The Opposite of Hurt

By Sharon Livingstone

“I want to show you a photo that’ll make you laugh,” said my niece, Katherine with a grin. Then she frowned. “Actually, it’ll probably make you angry.”

We were at a family gathering enjoying refreshments. It was probably just as well Katherine couldn’t find the photo that day because when I eventually saw it, I was indeed quite cross.

Katherine has terminal colorectal cancer and before her cancer diagnosis had only sought out massage for a treat.

“I would generally only get massages for special occasions and they would be aromatherapy relaxation ones at a salon place. I would also find deal websites and use vouchers. It felt like a novelty.“

Pain accompanied the cancer and Katherine turned to massage for help.

“I was feeling a bit sore in my side and wanted to alleviate some of that pain as well as get some relaxation that generally goes hand in hand with massage.“

Katherine booked in with a local therapist she hadn’t seen before and discussed her requirements, including informing them of her cancer. A not-so-great massage experience followed.

“I don’t feel that the therapist listened to me. When I said it was too hard, he said that I was tight and needed the pressure and that it may hurt a bit today but over time it will feel much better. My body sort of jolted (the only way to describe it) when he went over certain bits and it was painful and he just kept going over it again and again. It was overall a painful experience that left me physically bruised and more sore than when I walked in.“

The subsequent significant bruising was photographed and later sent to her not-laughing-but-cross aunty.

“I was very disappointed, and it made me reluctant to see other massage therapists for a long time.“

About a month after that family gathering, Katherine told me that one of the drugs used in her chemotherapy treatment had caused some nerve damage, which led to a “numb, tight and tingling” sensation in her hands and feet, and it was bothering her. She asked if I knew anything that could help.

I treat neuropathic pain and parasthesia in clients with Multiple Sclerosis and had been asked a similar question by my brother when he was undergoing chemotherapy, so I’d already done a bit of research on treatment for people with chemotherapy-induced peripheral neuropathy (CIPN). A lot of the research and systematic reviews are relatively recent and although they’re positive, they aren’t conclusive that massage is effective in relieving CIPN. As usual “more research is required”. I passed on the information about massage to Katherine.

Katherine isn’t located near me, and it wouldn’t have been appropriate for me to treat her anyway. However, I know AMT member, Sam McCracken, who works nearby to her, and a trusted colleague recommended another local therapist. I approached them both, outlining Katherine’s terminal cancer diagnosis and her current issue.

The therapist I didn’t know came back requesting permission from Katherine’s treating doctor before treatment could commence.

I wanted to scream. Well, I did scream. What hadn’t I explained well enough? That I was a massage therapist? That Katherine’s cancer wasn’t curable?

The response I received from Sam was a simple, “Yes, I can help her.”

It’s difficult to know whether my spidey senses had been triggered or if I simply trusted Sam. Although I gave Katherine the details for both, I pushed her in the direction of Sam, and she booked in with him. After the treatment, Katherine sent me a text message, “He was fantastic. Very informative and lovely. I came out feeling very relaxed and (my) right hand already doesn’t feel as stiff.”

And that was all I knew until 4 months later when I visited a deteriorating Katherine and asked how her neuropathic pain was. She told me it was gone and that she’d continued to see Sam roughly fortnightly.

Something Katherine mentioned that day stuck with me.

I like that that hour is just for me.

Katherine later told me that she liked having her massage booking with Sam after she’d dropped her kid off at daycare and while her husband was at work. It provided her with time where she could focus on herself and her own needs. It reminded me that a massage is more than what the massage therapist does with their hands.

For Katherine, this shift from a “novelty” massage to a remedial one opened her eyes to the magic of massage. What sort of terrible aunty am I that I hadn’t made sure she already knew how wonderful a massage could be? But how fabulous to hear her rave about her treatments.

“I like that I don’t tell Sam what/how I’m feeling at the start of the appointment. He does a thorough examination of my body and tells me what he had found. I then discuss the similarities, which are usually 100% accurate. Then I feel like he’s not just agreeing with me about my symptoms. I feel he listens to me and makes allowances and changes when I need it. He is flexible in his treatment methods.

“Sam explains why he is doing a certain technique; why he is doing it helps me better understand my body and how it all works. He always asks about the amount of pressure he is using and adjusts accordingly. I love how the body is so interconnected – Sam could be massaging a certain area in my armpit, for example, and I can feel instant effects down my leg; it’s fascinating.“

Katherine explained the benefits she experienced from her massages:

“Apart from relaxation, calm and time to myself, I felt amazing relief from neuropathy in both my hands and feet. I would instantly feel my hands less tingly and achey and after a few consistent appointments, the relief was amazing and doing everyday tasks like opening jars and writing became a lot easier again.“

Those treatments ceased when Katherine’s pain increased after the chemotherapy stopped being effective and was discontinued, and she could no longer lie comfortably on her stomach. She missed the massages and the “Katherine time” they gave her but felt that her massage receiving days were over.

Knowing I can’t “fix” Katherine’s cancer is disempowering. I feel pretty useless when it comes to practical help. I don’t live nearby so I can’t pop over to entertain her kid or make a mountain of food to put in the freezer or drive her to appointments, or even help with grocery shopping. But I can investigate. I contacted Sam again to explain the dilemma and asked if he had a solution, such as a massage chair. Part of the issue was that Katherine wasn’t comfortable in a side-lying position either because it gave her the sensation that her internal organs were ‘sloshing about’.

Sam was quick to say that he’d work with Katherine to find comfortable positions for her during his treatments. I updated Katherine and she gleefully re-booked with Sam.

“Because of the cancer and certain pressure points and intolerances, Sam makes sure I’m comfortable by using a range of different techniques. He uses the massage chair for my back because I can’t lie on my stomach. He also uses the massage table face up for the remainder of the appointment and uses pillows to support my legs, a heated table blanket in winter and air-conditioning in summer.

“Also, how he explains things, what he does in terms of the pressure used and any other things I like about my treatments.“

Sam can’t “fix” Katherine’s cancer either. What he has done is provide Katherine with appropriate care, professionalism and respect. Sam hasn’t shown Katherine pity or removed her humanity. It would be simple to lump anyone in the palliative phase of cancer into a basket labelled “Poor Thing” and treat them in a generic manner that ignores the human behind the cancer diagnosis.

“Relaxed, calm, listened to, informed.”

That’s how Katherine described how Sam’s treatments make her feel.

I didn’t know whether Sam had specific oncology massage training when I recommended him (he doesn’t). But I knew enough about Sam to know that he is a client-centred therapist with an evidence-based treatment philosophy. I knew that Sam would treat Katherine, not her cancer. I knew that Sam would listen to Katherine and explain his treatment clearly.

I asked Katherine what she’d say to other cancer patients seeking massage.

“Good massage therapists will be very flexible and will accommodate you and your particular needs. Ask for a range of techniques, including massage chair if that will make you more comfortable.

“It is important to find somewhere you know the therapist is qualified and don’t be afraid to ask them to show it to you. You can get so many benefits from massage if it is done correctly and for me, the results I achieved with neuropathy in even such a short time was quite remarkable.“

Her advice for massage therapists was simple:

“Make sure patients know there are a lot of different techniques and options available to make them feel more comfortable; like knowing they don’t have to lie down, and that there are pillows and chairs available.“

Oh, and:

“Also I forgot: being able to book online for my appointment is a great feature.“

What does Sam McCracken have to say?

“My first meeting with Katherine started with the same greeting I give everyone. I opened the door, smiled and said ‘Hi, I’m Sam’. I guided her to the treatment room and again proceeded as usual in asking ‘so how’s life’. I suddenly became very self-aware that the first question I always ask people could have been highly inappropriate in this instance. While my self-awareness grew in anticipation of her response, she replied ‘life is good’.

“Like many cancer patients I have worked with, Katherine didn’t want me to change, she didn’t want me walking on eggshells around her, she seemed comfortable with a business as usual approach. It allowed us to be anchored in the normal. A safe well-trodden path.”

“Don’t hurt people and consider the role of the nervous system”

Diane Jacobs

“We can inadvertently hurt people simply by not ensuring their comfort.

“It is important to establish a line of communication that lets people feel at ease in asking for a more comfortable position or an extra pillow. Let them feel that nothing is too much trouble.

“All things that can be varied should be on offer. Light, sound, temperature and pressure can all have an impact on the nervous system.”

“Always strive for the opposite of hurt.”

“Ideally, if a person feels comfortable with you, they will tell you what they need, you won’t need to make a fuss or continuously ask them.

“It is important to never lose sight of the fact that we can never play out of tune with primary carers who orchestrate their care. I always ask about their GP and Oncologist and the type of care they are receiving. Always have a discussion about their pain meds and be mindful that they will often be drowsy, nauseous or constipated. Peripheral neuropathy is also a common side effect of cancer meds.”

The Final Word

The author acknowledges the assistance of both Katherine and Sam in writing this article. Two weeks after providing her contribution, Katherine died peacefully at home. Her aunty is really sad but also grateful that massage helped her, even if it couldn’t save her.

Further Reading

Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis, Oh, Kim

Case report of a patient with chemotherapy-induced peripheral neuropathy treated with manual therapy (massage), Cunningham et al

Effectiveness of massage therapy (MT) as a treatment strategy and preventive modality for chemotherapy-induced peripheral neuropathy (CIPN) symptoms, Menendez et al

About the Author

Sharon Livingstone is a massage therapist in Sydney, NSW. A love of sport drew her to the industry but discovering job satisfaction came from helping people live with less pain keeps her in it. Sharon is a writer, keen bushwalker and frustrated traveller who is also a coffee snob.