resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Billing and Coding for Moxibustion
Q: I am trying to locate a code for cupping and moxibustion, and have had various fellow acupuncturists indicate that they bill using the existing codes for heat, 97010 hot packs or 97026 infra-red for moxa and 97016 vasopneumatic device for cupping.
Changing the Cultural View of Medicine
Many hospitals in the U.S. are incorporating integrative clinics that include Traditional Chinese Medicine. Cleveland Clinic has led the charge for adding a traditional Chinese herbal medicine clinic to their existing acupuncture program.
The Future of Functional Neurology
Functional is the hot buzzword in health care these days; witness the rising popularity of functional medicine, functional testing and yes, functional neurology.
Do You Teach Patients How to Breathe Properly?
Spinal manipulation often produces quick results in terms of pain alleviation and improved range of motion. Unfortunately, once the patient is no longer in pain, they may discontinue therapy, only to be plagued by the same complaint at a future date.
Ethics: The Glue That Holds Us Together
Kudos to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for creating a code of ethics for the nationwide profession and for deciding to make courses in ethics a requirement for certification renewal.
News in Brief
A Winner in and Out of the Office; Ready for the "Have-A-Heart" Campaign? New Integrative Medicine Journal.
Integrative Medicine Can Shape the Profession
As the AOM profession struggles to define the role of "integrative" medicine within their practices their schools and organizations, students, faculty, alumni and administrators at schools wrestle with discussions of how much, where, how, and what to "integrate."
Elevated Shoulder? Check the QL
As you know, posture reveals a great deal about the body. Posture is a unique mental and physical landscape revealing compensations and adaptations to life. It's a classic mind-and-body story.
The MRI: When and Why to Order One
As I lecture around the country to both chiropractors and medical specialists, it's clear one of the main disconnects between the two professions is that of an accurate diagnosis.
Preventing ACL Injuries in Female Athletes
For female athletes, the key to optimal athletic health lies in preventing ACL injuries. In medical terms, the anterior cruciate ligament (ACL) is the primary restraint to the anterior displacement of the tibia on the femur at all angles of the knee flexor.
How to Humanize Your Content to Create Stronger Relationships
Content marketing is about building relationships, whether that is through updates on social media, offers on your website, blog posts, email campaigns, or even printed material. Now days a business needs to make a human connection.
Sell Out: Using Research for the Wrong Reasons
The above chorus is from the ska band Reel Big Fish's 1997 hit song, "Sell Out," from their album, "Turn the Radio Off." In the song, the singer sarcastically relates the plight of a musician who is tired of "flipping burgers" and is willing to get "lots of money" by playing "what they want you to hear" in order to get a recording contract.
From Antiquity to Modernity: Huang Qin Tang at Yale Medical School, Part 1
Traditional Chinese medicine is a coherent medical system with several unique characteristics: it originated almost 3,000 years ago; in its area of origin, it has been practiced without interruption since its inception.
The Roots of Insomnia
One of the most common clinical presentations is insomnia. Next to digestive disorders, sleep disorders are one of the most common complaints the clinician will encounter in daily practice.
Osteoporosis Isn't Always the Case
What is your diagnosis? The patient is a 58-year-old female with back pain. I am sure all of you see the compression fracture at L2; however, there are some findings that suggest this is not a compression fracture due to osteoporosis.
Top 10 Fitness Trends for 2016
The American College of Sports Medicine (ACSM) published its annual fitness trend forecast in the November / December 2015 issue of ACSM's Health & Fitness Journal.
Spine Surgery: A Tale of Greed and Corruption
All too often, where there's substantial money to be made, greed and corruption inevitably follow.
East Meets West
Gung Hay Fat Choi. Welcome to the year of the Monkey. There will be fireworks for both January and February this year. What great celebrations.
Asking the Insurance Rep the Right Questions
One of the first or last questions a potential patient often asks is: "Do you take insurance?" An ill-informed or optimistic, "yes" can result in delayed or non-payment. Instead, just say: "Let me check if you are eligible first."
Forgotten Options for Musculoskeletal Health
Challenges with musculoskeletal health are of tremendous concern for many people today.
We Get Letters & Email
In the Dec. 1, 2015 issue, we have Donald Petersen reporting on "the adapting chiropractic practice," which includes multidisciplinary practice as an option; a ChiroPoll indicating 59 percent of DCs are seeing at least 21 patients per day and 27 percent are seeing more than 40.
Percussion Therapy: An Experiment
My study of qi began more than 20 years ago — long before my study of TCM, points or pathways. It all started with an awareness in my hands and physical manifestations in the way of blockages while working on clients.
Yo San University Helps Make LA Communities Healthier
An element of healthcare training often overlooked is the residual benefit to communities served by Acupuncture and Oriental Medicine (AOM) schools nationwide.
Window of the Sky Points
The acupuncture points known as Window of the Sky are a modern creation. There is no reference in Chinese medical texts for an acupuncture point category called Window of the Sky.
The Amazing Clinical Versatility of Milk Thistle (Part 1)
Most of us know that the standardized extract from the seeds of milk thistle (Silybum marianum) is probably the best-proven herb for protecting the liver from chemical and inflammatory damage.
October, 2013, Vol. 13, Issue 10
Searching for Simple Rules in Massage and Cancer Care
By Tracy Walton, LMT, MS
In a Facebook post, a massage therapist requested quick advice for working with a client with cancer. On Facebook, of course, everything is quick.Almost immediately, he was bombarded with massage recommendations, safety protocols, references to books and trainings and encouragement to get a note from the client's doctor before beginning massage therapy. Opinions were all over the place and some didn't agree, but most were strongly held.
There are many safety protocols in massage for people with cancer, depending on the approach, and some of them may seem strict and even intimidating. They may even call to mind an old-school style teacher with a stern face and pointer in hand, barking a lot of, "No!" and "Never!"
And it's just as tempting to condense the protocols into a "Ten Commandments" format, a simple list to keep everyone out of trouble, without having to think much more about it.
More Than One Disease
But real oncology massage practice is not as simple as a quick list and here is why: the word "cancer" represents more than 200 different diseases. Even "breast cancer" is not a single condition but is classified into several different types. Drilling it down even further, two clients with the same type of primary breast cancer can present very differently, depending on the extent of the disease, reactions to treatment and other factors.
With so many ways our oncology clients can present, a list of "10 Things to Remember for Massage for a Client with Cancer" would not begin to capture them all. This is disappointing for those of us who've come to expect our advice in neat 5- or 10-point lists, packaged and propagated on social media.
Moreover, many of us learned and practice massage contraindications based on a client's diagnosis. Massage is contraindicated for X or Y condition. Unfortunately, this approach has never been adequate for any condition. But it particularly backfired in the case of cancer, where we had a single, flat-out, send-them-home massage contraindication that endured for decades. That one never worked well for clients or therapists. All it did was keep them apart.
Things have improved since then, with plenty of literature and training on oncology massage, a growing cohort of oncology massage therapists and even a professional organization, the Society for Oncology Massage (www.s4om.org). Thanks to the Society, there are standards of practice and even standards of oncology massage education with a fleet of recognized instructors around the globe. Some massage schools, as well, have made improvements in instruction, with careful attention to this population.
But in some places, the thinking hasn't evolved much at all. In many circles, "Send them home," has been replaced with, "Work lightly and you should be fine." This single approach is hard to justify for 200 different conditions representing thousands of different client presentations. Unfortunately, a blanket contraindication is not any improvement over a blanket contraindication. Still, we cling to rules like this. Sometimes too tightly. We strive to follow them to the letter because, if we do this, we will be doing everything "right" and the outcome will be positive. Or will it?
Beware the Blanket
Take all the many different types of cancer alongside all the different types of PEOPLE in the world – age, gender, level of activity, health history, ability to bounce back from illness, responses to cancer treatment and the thousands of other factors that make up who they are – and there just isn't a blanket rule big enough to cover it all. Nor should there be.
At a recent oncology massage practice clinic, we had two clients with similar-sounding diagnoses. Both had been diagnosed with breast cancer within the past four years, had received similar treatments and were about the same age. On paper, they could have been twins, except for their answers to this question: "What kind of activities are you able to participate in?" "Client A" wrote "kayaking and yoga." "Client B" wrote "babysitting grandchildren." Without making assumptions, this was our first hint that one might be more active than the other.
On the day of the clinic, "Client A" sailed into the treatment room, looking robust and buoyant with energy. She greeted everyone with clear eyes and shook hands vigorously. "Client B" was much more careful with her steps, stopping for frequent rests on the way up the stairs, her gait slower than her "twin-on-paper." The difference between the two was immediately obvious.
Different Presentation, Different Massage
"Client A" needed some adjustments in massage – notably in stroke direction, placement and pressure over the arm and trunk compromised by missing lymph nodes. With lymphedema risk, she had to receive thoughtful work in that area, as described in Gayle MacDonald's epic text, Medicine Hands: Massage Therapy for People with Cancer.
But outside these careful measures, "Client A" could take slightly stronger work in places, and that's what she received that day. Afterward, she was relaxed, glowing and effusive about the massage therapist's skills.
"Client B" needed the gentlest massage – light pressure, slow speed, even rhythms, gradual transitions and a host of other adjustments to the information in her history. Also at risk for lymphedema, she received similar work in the at-risk area. After such a gentle session, she looked blissfully relaxed. A stronger session could easily have wiped her out. Instead, she seemed to float out the door as slowly as she'd entered it.
After thoughtful interviews and sound clinical reasoning, each client received an individualized session. But had we practiced with a "go lightly and you should be fine" mentality, Client A and Client B would have received identical sessions. Client A would have received the massage meant for Client B, with the possibility of a much less satisfying experience.
This has serious consequences, because without customized care, we can lose clients. Why? Because they can feel as if they are not being heard or being seen for who they are beyond the "cancer" label. We want to stay far away from the possibility of causing injury to our clients with cancer, of course. Our hearts are in the right place. But if we are TOO careful, we can be seen as being out of touch with what our client really needs and what they are capable of safely receiving.
Some of those harder-and-faster "rules" are easy and there is comfort in that ease. But sometimes, in our quest to compartmentalize and label and follow rules X, Y and Z, the client themselves – how they present, what they want, who they ARE – gets pushed aside. When our client comes and sits down in our treatment room for the first time, they deserve more than an imaginary "cancer" stamp on their forehead.
A Place for Protocols
There is a time and place, certainly, for sticking closely to protocols that we have been taught so that we can deliver a safe massage. I'm a fan of protocols as a place to start.
But I also like principles – general guidelines to use in different scenarios with thought as to how they are applied. These wear better than rigid, inflexible rules. In my book, Medical Conditions and Massage Therapy, I offer principles to follow. One is the Unstable Tissue Principle, which states, "If a tissue is unstable, do not challenge it with too much pressure or joint movement in the area." Tissue can be unstable for many different reasons, but in the "twin clients' case," lymph node removal put them both at risk of lymphedema. (A carefully structured, gentle approach was necessary and it's impossible to describe it fully in a sentence or two.)
There, the clients' similarities ended. The Activity and Energy Principle states, "A client who enjoys regular, moderate physical activity or a good overall energy level is better able to tolerate strong massage than one whose activity or energy level is low." Client A could take more. Not lots more, because of some lifelong changes that can be caused by cancer treatment. But more.
Yet, by themselves, even principles are not enough to go on without good thought, good interviewing and solid hands-on skills for this population and other medically complex scenarios. Neither of the principles above captures the full range of clinical possibilities in people with cancer or cancer histories. That's the point.
We have to step back from the name of the disease, from the so-called "rules," and even from the friendlier "principles." Zoom out and see how the condition presents in this one person, this one individual so different from anyone else. This person living this person's life, not someone else's life. Then, a client receives the massage for the client; not the massage meant for someone else.
This is what we figure into our interview and hands-on work. Instead of one-dimensional, black-and-white rules for massage contraindications, critical thinking, clinical reasoning and interview skills deserve emphasis in massage education and clinical practice.
Some massage therapists can figure out what is needed by reading, self-teaching or prior experience with medically complex populations. But most need training in these skills. Training is just as important for learning what we can do, as what we should not do. That's where the Society for Oncology Massage comes into play. They laid a foundation; now the rest of us don't have to reinvent the wheel.
And there are many other resources out there. On my website (www.tracywalton.com), there are several bibliographies, a blog, and I've put up webinars about massage in cancer care for an intro to the deeper issues at work. For my own education, I read everything on oncology massage that I can get my hands on and I ask my students and colleagues to as well. Unlike 20 years ago, there is now plenty of literature available.
And plenty of clients deserving great, customized care.
Click here for more information about Tracy Walton, LMT, MS.
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