Massage Tales, MLD

Diet and Exercise is Not the Answer

Roberta* has been to several doctors. She is the patient that makes a doctor takes a big calming breath before walking in the room to consult with her. Roberta is relentless, opinionated, and she has articles from websites to go over with the doctor. Lots of them. These aren’t links that the doctor can look at later. Roberta has printed every one out on actual paper, and she puts them into the doctor’s hands. She will not be ignored.

Not this time. Not again.

Roberta woke up one morning and her trousers were all too small. Everything from her hips to her ankles ached, and even a gentle push on her leg was enough to make her gasp. Roberta has stopped wearing trousers. She has a closet full of dresses with loose, flowing skirts. She wears pantyhose, even in summer, because it calms the ache and it keeps her skin from chafing when her thighs rub together.

Roberta’s doctor wants to talk to her about diet and exercise. The doctor wonders if Roberta is being honest about her food intake and suggests that maybe Roberta is overeating due to stress.

And Roberta is stressed. She has been going to this doctor a few times a year for a couple of years with a similar complaint every time, and a handful of internet research. When Roberta got access to her medical records for the year, she sees that every visit, the doctor noted, “counseled about diet and exercise.”

Finally, Roberta broke through and got someone to say the diagnosis she suspected already: Roberta has lipedema.

According to the Lipedema Foundation:

Lipedema is a chronic condition that manifests as a symmetrical buildup of painful fat and swelling in

the arms and legs, sparing the hands and feet. It occurs almost exclusively in women and is poorly understood.

lipedema.org

Lipedema is a disorder of the fat cells, or adipocytes, which commonly affects women. The fat cells swell to an unusual size, and the disorder may be accompanied by lymphatic swelling of the extremities as well. Lipedema most commonly affects the legs and arms bilaterally. Women who have the disorder often have heavy or thick hips and thighs which do not change with diet and/or exercise. It is estimated that about 11% of adult women worldwide have lipedema.

The diagnosis of lipedema can be tricky, as Roberta learned. Many general practitioners may not have heard of the disorder, and their well-meaning advice can have the unintended effect of making a patient feel unheard, confused, and mistrustful. This is the state Roberta was in when I met her.

Many of the suggested treatments for lipedema have to do with managing two of the major symptoms: swelling and pain. Manual Lymphatic Drainage (MLD) is recommended for the management of both these symptoms. Roberta, and others, have come to me for MLD as part of lipedema management.

I find that I am also holding space for the stories that come with lipedema. The healthcare professionals who dismissed, and the ones who listened. The hours of solitary research and the daily life in a body that would not be how it was supposed to be. The aching relief to know that other people know what they are going through. The tearful gratitude for every healthcare professional who listened without judgement, said “I don’t know” when necessary, and helped when it was possible.

About 1 in 9 women may be living with lipedema in some form. Many of them don’t know, they just understand their bodies as problematic, aching, maybe even “deformed.” I urge all of you to have patience, and

believe deep in your soul that you are the expert on your body.

Keep reaching out — there are many healthcare professionals who will validate and support you.

I hope to be one of them.

*– Like all the clients mentioned on this blog, “Roberta” is a composite of several individuals. Identifying details have been changed.

Massage Tales, Oncology Massage, Thoughts on the profession

What Did You Notice?

She’s a climber, a dancer, a multi-sport athlete.* She biked to the clinic and will most likely go to a yoga class on her way home. She eats clean, but she’s not obsessed about it or anything. She will eat a piece of birthday cake or a cookie when she wants to.

She is healthy, and she is doing everything right. I say that every client is the expert on their own body. She is the expert-archetype. She knows her body so well, takes such excellent care of it, that she found her melanoma before it was much more than a spot just beginning to touch the dermis, the layer underneath the top layer of skin.

After the massage, as I hand her a cup of water, she stretches her shoulders and looks at me, earnestly. “What did you notice?” she says.

I stammer for a moment, surprised. What did I notice? She lives so fully and attentively in her body, I wonder why she even wants to know what I might have noticed. It seems more appropriate that she tells me what she noticed, that she educate me on how best to support and care for her.

She looks at me, that direct gaze, with the question still in her eyes. She wants something from me, something that I am not sure I even know how to give. She wants the report card.

Photo by rawpixel.com on Pexels.com

The report card is the after-appointment summary, where the massage therapist lists all the spots of tension, adhesions, tightness, or just plain wrong-ness that they felt in the client’s body. Supposedly, it is a tool to encourage repeat visits and to begin documenting the effectiveness of massage for this person.

I was trained to give the report card after a massage, even though it always felt wrong to me. First of all, every client will have extensive direct experience of their body and how it feels and functions. Even if I work with someone for years, I will only have a fraction of the embodied information each client has about themselves. Secondly, as the provider of the massage, it is my job to receive a report card, not to give one. I’m not here to rank or rate any human body. I’m here to support, to love, and to learn.

She won’t give up, though, this client of mine. It is a quality which makes her an excellent athlete. I suspect she was also a good student, since she seems to be following the same massage training book I was given years ago. That book includes the report card. This box must be checked before we can call the massage complete.

So, what did I notice?

I spread my hands wide. “I noticed your breathing, the rhythm of it. I noticed your pulse as I massaged your hand. I noticed that you move with ease.”

She raises her eyebrows, just a bit, then draws them close together. The vertical line between her eyes quivers a bit as she tilts her head to one side. There will be no demerits, no suggestions for improvement on this report card.

She keeps her quizzical expression as she leaves. I peek out my office door and I see her pause and shake her head at the bottom of the stairs.

I’ll be honest — I’m tired of the assumption that any interaction with a health care provider or wellness professional ends in a list of instructions on how to be a better, more complete human. I’m tired of leaving every doctor visit, massage appointment, or acupuncture treatment with a list of where I went wrong and how to correct it. I think some clients might be tired of that too.

What would happen if we started with the assumption that the human in our care is already complete? What if we also acknowledged that they are the expert on their own experience? And what if, maybe, we led with humility and curiosity, keeping expertise for later, after our client has had a chance to educate us?

What would happen if we threw out the report cards? I hope that on the other side of report cards is a land of real conversation and exchange of information, as equal partners working towards the same goal.

*- This client is a composite of several different individuals. All identifying information has been removed.

Inner World, Massage Tales

Semicolon

Sometimes when I am working with someone, I see that they have a semicolon tattoo. Tattoos aren’t all that unusual, of course. I have three myself. Most of the time when I see a tattoo, I use it mainly as a handy marker to remember where I felt something notable in someone’s tissue.

The semicolon tattoo is different, though. Every time I see some version of it on a client, it reminds me to pause, to take in this human who has trusted me with their body for a time, and to respect the whole person, just as they are, right in this moment.

As you may know, the semicolon tattoo is a quiet message of acceptance and affirmation about suicide, depression, and other mental health issues. Even now, there is often fear and stigma around these topics, or around anything that’s not in the very narrow range of “normal.” When was the last time you had a real and open conversation about the times when you are not feeling all the way okay?

Photo by Dominika Roseclay on Pexels.com

One day, I was working with a new client at the spa. She came in for a “couples” massage with her sister-in-law. It was her first massage. This is not so unusual. Some times friends booked the couples massage because they felt more comfortable with more people in the room – especially if one of them had never had a massage before.

Normally, I dislike couples’ massages. The room is almost always not quite big enough for two therapists and two tables. There is always a point where the room temperature switches from comfortable to barely-able-to-breathe. And, in my experience, most of the people who get couples’ massages have no interest in considering regular massage to support their health. I only did them rarely at the spa.

This client, however, felt different to me. I’ll call her Kelly -*. Kelly answered my questions so quietly that I had to lean in and ask her to repeat herself several times. Her smile was warm and her eyes were on the edge of apprehensive. As the other therapist and I left the room, we heard Kelly’s sister-in-law give her detailed instructions on how to get on the table and where to put her clothes (something I had just done.)

I don’t know the exact thing that made me tune in with more attention when I met Kelly. For lack of a better word, I’ll call it tenderness. There was something tender and lightly shielded about her. Plus, I always feel a little protective of clients who are getting their first massage. It’s a vulnerable experience.

Kelly’s sister-in-law and her therapist chatted for most of the massage. Normally, this would have distracted me for the whole hour, but as I cradled Kelly’s feet, I noticed she had a small semicolon tattooed on her ankle. It caught my attention and helped me tune out everything in the room except Kelly and me. This human. Right now. Who deserves my time, my attention, and, yes, my caring love.

I am grateful for the semicolon tattoo, and for what it represents. I am grateful for the way it reminds me to come back to the present moment and just be with this person. I am grateful that there is a quiet way to acknowledge that some of us (all of us, if we’re honest) will struggle to maintain this life sometimes. I am grateful that Kelly did.

*- “Kelly” is a composite character based on several different client interactions.

Massage Tales, MLD

The Right Thing. The Sick Feeling.

I had a new client today. This person saw my card on the crowded Community Board at a local coffee shop and actually called me. He had a serious and extended conversation with me about the type of massage I do and where I got my training.

Once I got over my initial shock that someone actually (a) saw my card and (b) called me, I sank in to the process of interviewing and being interviewed by a potential new client. He asked appropriate questions, offered information about his own experience with massage, and generally did all the things that dispel any creepy vibes. We scheduled an appointment for later in the week.

Photo by Mikechie Esparagoza on Pexels.com

I asked him, as I always do, to tell me more about the specific reasons he was seeking massage. He deferred, said the problem was “embarrassing” and that he would rather talk about it in person. I decided not to press him and to wait until his appointment to get more information. And then I made sure two or three friends knew exactly when this new client was coming to my office, and that other people would be in the building while I was there.

I will say now that everyone leaves this story safe, and with their essential trust in human nature intact.

He arrived on time, filled out the paperwork and sat down with me to talk about his health history. He described his current discomforts with candid detail. He answered my questions and listened to my answers to his questions.

He started talking about everything that his condition altered in his life. I felt the frustration in his voice, and my compassion reflexes kicked in. This person is in pain. Witness this. Listen. Honor this experience. Be in service to this human.

And so he asked me the question, “Will this help me? Will this fix the problem?”

And I had to answer him honestly. “I don’t know.”

We talked a bit more and settled on what we both felt would be true — that if nothing else, this could be a time for his body to relax. That felt like enough. I let him get settled on the table and I started the session.

I should mention here that the work we agreed on — manual lymphatic drainage — is gentle work. There is no smashing of muscles or kneading of tissue. It involves rhythmic stretching of the skin that is so gentle it can be done after surgery. It is the kind of massage that one of my clients calls “petting butterflies.”

We discussed this, or I thought we did. I even demonstrated for him (on my arm) how manual lymphatic drainage looks much different than massage. I reminded him that this was his session, and we could switch to massage during the session if he felt like it would be better for him.

About 20 minutes into the session I noticed he had a confused look on his face. “What’s on your mind?” I said.

“I’m just not sure, I mean, I’m not sure this is working.”

I stopped what I was doing. “Okay,” I said, “What would you like to do?”

“I guess, I don’t know, I mean, you’re the professional, right?”

This is where I paused to take a deep breath and save my rants for later. Just because I went to school for a thing and have practiced it for many years does not mean I get any kind of agency or ownership over anyone else’s body. I would like the idea of the expert who also takes a client/patient’s agency to be extracted from every health care interaction everywhere, all the time.

I am the professional, I agreed, and I reminded him that he is the expert on his own body.

Then I got a sense that what he might need was permission. So I said, “Would you like to end the session?”

He sighed and looked at me, relieved. “Yes, I think that would be best.”

He wanted me to be confident and bold in my predictions for what I could do to help. All I could be was honest. He wanted something that he could not articulate, and that thing was definitely was not the type of work I was doing.

It was the right thing to say I didn’t know, to give no assurances where I had none, and to stop working when his mind and body were clearly agitated. We parted on good terms (yes, he paid for the session) and I have no regrets.

Except. There is always the voice from old stuff of the past that snickers in my ear and points at me, laughing, whenever I am not the smartest and most brilliant of them all. She is a persistent little gremlin and I can hear her laughing even as my stronger adult self knows this was the right thing.

I am a human who has chosen work that involves intimate interaction with other humans. There is no way to keep this from reaching in and stirring up all of my stuff. I am reminded, again, today that part of my job is to learn how to balance being an emotional being within the space of my professional work.

Inner World, Massage Tales, On Writing, Thoughts on the profession

Until They Know

The other night, I sat with my partner, talking about life’s work, life’s purpose, and other meaningful things. We have that conversation a lot, both as a way to check in with each other for support and as a way to clarify for ourselves what is truly important. Sitting there, in our middle ages, we stretch forward and reach into what we both hope will be our renaissance.

I was telling my partner about the moment. The moment when I was sitting with a client, presumably massaging them but really being a loving, peaceful presence for them. In that moment, I felt all the struggles and blocks to my creative energy dissolve away. I felt open to receive and translate what ever might come forward. I knew beyond the shadow of a doubt that I was in the exact right place doing the exact right work.

My client that day was frail, small, elderly. My client was also an open fount of love and kindness who never let me leave without telling me how beautiful and sweet she thought me to be. She was exhausted from a restless night and bouts of nausea. She was in extremis. From the outside, it looked like all I did was sit next to her and gently hold her hands.

As I finished telling the story, I tried to find a way to explain the rightness of that moment, to translate it into words that could describe what I want my work to be. Finally, I said:

I’m just here to love on people until they realize how much they’re worth.

And that was it. The exact right phrase. I have found my mission statement for the remainder of my career, and, truly, of my life as a human being.

Photo by rawpixel.com on Pexels.com

In my past, I spent several years in corporate America, and in those years I learned to deeply mistrust the idea of a “mission statement.” To me, it had the association of wasted hours in meeting rooms and whiteboards full of meaningless phrases. It meant a lot of back-patting while everyone settled back into the exact same soul-numbing atmosphere as before. Mission statements, I thought, look nice on annual reports or company-branded merchandise, but in practice they meant nothing.

When I hit on that sentence, though, I also hit on a new understanding of mission statements in general. After the political and religious definitions of the word “mission” in the dictionary comes this definition:

a strongly felt aim, ambition, or calling

dictionary.com

I am not a traditionally religious person, but the idea of a “calling” still resonates with me. The truth is, we humans really are intertwined and connected in ways we don’t quite understand. There is a need in the community that each of us is suited to fill. That need has a voice, which calls out and, I think, it is our job to listen, and, on hearing, respond.


A few weeks ago I started out trying to write a few different posts about relaxing massage, gentle massage, and the underappreciated benefits of both. As with much of my writing, I thought I was doing one thing, but the writing eventually led me to a new (better) place.

I thought I was providing some education about physiology and the mechanisms of massage therapy as I understand them. In fact, I was writing my way into my personal mission statement, the guiding force that all my endeavors must support.


I have a postcard on my refrigerator which I got form an artist at the St. James Court Art Show a couple of years ago. It says: “Don’t become famous for doing something you don’t love.” I get that now, in a way I didn’t get it before.

It’s the love. It has always been the love.

Inner World, Massage Tales, Modalities, Thoughts on the profession

Chicken Skin and Butterflies

“Rebecca, your touch is so gentle I bet you could pet butterflies.” She said this to me as she dropped into the table and let her arms fall away from her body. She breathed deeply and evenly and within a few minutes I could see that she was asleep, or nearly so. At the end of her session, she smiled at me warmly and said she appreciated being able to fall asleep comfortably.

Photo by Anthony on Pexels.com

She reminded me of my time in Thailand a couple of years ago. I studied Thai massage for a couple of weeks — just enough time to confirm that I really know nothing about Thai massage. The teacher used to joke about “elephant skin people” and “chicken skin people.”

Elephant skin people, to him, were those who wanted more aggressive bodywork. They seemed to thrive on the deepest compressions, the most rigorous stretches, and the rough handling of their bodies. He gave a demonstration on one of these people while I was there. The client, a muscled American motorcycle rider complete with leather vest and chaps, groaned and whimpered his way through the session with my teacher. After the session, he got up from the mat, smiling and testing his newly mobile joints.

Chicken skin people, on the other hand, required gentler handling. Their bodies could not take deep work and they often could not move into some of the postures typical of Thai massage. My teacher teased me that I was a chicken skin person. In that, he was (is) completely correct. I do not respond well to aggressive bodywork.

And, as I am starting to fully embrace, I am a massage therapist for the chicken skinned. I feel most connected and at my best with those whose bodies, minds, and/or spirits require gentle handling and a careful, loving approach.

My client, who found such a vivid and lovely metaphor for the way I work, also gave me the perfect ending to this three week exploration of “just a relaxing massage.” I am here to whisper, gently, to your nervous system and let your body sink into its own healing capability.

Inner World, Massage Tales

The Unarmed Opponent

I am doing battle with words and today I am the unarmed opponent.

 

It is a slow time of year for my massage practice, and I am finding myself with long stretches of unstructured time.  The perfect situation to get a little ahead on the blog posts, maybe re-write my website, dig deep into my long-term writing projects.

 

And yet today I faced down my morning pages and all that came out was blather.  Isn’t this the point of morning pages, though?  That is what I told myself, and so I closed the journal and came to the computer hoping all the detritus was out and the good stuff was rising to the surface.

 

I’m looking in the water and it’s still murky.

 

A few days ago I saw a movie with my partner — Ralph Breaks the Internet.  It was silly and goofy and had some really sophisticated moments, like this scene where one of the main characters finds herself in a room full of Disney Princesses.  The Princesses tell her that she needs to look into water and eventually she will spontaneously start singing about her deepest and most desired dream.  It’s a funny moment that pokes fun at the structure of Disney movies.  Last night, I was talking with my partner, and he joked about holding a cup of tea in front of me so I could sing about my deepest and most desired dream.

 

This morning I am here with a cup of tea, doing unarmed battle with words, about to dive into a project that is actually my dream, I think.  And yet no song is forthcoming.  I look deep into the tea cup, and all that comes to me is: “location-independent lifestyle.”

 

Dreams are terrifying.

 

I have built, am building, this massage practice, deeply rooted in the community where I live.  I chose this community after a couple of decades in Chicago, because I thought I could build a long-term life here.  I love my work.  I love my clients.  I even love the alien-looking terrariums my office mate has put all around our space.  But more and more, I am feeling the need to get back on my trampoline.

 

action air balance beach
Photo by Rafael on Pexels.com

For a little while, I had a trampoline life.  I would travel, gather experiences, challenge my comfort zone, then come back home long enough to regroup (do laundry) and then go out into the world again.  It wasn’t always a trip to an exciting international destination, but still, it was getting away to a place where all of my stuff fit into a small bag.  I got so good at packing light and gathering all of what kept me alive.

 

am doing unarmed battle with words because, among other things, I have not ventured out.  I am aware, also, that venturing out is more than physical removal from my home city.  It is taking a chance with my mind as well.  What kinds of new words can I generate if they don’t have the new thoughts to back them up?  

 

My practice is quiet these weeks, the days can be as slow as I want them to be.  I am seeking out mental and physical challenges to re-arm myself with experiences that I can then turn into words.  Eventually, I see this growing and changing into a location-independent lifestyle, happily back on the trampoline.  For now, I am taking these weeks to sharpen up and prepare.

 

I am going to make myself another cup of tea and sing about it.