Patients on palliative or hospice care all have a primary diagnosis. In hospice care, this is also known as the terminal diagnosis. The terminal diagnosis helps us to adjust our massage session in a manner such that the session is safe for the patient. For example, we adjust both the pressure and the direction of our strokes for any patient with a terminal cancer diagnosis, to avoid creating lymphedema in a treated quadrant. But take, for example, the 91-year-old patient for whom we received a hospice massage therapy referral just last week.
The patient’s terminal diagnosis was Alzheimer’s. Had we dug no farther, we might have proceeded with gentle massage to accommodate for the patient’s age and overall condition. But it turned out that this patient also had a history of prostate cancer. The cancer was long ago and none of the family or staff thought to mention it. The patient’s treatment history included radiation to a significant number of inguinal lymph nodes. And so suddenly, we had a new accommodation that we needed to make for this patient’s plan of care. The most helpful direction of our strokes would be toward the heart, working in proximal-to-distal sections, due to the patient’s cancer history.
Another example (also borrowed from our real-life experience) is an elderly patient whose terminal diagnosis is breast cancer. The patient has lymphedema in the affected upper extremity, and appears to be a good candidate for Manual Lymphatic Drainage. Let’s say you are recently certified in MLD and eager to practice your new skills to help your patient with her lymphedema. But upon reading the patient’s chart, you learn that the patient also has congestive heart failure. Which means that MLD is contraindicated for this patient.
In palliative and hospice care, we often work with very sick people, who are progressively becoming sicker. And it is not unusual for these people to have numerous medical problems which may include cancer treatment histories, diabetes, kidney or liver failure, heart disease, lung disease, and/or deep vein thrombosis histories. It is incumbent upon us to look further than the primary diagnosis in order to create the safest possible session for our patients. Ideally, this means accessing the patient’s medical records. If accessing the medical record is not possible, we need to ask the right questions to prompt patients or their family members to disclose helpful information.
