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 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.

MLD, Modalities, Oncology Massage, Thoughts on the profession

Absolutely Maybe

I have spent the weekend at a conference doing one of my favorite things — talking to other nerds about nerd things. The weekend started with discussion of the adaptations of lymphatic drainage protocols for specific types of plastic surgery, and ended with speculation on the titles of our future TED talks.

Mine is: “The Metaphor is Everything.”

But that’s not what I wanted to talk about today. Today I want to talk about certainty. Or, more accurately, capital-C Certainty.

Photo by Pixabay on

The end of the first day of the conference featured a panel of super smart guests, ready to talk about their particular view of oncology massage. It was a house tour of the neighborhood where you’ve always wanted to live — a chance to peek into the day-to-day lives, the medicine cabinets, and the private closets. (Metaphor. See what I mean?)

The first speaker made an entrance. She strode out from the wings of the stage and solemnly said her name and her specialty, then went on to spend her allotted time sharing images and stories of her work. I found the images and stories fascinating. I found her approach challenging.

After she introduced herself, she talked about the specific training she received, similar to mine, as it turns out, and talked about the danger of deviating in any way from the tenets and protocols of that training.

Here is where I admit that I have been deviating from the tenets and protocols of that training pretty regularly. I have a whole new kind of clientele — young, healthy people recovering from plastic surgery. For them, the exact protocol is often not as effective as some critically reasoned deviations.

I found myself becoming more and more uncomfortable as she spoke. She has been doing this a long time. She has gotten great results with some really challenging cases. She knows what she is doing. She is certain of it.

That is what made me uncomfortable. The certainty of it.

There are so many things in this profession that we were “certain” of — that massage increases systemic circulation, that mechanical pressure can change certain body tissues from solid to a more pliable gel, that we should never touch people who have cancer. Thank goodness enough open-minded, curious, smart people have challenged these and other certainties and proven them mistaken. Because of these people, who were uncertain, we can reach more people and provide much better care and education about these bodies we live in.

Certainty is a hard stop. It is the period at the end of a sentence and “The End” written at the bottom of the page. Certainty freezes us in time. I don’t want massage therapy to become dusty and desiccated like those life-size dioramas that used to terrify me at the Natural History Museum.

Photo by Pixabay on

We are, like the bodies we work with, living and growing. We may be educated, we may be experienced, we may be confident — but I hope, for own future growth and the benefit of our clients, we never become certain.

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

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.

MLD, Modalities

What is Manual Lymphatic Drainage?

I have letters after my name which are sometimes confusing: CMLDT. This stands for “Certified Manual Lymphatic Drainage Therapist,” and it is one of my favorite modalities.  Manual Lymphatic Drainage (MLD) is vastly under-utilized.  I am making it one of my goals for the coming year to introduce this work to a broader audience.

MLD is a gentle technique designed to increase the movement of fluid through the lymphatic system.  The lymphatic system is our waste removal system, transporting fluid from spaces between body tissues into the cardiovascular system for delivery of nutrients and removal of wastes.  The lymphatic system also serves immune system functions. 
MLD has a number of applications.  Most people hear about it in reference to cancer treatment where lymph nodes are removed and the risk for lymphedema is increased.  MLD is certainly a powerful part of lymphedema treatment and prevention, but it has many applications for everyone.
For example, MLD was initially developed by Dr. Emil Vodder and Estrid Vodder as a method of treating the chronic colds displayed by English visitors to their clinic in Cannes.  Their techniques showed dramatic successes, relieving colds and sinus congestion almost immediately.  I have also seen this effect with clients who use MLD to manage chronic allergy-related sinus congestion. 
MLD Is also effective as part of the treatment for whiplash, injury-related swelling and post-surgical swelling.  The techniques are so gentle that they can often be applied very early in the healing process, even before traditional massage techniques can be used.  
MLD can also help with management of chronic illnesses such as fibromyalgia, chronic fatigue syndrome and rheumatoid arthritis.  In addition, people who suffer migraines or sinus headaches often find relief with MLD.  
My clients report that the experience of MLD is profoundly relaxing.  Even a brief, 15-minute head, neck and face treatment can help alleviate overall tension and stress.  I have also noticed decreases in post-workout swelling and recovery time if a client receives MLD right after a training session.  
In short, MLD can benefit you, right now.  I’d love to tell you more about it, and talk about how you can incorporate this work into your overall wellness plan.