Archive for August, 2009

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Cancer and Neoplasia

August 31, 2009

And I have learned that people with cancer can benefit greatly from receiving a massage. The American Caner Society advocates massage to comfort and help improve the quality of life for cancer patients, although not to specifically treat cancer. Cancer may be a reason to begin, continue, or increase the frequency of massage treatments. Because there is an enormous amount of stress involved in dealing with a life-threatening disease, massage can play a vital role in stress reduction. Cancer treatments (surgery, radiation therapy, chemotherapy, and bone marrow transplants) are enormously taxing to the body. Some of the side effects of these treatments, such as hair loss, loss of organs or limbs, or skin changes such as redness or burning from radiation, can result in anxiety, anger, depression, and negative body image for the cancer patient. A knowledgeable, skilled massage therapist can play a major role in integrating client body, mind, and spirit; reducing muscle tension; and decreasing pain by administering client-centered treatments. Besides the benefits of relaxation, improved sleep, and pain reduction, massage also bolsters immune function, reduces or prevents edema, decreases nausea and vomiting, reduces the fatigue that affects most cancer patients, and may improve the quality and survival of skin during radiation therapy. Massage can provide a relief from the pain and discomfort of medical treatment and is a human-to-human contact that is relaxing, pleasurable, and noninvasive. In the past cancer was considered a contraindication for massage. This prevented many people living with cancer from receiving a massage. Cancer is characterized by the uncontrollable growth of abnormal cells that form a neoplasm or tumor. The study of tumors is called oncology. The tumors can be either cancerous or harmless. A cancerous tumor is called malignant and will often metastasize or spread cancerous cells to other parts of the body. A benign tumor does not metastasize, but may become life threatening if, as it grows, it puts pressure on vital areas, such as within the brain. Cancerous cells can spread throughout the body via one of two routes, the bloodstream or the lymphatic system. If the cancer is metastasizing through the lymphatic system, there is a predictable pathway the cancer cells can follow based on the structure of the lymphatic vessels, and the one-way flow of lymph. Lymph nodes will often be removed and checked to see if cancerous cells have migrated to them. If the cancer is spreading through the bloodstream, however, there is no predictable pathway for them to follow, and the cancer could spread anywhere. The most common type of cancers is found in the lungs, breast, colon, and prostate. Massage therapist and their clients need to be aware that some cancers are potentially preventable or curable if proper screening measures are followed. The incidence of different kinds of cancer varies greatly with age, ethnicity, gender, and geographic location. Cancer is not contagious, but it can spread internally.

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Reproductive conditions, Reproductive pathologies

August 31, 2009

I have learned that although massage does not directly affect reproductive system, it is an important system for massage therapists to know. Massage can be useful in decreasing anxiety and muscle tension that may accompany premenstrual syndrome and menstruation. It can help alleviate some of the physical discomforts associated with pregnancy. It may also be helpful in reducing anxiety with infertility issues. Sexual reproduction is the process by which male and female sex cells unite to produce offspring. Male sex cells are called spermatozoa and carry genetic information from the male that produced them. Female sex cells are called oocytes and carry genetic information from the female that produced them. When a sperm unties with an egg, the process is called fertilization. The resulting cell, called an ovum, contains genetic information from each parent. Reproductive organs are divided into 2 groups, primary and secondary. The primary reproductive organs are called gonads. They produce hormones and the cells necessary for reproduction. In the male they are testes; in female they are ovaries. The secondary set organs is a combination of ducts used to transport the reproductive cells for possible fertilization, and then transport the fertilized ovum to a place of incubation. This secondary set of organs in the male includes the epididymis, ductus defenses, ejaculatory ducts, seminal vesicles, prostate gland, bulbourethral glands, and penis. The scrotum is the supporting structure for the testes. It is a sac made of loose skin that hangs down from the penis and is attached to the body. Sperm production, or spermatogenesis, occurs in the testes. The testis also produces the hormones testosterone, dihydrotestosterone, and inhibin. Luteinizing hormones from the anterior pituitary gland stimulates the production of testosterone. The epididymis is a comma-shaped organ next to the testes. It is a site for the maturation of sperm. The ducts (vas) deferens is also called seminal duct. It carries sperm from epididymis to the ejaculatory duct. The ejaculatory duct is a tube that transports sperm from the ducts deferens to the urethra. Semen is a milky fluid that is mixture of sperm and seminal fluid. Seminal fluid is a transport medium and source of nutrients for sperm. Seminal vesicles, the prostate gland, and bulbourethral glands all secrete that together make up the seminal fluids. In males, the urethra is the tube that carries urine from the urinary bladder and semen from the male reproductive system to outside the body. The penis contains the urethra and is a passageway for the ejaculation of semen and the excretion of urine. In the female’s reproductive system, the uterus is located in the pelvic cavity between the urinary bladder and rectum. The ovaries are located in the superior part of the pelvic cavity, lateral to the uterus. Estrogens and progesterone are responsible for the development of the female sex organs and feminine secondary sexual characteristics that occur at puberty. The female has two fallopian tubes or oviducts extend laterally from uterus to the ovaries. The vagina is 4-inch long muscular canal that extends from the cervix to outside the body. The vulva comprises the external genitals of the female. It is made up of the mons pubis, labia, and clitoris. The mons pubis is mound of adipose tissue covered by skin and pubic hair, cushioning the pubic symphysis. At puberty the female begins a fertility cycle about every 28 days. The cycle is divided into 4 phases and is dependent on hormones. The menstrual phase is the 1st phase. Menstruation is the shedding of built-up uterine lining from the previous fertility cycle. Menstruation last about 5 days. The nest phase is the preovulatory phase. It last from 6 to 13 days in a 28-day cycle. The production of estrogen is stimulated by follicle-stimulating hormones. These estrogens, along with luteinizing hormone, promote the development and release of the oocyte from the ovary in a process called ovulation. Ovulation is the third phase. It usually occurs on day 14 in a 28-day cycle. The oocyte is released from its follicle and travels down the fallopian tube toward the uterus. If fertilization occurs, it normally happens in the fallopian tube. The 4th stage is the postovulatory phase. It lasts from day 15 to day 28. Luteinizing hormone stimulates the ovaries to secrete progesterone, a small amount of relaxin, and inhibin, and continue secreting estrogens. If the oocyte is not fertilized, the level of progesterone decrease over 2 weeks, causing menstruation; the unfertilized egg is flushed out of the body. If, however, the oocyte is fertilized, it continues to develop and travels through the fallopian tube to implant in the uterus. The developing embryo secretes human chorionic gonadotropin, which stimulates the continual production of estrogens and progesterone so that the uterus can maintain the pregnancy. During pregnancy, the ovaries and placenta produce large amounts of relaxin. It increases the flexibility of the pubic symphysis and helps the cervix dilate to ease delivery of the baby. After a gestation period of about 40 weeks, the uterus begins a complex process called labor. The hormone oxytocin from the posterior pituitary gland initiates and strengthens uterine contractions that continue until the baby is expelled through the vaginal opening. Oxytocin is also responsible for milk ejection from the mammary glands.

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Urinary Pathologies

August 31, 2009

I learned although massage does not directly affect the urinary system, it is still an important system for massage therapist to be acquainted with. The kidneys perform important function-filtering wastes out of the blood. They also play a significant role in maintaining homeostatic blood pressure. Because massage techniques can affect blood flow, pathologies of the urinary system need careful consideration before massage can be performed. The cells and tissues of the body are constantly making waste as by-products of cellular metabolism. These wastes need to be removed quickly because, if they were to build up, cell, tissue, and even organ death can occur. Cells export their wastes into the surroundings interstitial fluid. From there, the wastes diffuse into the blood, which transports them away from the cells to one of the body’s most important waste management systems, the urinary system. The urinary system consists of 2 kidneys, 2 ureters, one urinary bladder, and one urethra. The kidneys are the primary organs of the urinary system. The other parts are mostly passageways and storage areas. There are 6 main functions of the kidneys that help maintain the body’s homeostasis. The kidneys are reddish, kidney bean-shaped organs located in the posterior abdominal wall, just about waist level. They are about the size of a bar of bath soap. If one kidney is removed, the other will increase its filtering capacity so that it will filter at 80% of 2 normal kidneys. The functional unit of the kidney is the nephron. There are about a million nephrons in each kidney. Nephrons are responsible for filtering substances out of the blood, returning useful substances to the blood and forming urine. The 1st portion of nephron consists of a loop of blood capillaries called glomerulus surrounded by a hallow capsule. Between the wall of the glomerular capillaries and the capsule is a filtration membrane. This membrane has pores that allow only certain substances, such as water, wastes, ions, amino acids, and glucose, to be filtered out of the blood. The second part of the nephron is the renal tubule, which is a small, hallow tube connects to the glomerular capsule. As the fluid filtered out of the blood passes through the renal tubule, useful substances are returned to the blood. After urine is formed in the nephrons, it travels to the hollow center of each kidney, and then travels down the ureters to the urinary bladder. The bladder can hold 700 to 800ml. At 300 ml, the bladder is distended enough that the conscious sensation of needing to urinate arises. The urethra, which is 1.5 inches long in women and 6 to 8 inches long in men, the carries urine to outside the body.

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Gastrointestinal Pathologies

August 31, 2009

I have learned that because the digestive system is responsible for processing the food necessary for life, it is an important system for massage therapists to understand. Massage can affect the digestive system both directly and indirectly. Abdominal massage is one way to directly affect the digestive system. There are 6 classes of nutrients: carbohydrates, proteins, lipids, vitamins, minerals, and water. Carbohydrates, proteins, and lipids are very complex (and large) structures that need to be broken apart chemically into smaller molecules. This process is called digestion. Carbohydrates are deconstructed into their building blocks called monosaccharide, which are single unit sugars. The most common monosaccharide is glucose and the most common lipid is triglycerides. A triglyceride consists of a molecule of glycerol with 3 molecules called fatty acid chains attached to it. The different types of fats depend on the chemical composition of the fatty acids. Lipids are hydrophobic and tend to stick together in large clumps. I also learned that Roughage comes from the skin of fruit and veggies. And theses are necessary because they help from the mass large intestine needs to move substances forward and out of the body. The digestive system is responsible for breaking down the nutrients into their building blocks. The digestive system is made up of 2 groups of organs: the Gastrointestinal (GI) tract or Alimentary canal and the accessory digestive organs. The GI tract is a long tube that extends from the mouth to the anus. It is about 30 feet long in a cadaver, but is much shorter in a living person as a result of muscle tone in the wall of the GI tract. Most of the organs of the digestive system are found in the abdominal pelvic cavity. The digestive system performs 6 basic processes: Ingestion, secretion, mixing and propulsion, digestion, absorption, and defecation. Digestion begins in the mouth. The teeth mechanically break down ingested food. Salivary glands secrete saliva, which contains digestive enzymes, into ducts that empty into the mouth. The tongue helps mix food with saliva. The digestive enzymes initiate the chemical digestion of carbohydrates and lipids. After the food is formed into a soft, easily swallowed mass called a bolus, it is ingested. Most digestion absorption occurs in the intestine. Bile is made by the liver and is responsible for emulsifying fats. The gallbladder stores excess bile. Also by the time the chime enters the large intestine, most of the substances and water have been absorbed. The large intestine is about 6 feet long and consists of 4 main parts; cecum, colon, sigmoid colon, and anal canal.

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Cardiovascular and Lymphatic/Immune Pathologies

August 31, 2009

The cardiovascular and lymphatic/immune system plays a major roll in massage. I have learned that heart disease and other cardiovascular disorders are the most prevalent diseases in industrialized countries. And massage therapists will encounter clients with all manners of pathologies of blood, heart, and blood vessels. Massage can help clients by reducing stress. Massage also decreases the effects of the sympathetic nervous system, which is partially responsible for coronary artery vasoconstriction. The lymphatic immune system is one of the major protectors from disease. The cardiovascular and lymphatic/immune system plays major roles in maintaining homeostasis. Most of the body’s cells are embedded in tissues and thus are stationary. Three fluids interact to serve these stationary cells: the blood (part of the cardiovascular system), interstitial fluid, and lymph (part of the lymphatic/immune system). Interstitial fluid not only surrounds and bathes the cells and tissues; it also functions as a medium for exchange between the blood and the tissues. Some of the interstitial fluid continually drains into lymphatic vessels and becomes lymph. The body’s homeostasis depends on the continual movements of blood, interstitial fluid and lymph, and having the right amount of each of these fluids. The main components of the cardiovascular system are the blood, heart, and blood vessels. The purpose of the heart is to pump the blood through a vast closed network of blood vessels. The heart itself is mainly thick myocardium. The myocardium is cardiac muscle, which is responsible for the pumping action. The heart is divided into 4 chambers: 2 superior chambers called the atria, and 2 inferior chambers called ventricles. The major blood vessels associated with the heart are the superior vena cava, the inferior vena cava, the pulmonary trunk, aorta, the coronary sinus, and coronary arteries. Blood enters both the right and left atria at the same time. The heart has its own blood supply called coronary circulation. The lymphatic/immune system is composed of lymph, lymphatic vessels, structures and organs containing lymphatic tissue, lymphocytes, and red bone marrow. There are 3 primary functions of the lymphatic/immune system. The 1st function is to drain excess interstitial fluid. The 2nd function is to transport dietary lipids and lipid soluble vitamin (A, D, E, and K) from the digestive tract to the blood. The 3rd function is carrying out immune functions. Two main types of lymphocytes are created: T cell and B cells. Once the T and B cells are mature they travel to areas of lymphatic tissue. For T and B cells to mount an immune response, they need to come in contact and interact with a pathogen. Once the T and B cell contact the pathogen, they are activated for that specific pathogen. In autoimmune diseases, T and B cells are unable to distinguish the body’s own tissues from something that is foreign to the body.

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Respiratory Pathologies

August 26, 2009

In chapter 8 our book talks about the Respiratory system. I have learned that breath and the breathing process are synonymous with life. Breathing is the most easily observable of the body’s vital signs. Massage therapy also directly affects the respiratory system. By massaging the muscles of respiration, the therapist can perhaps ease a clients breathing. Cells continually use oxygen for the metabolic reactions that release energy from nutrient molecules. The two body systems that cooperate to supply oxygen and eliminate carbon dioxide are the cardiovascular and respiratory system. The respiratory system also helps regulate blood Ph. The respiratory system contains olfactory receptors, filters incoming air, produces sound, and eliminates some water and heat in exhaled air. Air movement and gas exchange are accomplished by the anatomical structures of the respiratory system. The entire respiratory tract is lined with mucous membrane. The lungs are in the thoracic cavity and rest on the diaphragm. The right lung has 3 lobes and is thicker and broader than the left lung because the liver, a large organ, is underneath the diaphragm on the right side. Inside each lung the primary bronchi branch into smaller secondary bronchi. Eventually, the bronchioles branch into alveoli. Between the walls of the alveoli is the respiratory membrane. Pulmonary Ventilation is a mechanical process because it involves muscular contraction, muscular relaxation, and elastic recoil of the alveoli. The diaphragm is the main muscle of inhalation.

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Premassages for the cancer patient?

August 5, 2009

An important step in working with client who have a form of cancer is a premassage evaluation consisting of very important questions needed to be answered by the client. The following are just a few: What type of cancer does the client have? The type of cancer can significantly affect the type of massage treatment. Is the client receiving steroid treatment? The client may be receiving steroids as well as chemotherapy. Long-term steroid use can lead to osteoporosis, which requires very light pressure during treatment. Is the client in treatment for the cancer? If so, what type of treatment is the client undergoing? This is important for many reasons. For example, if the client is undergoing radiation treatments, lubricants should not be applied on the areas to be irradiated. The substances in the lubricants can block the delivery of the radiation rays. Additionally, with certain types of chemotherapy, the therapist must wear gloves if the client has received the medication within 24 hours prior to the treatment. If gloves are not worn, the medication can be transferred from the client’s skin to the therapist’s skin.

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Dysmenorrhea

August 5, 2009

Dysmenorrhea, or painful menstruation, is very common and occurring at least occasionally in almost all menstruating women. Pain occurs in the abdominopelvic or low back region. The sensations are felt as cramps, and usually occur in successive waves or as a persistent cramp. Massage can be performed. If the client’s abdomen is tender, massage over the area is contraindicated because the pressure of massage can induce more pain. If pain and muscle tension in the low back are present, muscles such as quadratus lumborum, latissimus dorsi, the paraspinals, and possibly the gluteals can be addressed specifically with such techniques as deep gliding, deep friction, kneading, and stretches. The client may need to be propped with a pillow under her abdomen while she is prone. If this is uncomfortable, the side-lying position is permissible. The therapist should also recognize that if the client has severe cramps prior to or during the massage, the client may not desire further treatment.

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Kidney Stones

August 5, 2009

One of the most painful pathologies experienced are kidney stones. They may be crystals of salts in the urine, such as uric acid or calcium. They are caused by excessive calcium intake, low water intake, or abnormally alkaline or acidic urine. When the stones get stuck in the urinary tract, they commonly produce intense pain in the midback region, which may persevere to the lower abdomen or genitals. Massage is contraindicated if the pain is severe. Massage may help reduce pain, stress, and muscle spasms in the back. It is very important that the massage therapist ask the client about any referred pain, areas of the body to avoid massaging, and positions on the massage table the client finds comfortable. Propping under the abdomen while prone and under the lower back while supine may be necessary, or a side-lying position may be used.

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Kidneys

Indirect illustration of kidney stones

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Hernia

August 5, 2009

A gastrointestinal pathology that I just recently experienced and had surgery on was an inguinal hernia. A hernia is a protrusion of an organ or part of an organ through its surrounding tissue membranes or cavity wall. The condition may be congenital, resulting from failure of structures to completely close after birth, or it may develop due to obesity, injury, chronic illness, or surgery. The four most common types are hiatal (esophagus), inguinal (lower abdominal wall-inguinal canal), femoral (femoral canal), and umbilical(navel). If the pain is too severe, massage is contraindicated. If, however, the client is not experiencing pain, general massage may be performed, but local massage is contraindicated because the pressure of the massage could cause pain and damage to the tissues in the area. If the client has a surgical mesh, gentle pressure should only be applied over the mesh site, especially during the first 3 months after surgery. Moderate or deep pressure may disrupt the tissue-mesh relationship and potentially cause damage.

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Pneumonia

August 5, 2009

A respiratory pathology I have never experienced, however have witnessed in a few friends and relatives is pneumonia. Pneumonia is an infection or inflammation of the alveoli caused by streptococcus pneumoniae, but other infectious agents such as viruses, protozoans, and fungi could be responsible. During pneumonia, the alveoli fill with fluid and exudates such as dead WBC’s and pus. Exudates are substances that have been slowly discharged from cells or blood vessels as waste. Massage is contraindicated during the acute phase of pneumonia because it is infectious. If the client is not acute, percussion and vibration on the ribcage for five minutes can assist in draining secretions. The treatment should focus on the primary and secondary muscles of respiration. Deep friction, kneading, ischemic compression, and deep gliding strokes can help loosen these muscles.

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CHF

August 5, 2009

In congestive heart failure, the heart becomes a slowly failing pump. CHF impairs the heart’s ability to supply sufficient blood flow to meet the body’s needs. Causes of CHF include coronary artery disease, long-term hypertension, and myocardial infarcts. If the left ventricle fails first, blood backs up in the lungs and can result in pulmonary edema, causing a shortness of breath on exertion, and fatigue. Conversely, if the right ventricle fails first, blood will then back up in peripheral vessels and result in edema in the extremities. Clearance from the client’s health care provider must be obtained prior to massage. A light massage of shorter duration is permissible because a vigorous massage stimulates the return of fluid to the blood, which may add stress to an already debilitated heart.

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