Massage & Bodywork

MARCH | APRIL 2015

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F r e e m u s i c d o w n l o a d s f o r C e r t i f i e d m e m b e r s : w w w. a b m p . c o m / g o / c e r t i f i e d c e n t r a l 41 PATHOLOGY PERSPECTIVES Because more than 4 million people in the United States have hepatitis C, your chances of working with a client who has this condition are high. Further, research suggests that many people with chronic diseases seek out CA M therapies, either as an alternative to conventional treatment or as a way to manage side effects of medication. For that reason alone, we need to be well informed about this condition. As we know, the liver is central to fluid flow in the abdomen. If it doesn't work well, the whole system can back up and cause many symptoms and complications, some of which are very serious. Therefore, further challenging fluid management systems with rigorous circulatory massage may not be the best strategy for clients living with this infection, especially if they are in an advanced stage of liver disease. Among the many complications of liver disease are some issues that are of particular relevance to massage therapists. Ascites can make abdominal massage and lying prone uncomfortable or completely unmanageable. If the liver doesn't produce adequate clotting factors, then our clients become at risk for spontaneous bleeds or bleeding with only minor tissue disruption; that is to say, bruising following even gentle strokes. And liver dysfunction in general can lead to skin rashes and open lesions. Obviously, these at least locally contraindicate massage. On the other hand, many people with hepatitis C may have only minimal symptoms. In these cases, massage choices can be kept within the demands of normal daily activities. The overall goal needs to be to offer the best of what massage therapy has to offer—possible relief from the anxiety, depression, fatigue, headaches, joint pain, and other side effects of the infection and its treatment—while avoiding overwhelming a system that is already working hard to simply keep up with moment-to-moment needs. To date, no research has been published (none that is indexed in PubMed Central, at any rate) that explores the value of massage therapy for patients with hepatitis C, or those undergoing hepatitis C treatment. Because this infection is so common, it is certain that some massage therapists are working with clients who have this condition. We need to ask those practitioners these questions: • What are your clients' goals? • How do you strategize to meet those goals? • How effective have your strategies been? • What mistakes have you made? This is information we need so that we as a profession can build a body of knowledge about working with clients who have hepatitis C. I hope someday to read what massage therapists discover about working with this large and underresearched population. Notes 1. Centers for Disease Control and Prevention, "Hepatitis C FAQs for the Public," accessed January 2015, www.cdc.gov/hepatitis/C/cFAQ.htm. 2. World Health Organization, "Hepatitis C. Fact sheet No. 164," accessed January 2015, www.who.int/mediacentre/factsheets/fs164/en/. 3. The C. Everett Koop Institute, "Transmission of Hepatitis C," accessed January 2015, www.epidemic.org/thefacts/hepatitisc/transmission/. 4. J. Wapner, "We Now Have the Cure for Hepatitis C, But Can We Afford It?" Scientific American 331, Issue 3 (April 2014), www.scientificamerican. com/article/we-now-have-the-cure-for-hepatitis-c-but-can-we-afford-it/. Ruth Werner, BCTMB, is a former massage therapist, a writer, and an NCTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2013), now in its fifth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com. Who Should Be Tested? Readers may be feeling some interesting sensations at this point. Maybe you have a feeling of heaviness in the abdomen, or an ache under your rib cage on the right side. That little niggling headache—could that be related to a liver problem? The National Institutes of Health suggest you should be tested for hepatitis C if any of the following apply to you: 1. You were born between 1945 and 1965. 2. You have ever used intravenous drugs—even if it was only once, and even if it was many years ago. 3. You were treated for a blood-clotting problem before 1987. 4. You received a blood transfusion or any organ transplant before 1993. 5. You are on long-term hemodialysis. 6. You have abnormal liver tests or known current liver disease. 7. You work in public health or safety, and were exposed to blood through a needle-stick or sharp object injury at any time. 8. You are HIV-positive.

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