More information on certain topics of interest…

Post Elective Surgery FAQs

If you’ve had liposuction, BBL, abdominoplasty a face lift etc., you will need some recovery support.  I am a manual lymphatic drainage (MLD) therapist (Klose) with specialized training in this area. 

What is your goal?

If you’ve had a procedure, you want to decrease hardness & tightness. You want to increase softness, range of motion & ease of motion and regain sensation, specifically after lipo.  If you’ve had abdominoplasty, you want the scar to heal with mobility and no lumps bumps and also regain normal coloring. 

Where do I start?

You want to start your sessions about 4-5 days after your procedure to guide the swelling (contains fibrin hence fibrosis (you don’t want fibrosis)) into the body’s lymphatic system to eliminate the fibrin and the excess swelling through this waste recycling system. 

This is a good time to talk about incisional drainage…  see ** below at the end. 

How do I recover most optimally?

1. follow instructions from your plastic surgeon
2. wear you compression garment (Faja) with textured foams (more on that below)
3. get manual lymphatic drainage (MLD)

How often do I need MLD post op?

You want to have MLD treatment once/wk for 4 to 10 weeks.  Here is a guideline: 

• 4 to 6 sessions for lipo
• 8 sessions for lipo + BBL
• 4 sessions for face lift 
• 8 to 10 sessions for tummy tuck

When should I set up my MLD sessions?

When you set up your plastic surgery treatment.  This is when to find the lymphatic therapist you want to use and set up your MLD treatments with them.  

We are usually booked about 2 months out and if you call when you get home after surgery, you will be hard pressed to set up regular consistent treatments. 

Plan on starting 5 days post op and coming once per week for 4 to 10 weeks depending on what procedure you had done (see above). 

How do I use foams and compression garments (faja)?

You will need to wear a custom fitted compression garment or one that fits well enough with the use of textured recovery compression foams placed underneath. 

As you shrink, the foams will expand to take up the gaps and prevent lines/indents from the extra fabric. 

The textured compression foams and faja are expressly important to your healing and you must wear them to help your body absorb the extra swelling. They are used to:

• smooth out lumps and bumps (decrease fibrosis), 
• aid your body’s natural lymphatic drainage and absorb the swelling,
• increase blood flow to aid healing process of both soft tissue and nerves
• stimulate the nerve endings, reduce hardness and regain sensation
• provide smoothing contouring and healing to all incisions 
  • this includes lipo incisions – on the surface the lipo incisions look small but the under layers include severed nerve endings, which can sometimes take up to a year to heal completely.
    • you many want to cut smaller pieces from precut foams to spot treat lipo incisions and dog ears.

Use “lymphpads” textured foams to prevent fibrosis after abdominoplasty under your compression garment

Use “mobiderm” foams to treat anywhere (arms, flank, back, legs) under your compression garment after lipo

You can find these at BandagesPlus.com

A note about ab boards and back boards

If you’ve had a tummy tuck, do not use an ab board unless your surgeon has cleared you for this. You need to be cleared of blood clot risk and you want to make sure it’s fitted well enough to not create a tourniquet area or seroma. 

If you’re back is in stress from being unable to lie flat on your back after a BBL, get a heating waist pad with vibration massage for use on the low back:

• ValleyWind Heating Waist Belt wrap (Amazon) 

Decrease hardness, tightness and increase softness and range of motion and ease of motion while regaining sensation.

**Please note I do not do incisional drainage.  This is not lymphatic massage but a technique of pushing and moving the fluid out of the incision sites.  Not all plastic surgeons recommend this. Some of them do. It’s not something that appears to be recommended by the plastic surgeons on the East Coast.  Your body will eventually absorb this fluid and you will excrete it in your urine – this is why you are urinating so much post op.  However, if your surgeon is emphatic you need this and you cannot travel to their offices (because for instance you had a BBL and their offices are more than an hour away and you are now back home), please contact the Cosmetic Surgery Center at UMass and they will refer you to a PT that does this.  

Cancer Support Massage

Since I opened my massage therapy practice 10 years ago, I’ve noticed an increase in cancer among my clients and their friends and family. I received specialized training to practice cancer support massage in 2011 and often people ask me, “What is oncology massage?” and “How is it different from what you normally do?”

What is oncology massage?

An oncology massage therapist is trained to understand the changes that come with cancer. I know how to modify the massage to cause no harm while addressing key areas of relief: emotional (anxiety and depression) or physical (fatigue, nausea and pain).

What is the thought process and major considerations behind administering a cancer support massage? I ask many questions because I want to get a clear picture of where you are in your journey and what to change or add.

For example:

Where are you in treatment?
Have you just been diagnosed and need anxiety relief or are you deep into treatment?

Do you have a tumor site?
Massage is never done on or around the tumor.

What’s your platelet count?
Knowing how thin your blood is will tell me how much pressure I can use safely. I use a 1-5 scale: 1 is extremely light (gentle fascial work and holding), 2 is similar to applying lotion very softly, up to 5 which is deep; affecting muscle tissue, which in my experience I’ve never massaged a person that deeply who is undergoing treatment.

Do you have a device such as a PICC or port-o-cath?
I make a towel ‘nest’ for it so you can lay comfortably prone. Else I will modify your session to side-lying.

Have you had an organ(s) removed?
I can incorporate trigger point work along that organ’s acupressure meridian into the massage. Scar tissue work and/or lymphatic drainage therapy can be helpful.

Have you had a mastectomy?
I won’t apply more than 3 minutes of deeper pressure on that quadrant of your body. Lymphatic work is indicated here because you’ve had lymph nodes removed along with the breast tissue. Lymph is never moved toward an area where nodes have been removed. Instead, I move the lymph along a pathway such that uncompromised areas can process the protein-rich fluid.

Are you receiving chemotherapy?
You should wait the recommended 3 days after receiving chemotherapy before getting a massage treatment so the chemo agent stays in your body long enough to do its job.

What agents are you getting?
I may wear gloves if agents such as Thiotepa and Cyclophosphimide have been administered.

Are you on any steroid medications?
Steroids weaken the surface tension of water which means your skin may be more fragile. I’m mindful of pressure once again and of using certain lotions/oils that could irritate your skin.

Are you at risk for lymphedema?
If you’ve had lymph nodes removed, you are at risk. If your doctor has told you no blood draws or pressure cuffs on a certain limb, I position the limb so it’s supported and not hanging off the table. No deep pressure to the affected limb.

Are you receiving radiation? External beam or internal beam? Implants?
The radiation will make your skin more sensitive so I will avoid the direct beam area. Sometimes, only specific hospital-administered lotions can be used when receiving radiation. If you have implants and they are still active, this is a case by case situation. For instance, if your therapist is pregnant, she could not see you and would need to refer you because you are considered ‘hot’. If they are inactive, no advanced precautions are necessary.

Has there been bone or spine metastasis?
If so, you will experience no jostling during the massage and very light pressure to protect and not compromise fragile bones.

Are you experiencing any side effects like neuropathy?
Light pressure here. Another therapist told me she is seeing success with using THC-infused oils to alleviate neuropathy pain.

What is my perspective as a Cancer Support Massage Therapist?

In the last 10 years, I’ve seen more people using complementary therapies, such as massage, and traditional healthcare providers realizing the positive impact of oncology massage. Most palliative care providers are already aware because they have the experience of working alongside us.

I see adults and children and would like to call your attention to a non-profit organization called Lucy’s Love Bus (lucyslovebus.org). If you know of a family who has a child with cancer, please tell them about this valuable resource.

Closing Thoughts

In the next newsletter, I will discuss what manual lymphatic drainage is and how it can be used for many conditions besides lymphedema such as migraines and auto immune diseases.

Massage therapy is an investment in your well-being, not just blood circulation/cortisol reduction/endorphin release, etc.  I’ve witnessed its benefits go much deeper than what studies can prove. I’m delighted to take you on your personal journey with the oldest form of healing we know, healing touch.

Addiction Recovery Support

September is Recovery Month so I’m dedicating this newsletter to a brief overview of how massage therapy can be used in the recovery process.

I’ve been working with this population since June 2015 with patients at a recovery center in both their detox and residential programs. I offer massage at my private office to support life long recovery.

I use different non-talk bodywork therapies to decrease pain and agitation, release beta-endorphins, and improve sleep.

Stages – withdrawal, detox and abstinence

A medical detox is prescribed for heavy users who would experience the most acute withdrawal symptoms.

If you are experiencing withdrawal, I focus on bringing awareness back to your body and emotionally attaching you to your body again with soothing massage that doesn’t ask the body to do anything (unlike a deep, rigorous massage). Addiction at heart is about self-soothing and massage therapy creates a pathway to bring the emotions back to the body where pain often is.

From what I’ve learned, when one abandons their addiction, their ‘self’ separates into pieces.
Maureen Schwer, NMD sums this up: “The spirit is who we really are. Our mind is our thinking brain, and our body houses this. If you’re an addict, you often have to ignore your body, because you are, in essence, hurting your ‘house’.”  This is why bringing you back into your body is so important – it’s one of the first steps towards mindful action and self awareness so that when you are no longer physically addicted, you’ve practiced being with your self and feeling your body again mindfully.

Relaxation massage and lymphatic drainage massage are good treatment options at this stage because the brain is looking for that fix to be soothed and comforted.  When we feel safe, we can remain aware and open and mindful.

Additionally, it’s necessary to have a break from the interactive talk therapies that are part of any recovery program. Rather than being asked to do something once more or think of yourself and your addiction once again, the massage is a time-out for you to connect all that therapy on a non-talk, cellular level and gain insights. The peace and clarity can then be taken back to the treatment program to deepen the therapy with the many clinicians, counselors, etc.

Detox

If you are no longer feeling strong withdrawal symptoms, I can use a deeper massage on your soft tissues to assist the ongoing detox process. (Certain types of meds that are used to offset withdrawal symptoms might prevent receiving bodywork until a few days after they are first given – in similar thought to why oncology massage is not indicated within the first two days after chemo; there is a potential to move the med through the system faster when it needs to stay in the system.)

Deep tissue massage, trigger point therapy and very often fascial release therapy are very good at this stage because they flush your system.  Also, one of the biggest benefits of massage is the change in hormone levels that can be measured after a massage session: dopamine and serotonin increase while cortisol, a stress hormone, decreases (by as much as 33%).

Since stress hormones weaken the immune system and cause us to experience pain more acutely, the session at this stage additionally acts as a bridge to help break the pain cycle.  The massage generates endorphins release while moving out cortisol.  This brain chemistry shift has been proven to reduce agitation, anxiety, and lessen sleep problems (if you’re in a recovery program, you aren’t in the comfort of your own bed and often have a roommate(s).)

Maintaining

After dedicated help, receiving integrated bodywork therapies can be an important coping resource. The emotional, physical and situational stressors of everyday life can easily make a former user want to escape again. Massage should be a complementary therapy to any recovery program to assist abstinence.

You can find help for yourself or a loved one by contacting The New England Recovery Center. https://www.newenglandtreatmentcenter.com/resources/drug-rehab-faq/

Manual Lymphatic Drainage Therapy

What is MLD (Manual Lymphatic Drainage) massage?

MLD is a specialized form of massage that moves the lymphatic fluid back into the circulatory system.

• Helps post traumatic edema: sports injuries, bruising, whiplash, sprains, tinnitus, and migraine headaches.
• Has an analgesic component and pain blocking effect while being deeply relaxing so it’s also indicated for chronic pain syndromes (chronic fatigue syndrome) and autoimmune disorders (fibromyalgia, rheumatoid arthritis).
• Helps to move the fluid if you’ve had any change to your lymphatic system, such as node(s) removed due to cancer or compromised from radiation.
• Used as a treatment for post-surgical swelling and scar reduction.
• Is gentle and light (1-2 on a pressure scale of 5 being very deep). Extremely soothing and calming.
• Requires additional training and certification to perform.*

What does the lymphatic system do?

The lymph system moves metabolic proteins, fat, water, and large molecules between cells back to the cardiovascular system. This fluid is a protein-rich micro filtrate of our blood plasma. Unlike the heart muscle pumping blood (7000 liters daily) around the body, the lymph system (2.5 liters daily) uses no pump. The fluid moves one way via pressure drops along lymph capillaries in conjunction with blood capillaries. Exercising is the best way to move lymph fluid. Using a rebounder regularly may be excellent too.

What makes up the lymphatic system?

The lymphatic system is made up of lymph nodes, lymph vessels, thymus, spleen, lymphocytes, peyers patches (in the small intestine), and tonsils. The largest well of lymph is in a reservoir located in front of our lumbar spine called the cisterna chyle which drains directly into the left thoracic duct (the hollow above the left clavicle).  In fact, 3/4 of the lymph in the body returns to the cardio system via the left thoracic duct. The remaining 1/4 drains into the right subclavian vein.

About lymph nodes

We have between 600-700 lymph nodes in our bodies. Most nodes are in the abdomen but many are also in the head, neck, armpits, and groin areas. You cannot feel most of your nodes because they are in fatty tissue. If you are very lean, occasionally a node can be palpated in the groin area. In general, if you can feel a node for more than 60 days, the medical community suspects it for pathology. Lymph nodes are mini refining stations. Each node isolates and breaks down dead cells, cancer cells, bacteria, microbes, and any foreign cells from further progressing.

Lymph nodes have 3 purposes:

• Recycle and refine to ensure bacteria and malignant cells don’t progress.
• Produce or trigger lymphocytes, white blood cells. Important to fight infection.
• Regulate the protein/water concentration in the lymph fluid. This protein from metabolic waste processing (not dietary protein) is what sets lymphedema apart from plain edema (such as swelling from a sprained ankle).

What is lymphedema?

It’s an accumulation of protein rich interstitial fluid that has pooled. Most lymphedema has no known cause/origin and is attributed to poor lymphatic plumbing which some people are born with unfortunately. In tropical countries, certain mosquito or fly-borne diseases (filariasis) can infect the blood and lymph vessels.

If you’ve had lymph nodes removed due to cancer surgery or compromised from radiation treatment, you could be at risk to develop lymphedema. The affected limb will often feel heavy and sluggish. Your doctor will tell you no blood pressure cuffs or blood draws on the affected limb to keep risk down. Don’t wear tight bracelets or socks that would leave an indentation.

*I have completed more advanced training on how to specifically support breast cancer rehabilitation using MLD post-surgery (mastectomies and/or ALND/SLND, axillary web syndrome, fibrosis from radiation treatment).  If you know of anyone that may benefit from this therapy, please refer them to me. Thank you!

World Lymphedema Day

March 6th is World Lymphedema Day.  As a certified manual lymphatic drainage therapist I want to help spread the word about lympedema, what it is and how you can get assistance.

Boston’s Zakim Bridge will recognize WLD on March 6, 2018. The iconic landmark that overlooks part of downtown Boston and Boston Harbor will be lit up in teal on March 6th, 2018 to recognize World Lymphedema Day.

Here are 6 facts from LymphedemaTreatmentAct.org that you may not know

1. Lymph • edema (lim – fa – DEE – ma) is chronic swelling (edema) caused by a build up of fluid (lymph) that occurs when the lymphatic system is either faulty or damaged. There is no cure for lymphedema, but it can be effectively treated.

2. The Lymphedema Treatment Act (LTA) is a federal bill that aims to improve insurance coverage for the medically necessary, doctor-prescribed compression supplies that are the cornerstone of lymphedema treatment.

3. An estimated 3-5 million Americans suffer from lymphedema — including many that are undiagnosed or undertreated. That is more than ALS, Cystic Fibrosis, Multiple Sclerosis, Muscular Dystrophy, and Parkinson’s Disease combined.

4. Most physicians in the United States are taught about the lymphatic system for 1 hour or less during their 4 years of medical school training.

5. There is no known cure for lymphedema, but it can be effectively treated. Compression therapy is the most critical component of treatment. Without it, patients are at increased risk for complications and disability.

6. Medicare, and many private insurance policies do NOT cover compression garments, wraps, or bandages — the supplies needed for compression therapy.

The Lymphedema Treatment Act is a bill, currently in Congress, that aims to improve insurance coverage for compression supplies, allowing lymphedema patients to maintain a healthy and productive life.

For more information visit LymphedemaTreatmentAct.org