Cancer Care 5 Notes - benbenjamin.com

4/1/2011

1

Cancer, Massage,

and the Vital Organ Principle

More Hidden Contraindications

A Webinar with Tracy Walton, MS, LMT

Part 5 of the Massage in Cancer Care Webinar Series

Background

• Author

• Educator

• Researcher

• Massage Therapist

• Specialist in

massage therapy

and cancer care

Tracy Walton

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Cancer Massage

The Old Massage Contraindication

Today’s Webinar

Set foundations

Effects of cancer on vital organs

Effects of cancer treatment on vital organs

Sample massage adjustments for each vital organ

Interview questions for each

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Foundations

1. The concept of “Circulatory Massage”

2. The Filter and Pump Principle

3. The Vital Organ Principle

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Is Massage Circulatory?

Back in

Webinar 1,

We

challenged

the claim

But that was

about massage

spreading cancer

This is about

increased

circulation

challenging a

person’s body

during disease

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Many massage contraindications based

on the assumption

(or possibility)

that massage increases circulation

Massage ↑ blood flow,

overwhelms a compromised organ

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We don’t

know.

?

This might take a while.

It could be.

It might not be.Research has yet

to tell us

yes or no.

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If it is circulatory,

does it matter?

In certain

medical

conditions?

?We observe that some people feel

worse after “circulatory massage”

Maybe,

maybe not.

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In the absence of information…

We need guidance

A guideline.

A principle.

“First, do no harm.”

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does it matter?

In certain

medical

conditions?


worse after

“circulatory massage”

Maybe,

maybe not.

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does it matter?

In certain

medical

conditions?


worse after

“massage with circulatory intent”

Maybe,

maybe not.

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And base this guideline on the

possibility that massage is circulatory.

Not the assumption that it is

What is Massage with Circulatory Intent ?

Effleurage

Petrissage

Repeated

compressions

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The Massage Pressure Scale

Medium pressure →

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The Massage Pressure Scale

- Used to warm up muscles for deeper work

- Body mechanics needed; adjacent joints rock

- Effleurage petrissage, repeated

compressions thought to be

“circulatory” at this pressure and above

Pressure

Level

3

“Medium

Pressure”

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⁺Effleurage

Petrissage

Repeated

compressions

Pressure

Level

3“Medium

Pressure”

(or above) 17


⁺Effleurage

Petrissage

Repeated

compressions ⁼

Increased

Blood

Flow

Pressure

Level

3“Medium

Pressure”

(or above) 18

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Foundations

1. The concept of “Circulatory Massage”

2. The Filter and Pump Principle

3. The Vital Organ Principle

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The Filter and Pump Principle

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The Filter and Pump Principle

If a filtering organ

or

a pumping organ

is functioning poorly or overworking,

do not work it harder with

massage that is “circulatory”

in intent.

←(liver, kidney, spleen,

or lymph node)

←(the heart)

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The Vital Organ Principle

If a vital organ is compromised in function,

use gentle massage elements and adjust

them to pose minimal challenge to the

client’s body.

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Complications

Vital Organ

Compromise

EssentialsCancer

Medical

TreatmentsEffects of Treatments

Vital Organ

Compromise

Massage

Adjustments

• Contact

• Lubricant

• Pressure

• Joint Movement Friction

• Position

• Site of massage

• Draping

• Speed

• Rhythm

• Session length

• Session timing

• Session intent

• Medical consultation

• Medical referral

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Complications

Vital Organ

Compromise

EssentialsCancer

Medical


Vital Organ

Compromise

Massage

Adjustments

“Dial it down;” take care with

• Pressure

• Joint Movement

• Friction

• Position

• Speed

• Rhythm

• Session length

• Session timing

• Session intent

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The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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Three Steps of Metastasis

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The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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Cancer and the Brain

Cancer effects depend on location of lesion

Clinical Features

• Headaches

• Nausea

• Seizures

• Neck pain/stiffness

• Disturbances in

special senses

• Speech disturbances

• Mood and personality

changes

• Memory loss/confusion

• Problems with balance

• Weakness or paralysis

• Numbness/tingling in

arms/legs

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Complications

Attention/

memory

problems

EssentialsCancer

Medical

Treatments

Chemotherapy

Effects of Treatments

Attention/memory

problems

(Chemo-brain)

Massage

Adjustments

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Complications

Attention/

memory

problems

EssentialsCancer

Medical

Treatments

Chemotherapy


Attention/memory

problems

(Chemo-brain)

Massage

Adjustments

•Good communication

•Simple questions

•Care with info-gathering

•Session timing/

appointment reminders

•Compassion

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Questions about Brain Function

• Has cancer or cancer

treatment affected your

nervous system at all?

• Any effects on brain or

mental function?

– If so, what are the effects?

– Do you have any problems with memory or

attention?

– Any problems with balance or movement?

– Any problems with…etc.

(see slide #41 for more possibilities) 31

The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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Complications

↓ Heart

function

EssentialsCancer

Medical

Treatments

•Chemotherapy

•Radiation

therapy


↓ Heart function

Massage

Adjustments

•Be alert for DVT, adapt to

risk of DVT

•No spa/heat treatments that

raise core temperature

•Avoid massage thought to

increase general circulation

Heart and Activity Questions


treatment affected your

heart function at all?

– If so, how?

– Is your doctor concerned about it?

• Are there any medical restrictions on your activities?

• Any restrictions on saunas, hot tubs, heat?

• What is your activity level, day to day and week to

week?

• What is your energy level?

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The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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36

Complications

Breathing

difficulty

EssentialsCancer

Medical


Massage

Adjustments

• Contact

• Lubricant

• Pressure

• Joint Movement Friction

• Position

• Site of massage

• Draping

• Speed

• Rhythm

• Session length

• Session timing

• Session intent

• Medical consultation

• Medical referral

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Complications

Breathing

difficulty

EssentialsCancer

Medical


Massage

Adjustments

• Position for ease of

breathing

• Slow speed

• Even rhythm

Adapt Position for Breathing Problems

Seated

Sidelying

Semi-reclining

Adapt to claustrophobia

Adapt to breathing equipment

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Adapt to Breathing Problems

•Adapt to

claustrophobia

•Adapt to breathing

equipment

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Lung and Breathing Questions


treatment affected the

function of your lungs?

• Is your breathing affected?

• Are there certain positions that help your breathing?

• Any that make you uncomfortable?

• In what position do you sleep?

• Do you use any breathing support, such as oxygen?

• Activity level/energy level?

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The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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Liver Failure

• Clinical Features

- Jaundice -Easy bruising, bleeding

- Itching - Osteoporosis

- Encephalopathy - Ascites

• Focus here on

– easy bruising, bleeding

– Itching

• The Filter and Pump Principle42

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Easy bruising

and bleeding:

Petechiae

and

Ecchymosis

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44

Complications

Liver failure

with

easy bruising/

bleeding

EssentialsCancer

Medical


Massage

Adjustments

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45

Complications

Liver failure

with

easy bruising/

bleeding

EssentialsCancer

Medical


Massage

Adjustments

Gentle pressure overall

Gentle joint movement

overall

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Complications

Liver failure

with Itching

EssentialsCancer

Medical


Massage

Adjustments

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47

Complications

Liver failure

with Itching

EssentialsCancer

Medical


Massage

Adjustments

Firm, stationary pressure

may be best

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Complications

Liver failure

EssentialsCancer

Medical


Massage

Adjustments

Follow the “Filter and Pump

Principle”

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Questions about Liver Function


treatment affected your liver

function at all?

– If so, how does that affect you?

– Is your doctor concerned about it?

– Any effects on skin? Breathing? Other functions?

• Do you have any swelling anywhere?

– Where? What causes the swelling?

• Any bruising or bleeding?

• Any itching? 49

The Vital Organs

Brain

Heart

Lungs

Liver

Kidneys

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Kidney Cancer

Clinical Features

- Blood in urine - ↑ blood calcium

- Pain in side/abdomen - Liver function problems

- Lump in side/abdomen - ↓ RBCs (anemia)

- Fatigue - ↑ RBCs (polycythemia)

- Weight loss

- Fever

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Comparing Anemia and Polycythemia

Anemia

• Too few RBCs

• “Thin blood”

• Fatigue

• Dizziness

• Intolerance of cold

Polycythemia

• Too many RBCs

• Thickened blood

• Congestion of spleen

• Breathing difficulty

• Dizziness

• Blood clots

• Poor clotting

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53

Complications

Anemia

with

• Fatigue

• Dizziness

• Intolerance

of cold

EssentialsKidney

Cancer

Medical


Massage

Adjustments

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Complications

Anemia

with

• Fatigue

• Dizziness

• Intolerance

of cold

EssentialsKidney

Cancer

Medical


Massage

Adjustments

• Gentle pressure

• Gradual transitions

• Slow speeds

• Slow rise from table

• Extra draping

“Dial it down” overall!!

THE VITAL ORGAN PRINCIPLE

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Complications

Polycythemia

with

• Congested

spleen

• Breathing

difficulty

• ↑DVT risk

• Headache

• Dizziness

EssentialsKidney

Cancer

Medical


Massage

Adjustments

• Avoid circulatory intent

• Adjust position

• Adjust position

• Be alert for DVT

• Care with face cradle,

pressure

• Slow rise from table

“Dial it down” overall!!

THE VITAL ORGAN PRINCIPLE

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Complications

Vital Organ

Compromise

EssentialsCancer

Medical


Vital Organ

Compromise

Massage

Adjustments

“Dial it down;” take care with

• Pressure

• Joint Movement

• Friction

• Position

• Speed

• Rhythm

• Session length

• Session timing

• Session intent

4/1/2011

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Complications

Impaired

•Liver

•Kidney

•Heart

•Spleen

EssentialsCancer

Medical


Massage

Adjustments

Follow the

Filter and Pump Principle

• No general circulatory

intent

• Avoid using pressure level

3 & above along with

- Effleurage

- Petrissage

- Repeated compressions

Massage Principles

• Vital Organ Principle

• Filter and Pump

Principle

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Essential Resources for Practicing Safely with People

with Cancer and Cancer Histories

MacDonald, G. Medicine

Hands: Massage Therapy

for People with Cancer.

Available at

www.medicinehands.com.

MacDonald, G. Massage

for the Hospital Patient and

Medical Frail Client.

Available at

www.medicinehands.com.

Curties, D. Massage

Therapy & Cancer.

Available at

www.curties-overzet.com

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Essential Resources for Practicing Safely with People

with Cancer and Cancer Histories

Walton, T.

Medical Conditions and

Massage Therapy: A

Decision Tree Approach.

Philadelphia: LWW, 2011.

Description and link at

www.tracywalton.com.

Collinge, W.

“Touch, Caring & Cancer:

Simple Instruction for

Family and Friends” View

trailers at

www.tracywalton.com;

complete description at

www.partnersinhealing.net

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The Society for Oncology Massage

www.s4om.org.

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Contact Information

Tracy Walton at www.tracywalton.com

Reach us at [email protected]

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Additional Questions on Facebook

Facebook.com/DrBenBenjamin

Some questions I cannot answer

Some questions I can answer

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Massage in Cancer Care

1. Cancer, Massage, and the Myth of Metastasis:

Why Skilled Massage Won’t Spread Cancer

2. Cancer, Massage, and Symptom Relief:

What does Research Tell Us about the Benefits of Massage?

3. Cancer, Massage, and Safety Essentials:

How is Oncology Massage Unique?

4. Cancer, Massage, and Unstable Tissues:

Hidden Contraindications

5. Cancer, Massage, and the Vital Organ Principle

More Hidden Contraindications

6. Cancer, Massage, and Detoxification

Does Massage Have a Role, or Not?

Other Webinars in this Series

(Pre-recorded)

(Pre-recorded)

(Pre-recorded)

(Pre-recorded)

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References

Chapman C. Lymphedema 101: what every therapist should know. Massage Therapy Journal

Winter 2001;39(4):86-89.

MacDonald G. Bodywork for Cancer Patients: the Need for a Less-Demanding Approach.”

Massage and Bodywork: June/July 2005, 16-26.

MacDonald G. “Easing the Chemotherapy Experience with Massage,” Massage Magazine

March/April 2000, pp. 85-91.

MacDonald G. “Learning from our Mistakes with Cancer Clients. Massage & Bodywork, May/June

2011, pp. 32-40.

Walton T. Cancer and Massage Therapy: Essential Contraindications (Part 1). Massage Therapy

Journal Summer 2006 45(2):119-135. Also available as on line course at www.amtamassage.org

Walton T. Cancer and Massage Therapy: Contraindications due to Cancer Treatment (Part 2).

Massage Therapy Journal Fall 2006 45(3):119-135. Also available as on line course at

www.amtamassage.org

MacDonald, G. “Cancer, Radiation and Massage,” Massage and Bodywork September, 2001, 16-31.

.

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Photo/Art Credits

Susan Mapel (Slides 7, 8, 14, 61)

Eli Kowalski (Slides 22-25)

Lippincott, Williams & Wilkins (Slides 23, 54, 58)

iStock Photo (72-74)

Fotolia (Slide 53)

Fotolia (Human Form Slides 38, 40, 46, 50, 56, 67)

Stephen Fischer (Slides 45, 49, 53, 55, 66)

Lenni Armstrong (Slide 39)

Microsoft (Slide 80)

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Unraveling the Mystery of Low Back Pain

Unraveling the Mystery of Cervical Pain

Unraveling the Mystery of Shoulder Pain

Unraveling the Mystery of Knee Pain

Unraveling the Mystery of Ankle Pain

Other Webinars

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All Webinars Available

at www.benbenjamin.com

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Cancer Care 5 Notes - benbenjamin.com