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Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Acquired Immune Deficiency Syndrome Description: viral infection that progressively destroys normal functioning of immune system Cause: infection by human immunodeficiency virus (HIV) via contact with infected blood or body fluids Signs and Symptoms – Initial primary infection phase: flulike symptoms such as fever, fatigue, headache, muscle pain, sore throat, diarrhea, enlarged lymph nodes, rashes (appear 2-4 weeks after infection) – Next phase: often asymptomatic (can last up to 10 years) – Full-blown AIDS phase: opportunistic infections, unusual cancers, enlarged lymph nodes, weight loss, fatigue, night sweats, fever Risk Factors – Unsafe or unprotected sexual practices – Sharing needles in intravenous drug use with an infected person – Receiving contaminated blood via transfusion – Born to HIV-positive mother Medical/Surgical Treatment: no cure; antiviral therapy Massage Therapy Cautions and Recommendations – Wear gloves and avoid open wounds on client. – Avoid massaging if you have an open wound. – After contact with blood/body fluids, immediately scrub the site of exposure with disinfectant solution and report incident to medical service. – Treatment regimen must be individualized; presentation may vary among clients and between each of their visits. – Inquire about medications client may be taking and research side effects. 1|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Anaphylaxis Description: severe, systemic allergic reaction to an antigen in a previously sensitized individual on subsequent exposure to the antigen Cause: allergy Signs and Symptoms – Difficulty breathing, hoarseness – Itching, redness, and swelling – Nausea, vomiting, abdominal cramps, diarrhea – Tightness in chest Risk Factors: exposure to hormones, enzymes, pollen, food, insect venom, vaccines, local anesthetics, antibiotics, diagnostic agents Medical/Surgical Treatment – Avoiding known antigens – Skin testing before use of new topical substance – Administration of adrenaline – Oxygen administration, intubation, tracheotomy Massage Therapy Cautions and Recommendations – Get allergy history from every client. – Eliminate known antigens from massage room. 2|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI – – Test small area of client’s skin with massage oil for allergic reaction. Becomes an emergency and can be fatal if not treated promptly Anemia Description: abnormally low level of hemoglobin in the blood Causes – – – Dysfunction in production of red blood cells (aplastic: tumors and radiation; dietary deficiencies: protein, iron, vitamin B12, folic acid) Blood loss Destruction of red blood cells (hemolytic) Signs and Symptoms – Fatigue, listlessness, irritability, inability to concentrate – Pallor Risk Factors: see Causes Medical/Surgical Treatment – Depends on cause – Well-balanced diet and iron supplements (dietary anemia) Massage Therapy Cautions and Recommendations – Use gentle pressure for clients with bleeding disorders. – Be careful not to introduce infection. – Consult physician before massaging client with aplastic anemia. 3|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Angina Pectoris Description: form of heart disease characterized by a shortage of oxygen to the walls of the heart, due to an inadequate blood supply Causes – – – Narrowing of coronary arteries by atherosclerosis (classic) Spasm of coronary arteries (variant type) Abnormal oxygen demand (aortic stenosis, hypertrophy of heart) Signs and Symptoms – Recurring episodes of pain over chest or posterior to sternum, lasting for a short duration – May radiate to the shoulder, arm, jaw, other areas of chest Risk Factors: family history of angina, hypertension, obesity, smoking, diabetes mellitus, stress, sedentary lifestyle, high blood cholesterol levels Medical/Surgical Treatment – Weight reduction, dietary changes, increased exercise – Medication to dilate systemic veins and coronary arteries and reduce heart rate and contractility of heart; aspirin therapy – Surgery: angioplasty, stent implantation, coronary artery bypass grafting Massage Therapy Cautions and Recommendations – If angina attack occurs, raise client to sitting or standing position and call for medical help. – Avoid extreme fluctuations in temperature if using hot or cold packs. – Ensure that the client has the prescription drug handy during massage therapy session. 4|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Angioedema Description: allergic skin reaction characterized by localized excess fluid under the skin, often occurring in association with urticaria (hives) Causes: allergic reactions, infections, systemic diseases, and physical factors that lead to release of chemical mediators from basophils and mast cells Signs and Symptoms: skin reaction is transient and appears as a red, edematous pattern on the skin, varying from a few millimeters to many centimeters Risk Factors: see Causes Medical/Surgical Treatment – Treatment is based on cause. – Oral antihistamines, drugs that block release of chemical mediators by mast cells – Epinephrine, corticosteroids Massage Therapy Cautions and Recommendations – Record client’s allergens. – Be aware that heat, cold, or pressure may trigger condition. Look for skin turning red and edematous along lines of massage strokes; condition can predispose to anaphylaxis Arrhythmias 5|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Description: changes in the normal rate or rhythm of heartbeat Causes – – SA node dysfunction, usually associated with hypothyroidism, advanced liver disease, hypothermia, acute hypertension, and typhoid fever Defects in impulse conduction Types: sinus bradycardia, sinus tachycardia, conduction defects (heart blocks), atrial and ventricular premature complexes, flutter, fibrillation Signs and Symptoms – Fatigue from cardiac output, dizziness, fainting (bradycardia) – Irregular heart rate (flutters and fibrillations) Risk Factors: see Causes Medical/Surgical Treatment – Implantation of a pacemaker – Antiarrhythmic drugs – Defibrillators Massage Therapy Cautions and Recommendations – Call for medical help when client with history of arrhythmia exhibits dizziness, palpitation, fainting – Avoid area of implanted pacemaker; avoid environmental factors that could interfere with pacemaker (e.g., cell phone) Atherosclerosis Description: buildup of plaque in inner walls of arteries Cause: buildup of fatty substances, cholesterol, calcium, cellular waste products, and fibrin in inner walls of arteries Signs and Symptoms – History of thrombosis, angina, myocardial infarction, stroke – Hard and thickened superficial arteries – Edema and discoloration of skin; gangrene Risk Factors – Males over 35, postmenopausal women; African Americans – Smoking, oral contraceptives, high blood cholesterol levels – Hypertension, diabetes mellitus, obesity, sedentary lifestyle, stress, type A personality, family history Medical/Surgical Treatment: changes in diet; exercise; cholesterol-lowering drugs Massage Therapy Cautions and Recommendations – Consult client’s physician; record client’s medications and history. – Beware of danger of dislodging a thrombus. 6|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI – Cyanosis Description: blue discoloration of skin and mucous membranes from increased deoxygenated hemoglobin in blood Causes: two types—central and peripheral – Central: congenital heart defects that result in mixing of venous and arterial blood in heart; any condition that results in less oxygen reaching pulmonary blood vessels – Peripheral: slowing of blood flow to a region Signs and Symptoms: bluish tinge in lips, fingertips, nail beds, ears, and tongue Risk Factors: see Causes Medical/Surgical Treatment: depends on cause Massage Therapy Cautions and Recommendations – Use heat application and massage for cases caused by reduced blood flow to periphery from temperature changes. – Massage is contraindicated if tissue damage has occurred as a result of exposure to extreme cold. – Obtain clearance from client’s physician before massage if cyanosis is due to other causes. Edema 7|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Description: collection of excess fluid in intercellular spaces of body Causes: pressure in blood vessels (capillaries) becomes higher than pressure of fluid between cells, as a result of blood flow blockage, capillary dilation; lymphatic obstruction; reduction in plasma proteins Signs and Symptoms: swelling, pitting, pain, heaviness Risk Factors: see Causes Medical/Surgical Treatment – Depends on cause – Diuretics used for some forms Massage Therapy Cautions and Recommendations – Learn cause of edema first, as some causes may contraindicate massage. – Elevate and support edematous limb to aid drainage. – Lymphatic drainage – Passive and active joint movements after massage Heart Attack Description: death of myocardial tissue from arterial blockage, resulting from insufficient blood flow in coronary arteries Cause: insufficient coronary blood flow due to thrombosis (blood clot), vasospasm, or increased oxygen demand by myocardium Signs and Symptoms – Abrupt onset of suffocating, squeezing, crushing pain below sternum or radiating to left arm, jaw, or neck – Nausea, vomiting, indigestion, palpitations, restlessness, anxiety Risk Factors: atherosclerosis, cigarette smoking, hypertension, abdominal obesity, excessive stress, high intake of saturated and trans fat, lack of exercise, depression Medical/Surgical Treatment – Drugs to reduce thrombosis, pain, spasm of arteries, and blood coagulation; oxygen inhalation; angioplasty; aspirin – Rest from aerobic exercise for 6–8 weeks Massage Therapy Cautions and Recommendations – If client shows symptoms of heart attack, assist to sitting position and call 911. – Avoid stimulatory or painful techniques; perform gentle relaxation massage. 8|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI – Heart Failure Description: syndrome in which heart is unable to adequately respond to body’s demands Cause: damage to heart muscle from coronary artery disease and heart attack; mechanical disturbances; rapid heart beat (atrial fibrillation); hypertension; leaky valves Signs and Symptoms – Damming up of blood in venous circulation, causing edema in legs or sacral region and enlargement of liver and spleen – Fluid collection in abdomen; pressure in pulmonary circulation, pulmonary edema – Difficulty breathing, coughing with blood and phlegm, drowsiness, muscle weakness Risk Factors: see Cause Medical/Surgical Treatment – Identification of underlying pathology needed before treatment – Diuretics and low-salt diet Massage Therapy Cautions and Recommendations – Position client seated or reclining. – Do not try to reduce edema or perform lymphatic drainage. 9|Page Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI – Perform relaxation massage of short duration, with short segmental strokes. Hematoma Description: localized mass of blood that collects outside blood vessels, either within an organ or tissue, or inside a space or potential space Cause: trauma; bleeding disorders; surgery Signs and Symptoms – Swelling and discoloration (if superficial) – Acute pain from pressure of blood on nerve endings – May persist for weeks or months Risk Factors: bleeding disorders Medical/Surgical Treatment – Can be drained early in process – Bleeding stopped by pressure or surgical ligation Massage Therapy Cautions and Recommendations – Avoid massage and stretching in acute and healing stages. – Employ ice application and elevation. – Perform friction and fascial massage to reduce adhesions in scar tissue (after healing). – Perform passive range-of-motion exercises in joints (after healing). Hemophilia Description: hereditary bleeding disorder resulting from absence of a specific clotting factor in blood Cause: genetic lack of clotting factor VIII or IX Signs and Symptoms – Mild, moderate, or severe abnormal bleeding – Formation of large hematomas in muscle or under skin with mild trauma – Bleeding into joints, causing severe pain, swelling, permanent joint stiffness – 10 | P a g e Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Risk Factors: family history of disease Medical/Surgical Treatment – Avoidance of drugs that reduce coagulation (aspirin) – Blood transfusions, factor VIII/IX concentrates Massage Therapy Cautions and Recommendations – Encourage clients with large hematomas to consult a physician. – Elevate limb and apply cold to stop bleeding. – Do not massage in severe cases; use superficial, light strokes for mild form. Hypertension Description: condition in which systolic and/or diastolic blood pressure levels are consistently elevated beyond normal ranges Cause: acute brain lesions that raise intracranial pressure; alterations in endocrine function and hormone levels; vascular disorders Signs and Symptoms – Typically asymptomatic; may be associated with early morning headache in back of head or neck – Heart failure, kidney disease, atherosclerosis, aneurysm, angina, retinal changes, stroke Risk Factors: African-American descent, family history, advancing age, high salt intake, obesity, excess alcohol consumption, stress, and use of oral contraceptives 11 | P a g e Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Medical/Surgical Treatment – Relieving stress, managing diet, regular aerobic exercise, weight reduction – Diuretics, anti-adrenergic drugs, vasodilators, angiotensin-converting enzyme inhibitors, calcium channel blockers Massage Therapy Cautions and Recommendations – Lymphatic drainage and full-body massage help reduce blood pressure – Avoid painful or stimulatory techniques, which may increase blood pressure Hypotension Description: condition in which blood pressure is lower than normal Cause: reduction in blood volume resulting from fluid loss or depletion; inadequate sympathetic nervous system activity Signs and Symptoms – Dizziness or fainting when getting up from a lying position or when changing posture Risk Factors: vomiting, diarrhea, or blood loss, antihypertensive drugs, diuretics, diabetes, prolonged bed rest, aging, disorders of the autonomic nervous system Medical/Surgical Treatment – Cause is treated – Increase in salt intake – Drugs that mimic effects of sympathetic nervous system – Avoidance of drugs that cause hypotension Massage Therapy Cautions and Recommendations – Clients with severe postural hypotension should be massaged in seated position. – Caution all clients to get up slowly from lying down. Lymphoma Description: cancer originating in lymph nodes and other lymphoid tissues Cause: unknown; may be caused by viral infection Signs and Symptoms – Painless swelling of lymph nodes, tonsils, adenoids, liver, or spleen – Nodes feel rubbery – Pressure on areas surrounding nodes; anemia; weight loss; fever; lethargy; fatigue 12 | P a g e Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Risk Factors: infection by the Epstein-Barr virus, immune deficiencies or autoimmune disorders, exposure to certain agricultural chemicals Medical/Surgical Treatment – Radiation and/or chemotherapy – Use of cytokines and antibodies to direct an immune reaction against cancer Massage Therapy Cautions and Recommendations – Refer client with symptoms of lymphoma to physician. – Consult physician if client is under treatment. – Avoid excessive pressure. – Because the client is immunosuppressed, do not massage if you have an infection. – Use ice packs in areas that have bled or bleed. Systemic Lupus Erythematosus Description: chronic autoimmune inflammatory disease Cause: unknown; considered to be autoimmune because of presence of antibodies and immune complexes that affect multiple body systems Signs and Symptoms – Imitates signs and symptoms of many other diseases – Cycles of exacerbation and remission; joint pain – Chronic joint inflammation – Butterfly-shaped rash over nose and cheeks (acute type) Central nervous system deficits; enlarged lymph nodes Risk Factors: women, especially those of childbearing age; genetic predisposition; triggered by UV light, chemicals such as hair dyes, certain drugs, some types of food, and various infectious agents 13 | P a g e Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Medical/Surgical Treatment – No cure; symptoms treated with nonsteroidal anti-inflammatory drugs and steroids Massage Therapy Cautions and Recommendations – Perform whole-body relaxation massage, avoiding inflamed areas. – Employ passive joint movement. – Use friction to reduce adhesions. Varicose Ulcers Description: chronic ulcers in leg Cause: sluggish flow of blood in legs in individuals with varicose veins, making skin prone to injury and delaying healing, thus resulting in ulceration Signs and Symptoms – Slow ulceration in medial aspect of leg in a person with varicose veins, accompanied by edema – Often follows infected injury to leg with varicose veins – Hardened, edematous, discolored skin around ulcer – If superinfected: redness, heat, swelling, pain Risk Factors: see Varicose Veins Medical/Surgical Treatment – Treatment of varicose veins – Proper cleaning of ulcers and antibiotics to prevent superinfection Massage Therapy Cautions and Recommendations – Elevate client’s leg above level of heart. – Use deep, slow effleurage and kneading to reduce edema. – Use deep friction around ulcer to soften area and improve circulation. Varicose Veins Description: abnormally dilated and tortuous veins of lower legs or other areas Cause: prolonged dilatation and stretching of vessel walls, making valves incompetent and resulting in backflow and stagnation of blood in veins of lower legs Signs and Symptoms – Pain or ache in lower legs, especially when using them – Progressive heaviness of leg on prolonged standing – Edema, tortuous veins, ulcers (chronic type) 14 | P a g e Information about Pathology of the Immune System and Lymphatics and CardioVascular System Roberta L. Wolff, LMT, LMTI Risk Factors: occupations or activities that require prolonged standing; women; pregnancy; obesity; genetic predisposition Medical/Surgical Treatment – Elastic bandages, stockings, exercise programs (mild case) – Surgery (chronic or severe case) Massage Therapy Cautions and Recommendations – Use light, local massage with leg elevated to move blood and lymph toward heart. – Local massage is contraindicated if client has twisted, hard veins with ulceration and edema, due to risk of thrombosis. 15 | P a g e