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Touch. Careful, calming, confident touch soothes the mind and the body. Where has touch gone in modern medicine, especially for the terminally ill? What shifted the focus from “caring for the sick” to “treating disease”?1 Was it understaffing? Heightened technology? “Professional distancing”?
Fortunately, hospice care has shifted the spotlight back on the patient, strengthening the family network and making it safe to share hopes and fears about death and dying.
Massage is establishing a foothold as a critical piece of hospice. It has received widespread acclaim from staff, patients and families in the human hospice setting.2,3 Responding to a survey, one patient noted, “[Massage is] the only time I can relax completely” … it “reduces spasms and makes me feel good.”
Gaining Ground
Massage is gaining recognition as a reliable way to reduce pain, medication requirements and isolation.4 End-of-life patients who regularly receive massage become more peaceful and comfortable.5,6 It alleviates constipation and encourages the elimination of metabolic end products from tissue.7,8 It also benefits circulation, relaxes muscle tension, settles the nervous system and relieves psychological strain.9 With aromatherapy, massage reduced both anxiety and depression for up to two weeks after the intervention in a study published in the Journal of Clinical Oncology.10
Dying can be lonely, frightening and painful. Humans regard pain as one of the most fearful aspects of dying;11 what they want is to spend time with family and friends, have pain well controlled, breathe comfortably, maintain dignity and self-respect, have peace with dying, be touched, avoid strain on loved ones, and side-step the need for artificial life support.12
Massage can and should become routine in hospice care.
One group noted, “Incorporating a five-minute massage of hands or feet into a schedule of nursing care should be within the capabilities of all palliative care nurses.”13 Regular hands-on treatment yields important opportunities to detect precipitous declines in quality of life, typically more common in patients with cancer.14 The growing veterinary hospice movement extrapolates principles and practice from the human side to animals.15,16
In veterinary medicine, patients suffering grave prognoses may live in a cage or bed in unmitigated pain for weeks or months. Dr. Robin Downing, who compiled a compelling series of articles on veterinary hospice care,17,18 noted, “Our obligation as veterinary health care providers is to advocate on behalf of beings that cannot advocate for themselves.”19 While medications and subcutaneous fluids may extend lives, sick and dying patients’ emotional, physical and psychological needs for touch and movement frequently remain unassessed and unmet, as often happens in human medicine.20
The Families
Families feel helpless when watching a loved one linger between life and death. A slow gentle backrub or neck massage may coax a dying patient to relax21 and shift the autonomic nervous system from fight/flight to rest/restore. Many clients express eagerness to learn simple and safe massage techniques; acquiring a skill for a treatment that their animals accept allows them to regain a sense of purpose and connection.
Caregivers have something “to do” instead of or in addition to providing more medication when they sense frustration, upset or distress in their terminally ill cat or dog. Learning how to massage appropriately alleviates their fear of touching a sick cat or dog, afraid that they will hurt them.22 Educated about where and how to touch, for how long and with what pressure can go far in removing barriers to physical connection and revitalizing the bond.23 Beset by burnout, caregivers need massage, too—a time of their own in which to relax, receive and recharge.
In addition to massaging one’s own animal, by enlisting the assistance of a veterinarian, technician or hospice worker trained in massage, the caregiver can enjoy an overdue emotional break. House calls made by a hospice volunteer trained in massage or a professional massage provider give families time to unwind while allowing someone else step in to lend support and impart relief on many levels.
The massage practitioner visiting a home or working in a veterinary clinic may also identify environmental sources of stress for the patient such as noise (radio, television, pumps, alarms, loud voices, barking dogs), hygiene and skin-related concerns, patient bedding and mobility issues and previously unrecognized areas of tenderness or dysfunction.24
Medical massage is a particular branch of massage that embodies “a wide variety of modalities or procedures utilized to focus the treatment based on the diagnosed condition,” “performed with the intent of improving conditions or pathologies” following a medical diagnosis.25
“Listening” to the patient through informed palpation and “thinking fingers” lets those who pursue medical massage better detect and interpret heart and respiratory rate, tenderness to palpation, and patient stress levels. Working on a weekly or bi-weekly basis alerts the therapist to increased pain or discomfort, prompting early re-evaluation of the analgesic regimen.
When death seems imminent, or in anticipation of a scheduled euthanasia, clients may ask their dogs’ or cats’ massage therapists to accompany them during the process in order to treat the animal as a means to ease the transition from life to death. This final act of loving kindness leaves a cherished memory in the hearts and minds of those left in this world, reassured that their treasured companions’ first step on the journey to the beyond was made that much more peaceful through massage.
Dr. Robinson, DVM, DO, Dipl. FAAMA, oversees complementary veterinary education at Colorado State University.
FOOTNOTES
1. Ellis V. Strengthening the family unit through the healing power of massage. The American Journal of Hospice & Palliative Care. 1995;12(5):19-21.
2. Byass R. Auditing complementary therapies in palliative care: the experience of the day-care massage service at Mount Edgcumbe Hospice. Complementary Therapies in Nursing & Midwifery. 1999;5:51-60.
3. Demmer C and Sauer J. Assessing complementary therapy services in a hospice program. American Journal of Hospice & Palliative Care. 2002;19(5):306-314.
4. Downing R. The role of physical medicine and rehabilitation for patients in palliative and hospice care. Vet Clin Small Anim. 2011;41:591-608.
5. Polubinski JP and West L. Implementation of a massage therapy program in the home hospice setting. Journal of Pain and Symptom Management. 2005;30(1):104-106.s
6. Hodgson NA and Lafferty D. Reflexology versus Swedish massage to reduce physiologic stress and pain and improve mood in nursing home residents with cancer: a pilot trial. Evidence-Based Complementary and Alternative Medicine. 2012, Article ID 456897. Doi: 10:1155/2012/456897.
7. Gray RA. The use of massage therapy in palliative care. Complementary Therapies in Nursing & Midwifery. 2000;6:77-82.
8. Preece J. Introducing abdominal massage in palliative care for the relief of constipation. Complementary Therapies in Nursing. 2002;8:101-105.
9. Gray RA. The use of massage therapy in palliative care. Complementary Therapies in Nursing & Midwifery. 2000;6:77-82.
10. Wilkinson SM, Love SB, Westcombe AM, et al. Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007;25(5):532-539.
11. Gorman G, Forest J, Stapleton SJ, et al. Massage for cancer pain: a study with university and hospice collaboration. J Hosp Palliat Nurs. 2008;10(4):191-197.
12. Downey L, Engelberg RA, Curtis JR, et al. Shared priorities for the end-of-life period. Journal of Pain and Symptom Management. 2009;37(2):175-188.
13. Buckley J. Massage and aromatherapy massage: nursing art and science. International Journal of Palliative Nursing. 2002;8(6):276-280.
14. Downey L and Engelberg RA. Quality-of-life trajectories at the end of life: assessments over time by patients with and without cancer. J Am Geriatr Soc. 2010;58:472-479.
15. Downing R, Adams VH, and McClenaghan AP. Comfort, hygiene, and safety in veterinary palliative care and hospice. Vet Clin Small Anim. 2011;41:619-634.
16. Villalobos A. Qualify of life scale. Accessed at Veterinary Practice News website at http://www.veterinarypracticenews.com/images/pdfs/Quality_of_Life.pdf on 10-04-12.
17. Downing R. The role of physical medicine and rehabilitation for patients in palliative and hospice care. Vet Clin Small Anim. 2011;41:591-608.
18. Downing R, Adams VH, and McClenaghan AP. Comfort, hygiene, and safety in veterinary palliative care and hospice. Vet Clin Small Anim. 2011; 41:619-634.
19. Downing R. Pain management for veterinary palliative care and hospice patients. Vet Clin Small Anim. 2011;41:531-550.
20. Gray RA. The use of massage therapy in palliative care. Complementary Therapies in Nursing & Midwifery. 2000;6:77-82.
21. Meek SS. Effects of slow stroke back massage on relaxation in hospice clients. IMAGE: Journal of Nursing Scholarship. 1993;25(1):17-21.
22. Gray RA. The use of massage therapy in palliative care. Complementary Therapies in Nursing & Midwifery. 2000;6:77-82.
23. Kutner JS, Smith MC, Corbin L, et al. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer. Ann Intern Med. 2008;149:369-379.
24. Smith MC, Yamashita TE, Bryant LL, et al. Providing massage therapy for people with advanced cancer: what to expect. J Alt Complement Med. 2009;15(4):367-371.
25. Waslaski J. Defining medical massage. Massage Today. 2004;4(6). Accessed at http://www.massagetoday.com/archives/2004/06/03.html on 10-08-12.
