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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 45 PATHOLOGY PERSPECTIVES letter describing how you work and the primary goals in your massage therapy sessions can open this dialogue, as you invite the team to share any questions or concerns. The abdominal area will be sore for quite some time—several weeks or more— so side-lying or semi-supine may be the best table position for your client who is recently postbariatric surgery. Elevating the legs can also help with any extremity swelling. Because of the abdominal digestive revision, the lymphatic pathways will be going through a rerouting process, and some fluid backup can be expected. As the person rapidly sheds their presurgery weight, skin changes can be expected, especially in texture and elasticity. Excess skin is a by-product of the weight loss, so strokes like long-drag Swedish effleurage may need extra lubrication. Some patients will go through follow- up body-contouring surgery to remove excess skin, and this requires different accommodations for massage therapy. It's hard to foresee where and what kind of massage will best suit a person who has been through bariatric surgery. One predictable challenge is how posture changes as the weight comes off. Overweight people are likely to have back pain, along with neck and shoulder pain. They may also have foot issues like plantar fasciitis or flat feet that persist after weight loss. Other physical symptoms will vary, and it is the practitioner's job to address these on a case-by-case basis. Massage therapists can contribute to a positive outcome by developing a long-term focused treatment plan that supports the physical transformation of their bariatric client. While Lisa went through her rapid, and then more manageable, weight loss, massage helped her get in touch with changing postural needs and encouraged a positive self-image. It was—and is—an important part of her recovery process. In conclusion, when a person who has had bariatric surgery makes an appointment for massage therapy, we need to anticipate certain needs. We also need to be flexible and teachable: our clients will know much more about their situation than we can. When we engage our clients in teaching us, and work together to design their perfect session, we invite them to long-term self-care with massage. This is a wonderful gift for all of our clients, especially those who, like people who have chosen bariatric surgery, are deeply invested in their own well-being. Notes 1. Susanne A. Fogger and Teena M. McGuinness, "The Relationship Between Addictions and Bariatric Surgery for Nurses in Recovery," Perspectives in Psychiatric Care 48, no. 1 (February 18, 2011): 10–15, 2. Jules R. Altfas, "Prevalence of Attention Deficit/ Hyperactivity Disorder among Adults in Obesity Resources American Society for Metabolic and Bariatric Surgery. "Bariatric Surgery Misconceptions." Accessed June 5, 2018. American Society for Metabolic and Bariatric Surgery. "Bariatric Surgery Procedures." Accessed June 11, 2018. Bond, D. S. et al. "Weight-Loss Maintenance in Successful Weight Losers: Surgical vs Non- Surgical Methods." International Journal of Obesity 33, no. 1 (January 2009): 173–80. https:// Gloy, Viktoria L. et al. "Bariatric Surgery versus Non-Surgical Treatment for Obesity: A Systematic Review and Meta-Analysis of Randomised Controlled Trials." BMJ 347 (October 22, 2013): f5934. Kahan, S. "Quick Takes: What You Need to Know About The 5 FDA-Approved Obesity Drugs." Medscape. March 2, 2017. "U.S. Weight Loss Market Worth $66 Billion." December 20, 2017. www. Semedo, Daniela. "In Morbidly Obese, New Non-Surgical Approach May Be an Option." Obesity News Today. December 7, 2015. obese-new-non-surgical-approach-may-option. Shayani, V. "Gastric Balloon — 14 Ways It Will Affect You." Bariatric Surgery Source. Last updated May 24, 2018. Accessed June 11, 2018. balloon.html. Weiss, Clifford R. et al. "Clinical Safety of Bariatric Arterial Embolization: Preliminary Results of the BEAT Obesity Trial." Radiology 283, no. 2 (May 2017): 598–608. radiol.2016160914. Treatment," BMC Psychiatry 2 (September 13, 2002): 9, 3. Susanne A. Fogger and Tenna M. McGuiness, "The Relationship Between Addictions and Bariatric Surgery for Nurses in Recovery." Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (available at, now in its sixth edition, which is used in massage schools worldwide. Werner is available at or

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