On The Bleeding Edge of Science

 

Twenty years ago, a friend of mine stopped being able to walk.

It happened intermittently. She’d be fine for a few weeks or months, then collapse. She had intense pelvic pain that doctors couldn’t find a reason for. Some thought she was faking it and sent her to the psych ward, or gave her a catheter without anesthetic “to teach her a lesson.”

No doctor, as far as I know, asked her if she had a history of childhood abuse.

Then came the CDC’s Adverse Childhood Experience study (ACE), a study of 17,000 adults which correlated long-term health outcomes with childhood trauma. It suggested that certain experiences are risk factors for leading causes of illness and death–as well as poor quality of life, including idiopathic pain. Chronic, high-intensity stress in childhood, it seems, can  re-engineer your nervous system, and not for the better.

In my bodywork practice, my biggest source of fascination and frustration is “mystery pain,” often accompanied by “mystery fatigue.” I can get a little obsessed. In trying to solve the problem of why a client is in pain, exhausted, dizzy, depressed, anxious, can’t walk properly, or gets “pins and needles” for no apparent reason, I’ve researched not only musculoskeletal problems, such as injuries, arthritis, disc disease, spinal stenosis and spondylitis, but also adrenal fatigue, chronic Lyme, and any nervous system illness we have a name for, including every type of sclerosis that they thought my friend had, and then ruled out.

And I keep going back to the ACE study. All the TED talks and spin-off studies and New Health Initiatives focus on prevention, which is splendid. But what about people whose nervous systems are already kerflucked? Is there any way to help them?

Answer: I don’t know.

We know the nervous system is plastic; it can be rewired, to a certain extent. We know that PTSD is treatable. Could we develop a protocol in cases of idiopathic pain and fatigue syndrome, otherwise known as Nobody Knows Why I’m Kerflucked?

Because the danger in addressing an undiagnosable problem in a holistic way, is that you may be attacking it at the wrong level. You can’t heal a broken leg by changing your mindset. Too many holistic practitioners make claims that aren’t backed up by research. As a colleague noted when she said, “I don’t know any other massage therapists quite like you.”

So I keep asking questions. I keep reading research. And I keep up my attempts to hack into your nervous system, and tell it there’s no cause for alarm.

The Five Stages of Healing (Bodyworker Edition)

Like a lot of other practitioners, I tend to suffer from bodyworker machismo. I spend my days treating other people’s pain, and ignoring my own. Which is exactly what I advise my clients not to do.

Woman and Snake

Recently, I hurt my foot. The technical description of what I did was tearing the plantar fascia on my right heel, after changing my running gait from heel-strike to ball-strike, and then doing yoga with a calf muscle in spasm. But that wasn’t my experience. My experience was that I got out of bed one day and my foot hurt.

So, for your edification and amusement, here are the five stages of Macho Bodyworker Healing.

1) Denial.

All I need to do is warm up, give my foot a rubdown, and it will go away. Like, in ten minutes. In a day or two. In a couple of weeks. Don’t mind me, I’m walking very slowly today. I’ll just stop running until this gets better. Dammit.

2) Bargaining.

I can’t afford to get this treated. I know all about plantar fasciitis, from that two-year bout with it I had, a decade ago. It’s not THAT bad. I’ll stay off of it for a weekend, roll my feet, wear my arch supports. Do some self-treatment on my gastrocs and soleus every morning, and evening, and several times during the day. See? All better!

3) Desperation.

It’s not getting better. I can’t afford to be crippled for two years, again. I can’t afford NOT to get this treated. I’ll call that Rolfer, what was his name? Brian Stern! He’s expensive, but so what? I’m crippled! My body is my livelihood! I have to keep up with two kids in the Franklin Institute! Help!

(Brian Stern is excellent at what he does. He restored considerable articulation to a pair of malformed ankle joints which were rusted stiff. Also, he is warm, approachable and sympathetic. Don’t you hate it when you go to a doctor, in desperate pain, and you get the sense that you are a boring nuisance to said doctor, and to most of his staff? That’s one nice thing about bodyworkers–most of them genuinely like people.)

4) Resignation.

Okay, that was great. My foot still hurts, though. I’d better do the foam roller every day, twice a day, and some gentle yoga. In fact, I should not skip the yoga even when I stop hurting. Because that’s what started this problem in the first place.

5) Exhibitionism.

All better! Mostly. I can walk right-left, right-left again, instead of thump-drag, thump-drag. I’ll do the foam roller for another week before I resume running. Meanwhile, I’ll describe this process in excruciating detail on my blog, so that others may learn from my foolish suffering.

The Myth of the Chemical Imbalance

by Sujatha Ramakrishna, M.D.

It’s been over a decade now since the pharmaceutical industry started exposing the American public to advertisements such as this one:

In that time I’ve encountered many patients who simply state, “I have a chemical imbalance,” when I ask them what brings them into the office. They don’t want to discuss their symptoms, or the details of their lives. They see a commercial on TV, decide that the description fits, and make an appointment so they can get some medication. Admittedly, these are some very effective advertising campaigns.

Thanks to the miracles of corporate marketing, we now have millions of people in the United States who are convinced that psychiatrists have deciphered the inner workings of the human mind to such an extent that we can add a little serotonin or norepinephrine to a depressed patient’s brain, and presto! Everything will be working smoothly again in no time at all.

If only our work was as simple as poking a dipstick into someone’s head, like a mechanic checking the oil in a car, and pouring a little dopamine in there if we find that they are a quart or two on the low side.

The truth is that doctors don’t really know how antidepressant medications work. We know that they alter the amounts of certain neurotransmitters in the synapses, and we know that they have positive clinical effects, but the exact mechanism of the process remains a mystery. Another rarely discussed fact is that the resulting improvements in mood are neither guaranteed nor permanent. Many patients experience no benefit at all from antidepressants, and even ones who do achieve satisfactory results report that the effects wear off after they have taken them for a few years.

Since psychiatrists are specialists, primary care doctors often refer patients to us after they have prescribed several different psychotropic drugs for them with minimal success, and much of what we do involves adjusting their medication regimen in an attempt to help them achieve remission. Unfortunately, I’ve had many people complain to me that they are tired of being “treated like a guinea pig,” because previous doctors have repeatedly switched them from one drug to another, as if they were conducting experiments on them to find out what worked.

The suffering that these patients endure during their frequent relapses illustrates the problem with believing in myths. In most of these cases, searching for the right mix of medications is a pointless endeavor, because describing their issues as a “chemical imbalance” is a horrible oversimplification. The human brain is not a piece of machinery. It can’t be manipulated and adjusted by a physician according to standardized specifications, as if it were the engine of a car. The biology of psychology is a much more subtle and intricate process than that. When human beings use their nervous systems in certain ways, it causes some neuronal connections to strengthen, while others are weakened. As an analogy, think of how people learn to play sports. The first time that someone throws a football, kicks a soccer ball, or swings a baseball bat, he or she might not be so great. With many repetitions, the neural pathways in the brain and body which are responsible for these acts of coordination become stronger, and the person’s performance improves.

While emotions and moods are different from motor activities, they are nevertheless functions of the nervous system, and the same principles apply. Being happy makes it more likely that a person will be happy in the future, because those neural pathways become strengthened over time. Unfortunately, sad people also tend to continue to be sad, and if the downward spiral progresses it eventually leads to clinical depression. It is theorized that the long-term administration of psychotropic medications somehow alters these pathways, and that those structural changes, rather than the the initial chemical changes, are what result in the relief of psychiatric symptoms. This is why it generally takes several weeks for the medications to start working when they are first prescribed. It’s also theorized that these drugs wear off after a certain period of time because the brain eventually reverts back to its original state, through a process resembling homeostasis.

More permanent changes in the brain can be achieved through other forms of treatment, such as psychotherapy. This is why mental health practitioners rarely, if ever, prescribe drugs as the only form of therapy for patients with active symptoms. Drugs can provide patients with a boost in mood, enabling them to work on the issues in their lives which resulted in their depression in the first place, but unless the underlying problems are addressed they will come up again when the medication effect wears off. A good counselor provides an objective voice, as opposed to a depressed patient’s inner voice of doom, and can help a patient come up with realistic ways to change his/her outlook or behavior that will eventually result in positive and long-lasting changes in his/her brain structure. Changing oneself for the better is commonly known as “personal growth” or “maturity,” and it is not achieved through ingesting chemicals. As with riding a bike, it takes time and practice, and once you learn you never forget.

There are many valid reasons that people want their symptoms to be managed with “meds only.” These include no time for therapy, no insurance coverage, and no interest in sharing their innermost thoughts and feelings with a therapist. However, if patients take psychotropic medications but opt out of other parts of their prescribed treatment plan, they rarely if ever achieve a full recovery. This is something that is left out of the drug-company advertisements, but it’s something that anyone who has ever taken antidepressants needs to know.

Big Healthcare and Cheesecake

I always get a little giddy when a new article by Atul Gawande appears. The latest, in which he compares the quality control and cost efficiency at the Cheesecake Factory with that of Big Healthcare, does not disappoint:

The neurologist, after giving her a two-minute exam, suggested tests that had already been done and wrote a prescription that he admitted was of doubtful benefit. Luz’s family seemed to encounter this kind of disorganization, imprecision, and waste wherever his mother went for help.

“It is unbelievable to me that they would not manage this better,” Luz said. I asked him what he would do if he were the manager of a neurology unit or a cardiology clinic. “I don’t know anything about medicine,” he said. But when I pressed he thought for a moment, and said, “This is pretty obvious. I’m sure you already do it. But I’d study what the best people are doing, figure out how to standardize it, and then bring it to everyone to execute.”

This is not at all the normal way of doing things in medicine.

I’d strongly recommend that you go read the whole thing. There are so many things to discuss that it’s hard for me to pick one. But in answer to the biggest and most obvious question–why aren’t best practices standardized in modern healthcare?–I offer this theory: Because doctors, by and large, are smart and ambitious people. And smart, ambitious people vigorously resist rule by committee.

That is not at all what Gawande or the Cheesecake Factory are suggesting. But in order for best practices to be evaluated and implemented within a large, complex system, communication has to be far more nuanced and, ironically, less hierarchical than has ever been the case in human history. One of the more fascinating parts of the article is his description of a successful interaction between a remote monitoring facility and a suspicious doctor:

Half an hour later, Hayes called Mr. Karlage’s nurse again. She hadn’t received the orders. For all the millions of dollars of technology spent on the I.C.U. command center, this is where the plug meets the socket. The fundamental question in medicine is: Who is in charge? With the opening of the command center, Steward was trying to change the answer—it gave the remote doctors the authority to issue orders as well. The idea was that they could help when a unit doctor got too busy and fell behind, and that’s what Hayes chose to believe had happened. He entered the orders into the computer. In a conflict, however, the on-site physician has the final say. So Hayes texted the St. Anne’s doctor, informing him of the changes and asking if he’d let him know if he disagreed.

Hayes received no reply. No “thanks” or “got it” or “O.K.” After midnight, though, the unit doctor pressed the video call button and his face flashed onto Hayes’s screen. Hayes braced for a confrontation. Instead, the doctor said, “So I’ve got this other patient and I wanted to get your opinion.”

Hayes suppressed a smile. “Sure,” he said.

When he signed off, he seemed ready to high-five someone. “He called us,” he marvelled. The command center was gaining credibility.

Notice: this is not an authoritarian system. This is negotiation by persuasion, using facts, mutual respect, and good manners.

Woo hoo.

So How The Hell Do We Do That???

As some of my wise friends point out, changing the face of healthcare is a quixotic proposition. It’s all very well to saythat your doctor should be prescribing more massage than painkillers, that insurance should cover it, and that everyone should be insured.

But as we all know, our broken healthcare system makes far more money by selling drugs and high-intervention treatments to sick people than by investing in low-intervention therapies that keep them well. Too many people have their livelihoods bound up in the status quo. It’s not just difficult to get a man to understand something, when his salary depends upon his not understanding it; it may well be impossibleUpton Sinclair was an optimist.

So where do we start?

This is funny. Ha. Ha.First of all, like the global economy, our healthcare system is grossly overbalanced. Premiums are rising faster than our ability to pay for insurance, high rates of unemployment mean that more and more people are getting pushed out of employer-funded healthcare, and an aging population is using up more and more healthcare resources. Those who still have jobs and insurance are able to remain in denial, but the system as it stands is unsustainable.

buckyfuller

Second, our society is changing in some fundamental ways. Communication is infinitely easier, faster and more varied than at any time in history. There are a lot of smart, underemployed people with time on their hands, and highly sophisticated communications devices in those hands.

As the healthcare system slowly collapses under its own weight, there’s a lot more motive and opportunity for alternative practitioners to set up shop, and for desperate and disillusioned clients to try them. Due to the lack of a cohesive, non-exploitive alternative system (Massage Envy: even the name is bad karma), alternative healthcare practitioners have to be entrepreneurs, if they want to earn a decent living. And good entrepreneurs know that you live or die by the number and quality of your relationships.

Because of these factors, there’s a lot more scope for new healthcare paradigms gaining influence and visibility through lateral connections, like network marketing, rather than the top-down corporate capitalism model, which requires huge investments up front.

Therefore, Bucky Fuller’s ‘better model’ is building itself as we speak. As people lose their insurance, or see their premiums rise, they’re forced to take responsibility for their own health. As network marketing reaches more and more people, they will be savvier about how they choose a practitioner, and what healing modalities work for them.

At the same time, Big Healthcare is trying to save costs by cutting payments to practitioners. Mainstream healthcare practitioners will have less and less incentive to hitch their wagons to a system which is giving them less and less, and more incentive to look around for another model.

And there it will be. People like Atul Gawande are out there backing up their common sense advice with research and documentation. Practitioners who collaborate, develop skills and market effectively will have a wider range of influence over cultural thinking about healthcare. And people getting screwed by an insane system will have both the motive and means (through relentless communcation) for demanding change.

Any questions?

After the Fall

Recently a new client, Susie M., booked a four-session package sight unseen. “When I read about your ankle, I knew you were the one for me,” she said.

Susie sprained, and possibly broke, her right ankle four years ago. There was some confusion as to whether there was a bone chip floating around in there or not; what was certain was that she hadn’t been able to work out since. The ankle was chronically swollen and painful even after four years of treatment, including physical therapy and six months of myofascial release. Doctors had given her steroid injections to ease the swelling, but these did nothing but cause burn marks at the injection site.

As soon as I started work, I noticed that the anatomy train leading from her swollen ankle, up the right peroneal compartment, threading through her hip, and crossing the body to her left shoulder was bunched, knotted and compressed. There were so many adhesions in her right peroneals that I suspected the swelling was almost entirely a result of impaired circulation. Muscles and fascia don’t operate independently of the circulatory system; if they are compressed, they’re compressing everything around them.

After her first session, Susie declared, “I think you released more in one session than happened in six months of myofascial release.” She reported sharp pains in her left leg, hip and groin during the next few days, but on her next visit the swelling in the right ankle was 80% gone. She kept coming regularly as things unwound, and every week there was a different issue to confront, but ankle pain was not one of them. After four years, she was able to go back to the gym.

This re-confirms a long-held observation – that if one part of your body is injured, the trauma doesn’t just stay in one place. The body quickly redistributes strain to deal with it, but once the original injury heals, your body is still out of balance. This imbalance can then create a whole host of other problems unless it is addressed.

(“Confusion,” oil on linen, 36″x 48″, 2008 by Stephanie Lee Jackson, www.stephart.com

The Body Remembers

I am so thankful for the treatment that I received!!! I walked in the office a horrific mess, and Stephanie showed her concern and learned what the issue was that I was having and in four short weeks, my body responded to the gentle, yet firm work that she was putting into it.  My recovery was felt within the first visit, and continuously improved with each visit.

—Camille A., on Yelp.com

thornsivy

More than a year ago, Camille was struck by a car while she was crossing the street on foot. Most of the impact was sustained by her left hip. She underwent a plethora of treatments at the time, and reduced her pain to almost nil. Then one afternoon she ‘turned her head the wrong way,’ and it all started up, worse than before.

When Camille first came to me, she was stooped at nearly a 60 degree angle. She couldn’t lie prone with her back straight; she couldn’t lie on her back at all. She was in continuous pain in all positions. and I was concerned that she had problems outside of the scope of my ability to treat.

But she’d been to chiropractors, MDs and physical therapists, and the most recent chiropractor recommended massage. So I worked on her in the most non-invasive manner possible, adjusting positions to compensate for her pain. The entire left side of her body was in an extreme state of spasm, particularly her left piriformis and adductor muscles.

After her first session with me, she felt some relief, and decided to book a Crisis Intervention package. I didn’t find evidence of active trauma, such as inflammation, a slipped disc or scar tissue, so I simply encouraged her spasming muscles to calm down.

And ultimately, this seemed to be all that was required. By the end of her treatment, she was moving normally, the spasming had ceased, and she was nearly pain-free.

As I told Camille (and as I wrote to her lawyer, at her request), my belief is that she was suffering from post-traumatic stress. Memory of trauma is actually stored in our cells until it can be safely released; sometimes the smallest twitch is all that is required to re-activate the signal.

What does this mean, for clients and for therapists? Well, the good news is that it’s not permanent. Over time, and with patient engagement, the tissues will literally ‘release’ both the memories and the pain.

But at the same time, it’s important to remember that not all pain can be resolved by actively ‘fixing’ a problem. Some treatments, such as drugs and surgery, can make it worse. All too often, people take a hammer to a problem that merely needs a bit of unwinding.

Physician Heal Thyself

Piriformis_muscle

Image via Wikipedia

–guest post by Sujatha Ramakrishna, M.D.

Having a family full of doctors can be such a mixed blessing. Most physicians are aware of the pitfalls of being related to someone who knows way too much about every little ache or cough.

When I was a fourth-year medical student interviewing for residency positions in psychiatry, I met up with the department chair at UT Southwestern in Dallas, whose wife was also a physician. I guess he must have gotten bored with the usual interview questions, or perhaps he took one look at my transcript and decided there was no way was he accepting me into his program, because the discussion took a personal turn.

He asked me what it was like having two physicians for parents, and hinted that certain issues had arisen over the years with his own children. My response was simply, “Well, when I was a kid, and I got sick, they either didn’t care at all … or they totally freaked out.” He just about died laughing at that one. It must have sounded incredibly familiar to him. Perhaps that answer meant that I would have gotten accepted into his program after all.

Now I am a grown-up shrink, and I still have a family full of doctors who provide ample advice, both solicited and unsolicited, for every ailment imaginable.

A few months ago, I got up quickly after sitting in an awkward position on the edge of my couch, and I thought that my right leg was asleep. Well, walking it off, of course, was the solution. Only … whoops! I had foot drop. For those of you who don’t know, this means that when you try to walk your toes drag the ground. Flashback to those med school classes, trying to remember what that meant. Was I having a stroke? A compressed nerve? Hysterical paralysis?

Med school was 20 years ago, as was my last neurology rotation, so of course I had no idea. But I knew that Google would save me … hmm … “damage to the peroneal nerve.” Ok, that sounded reasonable.

But wait, it wasn’t so simple. I also started having twinges under my right seat bone, with radiating pain down the back of my thigh and around to the front of my lower leg. Not good. I had to cancel a trip to Texas, because I had been planning to drive but couldn’t sit for that long.

That’s when all hell broke loose.

My mom the family practitioner called me up, and suggested all sorts of narcotics and muscle relaxants that I could take. She said that if I came down to Texas my sister the radiologist would get me a free MRI. My cousin the orthopedic surgeon asked me if I had back pain, and wanted to know the positional nature of the symptoms.

My aunt the pathologist told me that the real problem was that I needed to acquire more padding on my ass, and suggested having a mojito to get that process started ASAP. As a side note here, one of the really wonderful things about belonging to an Indian family is that you get updates on how much weight you have gained or lost every time you see them, even if the scale says that you haven’t gone up or down 2-3 pounds in the last five years.

My uncle the vascular surgeon, after having a few scotches at that same gathering, started off with a recommendation for a nerve removal, assuring me that yes he had done neurosurgery rotations back in the 1970s (!) and finished with the brilliant idea that a total leg amputation would be a more permanent solution and also earn him more money.

My father the emergency room physician had the most practical advice of all, which was simply, “Don’t drive to Texas.” Words to live by.

Fortunately, another cousin of mine and her husband are physical therapists. I showed them where it hurt, and they immediately said, “Aha! Piriformis!” I said, “What???” We either hadn’t learned about that one in anatomy class, or I had forgotten. More likely than not the latter.

Basically, the problem was a tight muscle which was compressing the nerve. They showed me a stretch that would relieve the tightness — sitting on the floor with my knees bent, crossing the right leg over the left, and using my left hand to pull my right knee towards my left shoulder.

Soon the party at my cousin’s house turned into a mini-yoga class for everyone, which was hilarious but also more therapeutic than any advice that I had received from any of the physicians. I did the stretches that they showed me every morning, and I haven’t had a problem with that nerve since then.

Obviously I am lucky to have such a caring family, and their intentions were nothing but the best. But this story is a great example of how maybe we doctors are too quick to turn to pills, diagnostic equipment, and the knife in every situation. When those things are not indicated, we have few other resources to fall back on.

Back in the old days, doctors didn’t have all the fancy tests that we have now, so they had to spend a lot more time listening to and observing the patient in order to make their diagnosis. You might even say that the close personal relationships which they had with their patients were their best diagnostic and therapeutic tools. We could all use a lot more of that these days.

When to See a Doctor

Know your anatomy!You wouldn’t think people would ever get their massage therapist confused with their M.D., would you? You’d be surprised.It’s touching and flattering, how often I am asked for my input on potentially serious medical conditions. Possibly this is due to the fact that 1) I see a lot of people in varying degrees of pain, uncertainty and confusion, 2) I ask probing questions, 3) listen to the answers, and 4) read continually. Finding news of effective treatments for the conditions that plague my clients is one of my joys. I learn as much from them as they learn from me.

However, it ought to be staggeringly obvious that I am not a doctor. Massage and bodywork can be excellentsupplemental treatments for all manner of ills, but they should never be a substitute for comprehensive medical attention. When you have a diagnosis, I’m happy to tailor your session to support your treatment plan, but I know my limits. Here are some of the symptoms that will cause me to refer you for a check-up before I’ll see you again.

  • You have areas of unexplained hypersensitivity, or severe numbness. Since I work on a lot of people, I’m familiar with the range of pain sensitivities in healthy people. If you’re flinching when I touch you lightly in a place that shouldn’t hurt, if you have no feeling in a major limb, or if you insist that I ‘go harder’ when I’m working deeply in an area which should be sensitive, I want you thoroughly checked by a neurologist.
  • You have severe constipation over a long period of time. I once had a client who wanted two-and-a-half hour sessions to address her chronic constipation, but who categorically refused to see a doctor about it. “What could a doctor do?” she asked me, seemingly rhetorically. “Check you for diverticular disease and colorectal cancer,” was my response. It would be irresponsible of me to continue treatment until these possibilities have been ruled out.
  • You have unexplained swelling or bloating in your extremities. “It will go away on its own,” is often what my clients report hearing from their doctors. But if the swelling has no obvious cause, I think you should be tested forheart, liver or kidney problems.
  • You have a suspicious-looking mole on your back. One minor service I provide for my clients is keeping an eye on areas of the body that they don’t normally see. Most people know to visit a dermatologist if they have anirregular mole that changes appearance; if you’ve got one on your back, I always ask if you’ve had it looked at.
  • You suddenly start having migraines. Many of my clients have suffered from migraines for years; they find that regular massage can reduce the frequency and severity of their episodes. But if you’ve never had a migraine before, you should see a doctor before getting a massage.

A doctor’s job is often to do triage in an emergency; my job, as I see it, is not to ‘fix’ a problem, but to facilitate healing over the long term. Massage is less like a drug and more like a tonic–it stimulates the immune system, the parasympathetic nervous system, the endocrine system and the musculoskeletal system to balance and repair themselves. The subtle connections among seemingly disparate systems and processes fascinate me. My clients never have to worry that they’ll bore me, telling me their aches, pains, worries, triumphs, or last night’s bizarre dream. But they also know that they can count on me for the occasional blast of common sense.

Why Practical?

So why did I decide to name my massage therapy practice ‘Practical Bodywork’?

For entirely pragmatic reasons, of course.

On the West Coast, where I got my training, everybody names their businesses things like ‘Soul Harmony,’ and gets away with it. On the East Coast, this is openly mocked. I wanted a name that I could pronounce in front of a loan officer without cringing.

More importantly, I wanted to emphasize my conviction that taking excellent care of yourself on all levels–physical, mental, emotional and spiritual–IS practical.

What is impractical, in my view, is waiting to address your health until you have an incapacitating problem, then going to a doctor. This doctor may spend 8-15 minutes examining you, then order expensive diagnostic tests, which your health insurance (if you have it) may or may not pay for. Then a treatment is prescribed which may or may not alleviate your symptoms.

What you usually don’t get, unless you have a truly extraordinary doctor, is: a place where you can talk about everything that bothers you, no matter how long it takes or how seemingly trivial; a treatment environment that relaxes you, instead of sending your nervous system into ‘fight or flight’ mode; uncritical acceptance; and most of all, a treatment that feels incredible and nurtures you on multiple levels.

I am not suggesting that massage therapy is a substitute for medicine. Habitual self-care simply reduces the need for medicine.

This may seem obvious, except that on so many levels, ‘self-care’ is perceived as either self-torture (low-fat diets, punishing exercise, teetotalling) or self-indulgence (spa treatments every week.) My practice is founded on the notion that self-care is just that–listening to what your body needs, and providing it.

Much hoopla has been spouted by the media in recent years, touting the ‘holistic’ approach. In many places it has come to be seen as a synonym for ‘flaky.’ When I am working on a client, however, it is self-evident that she must be treated as a whole. I can’t work on her musculoskeletal system without affecting her nervous system, her immune system, her circulatory system and her myofascial system. Treating these systems has a profound effect on her emotions, her thoughts and her energy level.

People are infinitely greater than the sum of their parts. I do my best to address and honor that.