Issue link: https://www.massageandbodyworkdigital.com/i/1451559
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 71 PATHOLOGY PERSPECTIVES WHAT DOES THIS MEAN FOR MASSAGE? This condition is physically and emotionally painful. It can negatively impact the way a person feels about their body and self- worth. And this can infl uence whether they feel they deserve massage or are willing to risk having another person see their scars. "When you have this kind of pervasive imperfection all the time, it's a constant reminder that you're fl awed in some way, in a way that feels unclean." —VSW Because this condition is often undiagnosed, and people can feel ashamed and self-conscious about it, many people with HS may simply avoid massage or try to explain their lesions in a way that doesn't feel embarrassing. "When I have something open or draining, I don't get a massage. I don't want to leave a bloodstain or any seepage on the sheets. When I just have a big cyst or dark spot, I'll say it's a spider bite. I don't know how many 'spider bites' I've had over the years." —VSW We rely on our clients to give us a full picture of their health history, but this is something people may choose not to share— either because they don't know what it is or because they are uncomfortable about it. "I haven't told my massage therapists I have it, because until six months ago, I didn't know what it was. Before I had a name for it, I would be like, in my head, 'I'm a dirty, gross person and I have a zit there, so don't touch that.' " —VSW It's a safe bet that many massage therapists are not familiar with HS. The presence of active, pus-fi lled boils can be alarming, since most of the time we associate these with highly contagious and potentially dangerous bacterial infections. And even though HS is not contagious, • Don't tell me your special lotion is going to fi x it. • Don't even think you understand it. If you don't have it, you don't understand it. HS is common and it seriously impacts the quality of life for people who have it. Massage therapy won't help it improve, but it also won't make it worse (if we are careful). More to the point, people with HS deserve to feel strong, powerful, and worthy of excellent self-care. With just a few adjustments designed to improve our clients' sense of safety, we can be part of the coping skills of the many people who live with this diffi cult and frustrating condition. 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 booksofdiscovery. com), now in its seventh edition, which is used in massage schools worldwide. Werner is available at ruthwerner.com or wernerworkshops@ruthwerner.com. VIDEO: "AUTOINFLAMMATORY CONDITIONS" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch! and the bacteria involved tend not to be aggressive, any open lesion is at least a local contraindication, of course. Fortunately, the abscesses usually occur in places we don't usually see or touch during a massage: the inguinal line, the groin, and under the breasts. An exception is the axillae—the scarring these lesions cause in the armpits can limit the pain-free range of motion of the arm, plus, the client may not be willing to expose that part of their body. "When you take my arm up over my head, there it is: you're going to see all of it." —VSW Are there any benefi ts we can offer to clients with HS? Yes, but they are benefi ts for the whole person, not specifi cally addressed to this diffi cult condition. We can respectfully appreciate this client who has put themselves into our hands. We can, like no other health-care provider, offer educated, compassionate, nonjudgmental, nonpainful, supportive touch. We can help people become lovingly reacquainted with their whole body—not just the unscarred parts. In a practical sense, working with a client who has active HS presents some special challenges. Although this condition isn't contagious, the possibility of open or ruptured lesions requires we be prepared to reschedule or have some fi rst-aid tools handy: gauze or bandages just in case a lesion opens during the session. One way to minimize this chance is to ask our clients to cover any delicate, high-pressure boils when they come for massage. The risk to us is getting stains on our sheets that are diffi cult to remove. The risk to our clients is much greater: These open lesions may be exposed to secondary infection. Along with these practical suggestions for how to offer safe, effective massage for clients with HS, Vicki offers some ideas about what not to do: • Don't tell me it's from what I'm eating. • Don't tell it's from my soap. TAKEAWAY: Hidradenitis suppurativa (HS) is a noncontagious, painful, disfi guring, diffi cult-to-treat condition of hair follicles, mostly at the axilla and the groin, and massage therapy for people with HS requires some specifi c accommodations for client safety and comfort.