Some of the RN's where I see some patients in the hospital that are at the end of their life do not want me to see the patients because when I do,"they go down hill fast." I relax them and sometimes use some acupressure points that help "let go". The patients are suffering during the time they say they do not want me to go in the rooms. How do I get them to understand the transaction from this life to the next is going to happen no matter what? What is wrong with it being fast instead of lingering slow and painful for the patient and the families? Is anyone else having this problem? I do this for a hospice and everyone including the family members are grateful. I am frustrated especially today. A patient that has been in and out of the hospital for over a year and a half is going to die today or tomorrow. I did get them to let me in to say good bye, but was not allowed to touch the patient. This patient is a very gentle kind, still saying this is God's will it will be ok. A smooth, fast transition is what is diserved. Not suffering.

I believe that the way of passing is a delicate and complex one, also for the therapist (somehow you are dealing with your own mortality as well). Have you looked at any of Eliszabeth Kobbler-Ross books? Just for background knowledge-

All the best-
Nurit

I am not ready to die but I do try to live as if I have a year to live. I have read Elisxabeth Kobbler-Ross books. Being an eleventh hour vouleteer has opened my eyes a lot. When my time comes I hope it will be swift and painless. I have left instructions that I am to only get pain medicine when the time comes. I want the suffering for the ones around me to be over as soon as possible also. My problem is how can I get the point across to nurses that have been tought only that extending life every second that it can be is the number one pryority when the patient has said, "I am ready to go". If I hand them a book to read they won't. I think I am going to ask my supervisor to have a meeting with the director on that floor to see if she can find out where he stands and go from there.

I think it can be difficult for medically trained people to let go of control over treatment. End of life is especially challenging because it is actually a natural process where constructive interventions are meant to assist the person to die, but not to effect the death itself.
Since many people actually do die in hospitals, a helpful concept is palliative care. Palliative care is oriented toward symptom relief and is not curative by definition. Medical, nursing and complementary interventions can all be construed as different forms of palliative care and are as appropriate at end of life as when they are used to mitigate pain or side effects in an illness where curative interventions are also employed.
Nurses are very involved in pain management and other measures that assist patients to tolerate a medical or surgical intervention for an illness or problem. Keeping a dying person as comfortable and free from anxiety as possible with pain medication, oxygen or repositioning are examples of palliative care during the process of dying, not a means to hasten the process. Your interventions are also palliative care to mitigate suffering, not hasten death. My hope is that you can help the nursing staff to see that you are not in opposition to what they are doing, but part of the team.

To echo Barbara's post, when working in the medical paradigm, it's best to speak their language. And they speak research. Go onto Tiffany Field's website and give them what they need to understand the role you can play in their paradigm. Educate them in what it is that you do at the root level because it sounds like they really don't know. You're playing not in the holistic sandbox in this case, but in the medical sandbox, and you'll make your life a lot easier if you play according to their rules.

The other thing I'd like to add is that it is always advisable to not meet force with force. Yield to their resistance by knowing who you are and the value of what you offer. If their resistance does not yield in turn, perhaps it is best to shift your efforts to where you are not met with such resistance (and frankly, disrespect for your profession).

When I was a new therapist, I would struggle with clients who didn't want to embrace their healing, make changes, follow my recommendations, the ones who I knew I could help, if only they'd meet me half way and be compliant.

The hardest lesson for me back then was understanding where my journey ended and where theirs began. This might be one of those situations -- not on the one-to-one level of therapist/client, but on the level of therapist/facility. Perhaps this administration is simply not ready to embrace this journey. Consciousness has many tiers and it's not fair to demand a higher consciousness of people who haven't begun to do their work.

It's a hard thing to swallow. But sometimes "what we know" and "what is" simply cannot align because it's not what meant to be for reasons we can't even fathom. Learning happens at so many levels, individually, collectively. Gently test the barrier with the administration, arm yourself with research articles and stand in your power. If they do not yield, it might be best to invest your energy elsewhere (where it will be valued and embraced and where you can do your work without frustration).

Maria Troia, MSEd, LMT, NCTMB, CH
www.KIRAHolistic.com

Thank you both for your wisdom. I think the holistic RN spoke to them. Today they were actually kind to me for the first time in a long time. I have always been as nice as I could be. I have NEVER stepped on their toes or over their boundries. It has not been easy. I am not the type to keep my mouth shut. I know I am in their house and need to respect it. Their department used to have a palitive care team but have lost it over the years. It might be time to suggest that they look into starting it again. I have a lunch and learn schedueled to speak at in the spring on what Holistic Health can do to help you help your patients. I will try to find quotes that are helpful to this subject. If you can give me any page examples in any of the books please let me know. I have tons of books! I just need time to find the best quotes.

Sandra, Wholistic health blends the left brain skills of science, reason with right brained skills ff of direct perception, intuition and relation to the person behind the patient. It is using the best science to know that what you do will not harm the person and at the same time go beyond what you can measure and even fully rationally understand to work with the whole person. It is shedding the ego and what is right and focusing on help the person rather than treating the person. It is letting the person be in control and trying to help them be the best thy can of their own accord rather that fixing them.
It does not replace traditional medicine. If you are doing surgery or giving be drugs I want to to use the best science to do the right thing. But by taking this role I am depersonalizing the patient and limiting what I do to what I can know and understand with a reasonable certainty. I don’t think people can play both roles but I see the two complementing each other.
Wholistic wellness in a sense is more difficult than scientifically based methodologies because when cannot rule out things that cannot be scientifically explained yet they must objectively eliminate quackery and fantasy.

In addition to the studies done by Tiffany Fields, I would suggest Gayle MacDonald's book, Medicine Hands for some good quotes. Also, The Anatomy of Hope- Jerome Groopman, M.D., and Kitchen Table Wisdom - Rachel Naomi Remen, M.D. both have interesting ideas that cross over the medical/holistic boundary.
The lunch and learn format sounds like a great, non-threatening way to educate about holistic health. In a hospital where I have worked we had a monthly, lunchtime Journal Club where anyone could present an interesting journal article or something they had learned at a conference. I got quite a bit of positive feedback after I presented a study about massage therapy and the benefits of comfort and relaxation. It was basic information that connected relaxation with reduced anxiety, but I noticed that there were more referrals for patients I could help without adding another medication to their menu, so I suppose they 'got it'. Your dedication and patience will certainly benefit you and the nursing staff.

Thanks I consider myself lucky to have the opertunity to be part of integrating science with wholistic medicine at a hospital. The TOP people in the hospital are getting it. They still have a way to go. Every tiny bit is remarkable and I am so grateful to be part of it. I will be reading a lot before my lunch and learn so that I can have as much written quotes as possible.

AMMA Therapy Basic I will be held in the Red Rock Country of Sedona, AZ from October 30 - November 2, 2009 at Your HeartWalk Center on Hwy 179.

AMMA Therapy® is a 5,000 year old system of healing, originating in Korea and brought to the United States by the late Mrs. Tina Sohn, descendant of a royal line of TCM healers and a healing sensitive who could directly experience the energy of others. Along with her late husband, Dr. Robert Sohn, they founded the Wholistic Health Center on Long Island, the largest center of its kind on the east coast, now known as the New York College of Health Professions. AMMA Therapy® was also taught to acupuncture students at the college as well as Wholistic Nursing students who have integrated the technique into the hospital setting. The Sohns co-authored what is said to be the most comprehensive text on Asian bodywork: AMMA Therapy®, A Complete Textbook of Oriental Bodywork and Medical Principles.

AMMA Therapy® offers your clients a complete form of therapy, incorporating bodywork, Chinese diet, and concepts from Qi Gong and T’ai Chi Chuan. It is based on the Eight Principles of Traditional Chinese Medicine as well as Five Element Theory. The technique’s focus on the Five Elements places a high importance on the vital role of the emotions in healing. An AMMA Therapy® session completely embraces the notion of treating body, mind, and spirit.

At its most basic level, AMMA Therapy® addresses structural imbalances such as neck and back pain. At the advanced level, AMMA Therapy® also benefits conditions such as sinusitis, asthma, digestive problems, PMS, menopause, low immune function, fibromyalgia, chronic fatigue, and headaches.

As the therapist is taught how to direct energy from the Dan Tien (the hara), this therapy is easy on your body and reenergizes you along with your client.

Instructor: Maria Troia, MSEd, LMT, NCTMB, CH

Maria Troia is a former instructor of AMMA Therapy® and a student clinic supervisor at the NY College of Health Professions. She has the permission of the current trademark holder to continue to teach AMMA Therapy® independently. She is also approved by NCBTMB as a CE provider (# 450883-08).

$500 (32 contact hours) on or before 9/26/09
(After 9/26 tuition is $550)

To register call 480-313-6260 or visit www.kiraholistic.com for more information.

I will be offering an advanced aromatherapy class, "Beyond Basics: In-depth Essential Oil Monographs", to be held on Sat/Sun September 12 & 13 in Plano, Texas, just north of Dallas. This class is geared toward bodyworkers, holistic nurses and CAM practitioners. To register, please call 972-509-5588 and mention Aromaceuticals. The complete course description is available at www.aromaceuticals.com/classes.

I am a practicing Clinical Aromatherapist and a NCBTMB approved provider ((280770-00) of classes on Aromatherapy. I teach a series of classes designed for professionals within the healthcare delivery system and specialized classes for hopice employees and volunteers. To learn more about these, please visit my site at: www.LovingScents.com or telephone: 336.294.7727.

I would like to invite anyone interested to join the AMMA Therapy group I have created:

www.massageprofessionals.com/group/ammatherapy

AMMA Therapy(R) is a form of Asian Bodywork. More information can be found at the AMMA Therapy(R) group.

Maria Troia, MSEd, LMT, NCTMB, CH
www.kiraholistic.com

Upcoming October aromatherapy classes in Dallas, TX, taught by registered clinical aromatherapist Katharine Koeppen. The Mind & Spirit course is especially valuable for hospice workers.

INTRO TO AROMATICS
Sunday, October 4
9:30am – 4:30pm
Location: Ke Kino Institute of Healing, Plano, TX 75075
Visit www.aromaceuticals.com for course description. 6 CEU’s available for LMT.
Fee: $125. Call 972-509-5588 to register, and mention Aromaceuticals.

AROMATHERAPY FOR THE MIND AND SPIRIT
Saturday and Sunday, October 24 - 25
9:30am – 4:30pm
Location: Ke Kino Institute of Healing, Plano, TX 75075
Visit www.aromaceuticals.com for course description. 12 CEU’s available for LMT.
Fee: $250. Call 972-509-5588 to register, and mention Aromaceuticals.

Is it me, or has this group changes to just announcements of classes? I joined thinking that it would be to discuss issues involving introducing Wholistic concepts to traditional medicine and palliative care.
I think the hospice is s great place to start because the egos of being right tend to disappear and to focus s**** to the patient. As to moving into hospitals I think we need to work on integrating evidence-based practice and Wholistic approaches. Unfortunately people including many MTs equate EBP and medical massage. We need to learn and teach others that while science tends to be objective and rational, if we limit ourselves to just what fits into a scientific model we are not doing the best for our patients when we looks at the results of our treatment objectively.
W can use observations that we cannot quantify and tools and techniques that defy rational explanation and still achieve measurably better results.

THANK YOU! It is good to know what is available to attend but I did start this to talk about care of patients. I am presently giving Jin Shin Do(R) Acupressure sessions to two different people for tennitis. I have been working by the books with a little success. I am relaxing the head, face, and neck area. Focusing also on K, LV, and GB meridians. Have any of you had any sucess with tinnitis?

Sandra,
is it low or high pitch tinnitis? Low is Kidney deficiency. High is Liver excess. Let's start there. Also, are you trained in CST?

Maria,
Someone that speaks my language! One is high and one is low pitch. I have used Kidney tonification and Liver sedation points. I am not YET trained in CST but I have done one session on someone is school. Have you had any success for tinnitis? I have done two sessions on each and will be seeing both next week again.

Hi Sandra,

Keep doing what you're doing with the Kidney and the Liver. You're on the right track. But try to keep searching for causative factor under both too.... think 5 element. Look at the control and creation cycles. Is a Spleen deficiency creating a weak Kidney? Or is it Lung/Kidney and the Lung not nourishing the Kidney? With the Liver, is it a weak Kidney not nourishing the Liver? Or is the Lung not acting as the lid on the Liver? Keep pulling the threads to find the true root. I'm assuming if you are using TCM bodywork that you also do pulse and tongue assessment. What do those things indicate?

Yes, I've worked with tinnitis, both low and high pitch. I use both AMMA Therapy and CST with great results.

If you have a colleague nearby who can show you some basics of CST, particularly ear pulls, try to integrate that. And remember, the ear is the sense organ of the Kidney... so, there is often overlap. East and West can't really be separated.

Maria Troia, MSEd, LMT, NCTMB, CH
www.KIRAHolistic.com

Thanks Maria,

I have been used to seeing patients for 10 minutes. That is only enough time to work on small problems. The hospital is now letting me see patients as real clients for hour sessions. I have gotten out of the habbit of using tongue and pulses to help. I have had extra training in both. I am going to change my intake form back to having this information in my form. I will let you know how next week goes.
Thanks again for the reminders. It is a big help to have someone to talk to that knows TCM.

Sandra,

Glad to help. I teach TCM/5 element bodywork, so if you have any questions, you may contact me directly as well. Ten minutes per session is a challenge, but you do what you can, pull one thread at a time and really focus and set your intention. You should always look at pulse and tongue, even with time limits. It gives you invaluable information about the energy body, the emotions, and how to find the root, as well as how to evaluate your progress. I tell my students "tongues don't lie, even though patients/clients might." Plus, I firmly believe "if you don't use it, you lose it." I see it happen all the time with therapists who get away from traditional assessment and then try to go back to it and find they aren't as adept as before. It's really important to keep such subtle skills active. The other advantage is the more you use them, the more acute your assessment/sensitivity skills become. So, while charting this information in your notes is always best, form or no form, do pulse and tongue anyway.

Glad to hear they are letting you do some longer sessions! Sounds like things are coming along there for you!

Best of luck,
Maria Troia, MSEd, LMT, NCTMB, CH
www.KIRAHolistic.com

I have been a massage therapist for 6 years and I am back in school to become a nurse (graduate next Dec). I plan to practice nursing for a few years then go back for TCM or Oriental Medicine, which will depend on where we move. I believe that both western and eastern healing can work wonders together.
Does anyone have any thoughts or helpful advice on how to merge the two while I am nursing school. I get so frustrated at times because where I live there is almost no alternative health clinics, except for the one I work at. When I am a RN I plan to work in a hospital that integrates both western and eastern practices. However for now I am just trying to learn the basics of eastern healing so I will have some useful information when I begin that training, plus it just makes so much sense.

Lindsey,

You might want to look at my website to get some ideas of what is out there for you: www.KIRAHolistic.com. Go to the Student Seminars and then the AMMA Therapy Instruction tab. AMMA Therapy is an eastern system of healing (5 element bodywork, diet, Chinese exercise, TCM assessment tools) which was successfully integrated into Belvue Hospital and other hospitals in NY through the Wholistic Nursing Program.

I am currently providing CEUs to LMTs in AMMA Therapy and working on getting CEUs for nurses in 2010. The nursing program is going to be the next big shift in AMMA Therapy education and it was always said that the nurses were the ones who "kept AMMA Therapy pure."

Classes are based in Arizona right now, but will eventually be traveling.

You can always contact me privately with any questions.

As far as merging the two fields while you're in school, that might be tough depending on the pulse of the administration you have and might take some discerning. Try to network within your program and within the hospitals and see who is open to complimentary medicine. Also, have you contacted the Holistic Nursing Association in Flagstaff, AZ? They might have some good suggestions for you.

Best of luck with your program. You are wise to know that the current state of care is calling for something more. We are all pioneers at the edge of profound change.

Maria Troia, MSEd, LMT, NCTMB, CH

Maria,
Thank you for the information, I am going to check out your website and I am a student member of the AHNA. In fact I am thinking of starting a chapter here for my school.

Maria,

I have information on the clients I am seeing for Tinnitus. Thank you for helping us. Any suggestions are welcome.
Male early 60's has had this as far as he can remember. He had scarlet fever as a child. Has had open heart surgery. Can not take the daily aspirin the doctor prescribes because it makes it worse. Coffee makes it worse. His sinuses are bad. The pitch is medium and goes up and down. Sounds like mosquitoes buzzing. When he places his palms on his ears and applies pressure the noise gets better. Pulses SJ/P no pulse, ST/SP both forceful, big, slow, LI/LU no pulse. B/K no pulse, GB/LV and SI/H all slow and hard. Tongue narrow pointed thick red cracks on both sides about 1/4 inch in from the edge. He is heavy set, short; his head did sit on his shoulders. I am making progress using the Jin Shin Do (R) neck release. His neck is about 2 inches off the shoulders now after 3 sessions. I have been using Yang Bridge Vessel release points for most of the sessions with LU, LV, and K source points. GB points around the head. One time when I was on the jaw point he said there was a difference in the pitch but it went back right away.

Second client female mid 40's. Tall thin body, neck and back muscles were hard as rock when I started. Head tilted slightly to the right. High pitched sounds like crickets. Tongue round, thick, red, SJ/P, ST/SP, LI/LU, B/K all even, thin, strong, normal pace, GB/LV harder and larger, SI/H both less in strength. Tongue round cracked down middle, moist, red, thick, Pressure to ears improves condition. Jin Shin Do (R) neck release with Yang Bridge Vessel for most of the session. With H, LU and SI points. LV2 . Her body twitches from left to right when some of the points release. Sometimes it is just the head and sometimes it is the whole body. She feels her left ear is getting better.
Thank you,
Sandy

I was recently asked to do a fee for service Reiki consult for an inpatient with metastasized cancer who had painful muscle spasms which had not been helped by medication. Fortunately, what I did was useful and offered some relief, but I began wondering.. Are there models for hospital or hospice palliative care teams that include CAM therapists that anyone is aware of?

Barbara, I believe the Palliative Care team at Mt. Sinai hospital might be a useful model for you.

Thanks very much, Lisa.

You're welcome, Barbara,
trying contacting:
JD Elder, L.M.T.
Massage Program Coordinator
Tel: (212) 241-0914
E-mail: joseph.elder@mssm.edu

Barb, If you can volunteer for a Hospice around you. It is a great way to get your feet in the door and I learned more about life than I could have ever imagined by going through their training program.

Regarding models for Reiki in hospitals, Portsmouth Hospital in Portsmouth NH has offered Reiki for a number of years. At one point I believe they employed a full-time Reiki practitioner.

Thank you all very much for your responses. We all know how much patients are helped by manual and energy field interventions, but it's difficult to impress cost-conscious healthcare administrators of the value without some real world evidence to back the argument.

is it good to do massage on cancer patients?

Sandy,

Sorry for my delay in answering. Have been traveling to Sedona doing some promotional work for my AMMA Therapy class at the end of the month.

As to both clients, sounds like Liver/GB is the root. Aspirin and coffee intensifying the tinnitis suggests to me that there is toxic load on the Liver. Sinus problems are damp heat (Liver invading Spleen). Tonify Spleen, sedate Liver. I'm assuming what you call a "hard" Liver pulse is what we call a wiry pulse. That and the thick red cracks on the sides of tongue also suggests there are issues with an excess Liver, too much heat, drying up the Yin, causing the cracks. Tonify Yin, Sedate Yang.

Your second client is also Liver related, but sounds like maybe Liver Blood deficiency, given the thin pulses. Any visual disturbances? What about the menses? Twitching is always related to the Liver.

Pressure into the ear improving symptoms tells me again that you need to look at learning some cranial work, specifically ear pulls. Ear pulls will also release the GB meridian around the ears, so the technique will affect local symptoms, and also energetic block.

In both cases, bodywork is probably not enough. Diet needs to be looked at -- how does their diet compare to TCM diet? If you don't have it, get a copy of Paul Pitchford's book, Healing With Whole Foods. Spirit also needs to be considered. Where are their emotions at? What resources do they have to address emotions of anger, frustration and irritability?

Maria Troia, MSEd, LMT, NCTMB, CH
www.kiraholistic.com

Maria,
Thank you for your help. I have not seen either client since I sent my comment. Your suggestions are great. I needed to be reminded of these as you said before and I didn't use it so I Lost it. One of the clients has a lot of emotional problems that I am aware of. We are working on that with Jin Shin Do (R) Bodymind Transwork (R). I am not sure of the other but I will find out. By remembering to take pulses for just a regular massage on an outpatient turned out to make it very different. I added LU and LI source points and she started crying. By the end she confessed a problem and I will now be there to help support her through it at the hospital.
Thanks,
Sandy

Nyema,
I work the most with cancer patients. They need the touch. It helps them feel whole. Relaxing a cancer patient can be their only way left to feel anything good. You need to be aware of surgical procedures that have been done. Be cautious if Lymph Nodes have been removed. If you are not sure of anything have the patient ask their doctor.
Sandy

Sandy,

Glad I could help. Sounds like you are doing great work. Pulse and Tongue give us so much insight into the whole person and the true nature of dis-ease. I'm glad you've reconnected with these tools in your work!

Maria Troia, MSEd, LMT, NCTMB, CH
www.kiraholistic.com

I have a patient in hospice with end stage metastatic colon CA, gross ascites, and weeping edema in the legs/feet. I was thinking that lymphatic drainage massage might provide some relief from the edema, and maybe reduce the fluid in the legs so the weeping stops, but I am not sure if it is contraindicated in this case. I am concerned about cardiac overload with the massive amount of fluid involved, but as far as I know, this patient's cardiovascular system is healthy. The nurses on the unit seem to think that it would be a good idea, and they are going to try to wrap the legs as well to see if the compression reduces the edema. Should I attempt an LMD session with this patient, or stick with the gentle modified Swedish massage that I have been doing up to this point?

I would not wory about overloading his heart as much as can his body take it comfortably. At this point I do the best I can to relax the patient. If the skin is strong enough to take it and there is no pain go for it. At this stage the most important thing is will it make the patient more comfortable.

Came across this and thought it appropriate for here:

http://www.naturaltouchmarketing.com/HBMN-hospital-massage/HBMNHome...

Wanting to start a volunteer program at a local hospital. Any suggestions?

Anyone have any of these books/CDs used and interested in parting with them?

Hospital-Based Massage Programs in Review
1001 Sources to Build Your Hospital Massage Program
Exploring Hospital-Based Massage

all are by Laura Koch, ed.

Hello All, I will be working with our local Hospice starting next month. I feel fortunate to have found this group. You will inspire and support me on this journey. Blessings to you all.

SAVE THE DATE: September 30 - October 2
Alliance of International Aromatherapists
International Integrative Aromatherapy Conference & Wellness Expo
Save the date for the premier North American aromatherapy conference. Four days of learning from and networking with the most informed professionals in the industry, plus pre- and post-conference intensives.

Katharine Koeppen, RA, of Aromaceuticals will be a featured speaker on aromatherapy for the personal terrain. There will be a host of other speakers presenting on aromatherapy for hospice and palliative care, cancer care, skin care, massage, psychotherapy, Eastern medicine, and integration of aromatics into other clinical environments. Attend bonus lectures and meet vendors at the Expo. For more information, visit Alliance of International Aromatherapists at www.alliance-aromatherapists.org.

Katharine Koeppen, RA
Aromaceuticals/Essential Oils from Artisan Distillers
www.aromaceuticals.com
Texas AIA Representative

Hello everyone

I am looking for three more people to partake in a test pilot Pediatric Massage for Children with Special Needs home study course offering 20 CE's

NCBTMB approved

Touch-For-Life.Com for more information

Thank you

Aromaceuticals' next foundational CEU class in aromatherapy will be held on April 2 in Dallas. If interested, please visit the website for details. 

Namaste,

Katharine Koeppen, RA, LMT, NCTMB

http://www.aromaceuticals.com/classes

I'm new to insurance billing/PIP cases and am looking for input on what other LMTs are charging for writing narratives/reports (outside of SOAP notes), attending depositions, clerical (making copies/filing/researching documentation), etc. This also applies to insurance clients who are non-PIP. Any input you can give with your experience in this area would be appreciated. Thanks!

12 hour CEU class, Exploring Chakras, Lafayette, La. July 23 &  24, a unique and interesting exploration of your chakras and aura, aura photos included.  Energetic Trauma Release CEU class and Mind, Body Self care strategies CEU classes, August and September.

www.SynergisticCenter.com

I'd like to extend an invitation to list in my massage directory..the basic listing is free.

Synergistic Center Massage Directory

Job Opening: Medical Director of Integrative Medicine
The Roy & Patricia Disney Family Cancer Center
at Providence St. Joseph Medical Center, Burbank, CA
818.843.5111 

Contact Human Resources Dept