resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Guidelines for the Use of Modifier -52
Modifier -52 identifies that a service or procedure has been partially reduced or eliminated at the physician's discretion. This is to indicate the basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
Are Probiotics Doing More Harm Than Good?
Considerable controversy exists concerning the efficacy of probiotic supplements. Very few human studies show any real positive impact on the microbiome or health. The "promise" of probiotics is based on the few animal studies that suggest a positive effect.
A Study of Relationships
Sa-Ahm's five element acupuncture method is known to be one of the most effective acupuncture techniques in Korea because it gives an instant response at the time of treatment and has a high success rate in resolving chronic problems.
International Congress on Integrative Medicine
"Bridging Research, Clinical Care, Education and Policy" was the theme for the International Congress on Integrative Medicine and Health 2016 (ICIMH).
Traditional Chinese Herbal Medicine in Taiwan Hospitals
This spring, a team of Western medical doctors and TCM practitioners from Cleveland Clinic traveled to Taiwan to visit Kaiser Pharmaceutical Co. (KP), and China Medical University (CMU), Taiwan's leading integrative medicine hospital.
Adventures with the Pericardium
My previous column on the San Jiao deserves equal time for SJ's loving partner, the pericardium. I nicknamed SJ the travel meridian – but pericardium can also play a crucial role in air travel.
Chiropractic in the Eyes of the Public: 2nd Gallup-Palmer Poll
The second Gallup / Palmer College poll has been completed, yielding significant additional data regarding Americans' experiences with and perceptions of chiropractic care.
Illuminating the Hidden, Freeing the Source
Amongst the Primary Channels, from a classical point of view, the small intestine is perhaps the most important channel to understand. It is one of the least used acupuncture channels in modern acupuncture, yet it within it can be found a wealth of theories from the Ling Shu.
Let's Talk About Biceps Injuries at the Elbow
While most muscles cross over only one joint, the biceps crosses two joints: the elbow and the shoulder. Injuries to the lower biceps cause considerable elbow pain. Here's how to assess and treat an injury to this area conservatively.
The Professional and Practice Benefits of Political Activism
Welcome to election season, a vital part of our American culture. Every two years, without fail, we are bombarded with TV, print materials and phone messages seeking our vote.
Analyzing Acupuncture Case Studies
Confirm the answer quickly by the elimination method. Take this case study as an example. After two treatments for back pain, a patient presents for a third session complaining of rapid breathing and wheezing that is made worse during cold weather.
What are the Meridians?
The meridian and collateral system (jing luo, hereinafter referred to as "Meridians") is comprised of the main meridian channels (jing mai) and the collateral vessels (luo mai). Jing takes from meaning of the Chinese word pathway (also jing) and are the main branches of the system.
Work Stress and Musculoskeletal Health: Do Your Patients Get the Connection?
Most people underestimate the impact their job has on their health, especially if that job isn't particularly physically demanding. Big mistake.
MPA Media Wins More Publishing Awards
The American Society of Business Publication Editors (ASBPE) has honored Dynamic Chiropractic with a national award and two regional awards for editorial excellence, and sister publication DC Practice Insights with two regional awards for graphic design excellence.
Less Time Than Required
Q: When is it appropriate to use a modifier -52? Can I use it for a timed service when I do less than the time required by the code?
Time to Fight for Your Medicare Right
I have heard a lot of noise and a lot of debate about what is going on with Medicare. As an ACA delegate, I often get asked: 'What is the ACA even doing?'
Don't Ignore the Lower Half of the Pelvis (Part 1)
When your patient complains of lower back or pelvic pain, but your usual treatments are not getting the job done, what do you examine and treat? You may be missing important structures in the lower half of the pelvis.
Overuse Injuries in Young Athletes (Part 1)
More than 45 million children ages 6-18 participate in some form of organized athletics, and 75 percent of American families with school-aged children have at least one child participating in organized sports.
The National Institutes of Health (NIH) lists more than 80 common autoimmune diseases including asthma, Crohn's disease, Guillain-Barré syndrome, multiple sclerosis, myasthenia gravis, psoriasis, rheumatoid arthritis, and lupus.
Lessons from Functional Neurology
Chiropractic neurology, also known as clinical neuroscience or functional neurology, is moving the chiropractic profession forward by leaps and bounds.
Know Your Research: Tips for Evaluating Literature Reviews
Clinical and experimental studies are not the only types of published research we might encounter as we look for evidence to inform our practices. One of the most useful types is the literature review, which summarizes a group of studies.
February, 2014, Vol. 14, Issue 02
"Selling" Gentle Massage to Clients with Cancer
By Tracy Walton, LMT, MS
Sometimes, even the most thoughtful message, delivered with the best intentions, will disappoint a client. As a massage therapist, it can be tough to weather that moment. How do we break the news, when a client's health calls for a gentle session?
In our oncology massage clinic, a new client told us she had a long massage history. She also checked "Yes," under chemotherapy on the health form, and wrote "A little walking, light housework," under a question about activity level. She was extremely fatigued. We knew the client needed a gentle session. Yet, when asked her likes and dislikes about massage, she praised deep tissue work and asked for deep pressure and focused work in our training clinic. She said she was stiff and sore and craved a deep massage.
There it is. The Moment.
Zoom in on that "crave a deep massage" moment and you can see it teetering. It could fall anywhere. So many important things are poised: ethics, client safety, conflict, agreement, client expectations and possible disappointment, client satisfaction, the health of the therapeutic relationship and even therapist liability.
The student therapist had been coached to expect this. She channeled all the role plays we did and took a deep, centering breath. She nodded at her client and said something like, "I definitely understand the request for deep work. This time, because you are in chemotherapy, I need to work gently with you. We don't know how my work will interact with your body and your current chemotherapy treatment, so it's important to go gently with our pressure."
Clearing her throat, the therapist tried again. "There are many new things at play here. I haven't worked with you before and never during chemotherapy. Chemotherapy is strong treatment, as you know, and can bring about a 'new normal,' such as the fatigue you are experiencing. Clients in cancer treatment, even those who are used to stronger pressure, tell us that the gentler, careful work is what makes them feel better. It might take a little adjustment at first, but it can still be deeply relaxing — a great session."
At this, the client narrowed her eyes and crossed her arms. "But I don't want gentle work. It's not going to do anything for my soreness that way! You don't have to treat me like I'm going to break, just because I have cancer. I'm the same person as before."
By now, in cases like these, both the client and therapist have become tense. Not the friendliest beginning to a massage session.
Conflict and Client Expectations
Most massage therapists entered this line of work hoping to bring comfort and happiness to clients; it's tough to disappoint someone before they even get on the table. It's not a good feeling for either party. And yet, we simply can't honor all client requests, especially those that put client safety at risk. Even if they believe we are being too cautious. Even if they think we are unfairly treating them differently. I believe it is Gayle MacDonald who first stated that these situations require us to take a greater leadership role.
This is counter to the expectation of "client-centered care," and to the saying, "the customer is always right," and can even run up against our employer's expectations of us. At times, the fear of angering someone we are supposed to comfort, of losing business or the simple fear of taking an unpopular view can make us shrink from the responsibility to work gently.
Most of us aren't fans of conflict, and yet a moment of conflict can become a learning moment. It takes good skills in clinical reasoning and communication to send that moment off in the right direction. It also takes a bit of salesmanship.
Reasons to Work Gently
While the fear of massage possibly being able to spread cancer is thankfully on its way to becoming an old wives' tale in both the massage community and the lay community, there is still a long list of massage modifications for different cancer treatment presentations. In most cases, even a standard "relaxation massage" might be too much for a body to handle while going through treatment. Multiple body systems are affected during and after treatment and massage that is too forceful or taxing to the body can cause the client to feel worse physically and possibly increase their stress.
Even a client who "looks healthy" or has "good numbers" in terms of blood counts may not respond well to strong massage. There is no certain way we can truly predict what effect a massage might have on them. Sometimes, a massage might even feel wonderful on the table at the time, only to be followed with flu-like symptoms a few hours later.
In the case of the client example above, the therapist had to "dial down" a relaxation massage even further, with lighter pressure (think of the pressure you would use to rub lotion into the skin) and slower speeds. Even rhythms, gradual transitions and other factors are softened for the person in treatment.
There are many reasons to shift into this dialed-down mode and plenty of massage literature to support it. Reasons include bone metastasis, vital organ involvement and low platelets. There are strict precautions regarding pressure and direction at certain sites in cases of lymph node biopsy, radiation and DVT risk. Some cancer treatments have late effects, spanning decades after treatment, and massage adaptations are lifelong. Moreover, in a setting where little or no client health history is known, it's critical to dial down the session because of limited information.
With so many reasons to work gently during cancer treatment (and beyond) it's important to be able to communicate them to clients. But sometimes, the trickiest part is "selling" all of these points to our client who is convinced they want a vigorous massage because they don't want to settle for something "fluffy." Or they had heard that deep work would "clear the chemotherapy toxins out of their body."
The selling we must do here does not need to drum up the sound of a sleazy pitch. This is something that comes with our job as massage therapists. We are selling safe yet still effective massage to our clients and our words don't have to be creepy or uncomfortable. We do, however, use good communication wrapped in sensitivity and we assume a leadership role to deliver the message with confidence and ease.
Explaining the reasons behind dialing down the massage approach can often help to defuse some of the tension. Here are some of the phrases we use in our training:
Indeed, letting a client know what we can safely do during their session (perhaps spending extra time and a little more pressure on the feet, or a few gentle squeezes at the shoulders or a long stretch of gentle scalp massage) can ease the feeling of a long list of can't-dos and limits. The right tone can make it feel more like a friendly compromise, with still plenty of good things coming their way. Sometimes, it can be our words even more than our touch that can help the healing process along, and with that, our clients with cancer can feel safe but still encouraged and empowered.
In the clinic client story above, the student did their best and a skeptical but willing client followed them to the table for a very gentle session.
Afterward, I found the client resting quietly on a bench in the hallway. She was slumped against the wall and a little dazed. I asked her how it went. Smiling, she told me it had been a pretty light massage. But she acknowledged, "Even that was a little much. I feel good, but a little wiped out. Thank you for convincing me I needed lighter massage. I'm sorry I pushed it, but I get it now." "Thank you," she said again.
We don't always see such strong agreement with our gentle approach, but good communication boosts the chance that we'll get there. If we are clear within ourselves about our role and reasoning, our words come more easily. We can be present to the "craving a deep massage" moment and guide it to the best outcome. Through education, patience and understanding, we can deliver not only what our clients want, but also what they need.
Tracy Walton & Associates offers a 4-Day Intensive Course, "Oncology Massage Therapy: Caring for Clients with Cancer." Spring 2014 offerings are in Boston, Miami, Siler City, NC; Hartford, CT, and Atlanta. See the complete 2014 calendar at www.tracywalton.com/trainingschedule/trainingschedule.html. To learn more about hospital-based massage, oncology massage and other conditions, view Tracy's webinars at www.tracywalton.com/webinars/index.html.
Click here for more information about Tracy Walton, LMT, MS.
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