Pull Up A Chair

3 Red chairs overlooking the Hudson River

I see the title of this book, Pull Up a Book each time I  am at a client’s house.  It always reminds me of sitting down and inviting a friend to chat for a while.  Reminds me of my fascination with taking pictures of chairs as I vacation and photograph unique chairs that seem to invite me to sit and rest.

 I believe journaling is an important self help modality for oncology massage therapists.  We touch so many patients with compassion and a healing heart that we need to write down the moments to keep them with us always.  Many times they touch us in ways that are sacred and it is important not to lose the memories.  I hope that you will share your thoughts about a time when an oncology massage made a difference.

___________________________

Keeping Company with a Client with Depression

I first saw the patient at the front desk, trying to compose herself as she gave her insurance information and co-payments to the financial representative.  Our center is always cold, an old house renovated with air conditioning that makes it either too hot or too cold.  She was shivering from cold and crying, struggling to compose herself.  I brought her a heated blanket and stood behind her gently rubbing her back as she did all the initial paperwork.  It was the beginning of her journey of chemo, surgery and possibly radiation treatment.

As I waited with her, we talked about many things: about her occupation as a sales clerk in a store that I frequent, her upcoming wedding, family members who were with her.  She confided in me that she had a long history of clinical depression.  I thought to myself how cancer treatment alone puts people at risk of clinical depression; it had to be even harder, starting out with a level of risk.  And so often, depression and anxiety appear together.  I brought her something to drink and waited as she got her blood work taken.  At times, she was tearful as she talked.

 I asked her if I could give her a gentle shoulder massage while she waited to see the doctor.  First I taught her a relaxation technique that I use with lots of patients, something to focus on while I massaged her shoulders. It is an easy one: Breathe in, think of a word, breathe out, think of another.  Once she could do that, I massaged her hands for a few minutes until she was called into the exam room.  I know the importance of patients telling their stories.  So we talked.  I listened. 

A few days later I got a phone call from her.  She wanted me there on her first day of chemotherapy.  I was across the street at the other center, but told her to call me when they started and I would walk over.  When I walked in and saw her face, her smile was so genuine, her eyes lit up, it amazed me how different she looked from a few days ago.  I hardly recognized her. 

To decrease anxiety in a treatment center, this is what I do: bring blankets and refreshments.  Talk about our families and vacations and jobs.  Share photos of grandchildren, commiserate over parenting challenges.  Laugh.  Give hugs for good news and extra hugs when the news is not so good.  Depending on the patient, massage can also be done.  It can calm someone’s heart and put them on a beach someplace.  When there is a lot of anxiety and isolation, the personal contact of massage can offer a simple, brief diversion.

I never forget that each patient may come in with a host of pre-existing conditions.  In our work with people in cancer treatment, each patient comes in with a whole physical and emotional history.  We can’t forget or overlook those conditions.  In the case of anxiety and depression, someone may need extra care.  I am mindful of this as I work.

______________

The Radiant Radiation Patient

 Have you ever met someone who could simply light up a room with their eyes or their smile?  I was fortunate to meet just such a person–a young, beautiful and bald 4 year old girl in the radiation waiting room with her parents at her side.

It was obvious that this family had seen their share of medical treatments centers and waiting rooms, so I decided to offer the mother a mini massage while they waited.  She enthusiastically accepted my offer. 

 As I was massaging her shoulders, her daughter watched intently and seemed to want to a similar treatment!  With her parent’s permission, I picked her up and put her into my chair.  She promptly folded her hands in her lap, closed her eyes and appeared so contented, as if she’d had hundreds of massages before! 

 As I massaged her shoulders, I thought to myself, this child is about my granddaughter’s age, she’s beautiful and so healthy looking except for her hair loss.  And she’s so brave, mature and regal, like a sweet little princess.

 While I massaged her, the parents quipped back and forth–hopefully–about her future.  “Someday she will be my spa partner!” the mom told the dad, wistfully.

 “Most definitely, she will walk into the spa and love every minute” the dad answered with a chuckle.

______________________

Back to the Books!

We are fortunate that there are so many great medications available today for oncology patients, and that the pharmaceutical companies are continually updating the drugs and improving them.  While these medications can be miraculous for patients, they can be nightmarish for oncology estheticians if they don’t constantly keep up-to-date with the medications, their usage and their treatments.

 I recently met a patient who was taking a medication to help prevent bone loss during breast cancer treatments and getting ready to have radiation treatments to her cervical spine, which made me realize that her cancer had metastasized to her spine. Since she had just finished telling me that she was getting a massage therapist and esthetician to work out her knots in her neck, I explained to her why firm massage was not safe at this time. Firm massage worried me because hard or deep massage on the clavicle or neck area can be seriously detrimental to the patient if too much pressure is used. The patient may be at risk for a fracture. 

   Usually, tumors are aggravated and helped to grow by estrogen and progesterone.  Oncologists give the patient hormone-blockers which weaken the bones, so other medications, such as the one this patient is taking, treat this side effect by strengthening the bones

 It’s really important for the patient and the practitioner to have a thorough consultation before each service and to update the patients list of medications on their intake form.  Also, if you are a massage therapist working with oncology patients it’s imperative that you have a variety of drug resource guides at your disposal.  That guides will allow you to look up the meds a client, may be on and those guides will give you a clear and concise understanding of spa services are safe for the patient.

We have to understand the consequences of our actions, especially when, unfortunately some patients are not educated enough concerning their illnesses, medications and the precautions they need to take when looking for relief from the side of effects of treatment utilizing spa modalities..

 My advice?  When you don’t know how a medication works …go back to the books and look it up!

 __________________________

Vera’s secret to a long life

No arthritis pain until 83 she tells me

“How?” I asked, wanted to discover her fountain of youth.

 Qt. of fresh milk a day

Okra

Yams

Chicken/fish

Rum/beer

Partying and dancing

Faith

“So simple,”  I said.

 _____________________________-

Leave the Sweat Lodge Behind

There are all kinds of people in the world, with all kinds of ideas and beliefs about medicine and healing.  As an oncology practitioner I get to hear lots of stories of how people employ their thinking about wholeness and body to the diseases of cancer.  Here is one such story.

 An older Asian woman I met was in treatment for metastastic breast cancer to the bones, after being cancer-free for about ten years.  She told me that she had recently been diagnosed with lymphedema, swelling in the arm caused by excess fluid that collects after the lymph nodes have been removed by surgery or affected by radiation treatments.

 During our conversation I asked her why she thought she might have gotten lymphedema after 10 years.   She responded by telling me that she spent long hours on her favorite hobby–cross-stitching.  I know that excessive arm movements from hobbies may initiate a lymph edema diagnosis, but I was sure if her theory was correct so I pushed on.

With every question more and more of the story became clear to me.  Apparently a few months earlier when the woman wasn’t feeling as well as she thought she should, she decided to go back to practicing traditional oriental medicine. Without consulting her oncologist about her declining health, the patient felt that she should go through a sweat lodge experience so she could get rid of the toxins in her body, which she though would eradicate whatever illness she was suffering from.  She never realized that she was feeling badly because she was having a recurrence of breast cancer. 

 This woman didn’t realize, or perhaps was never told that that due to her earlier surgical procedure in which axillary nodes were removed, she was at a high risk of lymph edema.  It is probable that the sweat lodge experience was a factor in the sudden appearance of lymph edema to this woman’s arm. Lymph edema frequently appears for the first time after undue stress is placed on an already compromised lymphatic system. Often the swelling can occur years after the cancer related surgery was performed. The rapid increase in body temperature that occurred in the sweat lodge resulted in a larger than usual amount of lymphatic fluid being moved through the lymphatic system. When a sudden increase of fluid overloads the transport capacity of the intact lymphatic vessels, the lymphatic fluid has nowhere to go but to overflow into the tissue and swelling results

 Unfortunately survivors need to know that they are always at risk for lymphedema.  If you come across a patient who is having these kinds of issues, explain to her that she is at risk and advise her to call her oncologist immediately.

And, for goodness sakes, keep her out of the sweat lodge, the sauna and the ho

___________________________

I met a new patient that is going through radiation tx for bone mets, originally diagnosed with breast cancer.  I introduced her to gentle massage, her arms resting on a pillow, while sitting in a chair with the music on in a quiet waiting room in the radiation dept.  She loved how it felt and promised to seek me out the next time I was there.  When I saw her again, in broken Spanish she explained to me how she had given her husband a massage just as I had given it to her, she turned on the music, sat him in a chair and gave him a pillow to rest on.  “He loved it,” she told me, and afterwards she whispered to me, “He kissed my lumptectomy scar.”  She said that he was showing her that he loved her with her not being perfect, I told her he was showing her how happy he was that she was still here to love.  As she left the room, she confided in me how grateful she was to be able to do something for him in return for all he does for her.

 _____________________