Part One | Part Two
By: Jean Johnson for Uterus1
Gayle MacDonald, MS, LMT, observes that massage can have the unexpected consequence of providing neutral ground for patients – creating a space and place in which they feel safe enough to divulge their candid thoughts about what they are going through. It can be a welcome respite from having to conduct themselves as they think they should.
“Massage gives people in treatment a place to talk and share and unwind. They spend a lot of time protecting their friends and family,” MacDonald explained. “So with a massage they can tell their story; they don’t have to protect the massage therapist.”
|Gayle MacDonald, MS, LMT, offers the following tips on finding an oncology massage therapist:|
Call a local massage school and ask if anyone is trained to work with cancer patients.
See if your hospital has an integrative or complementary medicine section where oncology massage therapists work.
Ask other cancer patients that you meet in chemotherapy rooms or radiation clinics if they know of good practitioners.
Get recommendations from friends who have had cancer.
If uncertain, ask about what modalities a therapist is trained in. If their main focus is sports massage, trigger point therapy, or deep tissue, look elsewhere.
Oncology Massage Helps the Effects of Radiation
MacDonald notes that radiation can cause scarring. “Scarring and adhesions can develop, which cause the tissue to shrink and the shoulder to be pulled in. Massage can help this physical aspect – help the irradiated tissue become more pliable.”
Radiation also damages lymph nodes, creating increased risk for lymphedema, which can lead to a heavily swollen arm and severe fatigue, among other symptoms.
“If you drew a line down the midline of the body through the sternum and belly to the groin, that’s one watershed. Then if you use a horizontal line that runs underneath the ribcage, that’s another. So the body is basically divided into four quadrants.
“So, say I had a mastectomy and had some lymph nodes removed, plus radiation that causes scarring and damages the remaining lymph nodes – that puts me at higher risk for lymphedema,” MacDonald said. “What happens is the lymphatic load the person can handle in that quadrant is basically decreased. That’s why patients are given a list of dos and don’ts for that arm, like not picking up heavy groceries or working out too hard on that side.
“The same applies to vigorous massage, because the lymph system in this quadrant can’t filter at normal capacity. So the number one adjustment an oncology massage therapist needs to make is to be less vigorous in that quadrant,” MacDonald said. “And the next most important idea is that on the arm, the strokes should go toward the heart and they shouldn’t redden the skin. That’s why hot stones that are so popular right now aren’t a good idea. The same goes with hot tubs and hot wraps.
“Even 30 years from now they are at risk. It’s for the rest of the client’s life and they need to let any massage therapist they go to know about their breast cancer status, even if it’s long since in the past. It’s really important not to trigger lymphedema.”
Massage for Lumpectomy and Mastectomy Patients
According to MacDonald, “the majority of breast cancer patients are treated with lumpectomies rather than mastectomies.” That said, she underscored that “lymph nodes are still dissected and radiation is still given with a lumpectomy. So all of the precautions I noted for a mastectomy patient are true for one who has had a lumpectomy.”
When it comes to both lumpectomies and mastectomies, massage can be invaluable according to MacDonald. “It’s natural to be protective of any area that’s had surgery, and so mastectomy patients may curl their shoulder over. If given in the right way, massage can help increase range of motion, enable women to regain confidence in their bodies, and help them feel whole again.
“I think breast cancer especially can make a woman worry about her appearance and her femininity, so massage can help her feel comfortable and loveable again. Massage is reassuring. Many women who have come through a mastectomy, and who are ready again to be touched by spouses and partners will start with massage. It helps them come to terms with what happened.
“Finally, people tend to disassociate from the area that had the tumor, so massage helps them bring their awareness back to their entire body and bring wholeness back to the entire body.”
Massage by ‘Cowboys’ Should Be Avoided
While MacDonald clearly believes massage can help women who have breast cancer, she is adamant about avoiding practitioners who are not specifically trained in oncology massage. More, she is concerned about a trend in the larger field that licenses massage therapists who have illusions about their abilities.
“I call them cowboys. They ride roughshod over people and think that they can fix things with the deeper-the-better approach. That’s the over-riding theme of modern massage training. They’re teaching people to fix things.
“When I went to school in the late-1980s it was enough to just give a good relaxing massage. Over the past 10 years, though, it’s become over-professionalized.”
Indeed, MacDonald says that the average massage therapist today is armed with a toolkit they want to use to find and fix problems. Instead of this trendy approach, she submits that cancer patients simply need a good old-fashioned massage that is gentle and does so much to relieve anxiety and stress.
“Patients need to find someone they can relax with so they don’t have to be hyper-vigilant with the massage therapist,” said MacDonald. “Imagine being very vulnerable after treatment, and having a massage therapist who thinks they can fix things and is focused on finding painful spots for deep tissue work.
“Also you need to remember that as a cancer patient, you can be getting a wonderful massage and feel good in the moment, but later you will realize it was too much and pay the price by ending up fluish, deeply fatigued, and re-experiencing treatment side effects like diarrhea and nausea. That’s because it takes a long time to get all those toxins out of the system. Deep massage stirs all that up.”
For these reasons, MacDonald urges Uterus1 readers to be assertive in making sure massage therapists treat their bodies carefully.
“Clients should not let the massage therapist, or any practitioner like a chiropractor or acupuncturist, do something to the body to traumatize it. Also if you’ve asked them twice to change something negative about the massage and the therapist does not respond, then I would get up off the table and end the session.”
It’s important to remember that you have the power and should not doubt yourself when it’s time to use it. As MacDonald said, “This is your experience, so the level of pressure should be up to you just as is the extent to which you disrobe. So if you feel trauma in any way that isn’t getting resolved, simply get up off the table and end the massage.”
Cautions duly stated, MacDonald offers a sound approach for working with an oncology massage therapist. “The first massage women have with their practitioner needs to be light and moderate so that they leave the session feeling good all that day. If that works, then they can inch up the next time with a little more pressure. It’s all about finding your new normal. You can’t just pick up where you left off. You have to find your own new normal, and a good oncology massage therapist can help you do that.”
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