Terminated for declining Chemo Patient

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Permalink Reply by George Lee, LMBT on February 4, 2015 at 12:54am

Knowledge dispels fear. You don't have to be fearful, but become informed on the basics to guide you. If you find out someone has a history then have them fill out a detailed intake form so you know what you are working with. This is probably the single most important thing. I think Gayle has a sample in her book. If not let me know. And your single most important resource? The client. Ask them anything you don't know about. They know more about their own condition than anyone else. Ask them if there doctor put any restrictions on them physically. Even if they were not specifically OK'd or not OK'd for massage the doctor's guidelines will give you a clue. Ask about their general daily activity. Ask about any discomforts during any sort of activity. Ask if they tire quickly. The intake is the single most important piece. That's also why I add 30min to a typical massage, just for the information gathering. I would recommend this as a standard for anyone that is going to work with a cancer patient. This should be factored in to appointment schedules. Have the appointment setter ask the routine question on if they have any medical conditions. If so and they aren't screened out from having an appointment otherwise (Well, I have this weepy rash. Is that a problem?), have and additional 15-30min added to the appointment for intake information. Use the intake form as a guide for additional guide. "So what is this medication for?"

In some of my above post I have referenced Gayle MacDonald's Medicine Hands as the definitive book and it's not text book pricing like some guides.

http://www.amazon.com/Medicine-Hands-Massage-Therapy-People/dp/1844...

I have also referenced Tracy Walton's online classes and even listed the free published versions in PDF form of a couple of the classes. You can read the PDF's and then get online and get the CEU's instead of having to sit through the class online. So, that basic info is free and you can get a few CEU's if you want for for whatever price it its now. See my references above so I don't have to type them here.

I hope that helps everyone to get at least some basics down.This should get you on the road to being able to work with most stronger, healthier patients. We also teach a totally non-invasive method of massage that is appropriate for just about everyone. But, that gets into advanced work. As part of cancer therapy, I have a whole speech on if we would slow down our work we would be more effective with a lighter touch, but that's another story. It bridges into energy work. 

George

Permalink Reply by Steve Gordon on February 4, 2015 at 6:49am

Two things to keep in mind about this. First, getting a massage from someone who is very nervous about doing it isn't likely to be a wonderful experience, so forcing the therapist to do it or be fired isn't in the best interest of the therapist, the client or, ultimately, the business. Working with the therapist to ease her discomfort would be, though.

And second, the note from the doctor doesn't sound as though it was worth much. If it came from a PCP, keep in mind that many general practice docs don't know a tremendous amount about cancer, especially about cancer in the context of CAM practices. And even it if came from an oncologist, it's woefully short of information that the therapist should have. A good intake by therapist would make up for a lot of that, though.

Permalink Reply by Gordon J. Wallis on February 4, 2015 at 2:14pm

Well, after 30 years, I'm not aftaid to massage anyone. And I have massaged more then one cancer patient. But that being said. I'm going to do more research. Thank you guys for the info.

Permalink Reply by Gary W Addis, LMT on February 4, 2015 at 3:35pm

Therese, my education included pathology for massage therapists, which included providing massage of oncology patients. 

Not long ago we were bludgeoned with the erroneous notion that massage-- any massage-- would cause the cancer to metastasize to other parts of the body.   Now we know that to be flat wrong.  But we are still inundated by unnecessary cautions about many massage therapy techniques.  We are warned to NEVER stroke distal...NEVER work in any of the endangerment sites...NEVER apply pressure to this or that Shiatsu / Acupressure Point on a pregnant client.  Yet thousands of MTs regularly violate these "rules" without causing premature labor or paralysis or blood clots. 

    

Permalink Reply by George Lee, LMBT on February 5, 2015 at 3:23am

 Such hubris. You're not looking at the bigger picture. When dealing with other peoples lives and their physical and spiritual well being, do you error on the side of caution by not risking potential injury or do you go with what's ok MOST of the time and because you can get away with it? We didn't know things then, so we said, don't take the risk. As we learned more, we adapted and changed. Why? Because it was for the benefit of the client, not for the convenience of the therapist. Discovering new information is done with empirical data that is collected and studied. Where is your empirical data that no one is injured? Has there been a study? Who does that reporting, the therapist? If I've hurt someone am I going to tell the world? What about the client?

  One of my oncology volunteer therapist was also a survivor. She related a story to me, that she had once received a massage while undergoing chemo. She said that later in day, she felt so bad that she barely left bed for 3 days. I asked if she told the therapist? No. Did she tell anyone else? No, except her MD. She felt it was her own fault and didn't want to make a big deal out of it and while she was going through chemo, she didn't have the energy to do anything about it anyway. She never went back. Did that therapist know he had done harm?  What did that MD think about massage therapist in general? I have heard multiple stories from patients that have come to me after having bad experiences, but never "reported" it. But, there are instances.

What about those therapist that don't have your superior techniques or methods? By saying they should ignore the "rules" and that they should go ahead and work outside their scope of knowledge and training is both irresponsible and a unethical, regardless of how many therapist are "breaking the rules" and getting away with it. You say that as though it were somehow acceptable. It violates the sacred fiduciary trust between the client and the therapist. 

Getting an idea of what you may or may not know is easy and free. I've given you the links. Are they not worth your time?

By the way, distal strokes ARE bad. Circulation predominately moves outward through arteries that are deep and closer to the bone, while most venous flow that returns back to the heart is more superficial, closer to the surface. So, distal strokes primarily affect venous return and is contrary to natural blood flow. This can create additional pressure in the veins and limbs. In cancer patients, many of whom are taking blood thinners to avoid DVT's, the risk of edema of the limb or bruising or rupturing due to frail blood vessels from treatment is very real. Also factor in peripheral neuropathy where they may not be able to accurately report pain or discomfort to the therapist. Cancer patient's are at higher risk of DVT's due to chemo, radiation and surgeries.  

I'm not saying everyone needs some special certification to work with cancer patients. For our local Komen Race for the Cure,I've trained groups of new therapist in one hour sessions on how to work with cancer patients giving chair massage. They learn the basics of what to look out for, what to ask and to raise their hand if someone is complicate beyond their understanding. I'm usually standing by. We usually work about 200 people per an event of 35,000 participants, the majority of whom are cancer survivors.

You shouldn't go blindly into something you don't really know about. Learn something about it and if you are so inclined study more so you can do more. Find out what the risk are and your individual limitations are based on your knowledge and experience. You owe that to your clients. 

Gary W Addis, LMT said:

Therese, my education included pathology for massage therapists, which included providing massage of oncology patients. 

Not long ago we were bludgeoned with the erroneous notion that massage-- any massage-- would cause the cancer to metastasize to other parts of the body.   Now we know that to be flat wrong.  But we are still inundated by unnecessary cautions about many massage therapy techniques.  We are warned to NEVER stroke distal...NEVER work in any of the endangerment sites...NEVER apply pressure to this or that Shiatsu / Acupressure Point on a pregnant client.  Yet thousands of MTs regularly violate these "rules" without causing premature labor or paralysis or blood clots. 

    

Permalink Reply by Gary W Addis, LMT on February 5, 2015 at 12:54pm

Sigh.  George, you are a strong advocate for your agenda.  You're stepping over the line, however, when you accuse me of hubris, a sin you, imo, commit in this discussion.  For you, sir, are sitting in judgment, informing us unless we obtain your self-proclaimed high level of education in oncology massage, we are endangering cancer victims.  The attitude you express so well fuels paranoia, fear of touch-- 'she keeps rubbing her arm, her leg, her low back, but her therapist told me I might hurt my momma if I rub her.  Cancer victims are considered pariahs by far too many.  A niece admitted to me that she had what she knew to be an irrational fear that her grandmother's cancer was somehow contagious.  

It took my mother in law a year to die.  During her long illness, I provided a small degree of comfort to her.  I urged other family members to touch her lovingly, to stroke her back and tight neck, to lightly knead her aches away.  A grimace or flinch provided ample guidance about the pressure used.  I also provided massage to other residents of the hospice center, within sight of oncologists and nurses.  No one was injured; to the contrary, the appreciation was evident in the eyes of patients and their families and medical staff.      

George, I mentioned distal stroking passingly, certainly not in connection to your specialty, Oncology Massage.  A cancer patient's skin may be paper thin, often develops purpura, bleeding beneath the skin.  So, no, George, I do not stroke cancer patients distal: I assumed you credited me with commonsense.

But, since you brought it up......Distal strokes are not automatically harmful.  No one is suggesting DT stroking toward the feet, nor am I condoning even relatively light distal effleurage for an entire session: nay, I am advocating letting the tissue be the guide.  A google search produces lots of condemnation of this ancient myth.  Dr Ben Benjamin, Clair Davies et al have stated unequivocally that the blanket condemnation of distal stroking is ludicrous.  For how else would you elongate a short, tight muscle if not by stroking away from the muscle's origin toward its insertion?

You are not qualified to sit in judgment of LMTs you do not know, Mr. Lee. 

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