Issue link: https://www.massageandbodyworkdigital.com/i/72343
PATHOLOGY PERSPECTIVES Incidence Hepatitis A About 22,000 new infections per year; approximately 30 percent of adults have been exposed at some point. Hepatitis B Approximately 38,000 new infections per year (may be under-reported); about 1.4 million people in the United States have chronic hepatitis B. Hepatitis C About 18,000 new infections per year (may be under-reported); 3–4 million people in the United States have chronic hepatitis C; most were born between 1945–1965. • Psychosis. Impaired liver function means that ammonia accumulates in the bloodstream, damages the blood- brain barrier, and leads to temporary or permanent brain damage. • End-stage liver disease. This includes cirrhosis, liver failure, or liver cancer. Hepatitis B and C kill about 15,000 people in this country every year. WHERE DOES MASSAGE FIT? Since between 3 and 4 million people in this country are infected with either hepatitis B or hepatitis C (or both), the chances for massage therapists to have an infected client are relatively high. Clients may or may not know about their status, or they may choose not to share their status with you. What implications does this have for bodywork choices? Story 2: I did my massage school outreach paper on a client with hepatitis C who was being treated with interferon and ribovarin. I did 10 sessions with him and the massage significantly reduced the side effects of the interferon (which can include muscle soreness, flu-like symptoms and depression/irritability). Most efficient means of communicability Oral-fecal contamination; this virus concentrates in the gastrointestinal tract rather than blood. Shared intimate fluids, usually through unprotected sex, or contaminated needles, tattoo, or piercing equipment. Contaminated blood or equipment appear to be the most efficient mechanisms to spread hepatitis C, although unprotected sex may also be a possibility. Risk of long-term damage? Vaccine available? Relatively low. Hepatitis A has the most severe symptoms, but for the shortest time. About 5 percent of hepatitis B patients become long-term carriers who can continue to spread the infection and may develop end-stage liver disease. Without treatment, 75 percent of hepatitis C patients remain communicable, and are at high risk for the results of long-term liver damage. People with an advanced form of hepatitis B or C may be prone to bruising and bleeding. Skin rashes from systemic toxicity are common. Many people with hepatitis report general malaise; this may be due to the virus, or it may be connected to antiviral medications. Massage may be able to help with this, as long as it's done with caution to avoid overtreatment. Story 3: "I have a client who has both hepatitis B and hepatitis C. I have another client who's been trying to get pregnant for several years, and she finally succeeded. Next week, she is scheduled to see me immediately after my client with hepatitis. Is there any chance that she could be at risk by following this person?" For advice about this precarious situation, I called the infection control department at my local hospital. The expert there assured me that standard precautions—that is, swabbing surfaces with a good cleaner, changing linens, and of course washing hands—are adequate to be sure that every client is safe. In massage therapy settings, we must practice good hygiene: we make sure that the surfaces our clients touch are regularly cleaned; we wash any fabrics that one client contacts Yes. This is recommended for travelers to places where hepatitis A is prevalent, if they have never been exposed. Yes. A series of three inoculations over a period of six months provides about 15 years of protection. No vaccine is currently available for hepatitis C. before another client uses them; and we make sure that our own best defenses—our clean, intact skin and our good constitutional health—are in place before we see clients. Ultimately, it doesn't matter whether our clients are positive for hepatitis B or C or the Creeping Gombooh. When we use good hygienic practices, we are prepared for the possibility that any of our clients may have a blood-borne infection, and we protect ourselves and them from any risk of transfer. Author's note: My deepest thanks to all the contributors who brought me their hepatitis experiences; it is my honor to share your generosity. and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and educator tune in to your practice at ABMPtv 105