- By Ginny Vickers

I've wanted to write a blog about cancer and integrative therapies.  But what was holding me back was trying to figure out what to write about first, since there's so much information I want to share.

So here I am - ready to share my passion for oncology massage, which truly feels like my mission.  In my blog posts I’ll talk about what originally led me to this work, what happens when one receives a cancer diagnosis, cancer and its side effects, living with cancer, end of life care, care giver support, research supporting oncology massage, and healing versus curing...

But where I want to begin is to talk about “healing versus curing." I bear witness to this all the time. I see it here at work,. I see it with my patients in hospice and I see it with the kids at Tufts Floating Hospital.

Let's face it, when one receives a cancer diagnosis, it's a game changer. After the initial shock, when the dust begins to settle, a cure is what one aims for. And because we are at an unprecedented precipice in cancer treatment (i.e. immunotherapy), this is a real possibility in many scenarios.

I've seen people "cured" - or more accurately the term NED (no evidence of disease) is used. My brother is one such medical miracle; over 10 years now remission from stage 4 metastatic melanoma. His oncologist is still scratching his head, albeit with a huge smile...

Some cancers of the blood are deemed curable, in particular ALL (the most common form of leukemia in children), with a very high survival rate. In the short time I've been working in the pediatric hematology/oncology clinic at Tufts, I see this extraordinary chain of events played out weekly.

Surgery, radiation, and chemotherapy - all lifesaving - come at a cost. The stories I hear from my patients and clients all share a similar theme; their bodies are not the same. Yet oncology massage can bring bodies to a place where they move easier due to an increased range of motion, it can soften tissues that are rigid and scarred, and it can decrease pain and help to relive feelings of anxiety. It can indeed begin to change the body. These bodies and minds eventually come to accept this as their new normal...and this can be called "healing."

The simple and timeless act of "laying of hands"on another, is for me what this is all about and where the healing occurs. There is something so profoundly sacred in this exchange. It does not need to be proven nor researched. I trust this process and I am beyond fortunate and humbled to call this my work.

"Touch was never meant to be a luxury. It is a basic human need. It is an action that validates life and gives hope both to the receiver and the giver." ~ Irene Smith

This article came across my desk and caught my attention. The discussion is about how and why more and more, therapists and schools in the US are backing away from a true full body experience.  It does not have to be.  with proper training, good client communication and informed consent there is no reason why in 2019 this should be. I have interjected my thoughts in italics, but otherwise this is re presented in abridged form from Massage Magazine. published from

The anterior (front) torso, including the chest and abdomen; hips; buttocks; and medial thigh are often avoided or only given cursory attention during many massage sessions.My awareness about this developed after reading many posts on social media about “full-body massage.” Discussions with massage colleagues, educators and therapists indicate this problem is real. I Have seen many posts about the chains not allowing massage 1" below the collar bone, or glutes at all.
“There is a significant decline in the number of massage therapists that are willing to perform massage therapy on gluteal, pectoral and abdominal areas,” said Brent F. Jackson, academic program manager, massage therapy, at Central Carolina Technical College, headquartered in Sumter, South Carolina. He said he believes there are three factors contributing to this situation.

First, he said, massage therapy businesses and schools alike are wary of being involved in litigious situations, because of criminal acts by some massage therapists have made the news and are therefore overly conservative when it comes to creating curriculum.
Second, he said, “In academia, we are also encountering a broad spectrum of skill, and therefore a possible lack of qualified and confident massage therapy educators. That lack of training may be inhibiting the student’s professional growth.”

Third, said Jackson, there is simply a growing trend of the therapist not wanting to put in the effort required of a true full-body massage. Instead, he said, therapists are cutting corners.
“As a profession,” Jackson said, “it is necessary to be open to treating these areas when warranted, as would any other health care professional.”
Educator Nancy Dail, of Downeast School of Massage in Waldoboro, Maine, has also witnessed this trend. “I have long been aware that massage therapists have been cutting corners around the human body, basing massage on a rote recipe and repetitive sequence versus a treatment based on the individual’s medical history, posture, repetitive actions or injuries,” she said.

“Since society has a vulnerable perception of the abdomen, it has been the most logical area to skip,” Dail continued. As to other areas, she said, state regulations on breast massage, draping and professional conduct have led to restrictions on how the client’s body is addressed.”
However, student ignorance and state regulations cannot fully explain the diminishment of the full-body session. In my research and conversations, I have come to realize there are three pieces to this situation: incomplete massage education; apprehension on the part of clients; and insufficient informed consent across the profession.
Massage Education“Attempting to avoid excessive intimacy, my students’ hands often tense up around buttocks, chest, belly and inner thighs. I teach them instead to deliberately connect with these tissues using safe touch,” said Barbara Helynn Heard, a continuing education provider and practicing massage therapist in Seattle, Washington.

Although many massage schools provide a comprehensive education that prepares students to offer complete, full-body massage sessions, Heard’s approach isn’t how all massage students are being taught to touch clients’ bodies.
I, and many other massage educators, believe some schools’ entry-level education falls short in developing skills in positioning, draping, time management, communication and consent about the process of massage. Massage education sometimes creates fear related to boundaries and sexual misconduct litigation instead of developing professionalism. Instead of assessment and critical thinking skills imbedded into the massage session, a massage sequence is sometimes drilled into students.
For example, the common statement, “Disrobe to your level of comfort,” only creates confusion. Instead, direct instruction needs to be given. Such an instruction might sound like one of these two examples:

“I regard the anterior torso as crucial, yet it is avoided in 90 percent of the massages I receive,” said Eric Stephenson, who was interviewed for this article when he was director of education at imassage continuing education and consulting company and who is now chief wellness officer for Elements Massage. “This is one of the great paradoxes of massage therapy.”

Part of the problem, in my opinion, is that the two national massage organizations do not accurately educate the public. One association’s website states, “A typical full body session will include work on your back, arms, legs, feet, hands, head, neck, and shoulders. You will not be touched on or near your genitals (male or female) or breasts (female).” This statement essentially omits the chest, abdomen, hips, buttocks, thighs and face. With these areas unmentioned, what type of expectation does this create in the consumer and employer?

Another association’s website states, “Depending on your needs, the massage therapist will massage either the full body (except private areas) or only specific areas that need attention, such as especially tight muscles.” This statement is so ambiguous that the information is confusing. What are private areas?
Despite professional strides in the massage industry, confusion between massage therapy and illegal sexual solicitation continues to occur. Something must be done so that the massage therapy profession as a whole can move beyond this degrading situation. I challenge our professional organizations and major employers of massage therapists to collaborate and directly address this issue.

Additionally, there is gender bias pertaining to male massage therapists.

 “As a male therapist, I have to maintain trusted professional relationships with clients, [which includes] education about various body areas included in the massage session, to achieve client goals,” said massage therapist (and my son) Luke Fritz, an instructor at my school, Health Enrichment Center in Lapeer, Michigan.
I believe the massage field should launch a public awareness campaign that clearly discusses sexual inappropriateness by both the client and the massage therapist, and that describes body areas included in general massage coupled with an example of informed consent. There should be ethical guidance by our professional associations and employers that frames clear statements to the public and massage therapists about appropriate behavior.
Such a statement might read: “Massage therapy is a nonsexual health service. Sexual behavior by the therapist toward the client or by the client toward the therapist is always unethical, inappropriate and illegal. It is always the responsibility of the massage therapist and business management to ensure that sexual misconduct does not occur and to report sexual solicitation by clients to law enforcement. Clients who feel that the massage therapist engaged in sexual misconduct should immediately report to the business management and to law enforcement.”


Informed Consent
The problem is that major employers are accepting substandard massage as the norm.

One reason for this may be that the confusion between massage and sexual interaction will just not go away, so employers might limit massage application to particular body areas because of the fear of sexual misconduct lawsuits.
It is very concerning if we have come to believe that the major body areas cannot be massaged in the typical 50- to 60- minute session. Massage employers and clients need to be assured that all massage therapists are providing quality massage services and can provide massage to all appropriate areas of the body.

Your thoughts
I welcome comments on all my posts but especially would welcome comments on this one. What has your experience been? What is your preference?

From the perspective of a  massage therapist, and I can only really speak for my self, there are few things that warm my heart more than a handwritten thank you note from a client.

If you’ve recently had a wonderful massage experience and want to leave or send a thank you note to your therapist, please do!

I can still remember one of my very first clients many years back.  When I can back into the room, I saw a very simple yet very lovely handwritten note had been left on my table.   It meant so much that I still have it. 

Moving a client is itself very rewarding, and the testimonials I receive by email or on sites mean more in terms of job fulfillment than money.  I need money to live, but money in and of itself contributes almost nothing to how you feel about how you spend your days.

It can be hard to know what to say and you may worry how it may come off, but as long as you are sincere and appreciative it will most likely be very well received.

If you are really uncertain what to say, I will make it simple. Two words- Thank you !

As a culture we have almost moved completely away from handwritten notes, postal letters and anything personalized. But a note not only shows how much you appreciated the experience but that you took the time even just a moment to do it.  It is likely to put a big smile on the face of your therapist which in turn will cause someone they encounter to smile.  There is an expression "most smiles are created by another smile" and this is true.

Some suggestions on what to write:

Why you’re thanking them – What was it exactly that made you want to write a note? Did they help fix a particular issue, resolve some pain, was it a life-changing experience?

How did the massage make you feel – I think it’s important to mention how their massage made you feel. This is great feedback and for me the most important. I generally don't work with pain as much as I do feelings and state of mind.

Let them know you will be back - or refer a friend
This is the most impactful way to also show your appreciation, by re-scheduling and or referring a friend.  When you write your note consider a short ending by letting them know you will be back.

And again, if you are really uncertain what to say, I will make it simple.
Two words- Thank you !

Try it, it may make you feel just as good writing it as the person reading it !

 Aloha

Have you ever written a Thank You note of this type? If so please fell free to comment with your story and or suggestions.

UPDATE / PART II TO AN ARTICLE WRITTEN 10/17

With  this subject coming up more and more online and with clients, here are some further thoughts utilized t.
________________________________

Breasts aren’t usually invited to the self-care party—despite the fact that there’s a restorative practice for pretty much every other part of the body (hair included). But there’s an argument, more than one, for incorporating full chest and breast massage into your treatment.

“Massage is a wonderful, stress-relieving, detoxifying practice for the whole body,” says natural beauty expert Jessa Blades.

                “It’s odd that we don’t massage the breasts [in the West].”
                                                                         —Jessa Blades

And no, you don’t need to be pregnant or nursing to reap the rewards, a fact the holistic wellness world’s been clued in to for ages. “In Ayurveda, if you get a full-body massage, your breasts are massaged too,” Blades notes. “It’s odd that we don’t massage the breasts [in the West].”

Breast massage  may provide huge psychological and emotional benefits, especially for those recovering from breast disease and the aftermath of invasive treatments.

While this work is not even close to being mainstream at the moment, that’s starting to change as word gets out about the physical and emotional benefits the practice produces. And lets not forget about choice.  There is an emotional long tail effect about subconsciously feeling the need to "hide" them.

Breast health is too often ignored until after a problem arises. It’s an area of the body with powerful associations that sometimes makes women hesitant to seek care, despite the fact that the vast majority experience discomfort at some point.

Breasts are often compressed with sports bras, constrained by underwire, or enhanced with padding. This can restrict the flow of lymph, the clear liquid derived from blood that contains disease-fighting cells called lymphocytes.  It is widely speculated that chronic impairment of lymph drainage may be implicated in many breast health problems, including cancer.”  This is the case for not wearing a bra.

Therapeutic breast massage also loosens the tissues of the chest, shoulders, and neck, using a combination of deep-tissue massage techniques, movement, breathing, and stretching. Whether your breasts are healthy or compromised, every woman can benefit from this work, and it can be a powerful aid to emotional healing or healing after surgery or radiation therapy.

If you are It is important that you find a therapist who is qualified;  trained and experienced with this work.  Just as it is surprising to many clients, it is surprising to many therapists. A qualified  therapist will be able to explain the work, discuss benefits, address curiosities, fears and or/concerns, go over the protocols for consent and choice - and ultimately help determine if you might be a good candidate for this work.

I have created an FAQ page that for the moment is password protected. It contains further discussion, FAQ's, and other information along with testimonials.  If you would like to access it, please go here 

Here is a list of prior blog posts for further reading on this topic:

•      Full Chest & Breast Massage and why it's Important
•      Breast Massage and Breast Cancer - Aids in Healing and Recovery
•      Ayurvedic Breast Massage - Why, Benefits & Self Care

If you have had breast massage and would like to share your story, it may help others - please send me an email.