January 24, 2011

The MRSA Pot

Sometimes when clients come in the door looking for a massage, they seem a little wary.

They look around the office, check out the sheets, stare at the clock before they go in the room. I've gotten questions about whether I use fragrances in my oils or in the laundry soap. They peer at the board certification, the license, and the credentials. They want to know how long I’ve been doing massage.

“About 16 years,” I say. “Someday I’ll get it right.”

It’s the massage, of course, that will convince them. But the details are important. Is the place clean, neat, up to date. Am I wearing jeans and flip-flops? What about washing hands before I start?

Recently a client came in who’d been to me a couple of times in the last few months, looking for some relief of low back pain. She hadn’t seemed to be real picky, but when she first came in, she told me she wanted to get a “real” massage. I’ve heard that phrase before, and I think I know what it means. No cookie-cutter fluffy stuff, just get the pain out of the back and shoulders.
Just for my own edification, of course, I asked her what she meant. “I want you to find and address the problems so I feel better after the massage,” she said.

As I was working out the troubles, she told me what she’d had before. She had a hard time finding a therapist who was able to and willing to work on the problem areas. When she finally found a therapist, she developed a massive infection on her thigh after a massage.

“It was MRSA,” she said.

Angry didn’t begin to describe how she felt. This client, a very experienced nurse, had worked some of the toughest areas of her hospital for more than a decade and never gotten a MRSA infection.

MRSA is a resistant staph infection that can kill people. It’s a bad word in hospitals, because it’s a sign of poor or inadequate hygiene. Every instance has to be investigated and followed up. A MRSA infection in a hospital means people haven’t been paying attention and following the rules.

This client, of course, had prided herself on never having a MRSA incident at work. Now she had an infection pop up after a massage.

She knew her therapist liked to mix oil and lotion in an open bowl and use it as a lubricant, and assumed that mixture was for her massage only. She called and the therapist admitted she used the same mixture on several clients.

In short, the bowl was a “Petri dish.”

Angry doesn’t quite describe how she felt. It wounded her personal pride in her work, her self-image and the problem was so preventable.

Sure, she could have gotten the MRSA from shaving her legs, and the massage just helped propel the infection. But because her therapist wasn’t following good hygiene procedures, it didn’t matter. That’s why we wash hands, use closed containers and don’t stick our paws into open bowls or jars and later use those same vessels and mixtures on multiple clients. It does matter.

January 18, 2011

Stress Test – Deal with It

We massage therapists often see similarities in our clients, the tight upper traps, the weak glute max, etc. But I must say I’m fascinated by the differences.

Why does one person develop carpal syndrome after three months on a computer, when another person can spend years lifting granite wedges before something goes?

Chief suspect: Stress. It brings it out in us humans, at astoundingly different speeds and with different somatic symptoms. God knows why, and I’m looking forward someday to getting the explanation. I hope it isn’t like the manual that came with my first PC.

Is it something linear and calculable, such as stress times the number of exposures divided by the number of deep breaths and an individual’s underlying sense of optimism or pessimism? [(S x E/1) * DB +/-] Or something like that. I hope not. Math and I don’t get along.

Stress isn’t the only thing, though. It seems as though people under stress have very different ways of dealing with stress and tolerating it. Perhaps the person at the computer has little tolerance for sitting in an office all day, but the granite installer thinks his job is a piece of cake.

Let’s try out a stress test. You and two other passengers are late for your flight, and the airline sits the three of you in the last row of the airplane. On your right sits Ronald Reagan, his heady optimism and faith glowing. You are in the middle seat. To your left, Woody Allen, nervously clutches his good luck charm.

The plane takes off, has some mechanical problem and crashes. All the crew and passengers on board are killed - except the people in the last row.

Ronald Reagan gets up, dusts off his shoulder pads and says “Wow! We almost got killed! What’s for lunch?”

Woody Allen is down for the count, shocked to be alive. “Why did I survive when all these other people were killed? How can I bear this terrible tragedy? I’ll never be the same again!”

Hey, you in the middle seat. How do you deal with it?

January 15, 2011

Get Disability Insurance; and Beware of Falling Pianos

In early November of last year, I was asked to take on a sixth shift due to an emergency. "What emergency?" I asked. "Sandra [another massage therapist] broke her foot in thirteen or fourteen places; it's practically crushed," was the reply. "WHAT? How did that happen?" "Well, she dropped a piano on it."

WHAT? And so what sounded like the plot of a Looney Tunes cartoon (I could practically see Wile E. Coyote with a mouth full of piano keys) was the beginning of a six-week unplanned hiatus for poor Sandra and a really screwy schedule for the rest of us. Undoubtably, though, Sandra suffered most. Her foot was so swollen, she couldn't really even stand on it for at least two weeks. When the swelling when down, a cast was put on, almost up to her knee, and she still couldn't work due to pain. Finally, at about a month into the whole mess, she was almost forced to return to work due to financial needs, and she returned on a knee scooter, which she had to leave outside the room, then hop over to her stool for the session. And after several weeks of that, it was a boot and crutches. Only now in mid-January is she finally limping around in regular shoes on two feet.
The scariest part of Sandra's story is how easily something like this could happen to any of this. I love what I do, but this is the most unsecure profession I've ever worked in in terms of stable finances in the face of health issues. Most massage therapists are not salaried and are paid by the session. Most of us do not have sick days or paid vacation or health benefits, even when we are employees, not independent contractors. Which really sucks. Because unlike someone who does data entry, we cannot work easily with a broken foot. Break a hand or finger or dislocate a shoulder, etc., and we are REALLY in trouble. This potential for financial disaster has really worried me at times, especially since short term/long term disability insurance is not always affordable, and some of us aren't even sure where to start looking for it.
This is why I was glad that our employer at least brought in an AFLAC representative after Sandra's accident. At 40, I know I am no longer ten feet tall and bullet proof, so I was very happy to have the opportunity to get disability insurance. Most of us have heard of AFLAC insurance; it's the one with the annoying duck that pays the suffering policy holders directly so that they can have money for whatever they need most during their trying times. A six-month disability policy for me, I believe, will pay a little over half of my typical monthly salary should I lose a month due to illness/injury. Because we got a group rate I'm paying in the $30 range per paycheck, not the $50 range.
I highly suggest all massage therapists consider getting disability insurance, no matter how young and strong they are, because accidents happen. People slip on ice, get Shingles, have babies (yes, birth and several weeks post-labor constitutes disabililty at AFLAC), and even (YIKES!) drop pianos on their feet. I have a little more peace of mind knowing that if something were to happen, my income might suffer . . . but at least it won't disappear. Best of all, if you leave your massage business, you can take your policy with you at no rate change. And all it takes is a call to an AFLAC representative who will come in, bring lunch, give a staff presentation, and hopefully give you your own extra dose of peace of mind.

January 11, 2011

Scrunches, Wobbles, and Breathless Sumo

The hamstrings tell the tale.

These hamstrings, normally smooth and strong, were developing bumps I associate with adhesions. The bellies of the muscle were like a bit of bad road, dipping up and down with jellied clumps of static muscle tissue even though they were supposed to be at rest.

A monument to adhesions myself, I asked about the workout. The new exercise was feet on the ball, back on the floor, with the butt up and slow knee flexions to work the hamstrings.

A great exercise, for sure, but this had been done with much wobbling and too many reps. The hamstrings had kicked in to provide the stability my client’s spinal column was missing. Now, a few days later, I was feeling the results.

These muscles had overloaded and paid the price. As I worked out the adhesions, hoping to prevent or derail future trigger points, I was trying to figure out how to address what might well turn into body armor – a perimeter of static, overloaded long muscles helping someone work through exercises despite a wobbly, sleeping core.

We tried some pelvic tilts, scrunching the rectus abdominus while breathing out, holding the scrunch while using the diaphragm for three breaths. Rested for three diaphragm breaths, then scrunch. Rested and scrunched. The posterior spinal muscles relaxed and the core woke up.

Core stability is not breathless Sumo. It's an ability to balance one’s weight in the pelvic bowl without sloshing about and tightening the posterior spinal muscles, all the while using the diaphragm to breathe.

When I went home that night I did my tilts and ball squats. It’s always good to practice what my clients teach me.

January 3, 2011

Great Moments in Customer Service

The rain was coming down hard and sideways, an event very unusual for Southern California. After a sticky freeway ride, my 18-minute drive to work took 30 minutes; I pulled into the driveway at my office two minutes late and saw my client huddled in her car.

"Sorry I’m late. What’s with this rain? Where’s my California? And why do people insist on tailgating in the fast lane - with no lights on - in hard rain?"

We were standing on the doorstep with the rain swirling around the brick steps. I put my keys to work. First the deadbolt, then the regular lock. I grasped the handle and felt solid alder wood. No give at all. I was standing with my bag of laundry, phone and my Louis Vuitton bag (a paper bag from the LV store at the mall, Recession chic, which I use as a briefcase.)

“Could you hold my bag? It’s too wet to put down.”

I tried both keys again, and then gave the door a shove. Nothing.

“Could you hold my laundry?”

I gave it another shove, this with a good foot and shoulder into it like an episode of Law & Order. Nothing.

“This is a first for me!” I said cheerfully.

I gave up on the door and asked the client to return to her car while I called the landlord. I shoved my stuff back into my car and sprinted to the next office.

Shivering in the cold, I thought about all my good intentions when I left early from the house. My landlord doesn’t have a key to my office. We went into the adjacent office of the vacationing acupuncturist, and I made my way into the back, through the bathroom we share and to the inside of my office. The deadbolt was stuck on the last bit of the jam. I remedied that and with enough force to pull a Buick uphill, finally swung the door open

After my very understanding client had her massage, I realized I had left the hall light on the acupuncturist’s office. I was going to have to call the landlord again.

It is, at times like these, when I think of my list of “Great Moments in Customer Service”. I think we massage therapists all have them. The double-booked. The forgotten appointment. The wedding party that had booked every room in my spa just before the computer went down and all the appointments disappeared into computer ether, along with the call-back number.

The day I was in the midst of a soothing, relaxing massage and I bumped into the towel caddy table, causing the lamp to fall, loudly, breaking the glass shade and then the bulb popping like a gun.

Or the day I tried a wheat grass shooters at the juice bar just before a 2-hour massage appointment. Shooters indeed. I have never run so fast with my knees stuck together.

Thank heaven people are kind, understanding and in search of relief enough to put up with an ordinary human like me.

As Homer Simpson would say: “D’oh!”