Archive for the ‘post-surgical care’ Category

Some gutsy learning

| May 26th, 2014 | No Comments »

vis·cer·al

adjective

  1. of, or relating to, the viscera
  2. relating to deep inward feelings rather than to the intellect

synonyms: instinctive, instinctual, gut, deep-down, deep-seated, deep-rooted, inward


 

 

I found this definition online and it perfectly encapsulates the nature of the course I went on this weekend. The course was called Visceral Manipulation I and both of the definition options above speak clearly to the nature of the work we did this weekend.

 

The course reviewed the anatomy and physiology of the internal organs – and reminded me that the lungs, heart and brain – with all their accessory bit are a part of that viscera. Our focus though was on the gut organs this time. The other definition is very appropriate to as the work requires that you use your knowledge of the structure of the body and then release it to simply feel the body. I knew going in that for myself the need to be patient and quiet my mind in favour of listening to my body would be my greatest challenge.

 

I am very aware, with a kind of chagrined pride, that I tend to over-think things at times. I often have said that I am more comfortable in my mind than in my body – but I have also said that my education and practice as a massage therapist has balance that to some degree. This weekend was, for me, another step toward embracing that balance. I do not think that I will ever be someone who first speaks to how they FEEL, I suspect I will always first go to the place of THINKING, but I do believe my life is richer for the fact that I strive to improve the balance between the two.

 

What is all this work for anyway? What will it help and might you be one of the people that experiences this work when next you are on my table. There are many indications for this work, some are emotional or life related (stress, depression, anxiety), many more physical – including digestive issues, disease process or history in the body – especially those where organs have been damaged or altered – right through to pain patterns in the body, especially those that are persistent and respond to, but do not resolve, with direct massage. Quite a few of you might just be finding yourself experiencing something a bit different in the near future. If you are interested in this work specifically feel free to ask more when you are in next time or to drop me an email or call.

 

For myself, I had an interesting time on the receiving end of all of this work and will be bringing some of treatments into my own self-care regime. I am interested to see the way this subtle and progressive work unfolds within me over the next weeks.

 

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International Fascia Research Congress 3 – Vancouver, BC, Day 1

| March 28th, 2012 | No Comments »

***Beware – this post is a total fascia geekfest, if you are not prepared to deal with that, read a different post!  Also, any factual errors are my faulty memory, not faulty presentations.***

 

Today I had the absolute pleasure of beginning my time at the 3rd gathering on scientists and clinicians who have an abiding interest in fascia in all its varied and wonderous forms.  I began the day with a flight to Vancouver and a slightly late arrival – but I got before the real geek-out stuff began, so it is all good.  

After some general introductory speeches we dove right into the first keynote speaker.  A anatomist from Temple University, Mary Barbe spoke to us about her research in duplicating repetitive stress injuries (RSI’s) in rats and the tissue changes that occurred in response to various types (high, low and negligable intensities) of work.  How could this possibly relate to massage therapy you ask? Well the road hasn’t fully been built, but knowing that rest doesn’t always fix the problem and that inflammatory processes have likely come and gone prior to anyone presenting at my office (they peak between week 4 and 8 of performing the task) after months or years of a repetitive task, provides me with insight into what interventions and homecare might best benefit my clients.  simply knowing that there are significant connective tissue changes that occur within weeks of undertaking an repetitive task shouts loud and clear about the importance of the fascial work that I am a huge advocate for.

After a quick break we moved our second speaker, Michael Kjaer, whose topic was the impact of exercise on tendon tissues.  We discovered that exercise (and not a lot, 1x creates 72 hours of increased collagen production which is what builds your tendons) increases the density of tendons.  Interestingly, there seems to be little issue with maladaptive changes in the tissue to repetitive exercise as there is to repetitive work activity (there’s a thinker).  More surprisingly, it turns out men exhibit greater tendon density increase than women, and that within the female population women taking oral contraceptive exhibit even lower levels of tendon response than the general population.  Further interest in gender issues came when it was revealed that in post-menopausal women being on hormone replacement heightened tendon response.  Hmmm, that estrogen, funny stuff.  

 

After a break for lunch we broke into three groups for presentations on specific areas of fascial research.  I chose the “biomechanics” room and got to learn about different means of trying to empirically measure different types of mechanical interventions.  From pressure sensitive pads on fingers to rather medieval looking table devices this part of the afternoon was an interesting insight into the various ways we can try to research the interventions we apply with our hands and their outcomes.  I also gained an interesting insight into the world of research.  Failure, or rather, not proving your hypothesis fully or at all.  Even in those cases it was interesting to see how that research could be used to launch into better studies.

Our next keynote speaker, Albert Banes, was a doozy.  I am pretty sure I learned so interesting things, but they went by so fast I think I might be lucky to catch up with them sometime next week – after reading the paper a few times!  He seemed to be summarizing quite an extensive array of studies in the field of fascia research and had some very interesting things to say – and showed us pictures of some lab grow tendons, but it was a lot in just a little time

The final event of the afternoon, academically, was a panel of  four clinicians presenting of “scars and adhesions”.  One of the exciting bits of us BC RMT’s was having one of our own on the panel – Susan Chapelle of Squamish, BC who talked about the benefits of integretive treatment and the need for increased research that included a manual therapy aspect.  She was preceeded by a surgeon, Dr. Michael Diamond, who discussed post-surgical adhesions (things sticking together that shouldn’t after surgery) which I was surprised to find has a 65-100% incidence rate in abdominal surgeries (though they are not limited to those surgeries).  We were then treated to a new movie by Jean Claude Guimberteau, a French physician, who has now produced several in vivo movies of fascia using endoscopic techniques (his first being “Strolling Under the Skin”, presented at the first fascial congress).  We also had a naturopathic doctor, Hal Brown, present some of his case studies of the impact of the injection of aenasthetic under the skin into scars to improve function in both near and far tissues. 

The day finished with a welcome reception that was very well attended that allowed us all to review and discuss our reactions and thoughts regarding the days flood of knowledge.  I can hardly wait for day two….

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m-Medicine – the future of your doctor’s smartphone?

| January 23rd, 2012 | No Comments »

This weekend I was reading an article in the Globe and Mail regarding the impact of technology on health care, specifically mobile technology.  The article referenced several areas in which mobile technologies can improve health care with remote monitoring, to i-tunes credit for diabetic teens who comply with their insulin regimes.  The focus, and one of the most exciting parts, for me was an improvement in post-surgical care monitoring.  

Dr. Semple, the surgeon-in-chief of Women’s College Hospital in Toronto, is running a pilot project to monitor the ambulatory surgery (in hospital less than 23 hours) patients under his care.  Dr. Semple and his research team have developed an app that allows patients with a smart phone or tablet to be in regular touch with him post-operatively.  This app allows patients to photograph their surgical incisions and send them to Dr. Semple along with text regarding how they are feeling.  From this information Dr. Semple can very accurately assess the progress of their recovery and make decisions regarding any need they may have to return to the hospital for follow-up care prior to their scheduled appointment.  

This seems simple, wouldn’t a phone call do the same?  I see this new evolution addressing several weaknesses in the call-in follow-up.  One, for time pressed surgeons – and patients – there is no need to mesh schedules.  Patients send in their information when they can and the doctor can pick up the information whenever he chooses.  Yes, this sounds a bit like answering machine tag, but there are other factors.  When the doctor picks up that message he is not just listening to a voice trying to squeeze their information into a brief window before the beep – he is reading a summary that the patient has been able to compile at their leisure.  He is also able to pick up that piece of information anywhere.  The other highly valuable piece of information he is getting is the visual.  They say a picture is worth a thousand words, and with this technology it may very well be so,  it may even be worth a life.  The article talks about a scenario where Dr. Semple is able to save himself, his patient and the system, time and money by preventing an unneeded hospital visit from the other side of the globe, but lets look at the other possibility.  What if his patient’s bruising wasn’t benign?

Using the app the doctor could have gotten that patient into the hospital as soon as he saw cause for concern.  Post-surgical care costs can escalate through to means – unneeded return, and delay of needed return.  The later being more costly in the end for all concerned as it would be associated with re-hospitalization, care for the complication that would be more extensive than a promptly dealt with one, and, perhaps, long term health issues or death if an infection was not dealt with for a prolonged period.  Close monitoring has always had benefits in terms of preventing complication but earlier discharge offers huge savings, higher numbers of patients processed and, frankly, more comfort for the patient.  Anyone who has spent time in hospital knows it is not very restful or healing.  The food is awful, it is noisy and people are disturbing you at all hours to check your temperature.  Who wouldn’t prefer the privacy of their own room, in their own home with undisturbed nights?  When those things can be accompanied by closer monitoring we have a winning solution both for the patient, for their health and for the system.

This week there is a conference in Toronto that offers doctor’s the opportunity to explore the options of mobile health technologies and hear from leaders in the field.  I hope my doctor is on her way there! 

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Willem Fourie, again…

| May 5th, 2011 | No Comments »

Last week I spent two wonderful days in Vancouver. With hardly any shopping to enhance the experience. I attended an advanced seminar on post-mastectomy care with Willem Fourie, a leader in the world of fascia. Willem is a physiotherapist from South Africa and has made a study of the specific impacts of breast cancer treatment, due to lump- and mast-ectomies, radiation and reconstructions.

I wrote, glowingly, about my introductory course last June. When the opportunity to attend a more advanced course arose I was quick to sign up. Out of the 75 of us who attended last year’s introductory course 11 of us returned this year to broaden our understanding of approaches to care for breast cancer patients.

One of the things that quickly became clear was that we had all, myself included, found uses for the approaches taught by Willem in the 11 month since the first course. We opened the course with each attendee describing how they had employed the techniques and what they sought to learn. Some had very emotional stories to tell of breast cancer patients who they had been able to help and who had inspired them with their strength and courage. Others, myself included, had taken the approaches and been able to apply them with great results to a number of other conditions, from abdominal surgeries to burn victims. The scope of application and success from these fascial techniques was impressive.

The intensity and integrity expressed in the opening of the course set the tone for the whole two days. Often at this type of course there is a very chatty, social atmosphere as the attendees enjoy a break from their regular routines. Schedules are often quick paced and hands on time limited. None of these was the case for this course. There was chatting for certain, but never disruptive to the course. The tone was quiet and the schedule was full of hands on time and quiet diligence. Where hands on time in other courses might become a bit raucous and unfocused in this instance it was very much about applying the techniques and learning to treat what you found in the connective tissue. Though we had no actual breast cancer survivors, we did apply the techniques to the variety of injuries and old surgeries we collectively brought to the occasion. We addressed armpits, abdomens and breasts without giggles or discomfort.

I came away with a deeper understanding of the anatomy, physiology, surgery and the humanity that are all part of treating any patient, most especially those who have faced such monumental challenges as breast cancer. I am continuing diligence of the course having already found several patients who could benefit from these techniques. I hope that they have found some benefit from those two days I spent in thoughtful pursuit of new information and new ideas.

Willem Fourie’s website

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Healing Series #5 – fractures

| February 22nd, 2011 | No Comments »

Have you ever broken a bone? Felt something go crunch and known that there were things moving against each other inside you that shouldn’t be?   Did you have the trip to the emergency room, the inspection by the doctor and radiology?

not so bad as this picture though...

Say a person breaks their tibia and fibula, that both bones have completely, but cleanly snapped.   They are sent into surgery and have some combination of plates, screws and rods inserted in your leg. You are given a walking cast, told to take it easy, and given follow up appointments. So begins the bone healing.

This is a simplified story of a significant, though straight froward, fracture. You are far better to snap your bone cleanly and completely than to have a crush injury or a significant displacement – both of which have larger risks of complications than a clean break. Though surgery was required to stabilize the fracture site the bones stayed close to alignment and there were no small fragments or jagged ends to contend with. This means that the healing will be relatively easy, with the internal stabilization they will be mobile (avoiding a lot of muscle loss) and should not have issues with alignment or leg length discrepancy.

Internally the healing process has both similarities and differences to soft tissue healing. Bone is well vascularized compared to ligaments and does heal more quickly, but the structure is quite complex and there are several stages between basic reconnection and complete restoration. With bone tissue, like skin tissue we will see regeneration more than scarring. With good healing there can be healing that is almost impossible to detect.

In the first 6-8 hours the blood that is being released by the torn capillaries in the bone forms a clot called a fracture hematoma. This clot means that the to ends of the bone are divided by dead tissue. Any cells within that clot will die and need to be carried away before repair can be carried out. Within a week the torn capillaries work their way into and through the fracture hematoma, reconnecting the to separated pieces and bone and begin delivering osteoclasts (bone destroyers), to dissolve the dead bone fragments. Phagocytes also arrive to carry away the other dead tissues. In this stage the fracture hematoma is transformed into a procallus, a proto-scar tissue made up of granulation tissue,

Over the next two weeks fibroblasts and mesenchymal stem cells invade the procallus. The fibroblasts build a latticework of fibrocartilage across the fracture site and the mesenchymal stem cells become osteoblasts (bone builders). This structure is called a soft (fibrocartilaginous) callus.

From 3 to 6 weeks the spongy bone begins to develop. This process begins close to the healthy bone tissue and works its way across the gap. As the spongy bone is deposited it begins to transform the fibrocartilage into bone too. This stage is the development of the hard (bony) callus stage. Many of you will notice that it is at this point that casts and other fixation devices (internal or external) are removed.

After 6 weeks (really between 4-8 depending on the age and health of the patient, the bone involved and the type of fracture) there is new bone uniting the fracture site, but the healing is not done.

Over the next 3-4 months the body will be industriously remodelling this new bone. Destroying and rebuilding cells, increasing the deposition of the calcium and phosphorous to make the bone harder. In long bones the creation of Haversian canals will occurs as will the redevelopment of a central marrow canal.

This stage is when the bone becomes customized to your usage patterns and habits so that it is strong where and when you need it to be. This type of process is occurring in healthy bones all the time and until it is complete a fracture site is not completely healed.

How can this knowledge of healing help someone recovering from a fracture? By increasing their dietary intake of calcium, magnesium, phosphorus, the primary minerals needed to build bones, they can help encourage speedy and thorough rebuilding. By understanding the importance of circulation in moving cellular, nutritional and waste products to and from the area of injury they can choose massage therapy, acupuncture or physiotherapy to encourage fluid movement without increasing physical activity past safe levels.

 


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Surgery and the Body

| June 8th, 2010 | No Comments »

After surgery your body is very busy indeed. It must finish dealing with the lingering effects of whatever took you into surgery and also heal you of the damage surgery has done.

Strange to think of surgery as damaging, but it is. After all, the surgeon cuts through multiple layers of connective tissue and muscle. Disrupting blood and lymph flow by severing the vessels large and small. And they only repair the large ones!

This is NOT to advocate against surgery, just to point out that it is both a healing and a harming event. The healing benefits should greatly outweigh the harming side effects, but those side effects can still be profound.

As I mentioned, your body is still responding the the cause of the surgery itself. Whether your body was fighting a chronic illness, physical dysfunction or was thrust into red alert status to deal with an accident or injury of some kind, a surgery is generally a brief interruption in this and the body requires time realize the provoking event has stopped.

As it is becoming aware of the decreasing demands of the illness or injury, it is also becoming aware of the new insult it has suffered.

Now, this injury is generally much tidier and cleaner than any real world damage would be, but the body mobilizes the same kind of responses to heal it. Inflammation and a flood of white blood cells and resources flood into the area. Your body may also be discovering that it is stiff and sore from the, often odd, position it has been in during surgery and the minor muscle atrophy and aches of being immobilized.

So what can you do to help this process?

One, eat well and take in lots of fluid. You need to provide the resource components for healing – healthy food it the best way to do that. Keep the meals light, varied and frequent. You have lost blood and inflammation takes fluid out of the circulatory system and puts it into the swollen tissue, so lots of fluid helps the body move everything around and rebuild its blood volume.

Two, rest. Your body is working really hard inside to heal you, try not to ask it to do much else. Light activity is good. Fixing those light meals, going for a short walk. These help your body to move things around and prevent aches and pains. But take a nap, your body does lots of good healing work while you sleep.

Three, follow orders, the doctors and nurses may have sent you home with some self-care – DO IT!!! Take the medication, keep the incision clean, do any exercises (part of you light activity!). This is what the allopathic system does well, surgery and fixing problems. So let them exercise their expertise.

Four, get some massage! Soon after surgery a massage can benefit you by helping move all those resources around and making sure they don’t stagnate at the surgery site. If you are stiff and achy massage therapy can help deal with the soft tissue tension and restriction that is causing that. Should you have a lot of swelling at the surgical site find a RMT who has advanced lymph drainage training (not me!) as they can often make a huge difference. After about six weeks, when the scar has settled, a therapist with connective tissue expertise (me!) can help to ensure that your scar heals functionally.

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My Willem Fourie Course

| June 2nd, 2010 | No Comments »

I was one of a lucky few who got to attend a three day course on treating connective tissue in breast cancer patients taught by Willem Fourie. This course provided me with more specific knowledge and alternate approaches for helping women with breast cancer.

As a Registered Massage Therapist I am required to take a certain number of continuing education hours every two years to maintain my professional standing. A practice I wholeheartedly support and enjoy. When this course was offered, even though I didn’t need all the credits, I leaped at the chance to attend.

Mr. Fourie is a physiotherapist from South Africa and a student of anatomy. He brought an enthusiasm and curiosity to the course that was wonderful. This was not a course full of recipes for treatment, this was a course about understanding. Understanding the structure of the body and what treatment for breast cancer does to that structure. He had brought many dissections that included intact connective tissue, something that is not usual in anatomy books, and ultrasound examinations of post-cancer treatment patients that were enlightening.

This excellent basis was then used to apply our skills in an intelligent, thoughtful way to create better function and ease for our patients. Though I learned few specific techniques in the class, the learning for me was in the specific knowledge about surgery – both tumour removal and reconstruction – that was presented, and the approaches and thought processes used.

Mr. Fourie has a great deal of respect for the human body, and for the human being within that body, which informs all of his approaches. I found his thinking very much in tune with what I try to bring to my work and welcomed the opportunity to work with other professionals in my industry that bring the same thoughtfulness to their work.

Mr. Fourie has participated as a presenter at both the fascial congresses that have happened and taught hundred of practitioners in the UK about his very successful approaches to breast cancer aftercare.

I thoroughly enjoyed this event and am already bringing some of the approaches into my practice – even on non-cancer patients. I look forward to bringing this enrichment of my skill set to more breast cancer patients in future.

 

Willem Fourie’s website

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Massage Therapy as part of Breast Cancer care

| April 12th, 2010 | No Comments »

I have been working with a client who is in recovery from breast cancer and from the effects of the treatment for breast cancer. In many ways the latter is the larger piece. Her body bears the surgical scars of her lumpectomy, the internal effects of chemotherapy and damaged tissue from her radiation therapy.

The portion I have had the opportunity to support is her return to fitness and reducing the impacts of scarring from her lumpectomy and her radiation. Her return to fitness I am supporting by keeping her muscles healthy and in balance and relieving whatever aches, pain and restrictions occur as she begins to return to the vital physical health she had previously.

It is my work with her scars and adhesions is what I wish to focus on though. Any trauma inflicted on the body will cause scarring. In the case of breast cancer treatment you generally have two major traumas inflicted on your chest wall. First, some sort of surgery to remove the cancerous tissue. The second chest wall trauma comes from the radiation. Although no physical invasion occurs, the intense light energy can create burns and always creates an inflammatory response in the body.

These scars can be focal or broad but they, in conjunction with the surgical scars, tend to leave the skin and muscles of the chest wall constricted and tight. The close proximity of the shoulder and the fact that the chest muscles contribute to shoulder movement means that normal movement can be reduced and there can be a pulling pain with any attempt to open up the arm movement.

Now we know the mechanism, lets look at what is done about it. A couple of decades ago the answer would have been nothing, do NOTHING. Fortunately this thinking has fallen by the wayside. Active use of the arm, with such activities as dragon boating, is encouraged. But what happens if you need some help? If, as my client found, the process of simply using the arm is not sufficient to restore the mobility you crave? Or if you restore movement but can not quite relieve the pain the occurs with the extremes of movement? What are your options?

Perhaps the best option is myofascial release. Now, if you have found this, you have found my blog. If you scroll through you will find other pieces dedicated to the wonders of fascia. For those of you interested, I encourage you to read them in full. For now, I will just say that fascia is a form of connective tissue that pervades the body’s structure giving both separation and form. Myofascial release is the practice of releasing restriction in the fascia to restore movement and function to tissue.

Think of a scar as a place where a drop of glue landed and started sticking everything to it. This sticky point continues to adhere things together and in doing so tends to draw the surrounding tissue in tight around it. For some, their determination to move, and/or their own physiology, ensures that they maintain reasonable movement and limited amounts of pain and are able to continue much as they wish in their life. For others we see a progressive advancement of restriction in movement and a concurrent increase in pain with movement. When this is the case some live with that pain their whole live. Myofascial release can change that.

As a Registered Massage Therapist I am one of the best options someone can choose for help. I use my hands to bring tension and stretch into the restrictions and unstick those glued down bits. Over a series of treatments more and more stuck pieces are released, increasing pain-free movement. This encourages more movement, which in turn encourages more release. Then, instead of slowly decreasing movement with increasing pain, we see the opposing trends develop.

Who and when can this intervention help? Though we must wait until the scar has settled, a matter of a few weeks to a couple of months for most, there is no other real limit. Even for those who might be able to self-release these restrictions, a few treatments can hugely speed their recovery. Even if a scar is years old, significant progress can be made to improve function and reduce pain. Though results are often slower with older injuries the impact can still be profound.

Having breast cancer, or any kind of cancer, has a profound impact on your life. There is no way to prevent this impact. Your life will change in ways that you can not predict, or even imagine. What you can impact though, is how you choose to proceed through the course of your illness and, hopefully, recovery. One thing you can choose is getting care for your body that goes beyond treatment for cancer to treating the whole body and ensuring yourself maximal function. Myofascial release can help with the scars of cancer treatment. Generally, Registered Massage Therapy can help relieve pain and improve whole body function.

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