Archive for November, 2009

Nerve Impingement

November 30, 2009

Nerve impingement is a HUGE issue in massage therapy! It’s the cause of almost every tension headache and I guess the route cause of conditions such as Carpal Tunnel. Even if the impingement is caused by bone, the muscles can often be reworked to relieve the pressure form the bone on the nerve. I would venture to say that actually the most painful muscular issues that people come into to get massages for are because of Nerve Impingement.

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Malignancy

November 24, 2009

The American Cancer Society advocates massage to comfort and help improve the quality of life of cancer patients. *— In addition to the benefits listed, massage can also play a vital role in stress reduction for the cancer patient, family members, and caregivers. *— What other side effects can be helped by massage therapy? Edema can be reduced or prevented; nausea and vomiting can be decreased; fatigue can be reduced; and skin quality can be improved. A cancer patient might receive one or a combination of these treatment methods, each of which has its own set of risks. Massage therapy can address various side effects of each type of treatment. Surgical excision is commonly used to remove tumors, cancerous organs, and often neighboring lymph nodes. *— The massage therapist needs to consult with the client’s health care provider to find out when massage can be safely administered. When might massage be contraindicated? Massage is contraindicated around recent incision sites, during any period that might put the client at risk of forming a blood clot, or if infection is present. *— What effects can massage therapy have on the muscles in the affected area? Muscular spasm can be reduced or eliminated; muscular tension can be decreased; muscle strength can be maintained; and local circulation can be increased, which increases nutrition to the muscle tissue. Radiation therapy uses radiation directly on tumors to decrease their size or inhibit their growth. A person’s entire body can be treated with radiation. Radiation therapy can also be used to prevent rejection of a transplanted tissue or organ. *— What are some of the changes that might take place in a cancer patient’s skin? Redness, dryness, irritation, and itching are common skin changes. These areas can be thought of as being burned, as in a sunburn. A general guideline for massaging cancer patients undergoing radiation therapy is to avoid massaging irradiated areas. However, the therapist can use light pressure if it is tolerable for the client and the health care provider approves. *— What methods should be avoided if the client is experiencing nausea but is able to be massaged? Joint mobilizations, stretches, jostling, or moving client limbs are methods that are contraindicated because all of these can increase nausea. Gentle pressure should be used to help promote relaxation and decrease nausea. Nausea and vomiting are two of the most dreaded side effects of chemotherapy. The client may also have mouth sores associated with digestive tract disturbances. *— What are the symptoms of peripheral neuropathy, and what are the massage considerations? The symptoms of peripheral neuropathy include pain, tingling, burning sensations, or numbness in the extremities. Deep pressure massage is contraindicated because the client cannot give accurate feedback about pressure. The considerations for massaging chemotherapy patients are the same as those for surgery patients. Muscular spasms can be reduced or eliminated; muscular tension can be decreased; muscle strength can be maintained; and local circulation can be increased, which increases nutrition to the muscle tissue. *— What are some helpful techniques to use with patients undergoing chemotherapy? Helpful techniques include gliding strokes, kneading, deep friction, and ischemic compression. It is important to communicate with the client’s health care provider about the specific muscles to be addressed and the massage techniques to be used. Communication with the client about the pressure and effectiveness of the techniques is also very important. As with all types of cancer treatments, the massage therapist must be in close communication with the client and the client’s health care provider to keep the client comfortable and safe. The massage therapist also needs to do in-depth research to become familiar with the challenges that the client faces. The massage therapist needs to obtain information relevant to each particular client. Questions need to be asked in the premassage interview and findings need to be documented. *— In what ways will the answers to these questions affect the massage therapist’s treatment? The type of cancer and cancer treatment will significantly affect the choice of massage therapy techniques, the level of pressure that is appropriate for the massage, the areas that will be avoided, and whether massage is contraindicated altogether. If the client has a low white blood cell count or decreased immunity, what precautions should the massage therapist take to protect the client? The massage therapist should not massage the client when the massage therapist is sick. If anyone in the therapist’s office is sick, the client should not come to the office for massage treatment at that time. Also, the sanitation guidelines for massage therapists, as outlined in Chapter 1, should be followed diligently. *— The areas of the client’s body where indwelling medical devices are located are contraindicated for massage. Observation of the client can provide important indicators for the massage therapist. Slow, gentle massage should be used if a client appears fatigued. Pressure, techniques, length of massage, and position might need to be modified for a client who is grimacing, holding his or her breath, breathing rapidly, flinching, or tightening his or her muscles. Signs of inflammation should be brought to the attention of the client. It is imperative that the massage therapist follow the massage considerations delineated for each type of cancer treatment along with these general guidelines for working with cancer patients. When documenting symptoms, therapist observations, areas of the body worked, techniques used, and the outcomes of the techniques used. *— Why should the massage therapist ask questions before each massage therapy session? The symptoms a client is experiencing can be different for each visit. By asking questions each time, the therapist is better able to tailor the massage treatment to the client’s needs. Why is the pressure used in massage so important? The pressure used is critical because light stroking is generally aversive (much like a tickle stimulus) and does not produce the documented benefits of massage for cancer patients. Moderate, firm pressure should be used, unless the client is debilitated. If the client is debilitated, the therapist might need to use gentler pressure so as not to overtire the client. The side-lying position and/or special propping might be necessary to ensure client comfort. The side-lying position can also be used as an alternate position if the client cannot lie prone because of central venous catheters on the upper chest wall, radiation burns, or surgical wounds. *— The image labeled A shows how to use a towel to anchor the drape in the side-lying position. *— The image labeled B gives an overview of how to massage the client’s arm in the side-lying position. These illustrations give an overview of how to massage the inside of client’s leg (C), the outside of the client’s leg (D), and the client’s back (E) in the side-lying position. Breast self-examination includes the inspection of the breasts in a mirror while in an upright position. The breasts should then be palpated while in an upright position by holding the breast with one hand and examining it with the fingers of the other hand. Palpation should then be repeated while lying down with one hand extended above the head. The diagram on this slide shows the different steps involved in breast self-examination. What is the best preventative measure anyone can take to reduce the risk of skin cancer? The best preventative measure is to avoid overexposure to the sun and to use a sunscreen lotion with a sun protection factor (SPF) of 15 or higher. Breast massage is learned through special training and involves specific techniques that are mainly modified petrissage (kneading). *— These techniques are geared toward achieving what effects? They are geared toward increasing blood flow and lymphatic drainage. These techniques are most useful after nearby muscles, such as the pectoralis major, have been relaxed. Therapists need to be very clear about the legalities of breast massage in the state in which they practice massage therapy. *— When performing breast massage, what must the massage therapist never do? The massage therapist must never touch the nipple during the treatment. The massage therapist must also always obtain consent from the client before proceeding with breast massage.

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Dehydration

November 23, 2009

During my years of massage therapy, I have come across so many people that for one reason or another are extremely dry! Not necessarily on all parts of their body’s though, for example most of these people particularly have very dry legs but not really arms, which could be because it is actually the easiest place to put on some lotion. I know that people don’t drink nearly enough water, but their skin should not feel like paper, I think one of the main causes of this issue today is the consumption of coffee, soda, and energy drinks. Soooo bad for you.

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Structural Assessment

November 23, 2009

People tell you so much by the way that they stand. It is painfully obvious in some people where their issues lie, just depending on their degree of Kyphosis and Lordosis. In my massage therapy experience, I see very few people without a slight exaggeration of on of the two. I have seen the most severe cases in the elderly. I have also noticed, those who are short will often have a slight hump around C7 from constantly looking up. Kyphosis and Lordosis can often be solved with strengthening the antagonist muscles but a short person must always look up to be able to see.

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Oxygenation and pH balance

November 20, 2009

Two secretes of health that are usually overlooked are oxygenation and pH balance. Some of the most potent diseases including cancer and anaerobic bacterial infection thrive in a low oxygen environment or in the absence of oxygen. Anaerobic bacteria are normally found within certain areas of the body but result in serious infection when they have access to a normally sterile body fluid or deep tissue that is poorly oxygenated. Some anaerobes normally live in the crevices of the skin, in the nose, mouth, throat, intestine, and vagina. Injury to these tissues (i.e., cuts, puncture wounds, or trauma) especially at or adjacent to the mucous membranes allows anaerobes entry into otherwise sterile areas of the body and is the primary cause of anaerobic infection. A second source of anaerobic infection occurs from the introduction of spores into a normally sterile site. Spore-producing anaerobes live in the soil and water, and spores may be introduced via wounds, especially punctures. Anaerobic infections are most likely to be found in persons who are immunosuppressed, those treated recently with broad-spectrum antibiotics, and persons who have a decaying tissue injury on or near a mucous membrane, especially if the site is foul-smelling. pH stands for “potential of Hydrogen”, which is a measure of the acidity or alkalinity of a solution, such as a mixture of liquids. It is measured on a scale of 0 to 14 — the lower the pH the more acidic the solution, and the higher the pH the more alkaline the solution. When a solution is neither acid nor alkaline it has a pH of 7 (exactly in the middle), which is neutral. Your body’s pH is best when between 7.36 and 7.44, which of course, is slightly alkaline. Acidic blood pH levels, which cause toxic acid wastes (acidosis), is a mostly unknown but dangerously destructive circumstance because it leads to so many deadly diseases such as heart disease and cancer, as well as serious health problems such as low energy, unwanted weight gain, poor athletic performance and accelerated aging. The first major line of defense against sickness, disease and aging is the pH of your blood. Even your immune system will not work properly if your blood is even slightly acidic. Remember, the aging process, accelerated by acidic waste in your body, takes its toll every single day. By preventing this continuous accumulation of acidic waste in your bodies, we can in fact help to slow the aging process. In order to maintain health keep your body well oxygenated with a slightly alkaline pH. The basic American/Western diet (meats, processed foods, white flour, sugar, alcohol, etc.) and sedentary lifestyle creates a toxic, low oxygen and acidic state in your body. If you drink coffee or sodas you are consuming acids which will lower your pH level. Your body simply will not work to its optimum potential if it does not have a slightly alkaline pH level. Exercise and a balanced whole foods/diet are the keys to optimal health. Some high alkaline foods include dried figs, dried apricots, ,lima beans, swiss chard, spinach, bean sprouts, cucumber, beets, kale, dates, lemons, peaces, watercress, celery, and coconut milk. Acid foods include crackers, white flour, processed foods, meats, coffee, soda, and refined sugar. So the choice is yours. Make the right choices and enjoy good health.

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Reproductive System

November 20, 2009

Although massage does not directly affect the reproductive system, massage therapists should still be familiar with it. *— How can massage therapy affect pathologies and life stages of the reproductive system? Massage can help decrease the anxiety and muscle tension associated with PMS and menstruation. Massage can also soothe and relax clients who are dealing with various reproductive conditions. Deep abdominal massage is contraindicated throughout the pregnancy and for 3 months after the mother gives birth. Why is that? Deep abdominal massage is contraindicated because the pressure of massage could damage the uterus. What might abdominopelvic or groin pain indicate? These symptoms might indicate a urogenital infection, in which case massage might be contraindicated. If the client does not know the source of the symptoms, then the client should be referred to the client’s health care provider. *— What might genital inflammation indicate? These symptoms might also indicate the presence of a urogenital infection. If the client does not know the source of the symptoms, refer the client to the client’s health care provider. Can massage be performed on a client who is experiencing edema? If the cause of the edema has been ascertained and clearance has been obtained from the client’s health care provider, then massage can be performed. Since the massage therapist is not a health care provider, the therapist should refer the client to a health care provider for diagnosis and treatment if any of these symptoms are present. If the palpable masses found in the female breast are caused by fibrocystic breast disease, is massage contraindicated? No, massage can be performed on clients with fibrocystic breast disease. *— What are some possible reasons for unexplained skin lesions? The client could be suffering from an undiagnosed sexually transmitted disease such as genital herpes, genital warts, or syphilis. Deep abdominal massage is contraindicated until the client has completely healed because of any possible pain in the area that pressure could cause. *— The side-lying position or being propped with a pillow under the abdomen while prone could increase the client’s comfort. What are some possible causes for amenorrhea? Amenorrhea might be caused by dysfunction of the hypothalamus, pituitary gland, ovaries, uterus, or certain medications. Amenorrhea is normal before puberty, after menopause, during pregnancy, or after surgical removal of both ovaries or of the uterus. *— The client might prefer to be massaged in the side-lying position. What are some symptoms of BPH? Possible accompanying symptoms include: frequency of urination, need to urinate at night, pain, and urinary tract infections. *— Abdominal massage is contraindicated if the client’s abdomen is tender. The client might prefer to be propped with a pillow or massaged in the side-lying position. If the client is experiencing pain and muscle tension during dysmenorrhea, which muscles should be addressed during the massage? The following muscles should be addressed during the massage: the quadratus lumborum, the latissimus dorsi, the paraspinals, and the gluteals. What benefits can massage offer clients who have endometriosis? Massage therapy can help the clients relax. How can the massage therapist make the client more comfortable during the massage? The client might be more comfortable with a pillow under her breasts while lying prone. The side-lying position might need to be used if the client cannot lie prone comfortably. Massage can be performed on clients with uterine fibroids, but special positioning and propping adjustments might need to be made to help the client feel more comfortable. What symptoms would mean that massage therapy was contraindicated? Systemic symptoms, such as general body aches and fever, mean that massage is contraindicated. Abdominal massage is contraindicated if the abdominal area is tender. Massage can be performed on clients with mastitis even though acute mastitis is usually caused by a streptococcal or staphylococcal infection. Because of the prevalence of hot flashes during menopause, the massage therapist might need to adjust the room temperature for the client’s comfort. Because the menstruating client is likely to be wearing some form of feminine protection, it is common for the client to leave her undergarments on for the massage. *— What massage techniques can be helpful for a menstruating client who has low back pain? Deep gliding, kneading, deep friction, and ischemic compression on the quadratus lumborum, paraspinals, latissimus dorsi, and gluteals can be helpful. Massage can be performed on clients with ovarian cysts. Adjustments might need to be made for the client’s comfort. The client might be more comfortable being propped with a pillow under her abdomen while prone, or the side-lying position might need to be used. Severe or recurrent PID can result in infertility. PID can also be a secondary complication of an STD. Why is massage contraindicated? Massage is contraindicated because PID involves infection and fever. Complications of preeclampsia include premature separation of the placenta, pulmonary edema, fetal malnutrition, low fetal birth weight, maternal death, and fetal death. *— If massage is performed under the strict supervision of the client’s health care provider, then massage can be performed. However, massage strokes that target the flow of lymphatic fluids should be avoided. What positions for massage are recommended for each of the three trimesters of pregnancy? During the first trimester, the client’s position is not a concern unless she is uncomfortable. After the eighteenth week of pregnancy, the prone position is contraindicated. This is not a matter of client preference. During the second and third trimesters, expectant mothers receiving massage should be in a modified supine (semi-reclining) or side-lying position. The side-lying position, with the appropriate supportive devices, is shown on this slide. *— Pregnant women are at a higher risk for blood clots, so only gentle pressure should be used in the medial thigh region. *— An ectopic pregnancy, which involves the implantation of a fertilized ovum outside the uterine cavity, either ends with spontaneous abortion or needs to be surgically removed. Reducing caffeine and sugar intake, reducing stress, and receiving a gentle, relaxing massage can reduce or eliminate PMS. The client suffering from prostatitis might need to be propped with a pillow under the abdomen while prone, or the side-lying position might need to be used. Massage can be performed on a client who has vaginal candidiasis as long as the infection is not acute. Women with breast implants or large or tender breasts need special accommodations for comfort while lying prone. What options are available for client comfort? A rolled-up towel or pillow can be placed under, above, or between the client’s breasts. The following items are also available: commercial bolsters, special massage tables, and adjustable face rests. *— The client can be asked to use the back side of her hand to retract the breast medially, or can be asked to modify a side-lying position for massage near the pectoral region.

 

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Urinary Pathologies

November 20, 2009

During the premassage interview, the massage therapist should observe the client. *— What specific symptoms should the massage therapist look for when observing the client’s skin? The massage therapist should check the skin for bruising, pallor, flushing, jaundice, cyanosis, and varicosities. *— If there are signs of edema (pitting edema or mottled skin), then the cause of the edema must be ascertained and clearance from the client’s health care provider might be required. Massage therapists should be aware of the general manifestations of urinary disease and refer clients who exhibit signs of urinary disease to the clients’ health care providers for diagnosis and treatment. A light massage of short duration is best for these clients since they are often taking anticoagulants. Why is the timing of the massage important for clients on dialysis? Clients undergoing renal dialysis often feel extremely tired immediately after a treatment session, and they often feel progressively worse as wastes build up between treatments. Therefore it is especially important to consult with the client about the best time to schedule massage treatments. Cystitis is commonly referred to as a bladder infection and can be either chronic or acute. The massage therapist should encourage the client to seek medical attention if she has not already done so. A full body massage can help the client relax and manage stress induced by the disease. If clearance is obtained for massage therapy, what are the massage considerations? Massage strokes should be light, soothing, and of short duration. Also, lymphatic massage is contraindicated because moving fluid back into the blood may overload the heart or kidneys. Local massage and joint mobilizations are contraindicated during the acute phase because the affected areas will be inflamed and painful. However, the application of cold packs to the affected areas could be beneficial. If the client is not in the acute stage, then light massage can be performed on the surrounding areas. What can cause acute renal failure? Causes of acute renal failure include the following: low blood volume (possibly due to a hemorrhage), decreased blood output from the heart (possibly due to a heart attack), damaged nephrons, kidney stones, and reactions to certain medications. *— Why is massage contraindicated? Massage is contraindicated because clients suffering from kidney failure are severely debilitated. Also, a vigorous massage can increase blood flow, taxing the kidneys more. Massage for clients with kidney stones is contraindicated if the pain is severe. Also, if the client is taking medication to treat the kidney stones, then clearance from the client’s health care provider is required before massage can be performed. *— The massage goals should be to reduce pain, stress, and muscle spasms in the back. If clearance for massage is obtained, a light, soothing massage of short duration is indicated. *— Why is lymphatic massage contraindicated for clients who have nephrotic syndrome? Lymphatic massage is contraindicated because moving the fluid back into the blood can overload the heart and the already debilitated kidneys. Polycystic kidney disease is a disorder in which the nephrons become riddled with thousands of cysts (fluid-filled cavities). What measures can be implemented to help slow the progression to renal failure? Blood pressure medications, adopting a diet low in protein and salt, and controlling UTIs can help slow the progression to renal failure. *— If clearance for massage has been obtained, what sort of massage is indicated? The massage therapist should perform a gentle and relaxing massage that avoids the abdomen. If clearance for massage is obtained, what sort of massage is indicated for clients who have uremia? A light, soothing massage of short duration is recommended. After the client has finished healing, massage can be performed. However, the abdomen should be avoided if the client is experiencing abdominal discomfort. Urinary incontinence can result from a wide variety of causes, but a few of the more common causes include the following: damage caused during childbirth, straining while lifting heavy objects, and damage to the central or peripheral nervous system. *— A general massage is recommended for clients with urinary incontinence. However, the massage therapist should avoid applying pressure over the lower abdomen if the client is uncomfortable with it. Most UTIs are caused by bacteria. What are the most common symptoms of UTIs? Common symptoms of UTIs include an increased need to urinate, burning and pain during urination, and blood and pus in the urine. *— When the symptoms are not severe, general massage can be performed.

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Gastrointestinal Conditions

November 19, 2009

How can the massage therapist assist the client with gastrointestinal discomfort? The massage therapist can use pillows or bolsters to increase the client’s comfort. The therapist can also ensure that the client’s body position is comfortable. The therapist might even need to avoid massaging the client’s abdomen. *— If the client has a colostomy or ileostomy, the therapist should advise the client not to eat for the 2 hours prior to the client’s massage appointment. Using the side-lying position and placing an extra pad under the massage linens can also help accommodate these clients. When should the massage therapist proceed after the palpation of a hard abdominal mass? The massage therapist can proceed with the massage, avoiding the abdominal region until the source of the mass is determined by the client’s health care provider. A mass in the descending or sigmoid colon region is probably a stool, but it could be an indicator of something more serious. *— The images on this slide demonstrate how to test for rebound tenderness, which can indicate the presence of appendicitis or peritonitis, both of which require immediate medical attention. Is a colostomy necessarily permanent? No, it is sometimes a temporary bypass method used in conjunction with other surgeries. *— What should the massage therapist do if a spill occurs? The massage therapist should remain calm, assure the client that these things sometimes happen, and offer to assist the client in cleaning up the spill. *— Massage therapists should avoid getting lubricant on or near the bag opening. What are the differences among the three main body types? Ectomorphs tend to be long and lean, with little body fat or muscle. Endomorphs tend to have more adipose tissue and gain weight easily. Mesomorphs tend to be athletic and have a good balance between adipose and muscle tissue. Massage therapists should be able to effectively massage clients with any body type. How should the massage therapist approach working with skin folds on clients who have experienced recent weight loss? The massage therapist should avoid pinching these areas or working them deeply. Folds can be moved to the side or flattened out during work on adjacent muscle. *— The massage therapist needs to be aware of mechanics and efficiency when working on larger clients. It can help to lower the table height or stand on a small platform in order to gain leverage. If the client has any of these disease manifestations, the client should be referred to a health care provider for diagnosis and treatment. Rebound tenderness is the discomfort felt as the fingertips are lifted off the abdomen rather than during application of pressure. How is massage helpful for clients with anorexia nervosa? The massage therapist needs to obtain clearance from the client’s health care provider first, especially for clients with severe symptoms, but a gentle nurturing massage can be a helpful adjunct to psychological counseling. Massage can also help to improve the client’s self-image and decrease anxiety. What causes appendicitis? Appendicitis is caused by an obstruction of the hollow center of the appendix or an abnormal narrowing or kinking of the organ. *— Why is massage contraindicated? Massage is contraindicated because clients with appendicitis require immediate medical attention. Bulimia is classified as both an eating and an emotional disorder, and it is generally treated by psychological counseling. *— Massage can help decrease the client’s anxiety. *— Is massage indicated if the client has chronic cholecystitis? If the client has chronic cholecystitis and the pain is not severe, then general massage can be performed. However, the massage therapist should avoid the abdominal region. Why is massage contraindicated in clients with cirrhosis of the liver? Massage is contraindicated because it increases the fluid returned to the blood from edema and/or ascites, which would further tax an already debilitated liver. An impaired liver also increases the chance of bruising, since the liver synthesizes many clotting factors. The massage therapist should ascertain the cause of constipation before proceeding with massage therapy. If the constipation is not due to diverticulitis, then abdominal massage can help relieve constipation by stimulating the forward movement of intestinal contents using gliding strokes, kneading, and vibration. What are some massage considerations in clients with Crohn’s disease? Because symptoms can vary, the massage therapist should ask the client about current symptoms before beginning massage. The abdomen should be avoided, a side-lying position might be required, and an ileostomy could be involved. The massage therapist should ascertain the cause of diarrhea before proceeding with massage therapy. If clearance has been obtained from the client’s health care provider, then general massage can be performed, avoiding the abdominal region. Is massage indicated if the client has chronic gallstones? If the client has chronic gallstones and the pain is not severe, then general massage can be performed. However, the massage therapist should avoid the abdominal region. Chronic gastritis is generally an indication of an underlying illness, such as an ulcer. Therefore massage can be performed on clients who have chronic gastritis. However, the therapist should do the following: avoid the client’s abdomen if it is sensitive and elevate the client’s head slightly to aid in digestion. If gastroenteritis is caused by psychological factors or by eating food that is irritating, then massage can be performed. The massage therapist should help the client find a comfortable position to lie on the table, perhaps elevating the head, and avoid the client’s abdomen if it is sensitive. How can the massage therapist assist a client with GERD? The client should be urged not to eat a large meal in the hour before the massage appointment; the head of the massage table should be elevated to aid digestion; a side-lying position can be used to help the client feel comfortable; and the abdomen should be avoided if it is sensitive. Can massage be performed if the client has chronic hepatitis? If a client has chronic hepatitis, massage can be performed if clearance is obtained from the client’s health care provider. However, even with clearance from the client’s health care provider, abdominal massage is contraindicated because it can put undue pressure on the liver. HAV can have complete recovery, and infection provides lifelong immunity. HBV can cause rapid death or chronic disease. HCV can lead to liver cirrhosis or failure. HBV and HCV can both lead to cancer. HDV occurs as a coinfection with HBV and is responsible for half of all total liver failure cases. HEV resembles HAV and usually occurs in epidemics in the Middle East or Asia; it can be fatal in pregnant women. What types of hernias are pictured on this slide? The hernia on the left is a hiatal hernia. The hernia on the right is an inguinal hernia. General massage can be performed, but only if the client is not in pain. However, local massage is contraindicated. Intestinal obstructions can be caused by adhesions from past surgeries, impacted feces, or tumors, but most are due to mechanical reasons. *— Why is massage contraindicated? Massage is contraindicated because intestinal obstruction is a serious condition that requires medical attention. How can massage therapy help clients with irritable bowel syndrome? Massage can help reduce stress, but it should be undertaken carefully. The massage therapist should ascertain the current severity of symptoms, propose a side-lying position, and avoid the abdomen. Where can the distinctive yellow discoloration of jaundice appear on the client? The yellow discoloration of jaundice can appear in the skin, mucous membranes, and sclera of the eyes. *— Why is massage contraindicated? Massage is contraindicated for clients with jaundice because of the potential negative impact on the already debilitated liver. What are the symptoms for mumps? The symptoms for mumps include the following: enlargement of the parotid salivary glands, fever, and extreme pain during swallowing. *— Why is massage contraindicated? Massage is contraindicated in cases of mumps because it is contagious. If massage is not contraindicated for other reasons, it can be performed on the obese client. *— What are some important massage considerations for obese clients? A nonjudgmental attitude is important. The therapist needs to distinguish between adipose and muscle tissue to avoid causing bruises. The therapist will also need to do extra work on muscles that have become overdeveloped to support the client’s weight. Larger draping is required, and the massage therapist should consider lowering the table or standing on a small platform for better leverage. Is massage contraindicated for clients with chronic pancreatitis? For clients with chronic pancreatitis, the massage therapist needs to obtain clearance from the client’s health care provider. If clearance is obtained, massage is permitted, but abdominal massage should be avoided. What are some of the ways that bacteria and other irritating substances can gain access to the peritoneum? Bacteria and irritating substances can be introduced into the abdominal cavity by a ruptured organ, penetrating wound, perforation of the gastrointestinal or urogenital tract, or a ruptured appendix. *— When might massage be indicated? If clearance is obtained from the client’s health care provider, massage can be performed in a hospital to reduce stress and pain. If the cause of pharyngitis is not an infection, can massage be performed? Yes, massage can be performed if the pharyngitis is not due to an infection. If the polyps are noncancerous, is massage permitted? If the polyps are noncancerous, massage can be performed, but the affected area should be avoided. What are some massage considerations in clients with ulcerative colitis? The symptoms can vary, so the massage therapist needs to ask the client about current severity of pain and other symptoms before proceeding with massage. It is also important to help the client find a comfortable position to lie on the table and to avoid abdominal massage.

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Malignancy

November 16, 2009

If a client has cancer, the therapist needs to be aware of what kind of cancer they have, what they are doing to treat it, if they are currently getting treatments, or when the last treatment was, if they are wearing a wig, and just how they are during the massage, fatigued, uneven breathing, etc. Using a moderate firm pressure can help relax the client.

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Reproductive Conditions

November 16, 2009

Review of Mosby’s Pathology for Massage Therapists, by Salvo and Anderson. Within the course of Dr. Johnson.

Chapter eleven is extremely important things to know, although you can not massage the reproductive areas. As the therapist you need to be aware if the client has any STD’s or is pregnant. If the client is pregnant, depending on how far along, the client may still receive a massage. The massage must be given by someone who has been trained in this area and knows that the client must have pillows behind her so that she is in a sitting position, and to massage the back the client must lay side lying position.

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Respiratory Diseases

November 13, 2009

If the client has an inhaler, it should be readily available during the massage treatment in case the client needs it. *— Triggers for asthma or allergies are important to know so that the therapist can try to avoid exposing the client to these triggers. *— Clients with sleep apnea or other breathing difficulties might need extra pillows or bolsters to increase client comfort. If signs of edema are found, the therapist should always ascertain the cause of the edema before proceeding. Postural deviations and the client’s style of breathing can help the therapist decide on which muscles to focus treatment. *— The therapist should listen for the following respiratory-related sounds: high-pitched sounds, wheezing, rattling, crackling, and deep or harsh sounds. Wheezing indicates narrowed respiratory passages, and crackling or rattling can indicate excess mucus in airways. What can breathing through the mouth indicate? Breathing through the mouth generally indicates the presence of constrictions or blockages in air passageways (such as when a person has a cold). Massage therapists should be familiar with the medications used to treat respiratory disorders and the medications’ associated side effects. *— Clients who use inhalers should also be sure to have the inhaler available during their massage. Which medications are inhalers generally used to administer? Inhalers are generally used to administer bronchodilators and mast cell stabilizers. These medications are generally used to prevent or treat the symptoms of asthma. Massage therapists should be aware of the general manifestations of respiratory disorders and refer clients with any of these signs to their respective health care providers. *— Rapid, difficult, prolonged, or labored breathing are breathing patterns that can indicate the presence of a respiratory disorder. *— What breathing sounds should therapists listen for? Breathing sounds to listen for include the following: high-pitched sounds; rattling sounds; deep, harsh sounds; and no breathing sounds. Apnea often occurs during sleep and is referred to as sleep apnea. Clients who have sleep apnea generally suffer from loud snoring, insomnia, sleepiness, headaches, and sometimes depression. *— The massage therapist should determine the cause of the apnea and adjust the massage accordingly, including adjusting the position of the client to maximize the client’s comfort. What benefits can a general, relaxing massage provide clients with apnea? Massage can help the client rejuvenate and possibly help alleviate symptoms of depression. What are some useful massage techniques for clients with asthma? The following techniques can be useful: deep friction; kneading; ischemic compression; deep, gliding strokes; vibration; and percussion. If the client has chronic bronchitis, a full-body relaxing massage is helpful. Postural drainage (placing the head lower than the rest of the body) can be useful for clearing mucus from the respiratory tract. Percussion and vibration on the ribcage can also be helpful. The common cold is an acute inflammation of the mucosa of the upper respiratory tract. Clients will be contagious 2 to 3 days after cold symptoms appear and should not be massaged during that time period. *— Once the symptoms are no longer acute, massage can be performed although it may exacerbate cold symptoms for a short time. *— What are the benefits of massage for clients with the common cold? Massage therapy decreases the overall recovery time for the common cold. Cystic fibrosis is a genetic disorder that causes thick mucus to obstruct the airways. *— If clearance is obtained for massage, what techniques and positions should be used? The client should be positioned so that the head is lower than the rest of the body to promote clearing the respiratory tract of mucus. Percussion and vibration on the ribcage can be helpful. The massage should focus on the muscles of respiration using deep friction, kneading, ischemic compression, and deep gliding strokes. The difficulty in exhaling will cause the muscles of respiration to be especially tight. What are the secondary muscles of respiration? The secondary muscles of respiration include the following: the sternocleidomastoid, the intercostals, the scalenes, and the pectoralis minor. The semireclining position for clients with emphysema can help them breathe more easily. *— What massage techniques can be useful for clients who have emphysema? The following techniques can be useful: deep gliding, deep friction, kneading, and ischemic compression. However, a gentler massage might be required if the client tires easily. If the allergic attack is not acute, what positions and techniques should be used when performing massage on clients with hay fever? The therapist needs to ask the client if lying prone and/or using the face cradle is comfortable because these positions can help nasal passages to drain. General massage is indicated, but the therapist should ensure that the treatment area is free of dust and allergens. What is the most serious complication of influenza? Bronchopneumonia is the most serious complication of influenza. *— Massage is contraindicated because influenza is a contagious disease and because massage would only exacerbate the symptoms. If the cause of laryngitis is not due to an infectious disease, then general massage can be performed if the pleurisy is not caused by a bacterial infection, then what massage techniques should be used? The massage treatment should focus on the primary and secondary muscles of respiration, using the following techniques: deep friction, ischemic compression, and deep gliding strokes. What are some other types of pneumoconiosis and what are they caused by? Silicosis is caused by silica; welder’s lung is caused by iron oxide; and coal worker’s pneumoconiosis is caused by coal dust. *— If clearance for massage is obtained, then a general, relaxing massage involving ribcage vibration and percussion is recommended. The therapist should also keep tissues readily available because the client is likely to cough as a natural reflex. *— What should the massage focus on? The massage should focus on the primary and secondary muscles of respiration, using the following techniques: deep friction, kneading, ischemic compression, and deep gliding strokes. Pneumonia is the most common infectious cause of death in the United States. What groups of people are most susceptible to pneumonia? Older adults, infants, immunocompromised individuals, and cigarette smokers are most vulnerable to pneumonia. *— If clearance is obtained, then the massage should focus on the primary and secondary muscles of respiration, using deep friction, kneading, ischemic compression, and deep gliding strokes. Stretching and joint mobilizations can help prevent muscle atrophy due to prolonged bed rest. Pulmonary edema also involves excessive amounts of interstitial fluid in lung tissue. The figure on the slide shows the effects of pulmonary edema due to congestive heart failure. What are some other common causes of pulmonary edema? Some other common causes of pulmonary edema include near drowning, renal failure, cerebrovascular accidents, and infection. *— If the symptoms are less severe and clearance is obtained from the client’s health care provider, then a shorter, lighter massage is indicated. A pulmonary embolism is caused by an embolus blocking off the pulmonary artery or one of its branches. What is an embolus? An embolus is a blood clot, bubble of air, or any piece of debris transported by the bloodstream. *— Why is massage contraindicated? Clients experiencing a pulmonary embolism require immediate medical attention, so they should not receive massage. What are some symptoms of RDS? Respiratory distress syndrome is characterized by a high respiration rate (more than 60 breaths per minute) and nasal flaring. *— Why is massage contraindicated? Adults and infants with RDS are very debilitated, so massage is contraindicated for this life-threatening disorder. Because individuals with SARS will be very debilitated, massage is contraindicated. Why is massage contraindicated if the client has a fever? Massage is contraindicated for clients who have fevers because massage increases blood flow, which only exacerbates the symptoms and makes the client feel worse. If the client does not have a fever, then general massage can be performed. What massage techniques are useful for clients with sinusitis? Local moist heat applications and deep ischemic pressure applied over the frontal and sphenoidal sinuses can help to relieve pain. The inhalation of steam can help the client relieve congestion. When is the client no longer infective? Generally, 2 to 4 weeks after the start of medication treatment, the client is no longer infective, but this should be determined by the client’s health care provider.

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Cardiovascular Diseases

November 13, 2009

The therapist should ask about both current and previous conditions to develop an appropriate treatment plan for the client. *— Why should therapists ask clients whether they are taking medications? The medications might have side effects that could affect the massage considerations, and the client might need to have certain medications readily available in case of an emergency. *— The presence of a pacemaker, implantable cardioverter defibrillator (ICD), or catheter requires modifying massage positions and taking other precautions. Shortness of breath can also indicate a need to modify massage positions. *— Fatigue, anxiety, headaches, and insomnia can be indicators of cardiovascular disease or medication side effects. Therapists need to discuss these symptoms with the client and might need to refer the client to a health care provider for evaluation or clearance before performing massage. *— If the client has hives or rashes, then those areas should be avoided during the massage what signs should the therapist look for when assessing the client’s skin? The therapist should look for bruising, pallor, flushing, jaundice, cyanosis, and superficial varicosities. The temperature of the skin should also be evaluated. *— Nail beds should be checked for clubbing and spooning. *— If edema is suspected, the cause of the edema must be ascertained before proceeding. Swollen lymph nodes can suggest the presence of a local or systemic infection. Hematological agents are anticoagulants and platelet inhibitors. What are some side effects associated with hematological agents? Abdominal pain, gastric irritation, hemorrhaging, nausea, and skin rashes are all potential side effects of hematological agents. *— Which massage techniques should be carefully monitored or avoided if clients are taking these medications? Ironing, deep petrissage; ischemic compression; and deep, specific frictions should be avoided because they could result in internal bleeding. Which class of medications listed here has hallucinations as a possible side effect? Hallucinations are a possible side effect of cardiac glycosides, which are used to improve the strength and efficiency of the heart or to control the rate and rhythm of the heartbeat. *— Which class of medications listed here has edema as a possible side effect? Edema is a possible side effect of lipid-lowering drugs, which are used to lower the lipid content of the blood. Local massage around the surgical incision is contraindicated until the client is fully healed. *— The therapist should exercise caution when performing shoulder joint mobilizations on clients with pacemakers since moving the client’s arm over the client’s head could disturb the lead connections for the pacemaker. An implantable cardioverter defibrillator (ICD) is a device that briefly passes an electric current through the heart to help it beat steadily. It is surgically implanted and is used in patients at risk of sudden death from ventricular fibrillation. The shock is painful to the client. It can be felt by the massage therapist as a tingling sensation but it is not harmful. A central venous catheter (central line) is a form of intravenous access that can be used for a prolonged period of time. The catheter is usually sutured to fascia and muscle and it can protrude from the client’s skin. Central venous catheters are most often placed in the jugular vein, subclavian vein, or femoral vein. The catheter makes it difficult if not impossible for the client to lie prone comfortably. Use pillows or a side-lying position for the client’s comfort. *— Local massage is contraindicated near the area or joints where the catheter is located to avoid damaging the device or surrounding the tissues. If the client has any of these conditions, the massage therapist needs to refer the client to the client’s health care provider for diagnosis and treatment. The massage therapist should also consult the health care provider about what type of massage, if any, should be performed. Hives (urticaria) is a relatively common allergic reaction that causes itchy raised skin welts. These should be avoided during massage. *— What is the significance of unexplained chest or calf pain? These can be signs of a serious underlying pathology, such as coronary artery disease, deep vein thrombosis, myocardial infarction, or phlebitis, that requires medical attention and can affect massage therapy or contraindicate it altogether. Limbs unequal in temperature can indicate inflammation, ischemia, or Raynaud’s syndrome. *— What is the significance of chronic fatigue? It can be a sign of chronic fatigue syndrome, congestive heart failure, depression, or other pathologies that require the massage therapist to consult with the client’s health care provider. Anemia occurs when the oxygen-carrying capacity of the blood decreases, the number of erythrocytes decreases, or the amount of functional hemoglobin in the blood decreases. *— What are the different types of anemia? Some different types of anemia include iron-deficiency anemia, B12-deficiency (pernicious) anemia, hemolytic anemia, and hemorrhagic anemia. *— If the client is not debilitated, the following massage techniques can be helpful: gliding strokes, kneading, and friction. These help oxygenate anemic clients. What are some common causes of aneurysms? Common causes of aneurysms include the following: atherosclerosis, hypertension, trauma, and congenital vascular weakness. *— If the client has been diagnosed with an abdominal aortic aneurysm, then abdominal massage is contraindicated. The pain generally originates in the chest and radiates down the inner side of the left arm or to the neck and throat, as seen in the diagram. The pain travels in this pattern because the area that is painful and the region generating the pain are served by the same section of the spinal cord. *— What beneficial effects can massage have on clients with angina? Massage can help these clients reduce stress and decrease the effects of the sympathetic nervous system, which is involved in coronary artery vasoconstriction. Clients with arteriosclerosis are generally instructed to get adequate rest, moderate exercise, and avoid stress. What sort of massage is useful for client with arteriosclerosis? A gentle, relaxing massage can help clients reduce stress. Deep pressure massage can cause pain, which causes the client’s blood pressure to increase, so it should be avoided. *— Atherosclerosis is generally associated with obesity, hypertension, hypercholesterolemia, and diabetes. *— Why should therapists avoid the use of deep pressure massage and electric massagers when working with clients who have atherosclerosis? Narrowed arteries lead to impeded blood flow, especially to crucial organs such as the heart and the brain. This also means that the client is likely to be prone to blood clot formation. Deep pressure massage and electric massagers are likely to dislodge blood clots that can get lodged in small blood vessels and lead to difficulty breathing, a heart attack, or a stroke. If the client is cleared for massage, after recovering from the cardiac arrest, then a lighter massage of shorter duration is indicated. If the client is further along on the route to recovery, moderate pressure can be used, but deep pressure is dangerous for a healing heart since it can cause an elevated heart rate. *— If a client has an attack during a massage treatment, what should be done? The therapist should assist the client in taking the necessary medications, and then 911 or the local emergency services should be contacted. What are some of the possible outcomes of a stroke? Muscle weakness or paralysis, an increase or decrease in sensation, speech abnormalities, or death could occur. *— If massage therapy is approved, then the goals of the massage treatment should be the following: prevent joint stiffness, decrease muscle spasticity, and address any postural changes. Therefore massage strokes should be slow, superficial, soothing, and rhythmic. What are some possible causes of CHF? Causes of CHF include the following: coronary artery disease, long-term hypertension, and myocardial infarcts. *— If clearance is obtained, what sort of massage should be performed? A light massage of shorter duration is recommended since vigorous massage stimulates blood flow, which can unduly strain a weak heart. Some of the signs of congestive heart failure are listed on the diagram. What are some other signs? Shortness of breath and fatigue are also symptoms of CHF. *— Why is lymphatic massage contraindicated if the client has edema in the extremities? It is contraindicated because lymphatic massage stimulates lymph flow and lymph drainage back into the bloodstream, and the increase in blood volume can put undue strain on a weak heart. Coronary artery disease is the leading cause of death in the United States. *— Clients with coronary artery disease are often prone to blood clots, which is why deep pressure and electric massagers should be avoided. *— The risk factors listed here are those for which intervention has been shown to reduce the incidence of coronary artery disease. What are some risk factors for which intervention is likely (but not shown) to reduce the incidence of coronary artery disease? The following are risk factors for which intervention is likely to reduce the incidence of coronary artery disease: obesity, physical inactivity, diabetes, low HDL, oral contraceptives, hysterectomy or oophorectomy, and menopause without hormone replacement. Why is local massage contraindicated for clients with hemangiomas? Local massage is contraindicated because pressure over the hemangioma could cause subcutaneous bleeding. What are some common causes of hematomas? Hematomas often result from trauma or surgery. *— Why is local massage contraindicated for clients with hematomas? Local massage is contraindicated because it might dislodge blood clots and it could also worsen the pain of the hematoma. There are three types of hemophilia, but all of them impair blood clotting or prevent it entirely. *— Massage is contraindicated for clients with moderate to sever hemophilia because of the danger of causing bleeding. For clients with milder cases of hemophilia, what sort of massage is indicated? A lighter massage is indicated, and joint mobilizations are contraindicated. Clients who are hemorrhaging require medical attention because excessive blood loss can lead to cardiovascular shock and possibly death. What are some possible causes of hypercholesterolemia? It can be inherited or caused by the consumption of large amounts of saturated fats (found in red meats, eggs, and dairy products). What is considered the threshold blood pressure value for hypertension? The threshold of hypertension is considered to be 140/90 mm Hg. A blood pressure of 160/95 mm Hg is considered serious hypertension. *— What are some possible ways that hypertension can be controlled? Hypertension can be controlled with a low-sodium diet, by losing weight, and with regular exercise. Anti-hypertensive medications can also be used. What are some possible causes of hypotension? Hypotension can be caused by shock, dilated blood vessels, or diminished cardiac output. *— Massage tends to lower blood pressure, so clients with hypotension might need extra assistance getting off the massage table or might need to be massaged in a seated position. How can massage help clients with a history of myocardial infarction? Massage can help clients relax, reduce stress, and decrease the effects of the sympathetic nervous system. *— Why should massage therapists avoid using heat or cold packs? Heat and cold packs should be avoided because extreme cold or heat can bring on a heart attack. Massage therapists should be able to recognize the early warning signs of a heart attack so that they can get the required medical attention for their clients, if necessary. *— The early warning signs listed on this slide are considered the more common ones. *— The early warning signs listed on this slide and the next slide are considered less common warning signs, and they are often associated with warning signs for heart attacks in women. Pain unrelieved by antacids is also considered one of the less common warning signs of a heart attack. Why is massage contraindicated? Massage is contraindicated because pericarditis is a debilitating disorder that requires medical attention. What are some symptoms of peripheral vascular disease? Numbness, pain and discomfort, and skin discoloration are all symptoms of peripheral vascular disease. *— If the symptoms are mild, such a numbness and/or tingling in a small area, then a light pressure massage is indicated. Phlebitis is often accompanied by a thrombus (blood clot). When does phlebitis usually occur? It usually occurs after an acute or chronic infection; pregnancy or childbirth; surgery; prolonged sitting, standing, or immobilization. *— Why is local massage contraindicated? Local massage is contraindicated because it could dislodge the blood clot and/or worsen the accompanying inflammation. What are the general causes of Raynaud’s syndrome? Raynaud’s syndrome is generally caused by exposure to cold, by smoking, or by emotional stress. It usually affects the most distal parts of the body, including fingers, toes, ears, and the nose. *— How can massage be beneficial for clients with Raynaud’s syndrome? Massage helps increase local circulation, reduce stress, and relax the smooth muscle tissue of blood vessels. Massage therapists should ask clients about any allergies they might have so that the therapists can avoid any reactions to product ingredients that might lead to shock. *— Why is massage contraindicated? Massage is contraindicated because a person in shock requires immediate medical attention. What does the abnormal hemoglobin do? The abnormal hemoglobin causes the red blood cells to "sickle." This sickle shape can obstruct blood vessels, and it significantly reduces the amount of oxygen that can be supplied to tissues. *— If clearance from the client’s health care provider is obtained and the client is in remission, what kind of massage is indicated? A short, light massage mostly consisting of gliding strokes is indicated to help the client relax. What are some common causes of telangiectasia? Rosacea, elevated estrogen levels, and collagen vascular diseases are some common causes of telangiectasia. *— Deep pressure massage of the affected areas is contraindicated, but light massage can be helpful. Who is most likely to be affected by thromboangiitis obliterans? Thromboangiitis obliterans occurs most often in young men. *— If the client’s health care provider indicates that blood clots are possible, then local massage is contraindicated. What are some other massage considerations in this case? Deep pressure massage is contraindicated; electric massagers should be avoided; and heat and cold packs are contraindicated. Why is local massage contraindicated? Local massage is contraindicated because of the possibility of dislodging the blood clot. *— What are some other massage considerations associated with clients who have thrombophlebitis? Deep pressure massage in the inner thigh and electric massagers should be avoided. What are some common symptoms of a transient ischemic attack? Some common symptoms of a TIA include the following: abnormal vision in one or both eyes, shortness of breath, vertigo, general loss of sensation, and unconsciousness. *— If clearance from the client’s health care provider is acquired, what are some of the massage considerations? The client might be taking anticoagulants, which mean that a lighter massage is indicated. Also, TIAs could predispose the client to a stroke. Massage depends on how painful to the touch the varicosities are and whether the client has a history of blood clot formation. *— If clearance for massage has been obtained, what are some of the massage considerations? Electric massagers should be avoided. The client’s legs should be elevated above the heart during treatment. Gliding strokes toward the heart can help empty veins, aiding circulation. Secondary conditions are common in clients who have AIDS, since their immune systems are compromised by the HIV virus. Any secondary conditions should be assessed as separate and individual conditions. *— Areas where recent blood work has been performed need to be avoided. Also, joint mobilizations and stretching might need to be limited if the client is bedridden. HIV attacks the immune system of the person infected with the disease. HIV infection generally leads to the onset of AIDS. There have been no known reported cases of massage therapists contracting the HIV virus from clients while performing massage, but therapists should always exercise caution, especially since clients with AIDS are very susceptible to contracting diseases from the therapist. What is Kaposi’s sarcoma? It is an aggressive malignancy of the blood vessels that appears as blue or purple patches. *— Lymphoma is characterized by cancerous lesions of lymphoid tissues. *— What is PCP? PCP is the most common lung disease in persons with AIDS. Tuberculosis is another lung disease. What are herpes simplex and herpes zoster? Herpes simplex is caused by the herpes virus and is characterized by painful, blister like lesions of the mouth, anus, or genitalia. Herpes zoster is caused by the varicella-zoster virus and is characterized by clusters of red, blister like skin lesions that follow the path of an inflamed nerve. *— Thrush is a fungal infection of the mucous membranes. Toxoplasmosis is an infection caused by a protozoan parasite. What type of massage is indicated for clients with chronic fatigue syndrome? A shorter massage is indicated to avoid tiring the client. The therapist should also ask the client for a list of current symptoms before each massage session so that treatment can be adjusted accordingly. What are some of the possible causes of edema? Some possible causes of edema include the following: inflammation, obstruction of lymph flow, removal of lymph channels, physical trauma, high blood pressure, or damaged blood vessels. Edema can be aggravated by pregnancy, obesity, and prolonged standing. *— Massage is contraindicated for clients with a history of heart or kidney disease. For clients without a history of either heart disease or kidney disease, light friction and gliding strokes are recommended. The edematous limb should be supported and elevated during the massage. Why is massage contraindicated for a fever? Massage is contraindicated because it will worsen the symptoms of fever and because a fever often indicates the presence of an infectious disease or other tissue damage. Which type of lupus is the most serious? Systemic lupus erythematosus (SLE), in which the body attacks connective tissue in joints, skin, and organs, is the most serious type of lupus. *— During periods of remission, what sort of massage is indicated? A gentle full body massage is indicated. Special care should be exercised when performing stretches and joint mobilizations. Extra care should also be taken to avoid exposing the client to any form of infection if the client is taking immunosuppressants. What are the symptoms of lymphangitis? Some symptoms of lymphangitis include the following: painful, subcutaneous red streaks extending from the infected area to the axilla or groin; fever; chills; and headaches. *— Why is massage contraindicated? It is contraindicated because massage will only worsen the pain and swelling. What are some of the symptoms of mononucleosis? Some symptoms of mononucleosis include the following: fever, sore throat, red throat, soft palate, stiff neck, enlarged lymph nodes, coughing, rash, and fatigue. *— Why is massage contraindicated? Massage is contraindicated because the disease is highly contagious. However, after the client has recovered, the application of heat packs and a gentle massage in the abdominal region can be helpful. Which types of medication have convulsions as a possible side effect? Nucleoside analogs and protease inhibitors have convulsions listed as a possible side effect. *— Which types of medication have fever as a possible side effect? Non-nucleoside reverse transcriptase inhibitors, nucleoside analogs, and protease inhibitors all have fever listed as a possible side effect.

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