Issue link: https://www.massageandbodyworkdigital.com/i/1512873
• Identify the variables that must inform that question: How severe is their disease? What treatments are they using? What symptoms and side effects are bothering them? What daily activities do they tolerate well? What activities make them feel better? Worse? (There are a lot of other possible questions, but these provide a good start.) • Look for assumptions about this situation: What have you missed? Are you focused on treating the kidney problem rather than the reason the client came to see you? • Find what others have done in similar situations: Look at the research, consult with peers, and if appropriate, reach out to the client's medical providers with specifi c questions about goals and safety. • Plan and execute the session: Use what you've learned to work with your client. Consider the risks, benefi ts, and appropriate accommodations. • Evaluate the results: How will you determine if your work is successful? What will you do differently next time you work together? RISKS, BENEFITS, AND ACCOMMODATIONS We know people with chronic kidney disease have a hard time managing f luid f low, and we can surmise that to challenge that with deep, fast, draining strokes is probably not a good idea. Other risks that inform our work include bone thinning, skin rashes, itching that thoughtless massage might make worse, and general malaise that is not appropriate for rigorous bodywork. Organ transplant recipients often have complex health situations, and they use tissue-rejection drugs that make them vulnerable to infections. The benefits that massage therapy has to offer this population are substantial: Our work may help with pain, fatigue, muscle cramping, sleep quality, and much more. In a recent episode of the podcast "I Have a Client Who . . ." (Episode 377), I spoke about doing massage for a person undergoing dialysis. As long as the work is gentle and doesn't challenge the client's general energy levels, there is no reason to withhold treatment. The accommodations for clients with renal disease or renal failure must be led by their tolerance—some days they may be too tired to receive massage—and by their physical resilience. Obviously, the access site is a local caution, and it may be best to offer shorter sessions while you and your client evaluate how things go for them. Finally, let's bear in mind that clients with renal failure may seek massage for other issues— musculoskeletal injuries, for instance. And while we must accommodate for their limitations, their kidney disease might not be the centerpiece of their goals. Clients who have received transplanted kidneys may have extensive scar tissue and a new organ in their pelvis. Also, these clients use immune-suppressant drugs, so they require us to be especially careful about infection risk along with whatever other challenges they have. People with chronic kidney disease, those with renal failure, those who use dialysis, and those who have received a transplant all need us to adapt our work to their needs. But knowledgeable massage therapists can offer safe, educated, and caring touch in ways that might help with pain, stress, fatigue, and much more. Notes 1. National Institute of Diabetes and Digestive and Kidney Diseases, "Kidney Disease Statistics for the United States," accessed October 9, 2023, www.niddk.nih.gov/health- information/health-statistics/kidney-disease. A B M P m e m b e r s ea r n F R E E C E h o u r s by rea d i n g t h i s i s s u e ! 69 LISTEN NOW EP 377 – "DIALYSIS: 'I HAVE A CLIENT WHO . . .' PATHOLOGY CONVERSATIONS WITH RUTH WERNER" 2. American Kidney Fund, "Quick Kidney Disease Facts and Stats," accessed October 6, 2023, www.kidneyfund.org/all-about-kidneys/ quick-kidney-disease-facts-and-stats. 3. University of California, San Francisco, "The Kidney Project," accessed October 12, 2023, https://pharm.ucsf.edu/kidney/need/statistics. 4. National Foundation for Transplants, "Get Informed," accessed October 12, 2023, https://transplants.org/get-informed. 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.