Lymphoedema........is it OK to get a massage?

I'm often asked about getting a massage by people who have lymphoedema or may be at risk of developing it due to treatment over a lymph node area.  The answer to this is not a simple 'Yes' or 'No'.....more of a 'well, you can and you can't' (typical Irish way of answering a question I know!).  So here's my guide to the things to think about...
Most important  - is the person offering the massage qualified to do so, and what are their qualifications.  If you are paying for a massage (as opposed to a family member, partner or friend providing it) then you do need to check out what training they have done.  Gold standard would be they are trained in the lymphatic system by one of the recognised schools of Manual Lymphatic Drainage (Leduc, Foeldi, Vodder, Casley-Smith and the Lymphoedema Training Academy - this is the one I do my training with!).  Any therapist with this training should have a full appreciation of the lymphatic system and what can cause lymphoedema or make it worse and therefore you should be in safe enough hands getting massage from them (it'll probably very likely be an MLD type treatment anyway - which is the best thing for the lymphatics).
There are however many massage therapists available that do not have the above training, and I think I am right in saying that the majority of therapists who work in Spa's, beauty clinics, hotels and sports facilities etc would fall in to this category. So similarly ask them what training they have done in the lymphatic system.  I would tell them that I either have or am at risk of developing lymphoedema and ask them how that would impact on the massage.  I'd then judge by their response would I go ahead with the massage - so I would be looking for them to explain to me how in this situation massage needs to be gentle and that all deep heavy strokes need to be avoided.  I would also be looking for them to ask me for more information in order for them to make a full assessment of me and then to be able to deliver the most appropriate massage for me.  I would have to be assured that I knew that they knew about lymphoedema - if I feel that then grand, if there was any doubts in my mind I wouldn't go ahead.

Strong deep strokes around the part of the body where the lymph nodes are compromised is not recommended. So if it's your armpit that is affected, avoid deep massage in the associated arm, breast, chest and back area.   Massage in that area should be light and gentle and strokes should always go towards the centre of the trunk.  I would strongly advise against getting a 'cupping' massage - where heated glass cups are placed on the body and as they cool they create suction which apparently 'stimulates circulation and healing', think 'lovebite' - cos that's what you end up with -  a series of big dark bruises wherever the suction was applied.  Physiologically a bruise is a sign that tissue damage has occurred, whether it be from getting a bang off a piece of furniture or from a 'healing treatment'.  If your impaired lymphatic system cannot cope with the demand that the increased circulatory and inflammatory response to this 'therapy' will place on it then you could run into trouble.
After having cancer treatment you may find your skin a little more sensitive than it was before.  You might need to avoid the use of perfumed creams and lotions.  If getting an aromatherapy massage, be sure to tell the therapist that you have had/having treatment and they can select the most appropriate oil for you.
Ask around - word of mouth is often the best way of finding the best people.  There are some very good massage therapists around who I would happily refer any of my clients to and if anyone wants their details then let me know.
There are immense benefits of receiving massage therapy by a trained competent therapist who can work with you tissues to bring about relaxation and release of tension throughout the whole body, and this can be very healing in itself, both physically and psychologically.  It is so important if you have/are at risk of getting lymphoedema to make sure you take all precautions that you need to take.  It is YOUR body, and you have to give permission to someone to place their hands on your body - only do that if you are completely happy they know what they are doing because at the end of the day, if something does go wrong, it is you that has to then deal with it.  You need to do your own risk assessment.  Unfortunately I have seen many clients who have received 'massage' and then end up coming to me because lymphoedema symptoms have been exacerbated. On questioning all these clients have said that they didn't feel totally convinced or comfortable that the therapist knew about lymphoedema, despite the fact that they might have said they did.
In the Autumn I will be running a course aimed specifically at body work in clients that have had breast cancer.  This will be open to any touch therapist (massage, physio etc) who might encounter breast cancer survivors in their work. We will be exploding some of the myths and exploring the many possibilities and benefits available from working on the body tissues through therapeutic touch.  More details will be posted soon, or contact me for more info.

Treating breast cancer related pain

An article appeared in the New York Times this week entitled 'When pain persists after breast cancer surgery' It mentioned that upto 50% of women post mastectomy might be affected with ongoing pain for a long time after their surgery and for many this pain might never go away. Further down the article it mentions that a study had been done looking at giving women a pain killing injection to combat this pain and that in the majority of women this was looking like it worked.....although the long term effects are unknown at the moment. The doctor who has pioneered this work was quoted as saying “Even if you had to do the injection every six months, that’s so much better than having that pain.” And here's where I have the problem with the article. Yes, anything has to be better than living in constant pain, but there are alternatives to injections (and those injections look horrendous, if you're a bit sqeamish don't watch the video). It is amazing what a bit of hands on therapy can do!! This 'hands on stuff' is what I do day in day out, and I have to say that the vast majority of clients respond well to it, After breast cancer surgery there are many reasons for ongoing persistent pain, many of them directly related to the surgery - scarring, myofascial tightness and nerve damage. However, there are lots of other factors which impact on the woman's experience of pain and among these we have to look outside the area of the breast and chest wall. We need to be looking at the whole integrated mind - body system and consider carefully the emotional and physical impact that the breast cancer treatment rollercoaster has had on the woman. In my experience, breast cancer treatment related pain seldom occurs in isolation, it is often associated with other symptoms such as movement restriction, swelling, altered/ineffective movement patterns, cancer related fatigue, Axillary Web Syndrome (cording), lymphoedema. Add into that mix sleep disturbance, low mood, body image issues, and a whole load of other psychosocial problems.......would a six monthly injection help all of these??? The evidence for the effectiveness of the injections is looking good, but I would just hope that women who might be considering this line of treatment would see a physio who is skilled and knowledgeable in breast cancer recovery BEFORE they get the needle!! We've a lot to offer, we can fully analyse movements and tissues and have the skills to do something about the problems we detect and physio works! Physio V needle.....I know what I'd go for!

Pilates for Breast Cancer Recovery

I came across this article recently.  Pilates is a great way of exercising for women who are going through or have completed treatment for breast cancer.  Pilates can help to:

• Improve range of movement at the shoulder joint
• Improve the stability of the shoulder complex
• Increase strength and endurance
• Reduce cancer related fatigue
• Improve flexibility 
• Improve posture and body alignment
• Improve balance and coordination
• Improve the circulation
• Stimulate the lymphatic system, which aids drainage of fluid and is important in the prevention of lymphoedema
• Increase bone density, which is important to prevent osteoporosis
• Aid relaxation and reduce anxiety
• Provide an enhanced sense of wellbeing.

My 'Pink Pilates' classes are now available in Kilkenny! 

Calling all breast cancer survivors in Dublin

There is a huge amount of research evidence to prove that exercise and physical activity are beneficial for people with cancer for many many reasons, from increasing strength and fitness to enhancing wellbeing and quality of life and for some survivors, actually reducing the chance of recurrence of the disease.  I am delighted to see that The Irish Cancer Society are about to commence a programme for breast cancer survivors who are 12 months post surgery to evaluate the impact of an intensive, structured exercise programme.  The programme enrols at the weekend (9^thApril 2011) and will involve a commitment to exercise 3 times a week to the end of the year.

More details can be found here.

If you have completed treatment for breast cancer and are in the Dublin area, and are able to commit to the programme, why not give it a go – not only will you be improving your own fitness and wellbeing, but you will also be helping towards increasing our knowledge of the effectiveness of exercise and activity, which in turn will benefit us all in our fight against cancer .