Cancer Client with Lymphadema

[Kandie Kay]

OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage.

I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..
1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know?

2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?

3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself?

4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage.

I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.

 

[Pompal 09.]

Cancer Client with Lymphadema

Before referring her out, find out for sure what she wants. The manager should have done that yesterday, before anything else, actually, but the questions can still be asked.

After finding out what she wants, have her sign consent forms so that you can discuss this with her physician and/or treatment team members, to determine what YOU can, should or should not do. If it is determined that what you can offer based on your experience and training does not fit with the treatment plan, then by all means, refer her out. If, on the other hand, she wants to relax and the team feels that regular relaxation massage will be beneficial - which is quite likely - get specific, written instructions regarding whether or not hot stones can be used and where they can be used (they may say only on her back). Get specific, written instructions on whether to massage the lower body, and if so, what techniques and pressure to use. Gentle effleurage may be perfect.

If you feel, for any reason, that you are not equipped or do not want to work with this client, then it is best to refer her out - very, very carefully. People going through cancer treatment are going through a very emotionally difficult process, and being told "no massage" can make them feel rejected, and like they are frightening/untouchable. Ultimately, you have a right to choose what type of clients you want to work with.

The whole idea that massage spreads cancer was unproven. We were told in school that they thought it would spread since it increases circulation. However, not only has that "massage increases circulation" been disproved, but those with cancer are encouraged to walk - which increases circulation. Circulation is a good thing. Even for folks with cancer!!!

 

[2/20/2009]

Cancer Client with Lymphadema

RoS makes great points.

Food for thought as I had to tell a friend just yesterday that I would not work on her since she has cancer as an underlying condition (however, I will work on someone who has had cancer in the past, but is now "cleared" of it). I felt terrible having to tell her this, especially when she got angry, because she felt like I should be able to "do the job" just fine. I think her words were: "Well I came to you to work on me. The other person I use can do it, I just don't see why you can't." She left in a huff, after I tried to explain that I don't and won't do work with cancer patients, but am happy to refer her to someone who is competent with it. Our friendship is most likely strained. I feel awful that I let her down. But, I have to do what is right for me and what I am comfortable with in this situation.

I honestly believe that there are great bodyworkers out there who feel comfortable working on cancer patients and who don't have specific training, so that is not where I am going with this post.

I personally do not see oncocology patients, because I don't feel like I have enough training behind me for any complications which may arise. I have 17 years in private practice and even then think it's just best to have taken very specific training in regard to this. It's not something I am patient enough to do right now.

No, I don't believe that massage can spread cancer, but I do believe that if a patient has mets (metastisis), there can be some other problems occur, of which I don't want to get dragged into court over, just because someone doesn't understand what massage won't do. Society has too many litigation problems these days. So, I hold my cancer work to family and possibly my best friend if that work is ever needed.

I do hope that if I ever get cancer, I can find someone willing to work on me. But, I certainly won't hold it against them if they don't feel comfortable and want to refer me out, like my "friend" did.

Hope that helps you in your decision making process.

PS: I'll try to add some links to course work that may help you in the future, later on.




01/19/10 - edited for some typos.

 

[Philadelphia]

Cancer Client with Lymphadema

It is a shame that some people still think that massage can spread cancer. I did a project on massage and cancer whilst I was learning massage. For my research I visited a charity that offered complementary treatments to cancer clients. As a result of the kindness that the staff showed me I told them as soon as I was qualified that I would volunteer with them. Since 2000 I have been giving massages to these clients. With other volunteers we undertook additianal training to give us a better understanding of the illiness. We get consent from their doctor before visiting. Like any massage I perform I tailor the treatment to the client in terms of the areas they'd like me to massage and how they are feeling that day. Generally the massage is gentle.

My attitude with these clients is that at this time they need a loving touch compared to proding and pulling they may receive from the doctors but that is just my opinion. I am comfortable working with these clients but can understand those who have reservations.

For clients with lymphodema I thought that Manul Lymphatic Drainage could be a help.

I probably haven't answered the questions but just wanted to my 2 cents (2 pence - as I'm in England!!)

 

[Joshu@]

Cancer Client with Lymphadema

For the OP question...
I would suggest Lymphatic Drainage --
you can refer her to the Upledger practitioner site for therapist names by state
she will want one who is lymphadema certified. Wonderful work - I think that she would benefit immensely.
http://www.iahp.com/pages/search/index.php
I can't imagine any drug that could help the condition.

I would not have done a hot stone massage without notice either. Good call.

I DO work on cancer patients. Some in remission and some were terminal.
Mostly I do it because I like working with this population and understandably some MT's are uncomfortable to work on them for various reasons, so they have a hard time finding a therapist.
My clients who were terminal were desperate to receive loving ,nurturing touch - and not only did they enjoy our sessions, they experienced pain reduction and greater emotional peace. Most doctors know that massage does not spread cancer.

When I am at end of life I really hope that someone will be there to give me bodywork.
However I totally respect the decision of any MT not to work with this population and see no reason for someone to get upset about that choice.
Personally - although I will do pregnancy massage I don't really feel like it's my "thing". I would prefer to refer them to another therapist unless they just want cranio sacral work. But lots of MT's love pregnancy massage.

 

[Woody.]

Cancer Client with Lymphadema

For the OP question...

I just saw this post and realized that I never quite answered the questions asked. I thought I had done a pretty good job, but in re-reading, see where I pretty much failed the OP. How about I try again?

• OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage.
  
  I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..
  1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know?

  If you feel conflicted, you're first item of business is to decide what direction you want to go with her. I can't tell you which of the above options is right for you. But, I can tell you that now is a good time to set your boundaries regarding patients who have (or have had) oncology issues.
  
  Do you want to work on clients who have never had cancer? Do you want to work on clients who have had a cancer issue in the past but are now cleared? Do you want to work on clients who may currently have cancer? Do you want to work on alleviating pain or issues in clients who have cancer, but the pain and issues are not associated with the cancer? Do you only want to work on clients who have complaints which are only related to their cancer? Do you want to "mix and match" according to the client and how you feel about them as a person. Not how you feel about them having cancer as part of their "condition". ie: You'll work on some, but not others?
  
  These are the items you'll have to first decide on. Once you've come up with that decision, then question one will be easier to answer.
  
  

  2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?

  I don't see anything wrong with giving her information about maual therapies, if you don't think she is aware of how lymphatic massage may help. I think that would be well within your bounds. I get the feeling that is your overall concern with this question.
  
  As a therapist, you aren't in the position to let her medical team do anything. They will do what they will do. It is the clients decision if she wants to let that happen, so you shouldn't have to worry there.
  
  

  3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself?

  These are some general contraindications for hot stone work. Since enough of these can be co-existing problems in a patient with cancer, I would surmise that this would reason enough not to use them without a confirmation from the MD. As I mentioned earilier, with our unfortunate litigious society, it's usually best to CYA.
  
  GENERAL CONTRAINDICATIONS/CAUTIONS
  Please consult the referring physician whenever uncertain about any condition or response.
  • Cancer
  • Hemorrhage
  • Decreased Sensation
  • Weakness
  • Skin lesions
  • Pregnancy
  • Tuberculosis
  • Anemia
  • Diabetes Mellitus
  • Heart disease
  • Hypertension
  • Peripheral vascular
  disease
  • Fever
  • Pulse (Too high or too low)
  • If your skin is sensitive
  • Hypothyroidism
  • Kidney problems
  • Inflammation
  
  

  4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage.

  It is my belief that massage therapy for people living with cancer is best when practiced by a skilled therapist trained in oncology massage. Things to keep in mind: thorough intake; discussion with the MD or nurse working with the client and the condition; ability to modify sessions to work around the side effects of radiation, chemotherapy, surgery and medication; avoidance of solid tumors.
  
  
  

  I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.

  Hope this helps.

 

[Kriky]

PS: I'll try to add some links to course work that may help you in the future, later on.

Here are a few links that may help - I don't know anything about any except for MD Anderson, but the few I located appear to be useful. Some are for coursework, some are general information and articles. Also, I have a site for an oncology massage course in Australia, for our Aussie friends. Hope something is of help.

• Cheryl Chapman
• The Peregrine Institute of Oncology Massage Training
• Colorado School of Healing Arts -Oncology Program
• Oncology Massage Certification Program at the Massage Therapy Institute (MTI) in Davis, California
• Oncology Massage Certification Program
• Tracy Walton - Cancer and Massage Therapy Courses
• A Gathering Place - Working with Cancer Patients (4CEU's)
• Oncology Massage Training - Vivacious Living Centre - Applecross, WA AU
  
  
• Developments in Oncology Massage - Massage Today
• MD Anderson- Massage and Related Bodywork - Review
• Information on Massage for Cancer - Texas Massage Forum
  
  
  Note about MD Andersons Oncology Massage Training, found on the Texas Massage Forum:
  
  

  "Our Oncology Massage Course [at MD Anderson] is typically offered annually in June, so the next opportunity will be June 2010 and is currently held Houston at M. D. Anderson Cancer Center.
  
  
  
  If you want to be on their e-mail list, contact Sharon Parker: sparker@mdanderson.org
  
  
  
  Title of Course: An Integrative Approach to Oncology Massage."

[/quote]



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Topic review - Cancer Client with Lymphadema






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JLWmassage






 
Post subject: 
Re: Cancer Client with Lymphadema
 













Have you ever thought about vonlunteering your services with Hospice? In my area they are also looking for MT's. I would think that would be a great way to get training and experiance

Have you ever thought about vonlunteering your services with Hospice? In my area they are also looking for MT's. I would think that would be a great way to get training and experiance











Posted: Tue Jan 19, 2010 1:47 pm














Jenn@AttunedMotion






 
Post subject: 
Re: Cancer Client with Lymphadema
 













Thank you everyone for the great feedback!I haven't made any major decisions yet, but I decided to follow up with my client via mail. I sent her a lovely thank you card for coming in, and asked her to get a medical release from her Dr if she is interested in deeper treatment or for heat therapy (for her neck and shoulders). I also told her that I knew a therapist who was very skilled in working with cancer patients and doing lymphatic drainage and if she and her Dr decided it was a better course of treatment for her, I would be happy to give her that information. I also thanked her for allowing me to work with her and how I appreciated her, and that if she wanted to come in for another relaxation style session I would be happy to work with her again!I really find this field to be so fascinating, I have no personal concerns with working with cancer patients, (I just want to be sure that I'm not doing any harm!), and I can't wait to learn more about this. Thanks for the fantastic links too, now I have a lot of reading to do!

Thank you everyone for the great feedback!I haven't made any major decisions yet, but I decided to follow up with my client via mail. I sent her a lovely thank you card for coming in, and asked her to get a medical release from her Dr if she is interested in deeper treatment or for heat therapy (for her neck and shoulders). I also told her that I knew a therapist who was very skilled in working with cancer patients and doing lymphatic drainage and if she and her Dr decided it was a better course of treatment for her, I would be happy to give her that information. I also thanked her for allowing me to work with her and how I appreciated her, and that if she wanted to come in for another relaxation style session I would be happy to work with her again!I really find this field to be so fascinating, I have no personal concerns with working with cancer patients, (I just want to be sure that I'm not doing any harm!), and I can't wait to learn more about this. Thanks for the fantastic links too, now I have a lot of reading to do!











Posted: Tue Jan 19, 2010 9:39 am














pueppi






 
Post subject: 
Re: Cancer Client with Lymphadema
 













pueppi wrote:PS: I'll try to add some links to course work that may help you in the future, later on.Here are a few links that may help - I don't know anything about any except for MD Anderson, but the few I located appear to be useful. Some are for coursework, some are general information and articles. Also, I have a site for an oncology massage course in Australia, for our Aussie friends. Hope something is of help.Cheryl ChapmanThe Peregrine Institute of Oncology Massage TrainingColorado School of Healing Arts -Oncology Program Oncology Massage Certification Program at the Massage Therapy Institute (MTI) in Davis, CaliforniaOncology Massage Certification ProgramTracy Walton - Cancer and Massage Therapy Courses A Gathering Place - Working with Cancer Patients (4CEU's)Oncology Massage Training - Vivacious Living Centre - Applecross, WA AU Developments in Oncology Massage - Massage TodayMD Anderson- Massage and Related Bodywork - ReviewInformation on Massage for Cancer - Texas Massage Forum Note about MD Andersons Oncology Massage Training, found on the Texas Massage Forum: Quote:"Our Oncology Massage Course [at MD Anderson] is typically offered annually in June, so the next opportunity will be June 2010 and is currently held Houston at M. D. Anderson Cancer Center. If you want to be on their e-mail list, contact Sharon Parker: sparker@mdanderson.org Title of Course: An Integrative Approach to Oncology Massage."

[quote="pueppi"]PS: I'll try to add some links to course work that may help you in the future, later on.[/quote]Here are a few links that may help - I don't know anything about any except for MD Anderson, but the few I located appear to be useful. Some are for coursework, some are general information and articles. Also, I have a site for an oncology massage course in Australia, for our Aussie friends. Hope something is of help.[list][*][url=http://www.cherylchapman.com/calander.html][b]Cheryl Chapman[/b][/url][*][url=http://www.medicinehands.com/OCMP.html][b]The Peregrine Institute of Oncology Massage Training[/b][/url][*][url=http://www.csha.net/advanced/oncology.html][b]Colorado School of Healing Arts -Oncology Program[/b][/url] [*][url=http://www.oncologymassagematters.com/oncology_massage_certification.htm][b]Oncology Massage Certification Program at the Massage Therapy Institute (MTI) in Davis, California[/b][/url][*][url=http://www.massageprogram.com/goto/2/56/][b]Oncology Massage Certification Program[/b][/url][*][url=http://www.tracywalton.com/trainingschedule/trainingschedule.html][b]Tracy Walton - Cancer and Massage Therapy Courses[/b][/url] [*][url=http://www.agatheringplace.com/Continuing-Education.htm][b]A Gathering Place - Working with Cancer Patients (4CEU's)[/b][/url][*][url=http://events.linkedin.com/Oncology-Massage-Training/pub/161748][b]Oncology Massage Training - Vivacious Living Centre - Applecross, WA AU [/b][/url][*][url=http://www.massagetoday.com/mpacms/mt/article.php?id=13461][b]Developments in Oncology Massage - Massage Today[/b][/url][*][url=http://www.mdanderson.org/education-and-research/resources-for-professionals/clinical-tools-and-resources/cimer/therapies/manipulative-and-body-based-methods/massage.html][b]MD Anderson- Massage and Related Bodywork - Review[/b][/url][*][url=http://www.txmassageforum.com/content/information-massage-cancer][b]Information on Massage for Cancer - Texas Massage Forum[/b][/url] [i]Note about MD Andersons Oncology Massage Training, found on the Texas Massage Forum[/i]: [quote]"Our Oncology Massage Course [at MD Anderson] is typically offered annually in June, so the next opportunity will be June 2010 and is currently held Houston at M. D. Anderson Cancer Center. If you want to be on their e-mail list, contact Sharon Parker: sparker@mdanderson.org Title of Course: [b]An Integrative Approach to Oncology Massage[/b]."[/quote][/list]











Posted: Tue Jan 19, 2010 8:23 am














pueppi






 
Post subject: 
Re: Cancer Client with Lymphadema
 













squash_blsm wrote:For the OP question...I just saw this post and realized that I never quite answered the questions asked. I thought I had done a pretty good job, but in re-reading, see where I pretty much failed the OP. How about I try again? Jenn@AttunedMotion wrote:OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage. I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know? If you feel conflicted, you're first item of business is to decide what direction you want to go with her. I can't tell you which of the above options is right for you. But, I can tell you that now is a good time to set your boundaries regarding patients who have (or have had) oncology issues.Do you want to work on clients who have never had cancer? Do you want to work on clients who have had a cancer issue in the past but are now cleared? Do you want to work on clients who may currently have cancer? Do you want to work on alleviating pain or issues in clients who have cancer, but the pain and issues are not associated with the cancer? Do you only want to work on clients who have complaints which are only related to their cancer? Do you want to "mix and match" according to the client and how you feel about them as a person. Not how you feel about them having cancer as part of their "condition". ie: You'll work on some, but not others? These are the items you'll have to first decide on. Once you've come up with that decision, then question one will be easier to answer.Jenn@AttunedMotion wrote: 2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?I don't see anything wrong with giving her information about maual therapies, if you don't think she is aware of how lymphatic massage may help. I think that would be well within your bounds. I get the feeling that is your overall concern with this question. As a therapist, you aren't in the position to let her medical team do anything. They will do what they will do. It is the clients decision if she wants to let that happen, so you shouldn't have to worry there.Jenn@AttunedMotion wrote:3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself? These are some general contraindications for hot stone work. Since enough of these can be co-existing problems in a patient with cancer, I would surmise that this would reason enough not to use them without a confirmation from the MD. As I mentioned earilier, with our unfortunate litigious society, it's usually best to CYA.GENERAL CONTRAINDICATIONS/CAUTIONSPlease consult the referring physician whenever uncertain about any condition or response.• Cancer• Hemorrhage• Decreased Sensation• Weakness• Skin lesions• Pregnancy• Tuberculosis• Anemia• Diabetes Mellitus• Heart disease• Hypertension• Peripheral vasculardisease• Fever• Pulse (Too high or too low)• If your skin is sensitive• Hypothyroidism• Kidney problems• InflammationJenn@AttunedMotion wrote:4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage. It is my belief that massage therapy for people living with cancer is best when practiced by a skilled therapist trained in oncology massage. Things to keep in mind: thorough intake; discussion with the MD or nurse working with the client and the condition; ability to modify sessions to work around the side effects of radiation, chemotherapy, surgery and medication; avoidance of solid tumors.Jenn@AttunedMotion wrote:I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.Hope this helps.

[quote="squash_blsm"]For the OP question...[/quote]I just saw this post and realized that I never quite answered the questions asked. I thought I had done a pretty good job, but in re-reading, see where I pretty much failed the OP. How about I try again? :oops: [list][quote="Jenn@AttunedMotion"]OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage. I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know? [/quote]If you feel conflicted, you're first item of business is to decide what direction you want to go with her. I can't tell you which of the above options is right for you. But, I can tell you that now is a good time to set your boundaries regarding patients who have (or have had) oncology issues.Do you want to work on clients who have never had cancer? Do you want to work on clients who have had a cancer issue in the past but are now cleared? Do you want to work on clients who may currently have cancer? Do you want to work on alleviating pain or issues in clients who have cancer, but the pain and issues are not associated with the cancer? Do you only want to work on clients who have complaints which are [i]only[/i] related to their cancer? Do you want to "mix and match" according to the client and how you feel about them as a person. Not how you feel about them having cancer as part of their "condition". [i]ie: You'll work on some, but not others[/i]? These are the items you'll have to first decide on. Once you've come up with that decision, then question one will be easier to answer.[quote="Jenn@AttunedMotion"] 2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?[/quote]I don't see anything wrong with giving her information about maual therapies, if you don't think she is aware of how lymphatic massage may help. I think that would be well within your bounds. I get the feeling that is your overall concern with this question. As a therapist, you aren't in the position to [i]let[/i] her medical team do anything. They will do what they will do. It is the clients decision if she wants to let that happen, so you shouldn't have to worry there.[quote="Jenn@AttunedMotion"]3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself? [/quote]These are some general contraindications for hot stone work. Since enough of these can be co-existing problems in a patient with cancer, I would surmise that this would reason enough not to use them without a confirmation from the MD. As I mentioned earilier, with our unfortunate litigious society, it's usually best to CYA.GENERAL CONTRAINDICATIONS/CAUTIONSPlease consult the referring physician whenever uncertain about any condition or response.• Cancer• Hemorrhage• Decreased Sensation• Weakness• Skin lesions• Pregnancy• Tuberculosis• Anemia• Diabetes Mellitus• Heart disease• Hypertension• Peripheral vasculardisease• Fever• Pulse (Too high or too low)• If your skin is sensitive• Hypothyroidism• Kidney problems• Inflammation[quote="Jenn@AttunedMotion"]4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage. [/quote]It is my belief that massage therapy for people living with cancer is best when practiced by a skilled therapist trained in oncology massage. Things to keep in mind: thorough intake; discussion with the MD or nurse working with the client and the condition; ability to modify sessions to work around the side effects of radiation, chemotherapy, surgery and medication; avoidance of solid tumors.[quote="Jenn@AttunedMotion"]I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.Hope this helps.[/list]











Posted: Tue Jan 19, 2010 7:37 am














squash_blsm






 
Post subject: 
Re: Cancer Client with Lymphadema
 













For the OP question...I would suggest Lymphatic Drainage --you can refer her to the Upledger practitioner site for therapist names by stateshe will want one who is lymphadema certified. Wonderful work - I think that she would benefit immensely.http://www.iahp.com/pages/search/index.phpI can't imagine any drug that could help the condition.I would not have done a hot stone massage without notice either. Good call.I DO work on cancer patients. Some in remission and some were terminal.Mostly I do it because I like working with this population and understandably some MT's are uncomfortable to work on them for various reasons, so they have a hard time finding a therapist.My clients who were terminal were desperate to receive loving ,nurturing touch - and not only did they enjoy our sessions, they experienced pain reduction and greater emotional peace. Most doctors know that massage does not spread cancer.When I am at end of life I really hope that someone will be there to give me bodywork.However I totally respect the decision of any MT not to work with this population and see no reason for someone to get upset about that choice.Personally - although I will do pregnancy massage I don't really feel like it's my "thing". I would prefer to refer them to another therapist unless they just want cranio sacral work. But lots of MT's love pregnancy massage.

For the OP question...I would suggest Lymphatic Drainage --you can refer her to the Upledger practitioner site for therapist names by stateshe will want one who is lymphadema certified. Wonderful work - I think that she would benefit immensely.http://www.iahp.com/pages/search/index.phpI can't imagine any drug that could help the condition.I would not have done a hot stone massage without notice either. Good call.I DO work on cancer patients. Some in remission and some were terminal.Mostly I do it because I like working with this population and understandably some MT's are uncomfortable to work on them for various reasons, so they have a hard time finding a therapist.My clients who were terminal were desperate to receive loving ,nurturing touch - and not only did they enjoy our sessions, they experienced pain reduction and greater emotional peace. Most doctors know that massage does not spread cancer.When I am at end of life I really hope that someone will be there to give me bodywork.However I totally respect the decision of any MT not to work with this population and see no reason for someone to get upset about that choice.Personally - although I will do pregnancy massage I don't really feel like it's my "thing". I would prefer to refer them to another therapist unless they just want cranio sacral work. But lots of MT's love pregnancy massage.











Posted: Sun Jan 17, 2010 10:38 am














ukgal99






 
Post subject: 
Re: Cancer Client with Lymphadema
 













It is a shame that some people still think that massage can spread cancer. I did a project on massage and cancer whilst I was learning massage. For my research I visited a charity that offered complementary treatments to cancer clients. As a result of the kindness that the staff showed me I told them as soon as I was qualified that I would volunteer with them. Since 2000 I have been giving massages to these clients. With other volunteers we undertook additianal training to give us a better understanding of the illiness. We get consent from their doctor before visiting. Like any massage I perform I tailor the treatment to the client in terms of the areas they'd like me to massage and how they are feeling that day. Generally the massage is gentle. My attitude with these clients is that at this time they need a loving touch compared to proding and pulling they may receive from the doctors but that is just my opinion. I am comfortable working with these clients but can understand those who have reservations. For clients with lymphodema I thought that Manul Lymphatic Drainage could be a help. I probably haven't answered the questions but just wanted to my 2 cents (2 pence - as I'm in England!!)

It is a shame that some people still think that massage can spread cancer. I did a project on massage and cancer whilst I was learning massage. For my research I visited a charity that offered complementary treatments to cancer clients. As a result of the kindness that the staff showed me I told them as soon as I was qualified that I would volunteer with them. Since 2000 I have been giving massages to these clients. With other volunteers we undertook additianal training to give us a better understanding of the illiness. We get consent from their doctor before visiting. Like any massage I perform I tailor the treatment to the client in terms of the areas they'd like me to massage and how they are feeling that day. Generally the massage is gentle. My attitude with these clients is that at this time they need a loving touch compared to proding and pulling they may receive from the doctors but that is just my opinion. I am comfortable working with these clients but can understand those who have reservations. For clients with lymphodema I thought that Manul Lymphatic Drainage could be a help. I probably haven't answered the questions but just wanted to my 2 cents (2 pence - as I'm in England!!)











Posted: Fri Jan 15, 2010 7:21 pm














pueppi






 
Post subject: 
Re: Cancer Client with Lymphadema
 













RoS makes great points.Food for thought as I had to tell a friend just yesterday that I would not work on her since she has cancer as an underlying condition (however, I will work on someone who has had cancer in the past, but is now "cleared" of it). I felt terrible having to tell her this, especially when she got angry, because she felt like I should be able to "do the job" just fine. I think her words were: "Well I came to you to work on me. The other person I use can do it, I just don't see why you can't." She left in a huff, after I tried to explain that I don't and won't do work with cancer patients, but am happy to refer her to someone who is competent with it. Our friendship is most likely strained. I feel awful that I let her down. But, I have to do what is right for me and what I am comfortable with in this situation. I honestly believe that there are great bodyworkers out there who feel comfortable working on cancer patients and who don't have specific training, so that is not where I am going with this post.I personally do not see oncocology patients, because I don't feel like I have enough training behind me for any complications which may arise. I have 17 years in private practice and even then think it's just best to have taken very specific training in regard to this. It's not something I am patient enough to do right now.No, I don't believe that massage can spread cancer, but I do believe that if a patient has mets (metastisis), there can be some other problems occur, of which I don't want to get dragged into court over, just because someone doesn't understand what massage won't do. Society has too many litigation problems these days. So, I hold my cancer work to family and possibly my best friend if that work is ever needed. I do hope that if I ever get cancer, I can find someone willing to work on me. But, I certainly won't hold it against them if they don't feel comfortable and want to refer me out, like my "friend" did.Hope that helps you in your decision making process.PS: I'll try to add some links to course work that may help you in the future, later on.01/19/10 - edited for some typos.

RoS makes great points.Food for thought as I had to tell a friend just yesterday that I would not work on her since she has cancer as an underlying condition (however, I will work on someone who has had cancer in the past, but is now "cleared" of it). I felt terrible having to tell her this, especially when she got angry, because she felt like I should be able to "do the job" just fine. I think her words were: "Well I came to you to work on me. The other person I use can do it, I just don't see why you can't." She left in a huff, after I tried to explain that I don't and won't do work with cancer patients, but am happy to refer her to someone who is competent with it. Our friendship is most likely strained. I feel awful that I let her down. But, I have to do what is right for me and what [b]I[/b] am comfortable with in this situation. :(I honestly believe that there are great bodyworkers out there who feel comfortable working on cancer patients and who don't have specific training, so that is not where I am going with this post.I personally do not see oncocology patients, because I don't feel like I have enough training behind me for any complications which may arise. I have 17 years in private practice and even then think it's just best to have taken very specific training in regard to this. It's not something I am patient enough to do right now.No, I don't believe that massage can spread cancer, but I do believe that if a patient has mets (metastisis), there can be some other problems occur, of which I don't want to get dragged into court over, just because someone doesn't understand what massage [i]won't[/i] do. Society has too many litigation problems these days. So, I hold my cancer work to family and possibly my best friend if that work is ever needed. I do hope that if I ever get cancer, I can find someone willing to work on me. But, I certainly won't hold it against them if they don't feel comfortable and want to refer me out, like my "friend" did.Hope that helps you in your decision making process.PS: I'll try to add some links to course work that may help you in the future, later on.[size=85]01/19/10 - edited for some typos. [/size]











Posted: Fri Jan 15, 2010 1:30 pm














Rose of Sharon






 
Post subject: 
Re: Cancer Client with Lymphadema
 













Before referring her out, find out for sure what she wants. The manager should have done that yesterday, before anything else, actually, but the questions can still be asked. After finding out what she wants, have her sign consent forms so that you can discuss this with her physician and/or treatment team members, to determine what YOU can, should or should not do. If it is determined that what you can offer based on your experience and training does not fit with the treatment plan, then by all means, refer her out. If, on the other hand, she wants to relax and the team feels that regular relaxation massage will be beneficial - which is quite likely - get specific, written instructions regarding whether or not hot stones can be used and where they can be used (they may say only on her back). Get specific, written instructions on whether to massage the lower body, and if so, what techniques and pressure to use. Gentle effleurage may be perfect. If you feel, for any reason, that you are not equipped or do not want to work with this client, then it is best to refer her out - very, very carefully. People going through cancer treatment are going through a very emotionally difficult process, and being told "no massage" can make them feel rejected, and like they are frightening/untouchable. Ultimately, you have a right to choose what type of clients you want to work with. The whole idea that massage spreads cancer was unproven. We were told in school that they thought it would spread since it increases circulation. However, not only has that "massage increases circulation" been disproved, but those with cancer are encouraged to walk - which increases circulation. Circulation is a good thing. Even for folks with cancer!!!

Before referring her out, find out for sure what she wants. The manager should have done that yesterday, before anything else, actually, but the questions can still be asked. After finding out what she wants, have her sign consent forms so that you can discuss this with her physician and/or treatment team members, to determine what YOU can, should or should not do. If it is determined that what you can offer based on your experience and training does not fit with the treatment plan, then by all means, refer her out. If, on the other hand, she wants to relax and the team feels that regular relaxation massage will be beneficial - which is quite likely - get specific, written instructions regarding whether or not hot stones can be used and where they can be used (they may say only on her back). Get specific, written instructions on whether to massage the lower body, and if so, what techniques and pressure to use. Gentle effleurage may be perfect. If you feel, for any reason, that you are not equipped or do not want to work with this client, then it is best to refer her out - very, very carefully. People going through cancer treatment are going through a very emotionally difficult process, and being told "no massage" can make them feel rejected, and like they are frightening/untouchable. Ultimately, you have a right to choose what type of clients you want to work with. The whole idea that massage spreads cancer was unproven. We were told in school that they thought it would spread since it increases circulation. However, not only has that "massage increases circulation" been disproved, but those with cancer are encouraged to walk - which increases circulation. Circulation is a good thing. Even for folks with cancer!!!











Posted: Fri Jan 15, 2010 10:44 am














Jenn@AttunedMotion






 
Post subject: 
Cancer Client with Lymphadema
 













OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage. I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know? 2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself? 4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage. I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.

OK, I had a client come in yesterday that was diagnosed with cancer about a year prior. She did not undergo any chemotherapy or radiation, she had some lymph nodes in the pelvic region removed resulting in lymphadema in both legs. She is enrolled in an investigational drug study where she may be receiving medication or a placebo injection every 12 weeks, she is not sure what the drug is? She came in wanting a hot stone massage, my manager said no heat therapy could be done, and she could only receive very light swedish until we received a Dr's note okaying deep massage or heat treatments. I did a full body 80 min session spending most of the time on her back, shoulders, neck with light/medium pressure swedish and some deeper work on specific knots. I worked with featherlight pressure on her legs, just gentle effleurage. I searched through all my books at home, and looked online and I feel conflicted about treating this client. These are my concerns..1) I don't feel that I am professionally educated enough to deal with her condition (I wish I knew more, but at this time I have very little experience with cancer massage). Should I follow up with her today to make sure she is ok, and should I refer her to a medical massage therapist that I know? 2) Maybe she just wants relaxation massage and is ok with not receieving a specific treatment plan for her conditions? Or maybe she doesn't know what other therapy is available to help>? I know she went through OT and PT after her lymph node removal, so should I let her treatment team take care of her medical condition while I help her relax physically and mentally?3) While I understand that heat is contraindicated for certain conditions, why would using hot stones would be bad (just on her back), considering she could go home and take a hot bath, or use a heat pack herself? 4) I had another therapist tell me that they would never do massage for cancer clients because it "spreads the cancer". I think I have enough medical training to know that no research has ever been proven in regards to cancer metastasizing due to massage. I'm just at a loss here, this is the first client I have ever worked on that has cancer, and I really need some guidance please! I can fill in more details if needed.











Posted: Fri Jan 15, 2010 9:37 am


















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[Pompal 09.]

Cancer Client with Lymphadema

Thank you everyone for the great feedback!

I haven't made any major decisions yet, but I decided to follow up with my client via mail. I sent her a lovely thank you card for coming in, and asked her to get a medical release from her Dr if she is interested in deeper treatment or for heat therapy (for her neck and shoulders). I also told her that I knew a therapist who was very skilled in working with cancer patients and doing lymphatic drainage and if she and her Dr decided it was a better course of treatment for her, I would be happy to give her that information. I also thanked her for allowing me to work with her and how I appreciated her, and that if she wanted to come in for another relaxation style session I would be happy to work with her again!

I really find this field to be so fascinating, I have no personal concerns with working with cancer patients, (I just want to be sure that I'm not doing any harm!), and I can't wait to learn more about this. Thanks for the fantastic links too, now I have a lot of reading to do!

 

[viv]

Cancer Client with Lymphadema

Have you ever thought about vonlunteering your services with Hospice? In my area they are also looking for MT's. I would think that would be a great way to get training and experiance