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A Massage Therapists Guide to Pathology, 3rd Ed.

Answers to Review Questions

Chapter 1 Review Questions: 1. What is the cardinal rule for massage and skin conditions? The primary rule for noncontagious skin conditions and massage is: if the intactness of the skin has been compromised in any way, the client is vulnerable to infection. 2. A client has eczema on her hands that is extremely dry and flaky. Does this condition indicate or contraindicate massage? Why? As long as the skin is dry, intact, and not puffy or itchy, atopic dermatitis indicates massage, as long as no open lesions are present. A hypoallergenic lubricant will be useful in this situation. 3. A client has severe ichthyosis that is cracked and oozing. Does this condition indicate or contraindicate massage? Why? This situation contraindicates massage, because the skin has been compromised: cracked and oozing skin is vulnerable to infection. 4. What does psoriasis have in common with cancer? Psoriasis and cancer have a lot in common in terms of uncontrolled replication, and both may be treated with cytotoxic drugs (chemotherapy). 5. When working with a client who is prone to acne, is it a good idea to follow the treatment with an alcohol rinse to remove the oil? Why? Using alcohol to wipe down a client prone to acne after an oily treatment would seem to make some sense because alcohol can cut right through and remove all of the oil from the skin. But the human body has a habit of lashing back from such extreme changes in environment: it will work overtime to replace all the natural oils the alcohol just removed, and more. If a client is concerned about the lubricant, the

best options are to use a water-based lotion instead of oil, or to recommend that they shower with an astringent soap as soon as possible after their treatment. 6. A client has white flakes that cling to hair shafts and do not brush out. What condition is probably present? It is most likely that this client has head lice; the white flakes are the empty shells of the lice eggs, or nits. 7. A client has a raised red ring on the back of his upper thigh. What condition may be present? It is most likely that this client has tinea cruris, or jock itch. Any undiagnosed skin condition contraindicates massage. 8. What should be done with this clients massage sheets? To minimize the risk of contamination of the rest of the laundry, this clients sheets should be isolated and professionally laundered or washed with extra bleach. 9. In what stage of the development of a decubitus ulcer is massage appropriate? Massage is most appropriate as a preventive measure for decubitus ulcers. Therefore, it is best administered before the sores erupt, rather than after, when the risk of infection is very high. 10. In what situation would an open sore be a systemic rather than just a local contraindication? An open sore could be a systemic rather than local contraindication when it is indicative of a systemic disease, as seen with diabetes. 11. Your client reports a small lesion that never seems to get better. What do you think is present? The most likely situation is that the client has a nonmelanoma carcinoma. The most responsible course is to encourage the client to investigate it with his or her primary care physician before scheduling another appointment.

12. What makes acral lentiginous melanoma different from other types of melanoma? Acral lentiginous melanoma is different from other types of melanoma because it appears more often on extremities rather than on the trunk or head; it occurs in younger adults as well as older adults; and it is the most common type of melanoma to appear in persons of color.

Chapter 2 Review Questions: 1. What is the relationship between fibromyalgia and sleep disorders? Fibromyalgia is closely linked to a deficit of Stage IV sleep. Whether this deficit is a cause or a result of fibromyalgia is unclear, however. 2. What does hernia mean? Name three kinds of abdominal hernias. Hernia means hole. Varieties of abdominal hernias include epigastric, paraumbilical, femoral, and inguinal hernias. 3. Describe the differences between tender points and trigger points. Tender points are hypotonic; trigger points are hypertonic. Tender points occur all over the body; trigger points tend to be regional. Tender points are locally painful; trigger points refer pain to distant locations. 4. Where do massage therapists often get osteoarthritis? Osteoarthritis is an occupational hazard for massage therapists, who may develop it at the saddle joint of the thumb because it is easy put too much pressure on this joint if good body mechanics are not employed. 5. Why are women more prone than men to osteoporosis? Osteoporosis affects women approximately five times more often than men, for several reasons: women have lower bone density to begin with; they bear children an enormous drain on calcium reserves; and changes in hormone levels have great influence on how well calcium is added to bone mass. 6. Describe how pes planus can lead to headaches. If the arches of the feet are compromised and the bones lose their rebound capacity, the force exerted by walking reverberates through the rest of the skeleton. This is how flat feet or jammed arches can lead to arthritis in the feet, heel spurs, plantar fasciitis, neuromas, knee problems, hip problems, back problems, headaches, and temporomandibular joint (TMJ) disorders.

7. What kind of muscle spasm serves an important function in the healing process? Muscle splinting is an important protective mechanism. It restricts the injured person from making movements that could cause further injury. The muscles create an effective splint; the range of motion of affected joints is generally very small. The proprioceptors say, you can move this far; no further. 8. Describe several factors that may influence bone density and risk of osteoporosis. Bone density is influenced by initial bone mass accumulated in childhood and young adulthood; calcium consumption and absorption as a mature adult; calcium loss through protein metabolism; availability of Vitamin D; and osteoblast and osteoclast activity as controlled through hormonal secretions; 9. In which stage of healing do soft tissue injuries generally contraindicate circulatory massage? Why? The acute stage of healing in a musculoskeletal injury locally contraindicates circulatory massage because the tissues are busy cleaning up the debris and laying the groundwork for a good-quality healing process. Massage is much more appropriate in the subacute and maturation phase of healing. 10. What does RICE stand for? Rest, ice, compression, and elevation. 11. List the lines of defense against a joint injury. The lines of defense in joint injuries are: muscles, tendons, ligaments, and joint capsule. 12. Define specific muscle weakness. Specific muscle weakness is a situation in which only the muscles supplied by a specific injured nerve root become weak and atrophied; it typically occurs in a short amount of time. 13. Describe the pain-spasm-ischemia cycle.

In a typical pain-spasm-ischemia cycle, an initial muscle injury triggers a spasm to protect the area. This blocks off local blood supply (ischemia), which hurts, which reinforces the spasm, and so on. 14. Describe the differences between strains, sprains, tendinitis, and tendinosis. A strain is an injured muscle. A sprain is an injured ligament. Tendinitis is an inflamed tendon (this usually implies an acute situation). Tendinosis is a chronic situation in which inflammation may have subsided, but the tendon has healed poorly and is vulnerable to repeated injury. 15. Describe the relationship between stress and chronic injury. The hormone most closely linked to long-term stress is cortisol. This is an important and beneficial chemical that helps to limit inflammation and redirects metabolism away from fast-burning glucose and toward slower-burning proteins. This is a fine mechanism for dealing with the threat of long-term hunger or famine, but for people with elevated cortisol who are not suffering from life-threatening food shortages, cortisol systemically weakens all types of connective tissue, increasing the risk of injury and chronic pain.

Chapter 3 Review Questions: 1. What is the difference between spastic and flaccid paralysis? Where in the nervous system does each indicate damage? Spastic paralysis involves involuntary contractures and permanent tightening of muscle tissue; it implies damage to the central nervous system (CNS). Flaccid paralysis involves hypotonicity, and implies damage to peripheral nervous system (PNS) structures. 2. How can a person who has experienced spinal cord damage at C6 still have control of his head and neck? Spinal cord damage interrupts function at the affected level, and everything below it. Motor and sensory function for the head and neck is provided by nerve roots above C6, along with the cranial nerves. 3. Why is massage indicated for Bells palsy, when it is contraindicated for most other types of paralysis? Bells palsy is a flaccid paralysis with sensation left intact. If the underlying cause of the neuritis has been diagnosed to be safe for massage (i.e., not a tumor, Lyme disease, etc.), then massage can keep the facial muscles elastic and the local circulation strong. This sets the stage for a more complete recovery when nerve supply is eventually restored. Other types of paralysis usually involve spastic muscles, which are easily injured, or numbness, which contraindicates rigorously manipulative bodywork. 4. Is postpolio syndrome contagious? Why or why not? Postpolio syndrome (PPS) is not a resurgence of the original polio infection. Instead, it seems to be the result of normal aging combined with the loss of some percentage of anterior horn cells from the initial polio attack. The surviving cells, in spite of, or because of, whatever new synapses they were able to make in the recovery process, are severely overtaxed. PPS may be the result of over-stressed motor neurons. 5. Describe the safest course of action for a client who experiences an epileptic seizure during a massage.

It is inappropriate to try to massage someone who is in the midst of a seizure of any kind. In the event of a tonicclonic seizure, the practitioners job is to make sure the client is safe, call 911 or the local emergency number, and then wait until the seizure has subsided. If a client has a history of seizures, it is perfectly fine to work with him at any other time, although if his seizures tend to come on fast with no warning, the therapist should be alert to the possibility of seizure during an appointment. 6. A client who has multiple sclerosis comes for massage. The therapist performs a rigorous sports-massage type treatment and then recommends a soak in a hot tub. Is this a good idea? Why or why not? Care must be taken not to overstimulate clients with MS, because this can result in painful and uncontrolled muscle spasms. Symptoms also may be exacerbated by heat, so therapists must avoid allowing their clients core temperature to rise by working in an overly warm environment. 7. Can a person who has had chicken pox catch herpes zoster from another person? Why or why not? No: someone who has had chicken pox already carries the antibodies to this virus. Herpes zoster erupts as a consequence of an individuals immune system being taxed, not because of external exposure (unless that person had never had chicken pox). 8. A person with reflex sympathetic dystrophy may have poor circulation and bluish skin in the affected area. Is it appropriate to massage her here? Why or why not? Poor circulation and a bluish color to the skin indicate the dystrophic stage of reflex sympathetic dystrophy syndrome (RSDS). Massage is inappropriate in this extremely painful area, but it may be better tolerated elsewhere on the body. 9. List five types of depression. Major depressive disorder, dysthymia, bipolar disease, seasonal affective disorder, and postpartum depression are the most common types of depression.

10. A client is recovering from a major stroke. What are some of the key criteria on which to base a judgment about the appropriateness of Swedish massage?

The clients general cardiovascular health is a major consideration, because most stroke patients have other circulatory problems. Secondly, hemiplegia is a type of spastic paralysis, which carries specific cautions and guidelines for massage.

Chapter 4 Review Questions: 1. Describe the process of the development of atherosclerosis. A leading theory about the development of atherosclerosis suggests that it begins with endothelial damage (from chronic hypertension), leading to the invasion of monocytes, which then become macrophages. Then the uptake of excessive cholesterol forms foam cells, which leads to the infiltration of the smooth muscle tissue of the artery wall and the development of clots around these deposits. 2. Why are fatigue and low stamina signs of anemia? Fatigue is often the first noticeable symptom of anemia. Less oxygen is available to go around, so muscles wear out sooner, and stamina is nonexistent. 3. Where do all emboli from the venous side of the systemic circuit go? Why? All emboli on the venous side of the systemic circuit go to the lungs. This occurs because the veins in the systemic circuit get progressively bigger until the vena cava pours into the heart. Emboli can easily pass through the chambers of the heart into the pulmonary artery, where the diameter of the vessel now gets progressively smaller and eventually traps the debris as a pulmonary embolism. 4. Name three places arterial emboli can go to cause significant damage. If a clot is somewhere on the arterial side of the systemic system, it could wind up virtually anywhere, except the lungs. The brain, the myocardium, the kidneys, and the legs are statistically the most common sites for arterial emboli to lodge. 5. Heart attacks involve blockages where: in the heart itself, or in the coronary arteries? Heart attacks involve blockages in the coronary artery that supply the myocardium. 6. What is a term for uncoordinated contractions of heart chambers? Uncoordinated atrial or ventricular contractions are called fibrillations. The condition of poorly coordinated heartbeats is called arrhythmia. 7. Why is hypertension called The Silent Killer?

Hypertension has few recognizable symptoms, but the damage it causes is extensive. 8. Describe the relationship between high blood pressure and kidney dysfunction. Hypertension causes atherosclerotic plaques to form in the renal arteries, which are subject to huge blood pressure. This causes reduced blood flow into the kidney, which impairs kidney function, leading to kidney damage, systemic edema, and yet more pressure exerted against vessel walls from that edema. If the problem starts in the kidneys, decreased kidney function is an issue. This is often accompanied by extra release of renin, the kidney-based hormone that regulates some electrolyte balance. Excess renin results in vasoconstriction, water and salt retention, increased edema, increased blood volume, and high blood pressure. 9. Describe how a person may experience any three of the following conditions at the same time: high blood pressure, chronic renal failure, edema, atherosclerosis, diabetes, aortic aneurysm, stroke. High blood pressure is the starting place that leads to arterial damage and atherosclerosis. Weakened arteries may bulge (aneurysm). Excessive pressure damages the kidneys (which can cause systemic edema from fluid retention) and increases the risk of clots that may travel to the brain (stroke). Diabetes increases the risk for all types of cardiovascular disease because of changes in the metabolism of fats and sugars. 10. A client has ropy, distended varicose veins on the medial aspect of the right knee. Distal to the knee the tissue is clammy and slightly edematous. Pressing at the ankle leaves a dimple, which takes several minutes to disappear. What cautions must be exercised with this client? Why? It is most likely that this client has thrombophlebitis or deep vein thrombosis. This client is not a good candidate for bodywork because of the risk of pulmonary embolism; he or she needs to consult a primary care physician immediately.

Chapter 5 Review Questions: 1. What is an allergy? An allergy is an immune system mistake in which the body launches an attack against a stimulus that is essentially nonthreatening. 2. What is an autoimmune disease? Give two examples An autoimmune disease is situation in which the immune attacks some part of the body as though it were a threatening invader. Examples include lupus, rheumatoid arthritis, possibly multiple sclerosis, scleroderma, myasthenia gravis, and several others. 3. What are lymphokines, and what do they do? Lymphokines are substances secreted by immune system cells that help to regulate activity; they are chemical messengers. 4. What type of cell is the primary target for human immunodeficiency virus (HIV)? The primary target of HIV is nonspecific monocytes. The secondary target is helper T-cells. 5. Who is most at risk for getting sick when a massage therapist works with an acquired immune deficiency syndrome (AIDS) patient? Why? The person most at risk for catching a contagious disease when a massage therapist works with a client who has AIDS is the clientnot the therapist. 6. What is the link between chronic fatigue syndrome (CFS) and the central nervous system? CFS has among its features two central nervous system issues: a sluggish hypothalamus-pituitary-adrenal axis, and neurally mediated hypotension. 7. Describe how the inflammatory process causes pain, heat, redness, and swelling.

Vasodilation brings about the redness, heat, and swelling by drawing extra blood to a small area. Pain and itching can be the result of several factors: edematous pressure, damaged nerve endings, irritating pathogenic toxins, and irritating chemicals released by other cells. If the inflammation limits movement, the patient experiences loss of function. 8. What are the dangers of working with a client who is taking antiinflammatories? Anti-inflammatories may change the way tissues respond to stimulus and blood flow. Massage therapists must be especially conservative when working with clients who take these medications, to avoid the risk of inadvertent over-treatment. 9. How is lupus generally treated medically? Why? Lupus is treated to limit symptoms and to try to prevent or slow the progression of the disease. Treatment typically begins with nonsteroidal anti-inflammatory drugs (NSAIDs), then goes to steroidal anti-inflammatories, anti-malarial drugs, and also may employ cytotoxic drugs to limit immune system over-activity. 10. Why are massage therapists particularly at risk for lymphangitis? This condition is an occupational hazard for bodywork professions because repeated immersions of the hands in soapy water may lead to hangnail formation, and drying and cracking of nail beds, in combination with exposure to the pathogens that inhabit even healthy clients skin.

Chapter 6 Review Questions: 1. What is the function of mucous membranes? Where are they found? Mucous membranes trap incoming contaminants and help to expel them from the body with the use of cilia to move the mucous blanket along. Mucous membranes are found in all of the systems that open to the outside of the body: the respiratory, digestive, urinary, and reproductive tracts. 2. How does the structure of the lungs work to limit the spread of infection? The structure of the lungs themselves is well suited for fighting off infection. Each lung has two or three separate lobes, and each of those lobes has smaller separate segments. This isolation of different areas makes it difficult for pathogens to infect the whole structure. 3. Explain the sympathetic/parasympathetic swing that occurs with asthma. When an asthmatic trigger occurs, the bronchioles first dilate (a sympathetic reaction), and then the body overcompensates by sending the bronchioles into spasm (a parasympathetic overreaction). 4. What is the best defense against catching or spreading the cold virus? Keeping the hands clean so they do not transfer virus to a portal of entry (the eye, nose, or mouth) is the best way to prevent the spread of common cold viruses. 5. What is the danger associated with taking broad-spectrum antibiotics just in case? Only a small percentage of colds complicate into bacterial infections, and the frequent administration of needless antibiotics does not improve recovery time, but can contribute to the creation of new and more drug-resistant strains of bacteria. 6. What are the repercussions of having alveoli fuse together, as happens with emphysema? As the alveoli fuse and surface area for gaseous exchange is lost, the emphysema patient has to work much harder to move air in and out of the lungs. Less gaseous exchange means reduced hypoxia. This situation is toxic to brain cells. It also

causes the epithelial walls of the alveoli to thicken into tough fibrous connective tissue, which allows even less diffusion. As breathing becomes more difficult, the respiration rate slows. This leads to even higher concentrations of carbon dioxide in the blood. Hypoxia also leads to spasm of pulmonary blood vessels. All of these factors may contribute to pulmonary hypertension and right-sided heart failure. Eventually the untreated emphysema patient experiences respiratory and circulatory collapse. 7. Why is the prognosis for lung cancer generally so poor? This type of cancer often metastasizes before detectable tumors have grown. This makes it difficult to identify early. Only 20% of all detected lung cancers are caught before they have spread to elsewhere in the body. Approximately 25% of all diagnoses catch the cancer while it is still in the thorax but may be in both lungs. More than 55% of all patients have tumors growing in distant areas at the time of diagnosis. 8. What feature of the tuberculosis bacterium distinguishes it from most other pathogens? This microorganism has a waxy coat (a spore) that gives it many advantages over other bacteria. Ordinary antiseptics and disinfectants are ineffective because it rarely clings to surfaces. Even boiling it is not dependable. The only thing that will always kill Mycobacterium tuberculosis is prolonged, direct sunlight. 9. What happens when prescriptions of antibiotics for tuberculosis (TB) (or other bacterial infections) are not completed as directed? Why is this a particular danger for TB? When patients do not take all their antibiotics correctly, the bacteria may mutate into a form that most drugs cannot affect. In the case of TB, whomever is infected with this new strain will be likewise difficult to treat. This mutation is called multidrug resistant TB, or MDR-TB. 10. Why is cystic fibrosis (CF) associated with a high risk of lung infection? CF usually has its most profound effects on the respiratory system. The changes in mucous membrane function cause mucus in the respiratory tract to become thick, gluey, and difficult to dislodge. This provides a rich growth medium for bacterial infection.

11. What is the relationship between chronic bronchitis and acute bronchitis? Both chronic and acute bronchitis involve irritation and inflammation of the bronchi, but although acute bronchitis is caused by an active infection, chronic bronchitis is brought about by progressive, irreversible damage to the lungs. 12. A client has sinusitis. Her mucus is thick, opaque, and sticky. She has had a headache and a mild fever for several days. Is she a good candidate for massage? Why or why not? This client is not a good candidate for any kind of circulatory work. Her fever and thick, opaque mucus indicate that she is fighting an acute sinus infection. She should pursue this with her primary health care provider before receiving massage.

Chapter 7 Review Questions: 1. Describe how ongoing stress can contribute to digestive system problems. Most of the gastrointestinal (GI) tract problems that respond well to massage are related to autonomic imbalance; when a person is under stress, digestion becomes a low priority. If this state of affairs goes on for a long time, problems develop. The most common disorders of this type are spastic or flaccid constipation, indigestion, and gas. 2. Why is the appendix no longer routinely removed in the course of other abdominal surgery? It has been recognized recently that the lymphatic follicles lining the appendix may help to produce some types of immunoglobulins, so the appendix is only taken out when leaving it in poses significant danger. 3. What is ascites? How can liver dysfunction cause it? When pressure in the portal system increases, plasma seeps out of the veins and lymphatic vessels into the peritoneal space, causing the abdominal distension known as ascites. The bacteria that normally inhabit the abdomen may set up an infection in this fluid, causing spontaneous bacterial peritonitis, a life-threatening infection. 4. Why might someone with ulcerative colitis be at a higher risk of developing colon cancer than the general population? Patients with ulcerative colitis (UC) that involves the whole colon are at significantly more risk of developing colorectal cancer than the general population. This risk goes up significantly 8 to 10 years after diagnosis with UC. The increased risk probably comes about because of repeated damage and healing cycles that give rise to genetic mutations in the colon lining cells. 5. Describe the leading theory behind the development of colon cancer. A leading theory about colorectal cancer is that high-fat foods linger in the colon longer than others, and some of their by-products are carcinogenic. This theory also suggests that diets that are high in fiber cause matter to move through the colon faster and more completely, scrubbing the bowel walls of damaging or irritating materials.

Recent research indicates that insoluble fiber itself may not be the major cancerfighting aspect of eating grains, fruits, and vegetables; it may be the presence of phytochemicals that suppress the malignant changes in colon polyps. 6. What is the difference between diverticula and colon polyps? Diverticula are pouches suspended from the colon; colon polyps are small growths within the lumen of the colon. 7. Most people with gallstones never have symptoms. What finally causes symptoms to occur? Up to 80% of all people who have gallstones experience no symptoms. The only reason a person would have symptoms would be if a stone got lodged in the hepatic duct, the cystic duct, or lower down in the common bile duct. In this situation, the pain is excruciating, and it is referred to as biliary colic. 8. Why are oral antibiotics often ineffective for dealing with a bacterial infection of the gastrointestinal tract? Oral antibiotics often make gastrointestinal inflammation worse, so they are usually avoided as a treatment option. 9. What is a possible cause of ulcers that does not involve the Helicobacter pylori bacterium? Aspirin, ibuprofen, and naproxen sodium all interrupt the defensive aspects of stomach activity. They interfere with blood flow to the mucous membrane, they slow mucus production, and they inhibit the production of bicarbonate. An estimated 10% of all diagnosed peptic ulcers arise from long-term nonsteroidal anti-inflammatory drug (NSAID) use instead of from bacterial infection 10. A client is recovering from a bout with hepatitis A. His skin has a yellowish tone, and the sclera of his eyes is yellow too. What condition is probably present? Is this client a good candidate for circulatory massage? Why? This client has jaundice, an indication that his liver is not keeping up with his needs. He is not a good candidate for circulatory massage until his liver has regained full function.

Chapter 8 Review Questions: 1. Describe the negative feedback loop between insulin and glucagon. When a persons blood sugar gets low, two things happen: he perceives he is hungry, and his pancreas secretes glucagons, a hormone that stimulates the liver to release stored glucose. He eats, his digestive tract absorbs sugar from his meal; his blood sugar rises. This stimulates the pancreas to release insulin to carry the sugar out of the blood and into cells, lowering blood sugar. When levels are low enough, the person gets hungry again, and eats, beginning the cycle all over. 2. Both the autonomic nervous system and the endocrine system are controlled by what structure? The hypothalamus controls many aspects of homeostasis through the nervous and endocrine systems. 3. How can diabetes contribute to heart disease? Kidney disease? Blindness? Diabetes changes metabolism to create a situation in which atherosclerosis can easily occur. Damaged renal arteries plus the excessive demand of extracting sugar from the blood lead to kidney damage. The capillaries of the eyes of diabetic persons can become abnormally thickened, depriving eye cells of nutrition. Diseased capillaries leak blood and proteins into the retina. Microaneurysms can form that also cut off circulation. All of these contribute to diabetic retinopathy. Excess glucose also binds with special proteins in the lens, causing first cataracts, then blindness. 4. What are three symptoms of abnormally low levels of thyroxine? Signs of low thyroxine include: weight gain, fatigue, depression, sluggish digestion, dry skin, poor cold tolerance, and heavy menstrual periods. 5. What are three symptoms of abnormally high levels of thyroxine? Signs of high levels of thyroxine include: goiter, anxiety, irritability, insomnia, rapid heartbeat, accelerated metabolism, sensitivity to heat, weak muscles, light menstrual flow, unintentional weight loss, and protruding eyes. 6. How can hyperthyroidism lead eventually to hypothyroidism?

Treatment for hyperthyroidism that destroys much of the thyroidism often leads to hypothyroidism. 7. Describe the signs and symptoms of a person experiencing a hypoglycemic attack. Signs and symptoms of hypoglycemia include dizziness, hunger, headache, confusion, blurred vision, and a decreased ability to concentrate. Sweating and chills, pallor, shakiness, increased heart rate, and nausea also may occur. 8. Describe how successfully treating metabolic syndrome can prevent other serious health problems. Metabolic syndrome is a predictor for serious health concerns. Interrupting the processes that contribute to metabolic syndrome significantly reduces the risk for diabetes and cardiovascular disease.

Chapter 9 Review Questions: 1. Describe how high blood pressure can lead to kidney dysfunction. Chronic hypertension is a leading contributor to kidney dysfunction because the incessant pressure on the renal arteries and delicate nephrons leads to progressive, if silent, damage. 2. Describe how kidney dysfunction can lead to high blood pressure. Malfunctioning kidneys leads to an excess of fluid, along with potassium, calcium, and phosphorus. Fluid retention, in turn, raises blood pressure, which then puts more stress on the kidneys. 3. Why do people get kidney stones more often in hot environments than in other places? Kidney stones usually form in the absence of adequate fluids. Thus, they are very common in tropical environments, where people tend to lose more liquid through sweat than they replace. Peak months for the diagnosis of kidney stones in the United States are June through August, for the same reason. 4. Why are women more likely to get urinary tract infections (UTIs) than men? UTIs are almost always a womens disorder, because the female urethra is so short and located close to the anus, where bacteria that are harmless in the digestive tract can cause havoc if they gain access to the urinary tract. 5. How can renal failure lead to disconnected symptoms such as itching or mental incapacitation? Because the kidneys have so many functions, symptoms of renal failure affect virtually every major organ system of the body. Rashes and skin discoloration arise from the retention of toxic pigments in the blood. Other symptoms include lethargy, fatigue, headaches, loss of sensation in the hands and feet, tremors, seizures, easy bruising and bleeding, muscle cramps, and changes in mental and emotional states as the accumulation of wastes in the blood affects the brain. 6. Describe the relationship between long-term stress and urinary tract infections.

The relationship between stress and UTIs has much anecdotal support. Living in a sympathetic state may reduce blood flow to the bladder, which in turn may make it more susceptible to infection. However, clinical evidence shows that although stress may aggravate symptoms of UTIs, it has not been proved to cause them. 7. A client complains of transient extreme pain on one side of her mid-back. Her muscles are not particularly tender, and she shows no signs of infection. What condition is likely to be present? It is most likely that this person has a kidney stone. She should postpone her massage until her primary care physician has addressed her pain. 8. A client who is an elderly man mentions that he has been passing blood in his urine. What condition is likely to be present? This person is in the demographic for bladder cancer. Blood in the urine is always a sign that should be followed up with a primary care provider.

Chapter 10 Review Questions: 1. Why is the incidence of advanced cervical cancer a fraction of what it was in the first half of the 20th century? The Papanicolaou test (Pap smear), which was developed in the 1950s, makes it possible to detect precancerous cells in the cervix before they spread. Because of the Pap smear, women can have abnormal cells detected and removed before the risk of malignancy. 2. Is the risk factor profile a very useful guideline for breast cancer? Why or why not? No dependable profile of the women most likely to get breast cancer has ever been developed. Although statistics show slightly higher rates of breast cancer among women with specific risk factors, most women with those factors never develop breast cancer, and many women with breast cancer do not share the risk factors associated with the disease. 3. What are prostaglandins, and how are they involved in dysmenorrhea? Prostaglandins are chemicals produced all over the body, and especially in the uterus. They cause smooth muscle contractions, but they also sensitize the body to pain. Prostaglandins are found in higher concentrations in women who have menstrual pain than in women who do not. 4. Describe how stress can exacerbate menstrual pain. Sympathetic reactions in the body exacerbate uterine ischemia, leading to pain, which reinforces the spasm. The emotional state of dreading the pain and discomfort of menstrual periods can then become a self-fulfilling prophecy: the stress of anticipating an unpleasant event works to make that event even more unpleasant. 5. Under what circumstances may fibroid tumors cause symptoms? Usually fibroids cause no symptoms at all. In very extreme cases, the fibroid may grow large enough to put pressure on the sensory nerves inside the uterus, or press on nearby structures such as the bladder, which can cause urinary frequency, or the rectum, which can cause difficulties with defecation. If they press on the fallopian

(uterine) tubes, they may interfere with pregnancies. They also can cause heavy menstrual bleeding and occasionally bleeding between menstrual periods. 6. How can endometriosis or pelvic inflammatory disease lead to sterility? Endometriosis and pelvic inflammatory disease can lead to sterility because chronic inflammation in and around the uterine tubes can cause an accumulation of scar tissue. This can obstruct the uterine tube to the extent that sperm or a fertilized ovum may not be able to pass through. 7. An elderly client has been diagnosed with prostate cancer. He has opted not to treat it. Is he a good candidate for bodywork? Which modalities, and why? As long as the therapist works as part of a fully-informed health care team, massage may be appropriate for a client with nonaggressive prostate cancer. Techniques should be chosen to fit the clients resilience and to accommodate whatever kinds of treatment options he may pursue. 8. Discuss the relationship between certain hormonal changes that occur in pregnancy and muscle spasm. One of the hormones secreted during pregnancy is relaxin. It loosens the ligaments so that the pelvis is elastic enough to allow the baby to emerge. However, relaxin makes all of the ligaments in the body looser and more mobile. This can cause numerous problems from unstable vertebrae to asymmetric sacroiliac joints. Muscles then tighten to stabilize the joints, causing spasm and pain. 9. Why may it be uncomfortable to work with a late-term pregnant woman in a fully supine position? Being fully reclined allows the fetus to rest directly on the big abdominal blood vessels, which may either limit blood flow to the legs, leading to cramping in the gastrocnemius, or limit blood flow up the vena cava, leading to dizziness and possible unconsciousness. 10. A client has been diagnosed with endometriosis but has no particular symptoms at the time of her appointment. To help with her low back pain, her massage therapist works deeply on the psoas. Within a few hours, the client has sharp shooting pains low in her abdomen and cannot stand up straight. What may have happened?

Endometriosis can cause scarring and displacement of the pelvic organs. It is possible that an ovary was bruised during the psoas treatment. When a client has a history of pelvic disorders, deep abdominal work must be conducted extremely conservatively to avoid injuring any structure that might be out of place.

Chapter 11 Review Questions: 1. Briefly describe the staging process for cancer. What are the labels, and what do they mean? T stands for tumor and refers to the size or number of tumors present at diagnosis. N stands for nodes and refers to the number and proximity of involved lymph nodes. M stands for metastasis and refers to whether the cancer has spread to distant areas of the body. Staging may be further qualified by the use of A and B delineations to allow for differences in patterns of progression. Numerical staging (Stages 0IV) then uses the TNM classification to quantify the progression of the disease.


What are the possible risks of massaging a client who is living with cancer?

Massage risks for a client with cancer center less around the threat of exacerbating the spread of the disease, and more around the challenges presented by cancer treatment options. The cautions for working with someone who has recently undergone surgery include lymphedema, infection, and blood clots; the cautions for chemotherapy and radiation mostly have to do with suppressed immunity and uncontrolled bleeding. Skin damage from radiation is another consideration.


What are the possible benefits of massaging a client who is living with cancer?

Massage can assist in pain control, decrease perceived stress levels, and create a general parasympathetic state through reduced blood pressure and decreased muscle tension. It can improve appetite and the quality of sleep. Perhaps most of all, it provides for a basic human need: nurturing, caring, and informed touch at a time when many cancer patients feel isolated and dehumanized.


Name three external factors that may contribute to the risk of developing cancer.

External factors that may contribute to the risk of developing cancer include chemical or environmental agents such as ultraviolet (UV) radiation, cigarette smoke, or other toxic exposures, as well as exposure to some viruses that either cause or increase the risk of certain types of cancer.


Describe the circular relationship between mental/emotional fatigue and physical fatigue.

Living in chronic stress (mental/emotional fatigue) can throw the neck muscles into an ongoing contraction, leading to physical fatigue. The feeling of always being tired is a self-fulfilling prophecy; the perception that a person is tired causes him or her to move less efficiently, which exacerbates that loss of energy.

6. How have recent innovations in surgical techniques changed the way massage applies to postoperative patients? The rapid development of new less invasive surgical techniques (laparoscopic surgery, laser surgery, and other innovations) is good news for massage therapists, because the risks involved with major surgery are very serious and frequently make doing many kinds of bodywork impractical. Obviously, the appropriateness of massage for someone recovering from any kind of surgery depends on the scope and predisposing cause of the surgery and how much of the body has been affected.


Name two important risks to bear in mind for patients recovering from open surgery.

The risk of infection, especially when coupled with immunosuppressant drugs, is one postsurgical risk. The other is the risk of deep vein thrombosis and pulmonary embolism for a person who is even temporarily immobilized.


A client has a small (5 cm) undiagnosed lump on her upper back. It is dense but not painful and moves slightly on palpation. What is it most likely to be, and what should a responsible massage therapist do about it?

This condition is probably a sebaceous cyst, and poses no threat to the client or the massage therapist. However, as an undiagnosed condition, it at least locally contraindicates massage until the client gets confirmation from a primary care physician that it is a safe condition.