Originally published in Massage Bodywork magazine, August/September 2000. Copyright 2000. Associated Bodywork and Massage Professionals. All rights reserved.
It's a typical day at the oncology clinic. Several patients distractedly thumb through magazines in the waiting room, not really interested in reading the pages. They wait anxiously for consultations and treatments. In one exam room, Susan, a 43-year-old artist and mother of two, receives the diagnosis she did not want to hear - malignant breast tumor. A lumpectomy, chemotherapy and radiation are the recommended course of treatment. In the chemotherapy room, a man sits silently while the nurse adjusts a catheter that will deliver the drugs into his chest. Miguel, 64, a teacher and photographer, has been healthy all his life, but today he is beginning chemotherapy for multiple myeloma. He is anxious and fearful of the side effects. In the psychologist's office down the hall, a woman who just found out she has had a recurrence of lung cancer, cries quietly.
But this is more than just your typical day at the oncology clinic. It's "massage day," and there is a lot going on. Massage therapists and students are busily transforming small exam offices into massage rooms. The crockpots are filled with water to heat smooth rocks from the rivers of northern New Mexico. Therapists will use these stones to massage acupressure points, as well as use them in general treatments to soothe and calm. Sesame and mahanaryan oils are warming in small bowls of hot water. One therapist is preparing a tub of warm water and Epsom salts to soak Miguel's feet. She will then use foot reflexology to help ease his anxiety and nausea as the chemo drugs begin doing their work.
An oncology physician passes one of his patients in the hall. She is pale, has lost weight and walks slowly. He asks her if she will be getting a massage today. Rosanna is a 54-year-old woman struggling with breast cancer and the devastating side effects of chemotherapy and radiation. She is three weeks into her treatment and depends upon her weekly massage session to help deal with the nausea, anxiety, fatigue and other symptoms which often go hand-in-hand with the allopathic treatments most people choose to fight their cancer. Today she is on her way to receive her massage. She gives her doctor a big smile as she tells him, "This is the medicine you should give everybody!" Complementary Therapies
So far Rosanna has received three massages as part of a Complementary Therapy program, a collaborative effort by New Mexico Cancer Care Associates (NMCCA), The Scherer Institute of Natural Healing and Southwest Acupuncture College in Santa Fe, N.M. This program has been ongoing since February 1999 when Dr. Frank Lawlis, psychologist and director of NMCCA's Complementary Therapy program, invited The Scherer Institute (in its 21st year of bodywork education) and the acupuncture school to offer massage and acupuncture to their cancer patients. At that time, massaging cancer patients was just coming out of the closet and into the spotlight, displacing years of fear and contraindications.
Sandy Canzone is the clinical director and instructor of The Scherer Institute's oncology massage program. Canzone brings 22 years of study and practice in reflexology, connective tissue bodywork, massage and Ayurvedic medicine to the program. She recently graduated with a master's degree in acupuncture and oriental medicine.
There are many modalities and techniques which can be used safely, not only to help ease side effects of traditional treatments, but also to boost and enhance the immune system and to empower the client. Canzone has developed a unique bodywork protocol for cancer patients using the ancient techniques of foot reflexology, acupressure points and hot stone therapy. The benefits for the patients are often tangible: lessening of nausea; easing of pain, anxiety and depression; improved appetite; a better night's sleep; even empowerment. Perhaps empowerment is one of the most important benefits. As one patient described it, "I can help activate the healing process."
The rewards for the therapists are many. "My decision to participate in the oncology massage program enabled me to reach through my fear of cancer with the courage to touch what I was afraid of," said one student therapist. Clearly, the staff of the oncology clinic also benefits. How often are they able to see a patient leave with a smile, looking relaxed? This is one treatment the patients look forward to.
Most therapists who work with cancer patients are deeply affected by the experience. Sometimes it may be challenging to stay neutral and support the client in his or her treatment choices. Many people think they would go the "natural route" if they received a cancer diagnosis, rejecting surgery, chemotherapy and radiation. Yet, no one really knows until they come face to face with that dreaded diagnosis. Canzone encourages her students to stay neutral and empower the client, whatever their treatment choice.A Word about Contraindications
Despite the new-found liberation many therapists are experiencing with the lifting of the taboo on massaging cancer patients, it is still crucial to recognize there sometimes are contraindications. For example, a therapist shouldn't work directly on a radiation site or a tumor site. One also should not work an area of lymphedema without special training. Sometimes using heat is contraindicated if the person has high blood pressure or a heart condition. Therapists who wish to work with people living with cancer definitely need to do their research. A good start to learn about guidelines, and about cancer and massage in general, can be found in Gayle MacDonald's pioneering Medicine Hands: Massage Therapy for People with Cancer.1
When beginning to do specific therapeutic work with cancer patients, training and supervision are essential. In addition, it is important to note that every cancer patient is individual and the therapist must adjust to the needs of the patient on that particular day. The protocols described in this article are not recipes. They are by no means for every patient, and in certain conditions may even be contraindicated, but they will give an idea of the possibilities of this work. The Scherer Institute recommends speaking with the oncology physician if possible, and creating a treatment plan accordingly, while always remaining aware of the immediate needs of the patient. Start with the Feet
In her particular protocol for treating cancer patients, Canzone suggests starting with the feet whenever possible. It is an excellent way to help ground and create a feeling of safety for the patient. The feet are also a hologram of the body. The powerful technique of foot reflexology is based on the premise that there are reflex areas in both the hands and the feet which correspond to the body's systems and organs, and that massaging these areas can dissolve congestion and nourish the organs by promoting homeostasis. This technique can be used to begin the bodywork session, or it can be used alone when the patient is receiving chemotherapy.
History suggests that foot reflexology was used by the ancient Egyptians, Chinese and Japanese. Ancient Egyptian cave drawings, dating back to 2330 B.C., depict the practice.2
Even though reflexology has been used for more than 4,000 years, research projects are just beginning to validate the effects from a Western medical perspective. A recent oncology nursing study performed at East Carolina University suggests that foot reflexology can be used to mitigate anxiety and pain for patients with cancer.3
Kevin Kunz, of the Reflexology Research Project in Albuquerque, N.M., said, "There is considerable anecdotal information that the healing properties of reflexology, particularly in recovery, seem to be pretty evident. Obviously all of this needs further research."
There are three theories that explain the effects of reflexology. The energy theory suggests that organs communicate via an electromagnetic field. Reflexology can assist energy to recirculate through blocked electromagnetic pathways. The lactic acid theory suggests lactic acid accumulates as microcrystals in the feet. Reflexology can crush the crystals, allowing for freer flowing energy. The proprioceptive nerve receptor theory looks at it from a nervous system perspective due to the nerve endings in the feet. The relaxation caused by reflexology affects the autonomic response, which will affect the endocrine, immune and neuropeptide systems.4
Canzone starts with a simple warm-up of the feet to get the blood flowing. Patients who are receiving chemotherapy and radiation struggle with high levels of toxicity in their bodies. With these patients it is essential to first work the reflex areas corresponding to the eliminative organs which cleanse the body of toxins - the kidneys, bladder, ureter tubes, large intestine, lungs, liver and gall bladder. The intention is to support the eliminative organs and to strengthen and support the digestive system so the patient can take in sustenance. "This work is all about helping the person to take in sustenance on every level: physically, emotionally, spiritually," said Canzone.
Foot reflexology helps promote homeostasis by bringing the systems into balance. A thorough foot reflexology session can help many of the problems with which a cancer patient may present. An example can be found in one session with Rosanna, who was only three weeks into her chemotherapy treatments and was filled with fear and grief. Everything in her life had changed and she needed a great deal of reassurance. It is important to note that foot reflexology works not only to affect the physical organs, but the emotional body as well. With Rosanna, Canzone worked the lung area of the feet to help with the grief and loss, to release toxins and to take in vital energy. The kidney area was massaged to alleviate the intense fear and to nourish her essence. Working the liver helped move emotional energy and relieved Rosanna's constipation. In her case, the constipation was related to the fact she was often very cold, inside and out. Normal bowel movements depend on enough internal warmth and energy to keep the eliminative systems functioning properly. Massaging the area related to the intestines stimulated and warmed the entire system. Lastly, pressure was applied to the stomach and spleen reflex areas. This diminished Rosanna's nausea and increased her appetite. Working the spleen also helps support the lymph and immune systems.
Another patient, a 70-year-old man with bone cancer, had excruciating neck and shoulder pain. The therapist worked for only 15 minutes on each foot, with emphasis on the neck and shoulder reflex areas and on the areas corresponding to the large and small intestines. In Oriental medicine, the digestive system is often related to problems with the neck and shoulders and with the emotions of worry and grief. After this brief session the pain was greatly reduced and he was able to leave the clinic walking upright. In just a short time, foot reflexology can have a powerful impact on many levels.
Massaging someone's feet is also an effectual way to induce deep relaxation. The simple human contact and support offered through touch is medicine in itself. But during the administration of chemotherapy, especially the first time when the person is most likely terrified, foot massage proves to be a powerful and supportive technique to reduce anxiety and lessen the common side effect of nausea. "Massage in general helps the patient's overall well-being and promotes healing," said Ronda Fleck, a radiation oncologist with NMCCA, "but I see foot reflexology during the administration of chemotherapy to be especially helpful. It makes the whole atmosphere more inviting and helps the patient to embrace their care. I have also seen cases of the patient needing less anxiety medication during chemo."
At NMCCA, therapists first try to soak the patient's feet in hot Epsom salt water, then begin the treatment. It is an effort for the nurses and doctors to make space in the treatment room for all this to take place. Tubs of water on the floor and massage therapists in extra chairs holding and rubbing bare feet create an obstacle course in the chemo room. The staff's willingness to negotiate the hurdles is testimony to their belief in foot reflexology as a powerful and supportive adjunct therapy. They only need look at Miguel's calm face half an hour into his first chemo treatment to realize its value.Hot Stones
Using heated stones to massage acupressure points is an integral part of Canzone's oncology massage protocol. Relaxing hot stone massages, under various names, are now offered at most spas in the country. Many people do not realize, however, that the use of heated stones in bodywork is an old technique. One of the center's cancer patients reported his elderly Chinese acupuncturist in New York's Chinatown used a large heated rock on his abdomen years ago. The acupuncturist told him it was a 2,000-year-old technique from his province in China, used to help the internal organs.
Here in New Mexico, it is known that heated rocks have been used by sobadores and curanderos - the traditional massage therapists and medicine men and women from the Hispanic and Native American cultures. These cultures used hot rocks to treat shock, to ease pain, to help ground and connect to the earth. The grounding effect of the heated stones is understandable. Christine Sherwood of The Scherer Institute in Taos, N.M. has developed a heated stone massage she calls Bones of the Earth', a massage inspired, in part, by Seneca medicine woman Twylah Nitsch's The Language of Stones
. Sherwood said, "Rocks can be generators or movers of energy. They give to a place that is depleted, help move in places of excess." Sherwood's background is not focused on Oriental medicine, yet how interesting that she has discovered similar principles through her experimentation with the stones.
Canzone first used heated stones when her Ayurvedic mentor, Dr. Sri Krishna Kashyap, recommended she apply castor oil and rub a heated stone on a client's bone spur on his heel. The client also worked on it at home and after 15 days the spur dissolved. She continued to explore the use of stones, especially when the patient, because of severe pain and spasm, could barely stand to be touched. She had such positive results with her clients that her husband, David Canzone, Doctor of Oriental Medicine, was inspired to try the heated rocks with his clients. He was finding that although he was using smokeless moxabustion (the burning herbal sticks held over acupuncture points), the fumes were still irritating to him and to some clients. David began to use the hot rocks directly on the points in place of moxa. He now uses the hot rocks, which he calls Roxabustion(R), almost exclusively. He reports the same or sometimes even better results than moxa for many conditions.
There are many properties of the hot rocks which are beneficial for cancer patients. Clearly they hold heat. Heat invigorates blood circulation and the circulation of Qi, life energy, through the meridians. Hot rocks can be very soothing when used in a general massage as they glide over the muscles. They can have a magnetic effect of pulling pain from the body. They break up stagnation and help to consolidate the Qi of the organ systems.
The use of hot rocks on specific acupressure points can have significant results. In Oriental medicine, the kidneys are responsible for one's constitutional vitality and strength. In general, therapists at the cancer center use a hot rock to massage several points on the feet at the start of the session. A good point on the bottom of the foot is Kidney 1. Ki 1, also called "Gushing Spring," helps build the kidneys and calms the spirit.
After a session with hot rocks, the therapist often encourages the client to take a special rock or two to use at home. Canzone laughingly says this causes them to be "rock short" at the clinic. But the rocks can easily be replenished, and sometimes the patients will even go rock hunting themselves or send someone out to find a special rock. Clearly there is a special earth connection that is simple and obvious. Who doesn't find comfort from holding a rock that fits perfectly in hand, and radiates a strength and inanimate wisdom? The massage therapists often share a simple hot rock technique with the cancer patient to do at home.
The ancient stones are more than just effective tools. They represent and bring to the patient "medicine" from the earth that cannot be duplicated. The therapists in this oncology program feel it is important to cleanse the stones with loving appreciation for the work they do - generating and moving energy, calming the spirit and reducing pain.Healing Oils
One's choice of oil is a significant factor in massaging cancer patients. Canzone has found that cold-pressed sesame oil is the best choice. According to Ayurvedic medicine, sesame oil is the most deeply penetrating oil and contains strong healing properties. It is sweet and warming. It nourishes and detoxifies the deepest tissue layers, aids in relieving muscle tension, pain and anxiety, and supports the immune system.5
In some cases Canzone will use mahanaryan oil, an Ayurvedic combination of 31 herbs. This oil has a drying effect due to its energetic properties. It is warmer and more stimulating than sesame oil, and is not to be used when the patient's constitution is hot or if bones are brittle. Mahanaryan oil is not used in a full body massage, but rather in certain problem areas such as muscle spasms, swelling or neuropathy.Acupressure
It is beyond the scope of this article to serve as an introduction to Oriental medicine principles. For therapists who do not have background in acupressure or Oriental medicine, Integrative Acupressure by Sam McClellan is suggested.
For patients receiving a full bodywork session, acupressure and heated stone work are key techniques to accompany foot reflexology. Both chemo and radiation deplete the immune system and rob the body of Qi and substance. One of the main reasons to use acupressure and hot rocks is to strengthen and support the internal organs, to consolidate Qi at the center of the body where the organs reside. This helps the person take in nourishment and be better able to fight the cancer. In cases where the fight is over and the person is dying, therapists at the cancer center then look to support them by reducing pain and anxiety, and simply helping them feel cared for. This work has a therapeutic effect, no matter what stage the cancer.
These protocols can be very beneficial during the weeks the patient is receiving chemo or radiation, and afterward to rebuild the body. During the fifth week of treatment, Kay, another breast cancer patient, developed thrush. Thrush is an oral infection which can occur when the immune system is suppressed. Kay had a recurring case of thrush, and it made it difficult for her to eat. Her white blood cell count and platelet levels were down. Her entire immune system was compromised, as is often the case during chemotherapy. Canzone put together a simple treatment plan consisting of placing an oblong heated stone on Kay's abdomen over Conception Vessel 4,6 points. She used reflexology with special emphasis on the kidneys, digestive system and spleen. While the client was lying supine, acupressure points of focus were Kidney 3, "Great Stream," on the medial ankle; Stomach 36, "Foot Three Miles," below the knee; and Conception Vessel 4 and 6, "Hinge at the Source," and "Sea of Qi," on the Conception Vessel meridian in the lower abdomen. Ki 3, St 36, CV 4 and 6 all help build deep energy and support the kidneys, bone marrow and immunity.
While the client was lying prone, Canzone worked points on the Governing Vessel meridian. The Governing Vessel does not correspond to an organ system, but in Oriental medicine it is considered to be the regulator of the nervous system and of blood flow. It acts as a pressure relief valve, rerouting excess energy to other meridians which are deficient in Qi. She used a hot stone to massage GV 14, between C7 and T1 vertebrae. This point is excellent for stimulating white blood cell production and thus enhancing immunity.
After this session, Kay's thrush cleared up within a few days. Her immunity was strengthened, as measured by the rise in her white blood cell and platelet counts. She was better able to take in nourishment. The therapists continued to use this basic protocol with Kay throughout the remaining weeks of her chemotherapy. The thrush did not reoccur.
This is just one example of a very small part of one patient's struggle with cancer, but it is indicative of the effectiveness of these techniques in helping counteract the serious side effects of chemo and radiation. Even though Canzone's protocols are very specific, her philosophy goes deeper to embrace a wide perspective of the power of touch. "That hour is all about them, their wholeness - not just their symptom, their disease." The quality of touch and the loving energy of the therapist are essential to healing. That quality combined with the potent techniques described here create a powerful medicine. Just the Beginning
With cancer at nearly epidemic proportions in our culture, massage therapists can no longer hide behind the contraindication fallacy. We know better now. The growing numbers of cancer patients need massage therapists to come forward and offer their "medicine hands," as Gayle MacDonald so eloquently names the power of touch. Many may choose not to work with cancer patients, and that is to be expected. It's certainly not for everyone. But for those special therapists who open the door to the world of people who are affected by cancer, there is no doubt they will be enriched. And it is a wonderful opportunity to be at the cutting edge of a field about to blossom.
In the 21st century, when the bridge between allopathic and alternative medicine is solidifying, quantitative research is needed to validate and document results. The Scherer Institute of Natural Healing has yet to initiate formal research projects on the effectiveness of this particular method of working with cancer patients, but hopes to begin such projects within a year. Although research is not currently in place, the anecdotal evidence reported by patients is encouraging. "We have found that our patients have a very high satisfaction with their treatments, which is vital to the success of chemotherapy and radiation, said Dr. Lawlis of NMCCA. "We feel that these approaches enhance the healing capacities of our patients to a significant degree."
But perhaps the words of a person in a life and death struggle with cancer are more compelling: "During my massage I remember why it is I am fighting so hard. I remember why it is I want to live."Lonnie Howard, MA, LMT, is director of The Scherer Institute of Natural Healing in Santa Fe, N.M. Her training has been in bodywork, psychology and the Dreambody work of Arny Mindell and his associates. She helped develop one of the first oncology massage raining programs in the country through The Scherer Institute. She can be reached at the Scherer Institute, 935 Alto Street, Santa Fe, NM 87501; via e-mail at firstname.lastname@example.org; or by calling 505/982-8398.References