By Pam Mellskog
© 2009 Longmont Times-Call

LONGMONT — Despite the relatively common occurrence of lymphedema — the swelling of a limb — in breast cancer survivors with major lymph node removal, misperceptions still cloud the condition’s treatment.

“A lot of people think it can be tapped, like maple syrup,” said Jodi Winicour, a certified lymphedema therapist and physical therapist at Longmont United Hospital.

Instead, she uses manual — light, rhythmic massage — to gently flush the retained fluid from the swollen arm to a healthier section of the lymph system for re-circulation in the body.

This specialized massage technique for lymphedema patients debuted about 20 years ago. LUH’s Health Center of Integrated Therapies introduced it in 2001.

Though not often painful or life threatening in breast cancer survivors, lymphedema can cause discomfort and a disrupted sense of normalcy, according to patients.

“I was trying on a short-sleeved shirt, and I looked at myself, and I thought, ‘When did my arm get so fat?’” said Jo Geiger, 68.

The retired registered nurse and massage therapist was diagnosed with breast cancer in her right breast in 1990, the left breast in 1992 and had both removed.

Like so many other survivors, her doctor removed the cluster of about 25 Jelly Belly-sized lymph nodes in her armpit areas to determine if the cancer had spread beyond her breast.

Doctors screen cells from the lymph system to gauge the cancer’s reach because this system works like a sieve to catch cancer cells along with bacteria, viruses and other waste products, according the Mayo Clinic Web site.

“I think of lymph nodes as those security guards that drive around in gated community neighborhoods to identify intruders and then call the police — the immune system,” Winicour said.

The lymphatic system carries off undesirables through the lymph vessels, which lead to lymph nodes. Lymphocytes — infection-fighting cells that live in the lymph nodes — filter these wastes and ultimately flush them from the body.

Lymphedema occurs when, in the case of some biopsied breast cancer survivors, the flushing system gets damaged and clogged.

About half of those who undergo this type of invasive biopsy never develop telltale lymphedema-related swelling, according to the National Lymphedema Network.

NLN reports that even fewer, between 4 percent and 10 percent, suffer the condition if they qualified for sentinel node biopsy. Doctors began using SNB in 1991 to harvest far fewer nodes and reduce the kind of collateral damage that causes lymphedema.

Massage therapy is increasingly shown via research to benefit cancer patients, particularly in the areas of pain relief and relaxation.

On Aug. 21 MASSAGE Magazine reported on a survey in which breast-cancer patients said that massage therapy helped them relax; in fact, all of the program participants felt that massage therapy was effective in helping them relax, and the majority felt that it was very or somewhat effective in reducing muscle tension. Another recent article, “CAM Therapies Assist Breast Cancer Patients,” noted that Complementary health care (CAM), including massage therapy, is increasingly incorporated into the hospital setting.

According to the official National Breast Cancer Awareness Month site (www.nbcam.org), “The first NBCAM program took place in October 1985 as a week-long event to fill the information void in public communication about breast cancer … Today the National Breast Cancer Awareness Month (NBCAM) organization is comprised of several national public service organizations, professional medical associations, and government agencies working in partnership to build breast cancer awareness, share information and provide access to screening services.”

(From: massagemagazine.com)

Massage Today
September, 2009, Vol. 9, Issue 09
Massage and Alzheimer’s Disease, Part 2

What does the literature say?

By Ann Catlin, LMT, NCTMB, OTR

Mary, an 81-year-old female, has resided in a nursing home for seven months. Her medical history reveals that she has Alzheimer’s disease; anxiety (state unspecified); dementia with behavior disorder; insomnia; osteoarthritis; osteoporosis; and recurrent urinary tract infections. She requires a wheelchair because she no longer is able to safely ambulate and has fallen several times; she has increasing difficulty communicating her needs because she cannot find the appropriate words to express herself; she has recently begun to yell out and, at times, bangs on her wheelchair for long periods of time. She relies on staff to assist her with activities of daily living; she is incontinent of urine; she attends group activities, but the yelling and banging is upsetting to the others and she is removed from the group. She spends much of her time in her room or in the hallway. She has difficulty sleeping and is often anxious at night, which increases her yelling behavior. This concerns staff because they have difficulty calming her and other residents are awakened.
Following a referral for massage therapy, I arranged for sessions twice a week and it was agreed the need for continued session would be determined after six weeks. I saw Mary in her room while she was sitting in her wheelchair. Each session lasted 20 to 30 minutes and typically took place in the morning before lunch. Mary was receptive to having massage lotion applied to her hands in the form of a hand massage and she seemed to enjoy the one-to-one attention.

Following three weeks of sessions, the activity director reported that Mary was able to remain in more group activities without disruptive yelling and only occasional banging on her wheelchair. This resulted in less isolation and opportunities for social interaction for Mary. After six weeks, I demonstrated a simple hand massage technique that the staff could use in addition to continued weekly massage therapy sessions. The nurse assistant reported that Mary was more cooperative during self care activities and that she had decreased restlessness and agitation at night. The overall impact of massage therapy was an increase in the quality of life for Mary and decreased job stress along with increased feelings of satisfaction for the staff.

This scenario illustrates that, indeed, massage appears to have a positive impact on the care and quality of life of an elder living with the effects of Alzheimer’s disease. I’m not alone in witnessing these effects — many of my colleagues share similar stories that point to the efficacy of massage in Alzheimer’s care. But our stories may not be enough to substantiate what we experience during our sessions. As massage therapy becomes more recognized as a health care profession we are expected to back up our stories with data. Like it or not it is the world we live in. Fortunately there is a long-standing and growing body of evidence that substantiates the value of massage and touch in Alzheimer’s care. While there is need for further research, studies indicate that the use of some forms of massage are effective in managing challenging behavior often exhibited by elders living with Alzheimer’s disease and other forms of dementia.

Study:
Favorite music and hand massage
Two interventions to decrease agitation in residents with dementia

Sandee L. Hicks-Moore
University of New Brunswick, Saint John, Canada, shicks@unbsj.ca
Bryn A. Robinson
University of New Brunswick, Saint John, Canada, bryn.robinson@unb.ca

Agitation in individuals with dementia living in the nursing home environment affects care and quality of life. Relaxation techniques such as music and massage are showing promise to decrease agitation and improve quality of life in individuals with dementia. Using an experimental 3 x 3 repeated measures design, 41 residents with mild to moderate dementia participated in a study to test the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Agitated residents were randomly assigned to either the treatment or control groups. Residents in the treatment group received each of three treatments, HM, FM, and HMFM, with each treatment lasting 10 minutes. Residents in the control group received no treatment. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI) at three different intervals. The results suggest that FM and HM individually and combined are effective in significantly decreasing agitation immediately following the intervention and also one hour post intervention.

Key Words: agitated behaviour • Alzheimer’s disease • complementary therapies
Dementia, Vol. 7, No. 1, 95-108 (2008)
DOI: 10.1177/1471301207085369

After a day spent chasing her 3-year-old grandson and dealing with the busyness of life, Marva Gaymon rejuvenates with a massage.

“It feels wonderful. After it’s over, I’m so relaxed. All the stresses are gone,” said the 62-year-old Harrisburg resident.

Sometimes the pain of degenerative disc disease drives Gaymon to her nationally certified massage therapist, Carmel Jenkins at PinnacleHealth System WomanCare Resource Center. But pain or not, Gaymon schedules a half-hour back and neck massage at least once a month.

“Be it for pleasure or recuperation, Carmel works it all out,” Gaymon said.

Increasingly, therapeutic massage is being seen not as a luxury but as an important part of preventative health care, as well as effective therapy for painful medical conditions, local massage therapists say.

“In the last 10 years, massage therapy has really emerged from being something that’s mysterious to being recognized as a therapeutic tool for reducing pain,” said Sharon Crane, a certified massage therapist in Mechanicsburg, who also treats clients at the Lebanon Family Medical Center in Palmyra.

“Massage is great for increased circulation, blood flow, oxygen flow and overall stress reduction, which affects all systems of the body. It increases range of motion, can decrease blood pressure and it can give you better sleep,” she said.

“Massage therapy is becoming more mainstream,” agreed Gina Washalski, president of the Pennsylvania Chapter of the American Massage Therapy Association. “The medical society is accepting our modalities as health and healing rather than something spa-related like a manicure or a pedicure.”

Priscilla Herd, a certified massage therapist at The Hetrick Center in Middletown, said she is seeing more patient referrals from primary care physicians. “I wish more medical professionals would realize the vast benefit of massage therapy for recovery from surgery,” she said. “Rehabilitation of the musculature is so important.”

According to Washalski, research from the Massage Therapy Foundation found that the number of hospitals offering massage therapy increased by 45 percent between 2006 and 2008, with 85 percent of the hospitals offering massage for patient stress management and 75 percent prescribing it for pain management.

How does massage therapy work?

“As you apply strokes to the muscle, you work out tension and tight fibers so that oxygenated blood comes through the muscle, which brings nutrients in and toxins out,” Herd explained. “That truly relieves pain, tension and ache and promotes much better health for the muscles.”

Many users have an issue to deal with — such as neck and shoulder pain from working on a computer, headaches, sports muscle injuries or joint pain associated with aging.

Other people, such as Shiremanstown resident Judy Hughes, have massages as part of a holistic wellness outlook on life.

“In general, I believe in preventative medicine. With massage, your muscles feel better, it gets your lymph system flowing better and you have an overall better feeling,” said Hughes, whose health routine also includes regular visits to a chiropractor, good nutrition and cold laser therapy to help circulation.

There are many different types of massage, but in all of them, massage therapists apply pressure to muscles and soft tissue using their hands and sometimes their elbows, forearms and feet. In school, they learn specific techniques and how to use their sense of touch to locate problem areas and figure out the right amount of pressure to apply.

“I have many people coming in for relaxation massages once a month, where the timing is slower and we use more rhythmic strokes,” Herd said. “Other people notice that if they get regular, deeper tissue massages, they feel better overall.”

For Christine Foreman, an operating room nurse who competes in triathlons, deep tissue massages are a must after she runs 13 miles, bikes 56 miles and swims a mile. “I’m a little more than sore after that. Massages work out all the knots,” she said. “It’s part of your training if you work out. It’s the way to go to get back out there.”

Foreman, 50, of Hummelstown, admits surprise at her devotion to massages. “A few years ago, if you had told me that I’d be going for massages, I would have said, ‘No way!’ Ten years ago, you would’ve gotten raised eyebrows. Now, I think there’s more of awareness that it can be therapeutic,” she said.

The Power of Vitamin C

Considerable research supports the disease-preventing role of vitamin C, in fact, nearly 100 epidemiological studies have examined the role of vitamin C or vitamin C-rich foods in cancer prevention, finding strong evidence for its role in reducing the risk of cancers of the esophagus, oral cavity, stomach and pancreas, and substantial evidence supporting protection against cancer of the cervix, rectum, breasts and lungs.

Vitamin C also may reduce the risk of suffering a stroke, according to a 2008 study published in the American Journal of Clinical Nutrition. Study participants with the highest levels of plasma vitamin C had a 42 percent lower risk of stroke compared to study participants with the lowest levels of plasma vitamin C.

Foods considered good sources of this vital nutrient include citrus fruits and juices, tomatoes, cantaloupe, sweet and white potatoes, broccoli, peppers and leafy greens. The body cannot store leftover amounts, so make sure you get plenty of C every day.