterior to the anterior scalene. Thus, a shortening of these muscles from trigger point development can compress or irritate these nearby blood vessels. Therefore, it is not uncommon for clients with tight scalenes to complain of paresthesia, anesthesia, coldness, claudication and lymphedema in the involved extremity.

In general, a tight scalene group will pull the head to the same side. This can be tested by laterally flexing the neck and noticing where the motion is restricted. If flexion is restricted to the right, the scalenes on the left are tight. When working on the scalenes, massage therapists must be aware of the sensitive nerves and arteries nearby. The scalenes can impinge on the brachial plexus, causing nerve pain or numbness down the arm, otherwise known as thoracic outlet syndrome.

Scalene Release
When it comes to the increasingly common diagnosis of thoracic outlet syndrome, massage therapists are equipped to provide one of the most effective treatments. According to Doug Alexander, instructor of Natural Wellness' home study continuing education course Nerve Mobilization, "When the scalenes are released the first rib can be shifted downwards and the clavicle mobilized to create more space and ease for the plexus (brachial) to pass between these bones." In this course, Alexander teaches an effective sequence for releasing the scalenes, including the following techniques:

· Scalene length assessment and stretch
· Bowing the scalenes
· Scalene post-isometric relaxation
· Stripping of the scalenes

Due to the neighboring anatomical structures, Alexander consistently advises therapists to be careful of causing clients discomfort - and suggests ways of adjusting their technique if this occurs.

Since scalene constriction can cause pain in so many areas of the upper body, a comprehensive understanding of the neck musculature and underlying structures is essential for massage therapists. This anatomical familiarity will help therapists with accurate client assessment and safe, therapeutic applications to release the scalene muscles. With subsequently relaxed scalene muscles, clients are often amazed at the dramatic pain relief they experience.

Recommended Study:
Anatomy Review for Professionals
Clinical Massage Therapy
Nerve Mobilization

References:

Alexander, Doug, Nerve Mobilization Workbook, Natural Wellness, 2008.

http://en.wikipedia.org, Scalene Muscles, Wikimedia Foundation, Inc., 2008.

http://saveyourself.ca, Singing, Breath and Scalenes, Paul Ingraham, RMT, SaveYourself.ca, 2008.

Murphy, Donald R., DC, Scalene Trigger Points: The Great Imitators, Dynamic Chiropractic, November 1991.

www.realbodywork.com, Scalenes: Scalene Medius, Anterior and Posterior Muscles, Real Bodywork, 2008.

As healthcare professionals who regularly make skin contact with their clients, massage therapists must be able to recognize and assess an array of dermatological conditions. Although folliculitis is commonly encountered in the general public, it is also one of the least understood skin anomalies. Despite folliculitis simply being an infection of the hair follicle, it could have half a dozen or more different causes. While one type of folliculitis poses little threat to the client or massage therapist, others may create a formidable transmission risk.

Symptoms of Folliculitis
The signs and symptoms of folliculitis vary, depending on the type of infection. Typically associated with the part of the hair follicle that is infected, there are mild and severe forms of folliculitis. Superficial folliculitis occurs when just the upper part of the follicle is infected, and deep folliculitis affects the entire hair follicle. In general, symptoms include:

· Groups of small red bumps around hair follicles
· Blisters filled with pus that break open and crust over
· Pain, itchiness or tenderness
· Large, swollen bump (in cases of deep folliculitis)
· Scarring after the infection heals (in cases of deep folliculitis)

Types of Folliculitis
Whether you suspect your client has folliculitis or the person tells you that he/she has already been diagnosed with it, there are many variations of this common skin disorder. Resulting from curly hair or bacterial, viral or fungal infections, a general summary of folliculitis forms include:

Curls
· Pseudofolliculitis - Although not technically an infection, this is an inflammation of the hair follicles usually affecting people with wavy or curly hair. When curly hair is shaved, its re-growth can curl back into the skin leading to inflammation and scarring. Also known as razor bumps, pseudofolliculitis is not contagious.

Bacterial
· Staphylococcal folliculitis - When hair follicles become infected with Staphylococcus aureus, itchy, white, pus-filled bumps can occur anywhere on the body. When located under the facial hair of men, this dermatological problem is called barber's itch. Commonly occurring from shaving or a skin injury, it can turn into a boil or carbuncle if the entire hair follicle is affected. Unfortunately, a substantial number of cases of methicillin resistant staphylococcus aureus (MRSA) began as folliculitis. This virulent strain of bacteria is highly resistant to multiple types of antibiotics.

· Pseudomonas folliculitis - Also known as hot tub folliculitis, the pseudomonas bacteria thrive in a wide range of environments and can cause a rash of red, round, itchy bumps that will eventually develop into small, pus-filled blisters.

· Gram-negative folliculitis - Affecting the entire hair follicle, this type of folliculitis often develops in those on long-term antibiotic treatment for acne due to an overgrowth of gram-negative bacteria. Gram-negative folliculitis can cause severe acne lesions.

Fungal
· Tinea barbae - Also developing beneath the facial hair of men, this fungal infection causes tiny, white itchy bumps with surrounding red skin. Untreated, this rash can escalate to pus-filled nodules that eventually form a crust, which may be accompanied by swollen lymph nodes and fever.

· Pityrosporum folliculitis - Evidenced by chronic, red, itchy pustules on the back, chest, neck, shoulders, upper arms and face, this yeast-like fungus commonly affects young and middle-aged adults.

· Eosinophilic folliculitis - Although experts are unsure of its cause, this type of folliculitis is mostly prevalent in those with HIV. Characterized by recurring, spreading patches of itchy, inflamed, pus-filled sores, primarily on the face and sometimes on the back or upper arms, eosinophilic folliculitis is suspected to involve a yeast-like fungus.

Viral
· Herpetic folliculitis - When a herpes simplex viral cold sore is shaved through, it can spread the herpes infection to nearby hair follicles.

For the Massage Therapist
Unless curly hair is the culprit, most of the types of folliculitis are contagious. Unfortunately, many with folliculitis regard it as a minor annoyance and don't consider it important enough to discuss with their bodyworker. In addition, many cases of folliculitis are mistaken for a simple pimple or acne breakout.

A massage practitioner who makes contact with the affected area could spread the infection to neighboring hair follicles. Besides exacerbating the client's condition, the therapist and subsequent clients are at an increased risk of exposure to the folliculitis' causative pathogen. Due to these risks, there are several imperative steps bodyworkers must take to maintain safety:

1. Avoid the area - Never work on an area with folliculitis, whether it is a suspected or confirmed case. If possible, use gloves and a bandage to cover the problem area and request the client do so prior to future sessions.

2. Launder carefully - Make certain that any linen in contact with a client harboring folliculitis is separated from other linens and is properly laundered with hot, soapy water and bleach.

3. Protect your hands - If you do not use gloves, keep liquid bandage on hand to make sure any cuts or nicks on your hands are completely sealed. In addition, take extra care when washing your hands before and after clients.

When it comes to breaches in the skin's integrity, bodyworkers must be prepared to protect their client, themselves and subsequent visitors. By realizing that what could be mistaken for a pimple could actually be a bacterial, viral or fungal infection, massage therapists will increase their attentiveness to the presence of folliculitis. As long as bodyworkers avoid the affected area, are careful with dirty linens and protect their hands, they needn't worry endlessly about the pathogens lurking in their client's hair follicles.

Recommended Study:
Advanced Anatomy and Pathology
Infectious Disease: HIV/AIDS

References:

http://sportsinjuries.suite101.com/article.cfm/mrsa_infection_in_athletes, MRSA Infection in Athletes, Steven M. Cohen, Retrieved August 12, 2008, suite101.com, August 2008.

http://www.massagetherapy.com/articles/index.php/article_id/921, Break Free from Acne Breakouts, Cathy Ulrich, Retrieved August 12, 2008, Associated Bodywork & Massage Professionals, 2008.

http://www.mayoclinic.com/health/folliculitis/DS00512/DSECTION=treatments-and-drugs, Folliculitis, Retrieved August 12, 2008, Mayo Foundation for Medical Education and Research, 2008.

http://www.orlandoskindoc.com/pseudofolliculitis.htm, Pseudofolliculitis, Retrieved August 14, 2008, John L. Meisenheimer, MD, 2008.

http://www.webmd.com/a-to-z-guides/folliculitis-topic-overview, Folliculitis, Retrieved August 13, 2008, WebMD, LLC, 2008.

It is easy to understand our love of the outdoors. After a long, cold winter, we want to plant flowers and vegetables; we want to get out to mow lawns, pull weeds and watch birds. After all, we are all connected, participating in the cycles of life, the ebb and flow of Mother Nature. And then there is poison ivy, that lovely but toxic three-leaved plant that seems to invade our little plot of beauty.

It is important, as massage therapists, to be aware of both the causes and treatment of being exposed to poison ivy, as well as poison oak and poison sumac. If a client has it, should they get a massage? If the massage therapist has it should he or she give a massage? Can getting a massage spread, or otherwise affect the rash?

How Does a Person Get Poison Ivy?
There is basically one way to get poison ivy. (This applies to poison oak and poison sumac as well.) It is to come in contact with the plant and ultimately have the plant oils get on the skin. Even if you don't physically touch the plant with bare skin, it may be that your pet, or some item of clothing brushes by one of the plants, and in turn you touch them - by putting on your gardening boots or petting your dog - and come in contact with the toxic oil.

The toxin responsible for the allergic reaction is urushiol and, while it seems to be most toxic in poison ivy, oak and sumac, it is also found in lesser concentrations in cashew nut shells, mangoes, ginkgo biloba seeds and in its namesake, the Japanese lacquer tree (kiurushi or urushi ki). The resinous oil can remain potent for years under the right conditions, and herbarium specimens have caused contact dermatitis after 100 years of storage.

Once the urushiol comes in contact with human skin, it "locks on" within just a few minutes. It then affixes itself to the underlying tissue, gets into the immune system and triggers a histamine reaction in the body resulting in allergic contact dermatitis.

The urushiol is difficult to remove, and using plain soaps and water can spread the substance rather than remove it. The reaction, the itchy rash, is not immediate. Depending on the person's sensitivity, the rash may not develop for 24 - 72 hours after exposure. This is when a massage therapist needs to be most aware and alert when questioning a client prior to the massage session.

Unknowingly Spreading Poison Ivy
Because the urushiol is oil soluble, it can bind to other oils. And, a very small amount - just two micrograms - of the urushiol can cause a fairly severe reaction. Combine this with the delay in reaction and you can have a potentially dangerous situation. While the situation might be rare, there could be a case of a client working in a garden the morning of, or even a day or two prior to coming for a massage. Unbeknownst to the client, the oil could still remain on the skin even after taking a shower.

As the massage therapist spreads the oil, the urushiol can easily be disbursed to other areas of the body and result in a very dangerous situation. The same holds true for a massage therapist who may have come in contact with the toxic plants. If you have touched the plant with your hands or forearms and not yet had a reaction, you could spread the oils and transfer them to your client's skin.

The Best Precaution is Prevention
The best way to avoid the rash caused by poison ivy is to avoid coming in contact with the plant, or anything that has come in contact with it that you might touch. If you do come in contact with it the best thing to do is to wash the area with warm water and a commercially available poison ivy soap. (Burt's Bees Poison Ivy Soap and Ivarest Poison Ivy Cleansing Foam are two that are easily available.) Many of them contain Jewelweed (impatiens capensis), a plant that is known to grow near poison ivy and has been used for centuries by native peoples and herbalists to counteract the affects of the toxic weed. Others contain topical antihistamines to counteract the allergic reaction.

There are also topical creams and gels (such as Ivy Block Lotion, Hylands' Ivy Block Lotion, Enviroderm Ivy Block) to apply if you expect to come in contact with poison ivy. Some contain bentoquatam, a type of bentonite clay. These topicals either serve as a barrier to the urushiol or prevent the urushiol from binding to the skin's natural oils.

Contrary to some urban myths, repeated exposure to small amounts of poison ivy does not enhance your immunity to the toxin; in many cases it actually intensifies future reactions. Another dangerous folk remedy for preventing poison ivy reactions is to ingest small amounts of the plant. This is not just dangerous, but can cause death. Equally toxic to the body is the inhaling of smoke from burning poison ivy/oak/sumac.

Despite Precautions, I Have Poison Ivy. What Can Be Done?
It is estimated that anywhere from 80 - 90 percent of human beings show an allergic reaction to exposure to poison ivy, poison oak and poison sumac. Some reactions are mild; others are quite severe, approaching anaphylaxis. In mild to moderate cases various topicals can be applied to reduce the characteristic itching, redness and blistering. Severe cases where the rash covers a major portion of the body, or when it appears to affect the moist tissue of the body such as the mouth, eyes, lungs, larynx, esophagus and/or digestive tract, an immediate trip to the emergency room is necessary or a call to 911.

10 Easy Remedies for Moderate Reactions
Sometimes the best remedies are those that are natural and have been found to be successful by our friends, neighbors, relatives and local herbalists. Here are some topical applications with ingredients you probably have in and around the house:

1. Banana skins, plantain juice or puree
2. Tea tree oil
3. A paste of goldenseal root powder and aloe vera gel
4. Jewelweed (If you have poison ivy in your yard, chances are jewelweed is growing nearby.)
5. Juice from fresh cut rhubarb
6. Baking soda mixed with water to form a paste
7. Distilled white vinegar
8. Epsom salt baths
9. Lemon juice
10. Honey suckle leaves, steeped in water

Calamine lotion is a standard tried and true treatment, and applying ice to the area will cool and numb the skin and at least temporarily reduce the symptoms.

Boost Your Immune System
Boosting your immune system may help to mitigate the symptoms as well.

· Taking extra Vitamin C can help to prevent infection and slow down the rapid spread of the rash.
· Calcium and Beta-Carotene help boost the immune response and speed healing.
· Zinc helps to repair damaged skin tissue.

Urusiol is said to be one of the most potent natural toxins on the planet, and it is found just about everywhere. Avoiding getting this plant oil on your skin is the only absolute way to prevent it and to keep it from transferring to and from your clients.

Recommended Study:
Advanced Anatomy And Pathology

References:

Armstrong, W.P., and W.L. Epstein, M.D. "Poison Oak: More Than Just Scratching the Surface." Herbalgram (American Botanical Council) 34:36-42, 1995. Web.7 Jul 2009. http://waynesword.palomar.edu/ww0802.htm.

"Home Remedies for Poison Ivy and Poison Oak." June 28 2009. Home Made Medicine. 7 Jul 2009 http://www.homemademedicine.com/home-remedies-poison-ivy.htm.

"Ivy Off: Poison Ivy Facts & Fiction." 2003. Ivy Off, Inc., 7 Jul 2009 http://www.ivyoff.com/factsandfiction.htm.

Martz, Eric. "Poison Ivy: An Exaggerated Immune Response to Nothing Much." Poison Ivy Immunology. March 31, 1997. 7 Jul 2009 http://wwwbio.mass.edu/micro/immunology/poisoniv.htm.

"Natural Remedies." Poison Ivy, Oak & Sumac Information Center. 7 Jul 2009 http://poisonivy.aesir.com/view/natural.html.

Werner, Ruth, LMP, NCTMB. "The Mysteries of Poison Ivy, Oak and Sumac." Massage Today 9.08August 2009 Web.7 Jul 2009. http://www.massagetoday.com/mpacms/mt/article.php?id=14045.

Western medicine has made great strides in improving breast cancer detection and treatment. Despite these advances in diagnosis, surgery, radiation and chemotherapy, many managing this diagnosis do not fare as well as they possibly could. Evidenced by the frequency of breast cancer survivors reporting treatment side effects, isolation, depression, anxiety and anger, this illness requires support beyond the halls of traditional medicine.

Bodywork modalities such as massage therapy, acupuncture, reflexology and aromatherapy have demonstrated success in improving the quality of life measures that can make surviving cancer such a challenge. Unfortunately, a significant percentage of breast cancer survivors are unable to afford the supportive benefits associated with massage therapy and other holistic health practices.

Addressing this need, Luana Halpern had the vision and drive to found You Can Thrive!, a unique, integrative wellness center offering free or affordable educational, supportive and integrative medical modalities for breast cancer survivors. Located in New York City, Halpern is a pioneer in integrating patient advocacy, symptom reduction, mind-body cohesion and other educative tools to implement a breast cancer survivorship plan.

In an interview with Halpern, we learn more about her innovative and inspiring You Can Thrive! program:

Q: Can you share how and why you started You Can Thrive!?

LH: I was diagnosed with breast cancer at 35 years old, and was very aware of the discrepancy between the amount of funding and awareness for breast cancer vs. how hard it was for a survivor to find affordable services. Due to symptoms, treatment or side effects from treatment, breast cancer survivors often need to take a year off of work - and may consequently lose financial security. After doing research in the breast cancer community, I found that about 85 percent of breast cancer survivors were in some financial straits - with a large percentage in severe hardship. This translates to not having enough money for supportive services, especially when they are needed.

Q: What makes You Can Thrive! unique?

LH: You Can Thrive! is a multi-tiered program from a breast cancer survivor's perspective. Besides being available for low or no cost, each client receives five units of service to maximize results. After committing to coming in every week, clients first meet with a patient advocate, then receive massage or reflexology, then aromatherapy, then acupuncture and then nutritional counseling - all in one day. The effectiveness of one builds the effectiveness of another, thus maximizing each service's benefit. The overall goal is to help people not just survive breast cancer, but to see them thrive. This is accomplished by reducing symptoms with integrative health services, and providing support through nutrition, education and outreach to continue with healthy lifestyle practices.

Also, the volunteers are doing this because they want to help, not because they need to work and make money, so it strengthens the process.

Q: As a breast cancer survivor, what has been your personal experience with acupuncture, massage therapy and nutrition?

LH: I didn't have these services when diagnosed, and was angry - even with a moderate income - that I still couldn't afford it.

Q: How do clients at You Can Thrive! generally respond to your program?

LH: I see that people coming through our program have help dealing with anger and resentment and reconnecting their mind and body - which is as important as dealing with symptoms of breast cancer treatment. As determined by self-evaluation forms, clients have reported that within the first four visits, primary symptoms reduced around 50 percent. As a result, we are now starting research in collaboration with Columbia University to see how the You Can Thrive! program impacts quality of life from a breast cancer survivor's perspective.

Q: How is You Can Thrive! funded?

LH: We are expanding exponentially mostly without funding. While we have a few small grants, we primarily run on the generosity of our community.

Q: Have you found local healthcare practitioners eager to volunteer?

LH: Statistics show that one in three Americans want to volunteer, and it is the same with healers.

Q: How often do your practitioners typically offer their services?

LH: Most volunteers come in once a month for about four hour; this includes practitioners. We also have a core group of volunteers (about four people) who do administrative work and they donate their time up to four days a month.

Q: I see that the You Can Thrive! wellness center operates on Sundays. With this kind of weekly clinic, is it challenging to reschedule clients with the same bodyworker?

LH: We recognize that consistency in quality care is important. We maintain consistency within our multi-tiered program with a patient advocate, who is the same person for each client - and they communicate with the practitioners. Since there is not a lot of time to build relationships, communication is stressed.

Q: Is there anything you'd like to say to massage therapists who might be interested in volunteering?

LH: Giving back to the community has an intrinsic value that far outweighs the hours that you would give - and outweighs any fears or biases that anyone can try to place upon you. I am available to speak with massage therapists who are interested in volunteering or who simply have further questions.

After speaking with Luana, I was encouraged and inspired by her wellness center. Volunteering one Sunday a month in New York City is an ideal path for local massage therapists who want to give back to breast cancer survivors. If not, there may be other opportunities to participate in or create a system for gifting massage therapy to those especially in need. Regardless of where you stand, there is no doubt that the You Can Thrive! program is a giant step forward in the direction of true, integrative, compassionate healing.

More information regarding You Can Thrive! is available at www.youcanthrive.org.

References:

http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_How_many_people_get_breast_cancer_5.asp, How Many Women Get Breast Cancer?, Retrieved April 22, 2009, American Cancer Society, 2009.

http://www.massagemag.com/Magazine/2004/issue107/research107.php, Massage Benefits Women with Breast Cancer, Retrieved April 22, 2009, Massage Magazine, January/February 2004.

www.youcanthrive.org, Retrieved April 22, 2009, YouCanThrive.org, 2009.