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  • Lymphedema Case Study 1

    I have a client who has given me permission to share her story with you all, but honestly it’s been a little while since I gathered the details. So in an effort to not just misquote her, I’m going to say that this is a fictitious story inspired by a client, but is a very real scenario and excellent learning experience.

    Irene came to see me for Manual Lymphatic Drainage for her right arm.

    17 years ago Irene had been diagnosed with breast cancer. With the combination of chemotherapy, radiation, and surgery (lumpectomy), she became cancer-free within two years. The lumpectomy resulted in the removal of four lymph nodes in her right armpit. Both her radiologist and surgeon told her that there was a chance that she could develop lymphedema in her right arm because of the trauma done to her lymphatic system. They told her that from now on, she should not have blood pressure taken on that arm, blood drawn from it, or vaccines in that arm either but that if she didn’t develop lymphedema within a couple years, she was probably in the clear.

    When Irene came to see me it had been almost two decades since the radiation and surgery, she hadn’t developed lymphedema and had for the most part, forgotten that it was even a risk. And then last year she got a vaccine in her right arm. Over the next few weeks her arm started to feel heavy and tight and some of her shirts felt snug on her right arm only. After a few months it was clear that her right arm was bigger than her left and that she was likely developing lymphedema.

    The vaccine in her right arm prompted a healthy response from her body, sending lymphatic fluid carrying white blood cells to the area that had been damaged by the needle and injected with a foreign substance. This is how our bodies protect us. But because Irene had radiation damage to the lymphatic vessels as well as lymph nodes removed (either one would be enough to be the trigger for lymphedema, so she won’t necessarily know which was responsible), that influx of lymphatic fluid to her arm was not able to drain and leave the area the way it normally would have (by the lymph nodes in her right armpit).

    During Irene’s first session we worked on re-routing the lymph fluid to other lymph nodes so that the swelling in her arm could go down, this is done by manual lymphatic drainage, a process where the practitioner uses bare hands to gently stretch the skin in specific sequences and directions to guide and create movement. This process takes patience and dedication.

    Manual lymphatic drainage is great for everyone, even those who don’t have compromised lymphatic systems. Because Irene does have a compromised lymphatic system and indeed does have lymphedema, she will possibly also be partaking in Complete Decongestive Therapy. This includes Manual Lymphatic Drainage, but is also then followed up with wrapping the right arm with several wraps (not ace bandages though they look similar), a compression garment for daytime and one for nighttime, as well as certain exercises.

    Anyone who has had significant recent or previous damage to the lymphatic system is at risk for developing lymphedema. Once a person develops lymphedema they have it for life. It can be managed and maintained with manual lymphatic drainage and compression wraps/garments. These require the help of a Certified Lymphedema Therapist at first, but eventually can be done by the client at home.

    Nurses, Massage Therapists, Physical Therapists, and Occupational Therapists can all become Certified Lymphedema Therapists. There are many advantages to going to a Physical or Occupational Therapist for lymphedema therapy including resources, support, insurance coverage, access to technology, and budgets for things like wraps and compression garments. One main advantage to seeing a Massage Therapist who is also a Certified Lymphedema Therapist is that we don’t require a doctor referral, so we are a little more accessible. I can’t speak for all LMT’s when I say this, but I can also promise you that your session will be heavily focused on relaxation and feeling nurtured. Our bodies heal when we are resting, this fact guides my practice.

    If you are seeking Manual Lymphatic Drainage, here is some guidance to help you find the practitioner for you:

    -A Licensed Massage Therapist who is trained in Manual Lymphatic Drainage can offer this modality to people with uncompromised lymphatic systems (people who do not have and are not at risk for lymphedema).

    -If those same LMT’s take continuing education for post-op recovery they can work with plastic surgery clients.

    -LMT’s that go on to become Certified Lymphedema Therapists can work with people who are at risk of developing or have lymphedema.

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  • Manual Lymphatic Drainage (MLD): Applications & Definition

    The lymphatic system is finally getting some recognition. It has been a wild ride to have front row seats to learning about this system of the body as it simultaneously gains awareness and becomes a star of both social media and the beauty industry. It’s sudden boom has been empowering to many people who can now include the lymphatic system as part of their personal body literacy repertoire.

    Lymphatic fluid is responsible for clearing out excess wastes, cellular debris (internal exfoliation), bacteria, and viruses. It also contains fatty acids and white blood cells. It’s presence is integral to the immune system. The lymphatic vessels are located in close proximity to the circulatory system, but do not have their own pump like the blood has the heart. Instead, lymph fluid moves as we move, pumped by our muscles, our diaphragm, and by Manual Lymphatic Drainage (MLD).

    Manual Lymphatic Drainage is a technique that includes hand placements, pressure control, direction, and sequence. It mainly works with the vessels just underneath the skin and is incredibly gentle and rhythmic. There may be occasional deep techniques to stimulate the deeper lymphatic system of vessels and nodes. Your provider should do a thorough intake process with you and continuously give you resources and insights regarding your healing process. This might include exercise, garments, self-massage techniques, skin care, and breathing techniques.

    The main use for MLD in the US is to drain swollen areas of the body due to lymphedema, a chronic swelling condition that a person can be born with or develop as an after-effect of lymphatic damage (we commonly see lymphedema in breast cancer patients after lumpectomy, mastectomy, radiation, or the combination of all of these). If you have lymphedema it is important to seek a Certified Lymphedema Therapist (CLT) for your treatment. A CLT is trained in Complete Decongestive Therapy and will be able to offer advanced sequencing and help you with compression wraps, garments, and more. This will likely be available through insurance, but if not you can find a CLT in private practice and pay out of pocket. One of the benefits to paying for a Licensed Massage Therapist (LMT) who is also a CLT is that your sessions will also be incredibly relaxing. At Queen of Cups, no matter what my clients main concern is, the foundation of every session is relaxation. Our bodies heal while relaxed, so it is my priority that you feel safe, cozy, and comfortable.

    Another popular and effective use of MLD is for post-plastic surgery care. Liposuction, tummy tucks, and face-lifts in particular are traumatic to the lymphatic system and swelling becomes a medium-term part of the recovery process. While acute inflammation is a key part of the healing process, chronic inflammation and lymphatic stagnation lead to a hardening called fibrosis. Though I do recommend a CLT for this work, it is not necessary. You can find an LMT who is well trained in MLD and post-operative techniques (scar release and fibrosis techniques).

    Aesthetic use of MLD has rapidly gained popularity in the US in the last few years. I use MLD in all of my face massage sessions relieving puffy areas can create an immediate change in the appearance of the face. But there are long-term benefits as well. Chronic puffiness (think around the eyes and ears) stretches the skin and encourages stagnation. While puffiness in the face can actually look good in the short term because fine lines and wrinkles are being filled out, once it does drain there can be more sag to the skin because it has been stretched out for so long. Chronic stagnation can lead to pain, allergies, skin flare-ups, and brain fog. For this type of session you can seek an LMT/CLT who offers this type of session but again, it is not necessary. Both LMT’s and Aestheticians can be trained in Manual Lymphatic Drainage and can include MLD in face massage/facial sessions. LMT’s can offer full body MLD sessions.

    • During no part of you MLD session should you feel pain.
    • During no part of your MLD session should you have liquid pushed out of incisions. The only time this is appropriate treatment is for seromas, fluid filled pockets that have enveloped themselves with tissue and no longer have access to the lymphatic system. Seroma drainage is outside of the scope of practice for LMT’s and should only be preformed by a surgeon or nurse.

    If you experience either of these it is absolutely ok to stop your session and seek a different provider.

    It is so important to research your provider before booking a session. MLD is an incredible and effective modality when properly executed. Because of its rapid growth there is also a lot of misinformation that can be confusing and misleading. The right provider for you will continuously educate you, be a part of your journey, ask you questions, and never stop learning.

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  • 2022 – Year of The Lovers

    This year has absolutely flown by! It has been my busiest year in business and one of great personal and professional growth. At the start of the year I had taken shifts at a spa because November and December were so sleepy in my private practice at Queen of Cups. I do not enjoy spa work and not only did I not feel fulfilled, my body was in constant pain. Simultaneously I started learning about manifestation and how our daily actions can catapult us into joy when they are aligned with our goals. I put it into action and reaped immediate results with my family, my career, my friends, and more. The following is a 2022 gratitude dump.

    My very first validation of manifestation came in the form of a dream job. I had been working in my private practice and crushing my body at the spa when I connected with The Center for Cancer and Blood Disorders. My professional background in Manual Lymphatic Drainage and personal background with caring for my Grampa in his final months made me a perfect fit and I was on cloud 9 to accept the position as Oncology Massage Therapist. I’m still seeking the perfect work/life balance, but my role at The Center and with Queen of Cups could not have blended together any better.

    The Center was what lit a fire under me to finally fulfill my dream of becoming a Certified Lymphedema Therapist. This was something I had wanted since 2012 as a fresh bodyworker still in school, totally taken with the mystery of the lymphatic system. The training was 9 days in Dallas, 9 hours a day, and I committed myself fully. I didn’t allow myself any distractions, no coffee, music, tv, etc., and it really illuminated my strength as an adult learner.

    Because of this training I experienced an incredible up-leveling of skills and insights, which opened doors for new kinds of clients. I’ve seen clients for several kinds of surgery recovery including, liposuction, tummy tuck, mastectomy, lumpectomy, and reconstruction. Surgery recovery modalities that I offer include Manual Lymphatic Drainage (MLD), fascia release, scar release, and cupping and helps with swelling, scarring, and fibrosis.

    The training has also allowed me to become a source of accurate information for my oncology clients who often receive very minimal education around potential Lymphedema occurrence following surgery and/or radiation. I have watched MLD firsthand grow into a trending modality that has become something partially still shrouded in mystery, partially swirled in with misinformation driven by social media, and partially practiced and preached safely and correctly. My clients that receive treatment, education and results from me are incredibly grateful and that gratitude pours out of them. This is maybe my favorite part of my career.

    In 2020 I trained in facial reflexology. This was my quarantine hobby and I not only committed to learning the foundations of an epic face massage, but the biological and aesthetic benefits as well. Face massage and the modalities I use within a session have completely changed the way I view beauty care. Our skin is living and breathing, our faces take on the whole world and reflect it back out. It is an honor to work with women who support their beauty through deep nourishment. This year I have really changed and honed how I move through these sessions and I know I have not plateaued, there is more evolution yet.

    I’ve seen several women through pregnancy for prenatal massage this year and have met three of those babes since massaging them in the womb! I will never get over how cool it is to massage a pregnant belly and meet the little one earth-side a few months later.

    I have done 6 pop-up events, one with my mom by my side which was very special for both of us. I’ve done maybe 50 tarot readings this year and the one phrase I hear most often has been, “That was very validating.”

    My studio has gone from a barren room to a cozy and inspired space. I know that Queen of Cups will yet again have to move in a couple years, but it feels good to bring life into my little rooms.

    In my personal life, this is the first year I have started to feel at home in Texas. My partner and I bought our home and are deep in nesting mode, we created a heartfelt, fancy-free circle of friends who love and play hard, and we are both flourishing professionally.

    I could go on about the nuances of how I feel bolstered and bettered by the practice of manifestation, but I’m writing this on the solstice when the night has stretched farthest into the day, and I’ve stretched into the night. Mostly I just want to say thank-you, I am so grateful for you. For my clients and my cheerleaders who connect the right clients with me. In 2021 I stopped actively taking male clients and this was incredibly scary. I received a lot of opinions on this, some supportive and a few downright nasty. I took a Fool’s leap and it has rewarded me with an incredible, inspiring network of women. Because of the nature of one-on-one services my clients rarely meet each other, but there is a circle of women around me that only I can see, and you are all connected because of it. What a blessing.

    In numerology and tarot 2022 has been the year of The Lovers, a card that represents the beauty and wonder that we are able to see in the world and in others. This particular beauty is not just external, but that which is internal and reflected back at us. It is the kind that makes you feel warm and divine, not one that motivates envy or competition. I have seen so much beauty this year in so many forms (my clients on the table with a rainbow across their arm, a path filled with wisteria, New Orleans in the rain, the Atlantic Ocean, Vermont in October, a good haircut) and I plan on letting those experiences help shape the way I continue to view the world. But this year allowed me to look a little deeper at this card. I’ve also done a lot of up-leveling in my personal life, a lot of growing up and expanding my self-awareness. Just like my 9 days in Dallas, getting up early and studying late into the nights, it’s not easy to shed ourselves of our inner ugliness. It takes uncomfortable realizations. Today, The Lover’s card means more to me than just the goodness that we are able to see in ourselves and the world around us, it also asks us what we can sacrifice in order to see/feel more beauty, goodness, and love.

    Gratitude is really the perfect practice to take stock of what matters and what can be sacrificed, and the end of the year is the perfect time to do that. I hope you all have wonderful festivities into the New Year. Again, thank you so, so much for your trust and support throughout the year, and your overwhelming show of support through the holidays this year. What a welcome contrast to how I ended 2021.

  • Massage Therapy Awareness Week

    It’s Massage Therapy Awareness Week and I’m going to share what might be an unpopular opinion, but by the end of this piece you may have a new appreciation for the perspective I’m about to illuminate.
     
    Have you ever heard someone say that they’re a Massage Therapist by trade and then someone else responds with a joke about sex? These innuendos are so common it’s almost expected in conversation or even as the entire representation of the massage industry in pop culture. It seems harmless and sometimes even funny…until you’re the person in a situation where a client has confused your services for something very, very different.
     
    In my personal experience, there are several reasons why a massage client would try to initiate or ask for sex, but I’m only going to talk about one right now, and that is that the client has booked a session at a private practice or boutique business and they genuinely think that a “happy ending” is on the service menu. Again speaking from personal experience, this type of client is usually harmless in that they are not looking to coerce, force, or intimidate the therapist into a sexual service. They are trying to initiate a consensual transaction.
     
    This mix up isn’t entirely the clients fault. The terminology we use regarding massage is often highly charged if not completely overlapping with both the sex industry and the realm of human trafficking. Licensed Massage Therapists are trained to never use the words “masseuse” or “parlor” because they have long-ingrained connotations, but many people still use these words when talking about massage therapy. If you search for “Massage Parlor” on google you’ll first get a disclaimer that you might see nudity or sexually explicit content, and then you’ll see a list of “erotic spas” and “happy endings.”  Merriam-Webster has even updated the definition of massage parlor to include sexual services. So we start to see how a client looking for sexual services finds their way to a private or boutique massage practice. 
     
    In 2018, in an effort to curb human trafficking, congress passed FOSTA/SESTA, two bills that made it much harder for sex workers to market to clients online. 
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    I want to pause here to underline that human trafficking and sex work are two very different things, in the former the person is being coerced or forced into sexual services, and in the latter the person is consensually making a transaction. 
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    You can read more about FOSTA/SESTA if you’d like, but I’ll give you the broad strokes. Websites that were dedicated solely to making sexual connections were deleted entirely, and websites like Craigslist that had specific pages like the personals dedicated to these connections, had to delete those pages (though, interestingly enough, you can now find them in the health/wellness page of Craigslist disguised as massage). This meant that sites that were knowingly or even unknowingly enabling sex trafficking were being taken down, but it also meant that sex workers and their clients could not find each other online either. Because these laws were created by the US government, it pushed the ownership of these pages to international territories and they are now run anonymously. So while there was a hot minute when the sites had been taken down, they’re back now and if someone is trafficked through these them we have no way of finding anyone involved. Also, with the online arena more or less unavailable, sex workers and clients now have to go back to the days of finding each other in person. In short, both human trafficking victims and sex workers are more in danger now than they were before.  Additionally, it forces sex work to disguise itself under the umbrella of a different industry…and massage therapy is set up beautifully for this. Our terminology is already mixed up, our society is comfortable with making sexual jokes about massage therapists, and culturally many of us miss the nuance of physical touch so we just mash it all into one category – sex! 
     
    It is naïve and incorrect to assume human trafficking and sex work are one and the same. Human trafficking is a terrible thing that should absolutely be erased entirely from existence. Sex work is work, even if you are uncomfortable with it. These laws endanger more people by forcing them into unsafe situations and criminalizing the workers (clients usually face little to no repercussions). I am in complete support of decriminalizing sex work for these very reasons.
     
    And there’s also this: Decriminalizing sex work would mean that it could operate within its own industry. Clients who are looking for this work could easily find the services that fit their needs. If any confusion remained I (and my colleagues) could refer people out and not have to endure that awkward-at-best dance of figuring out that a new client wants sexual touch and not therapeutic touch. 
     
    Things to note:
     

    1. Decriminalizing is not the same as legalizing. Legalizing is an entirely different option that leads to conversations about regulation, unions, retirements, etc.
    2. If human trafficking is the real thing that we (as a country) are trying to combat (and I want to believe that it is), it needs to be explicitly separated from sex work. 

     
    I truly hope that this short piece of writing has brought a new awareness to Massage Therapy and the web it is connected to.

    • If perhaps you thought that sex workers and trafficking victims were the same, I hope that you see the difference and the importance of separating the two.
    • If you’ve made jokes about massage therapy being sex work, I hope you see the damage this causes.


    These are extremely broad strokes. I could have veered off into several tangents and expanded on many parts, but I want to start here. And if you have thoughts, please share them in my contact form (please, no abusive commentary).

    Originally published October 28th, 2022

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