Monday, October 26, 2020

Update, Refunds & Referrals

It has been a long year.

A lot of you have been waiting patiently. I had clients who didn't read my last post or e-mail and simply wanted the CliffsNotes version, so I'll keep this short:

I am offering refunds of all gift certificate purchases. If you haven't heard from me personally, please check the Contact page for ways to reach me.

When am I reopening? I could not tell you.

Do I want to get back to doing massage? Absolutely.

Why am I not doing massage? Because my conscience and the science says that it is currently not safe to do so.

Regardless, if you would like to continue receiving massage, these are the folks and businesses across the state that I trust to take care of you -- many of whom I've worked with, personally.

Other providers and resources are available here. Contact information should be up-to-date as of this posting, but I cannot guarantee that I will keep up with any changes.

What's next? I don't know. This isn't the first iteration of I Knead Serenity, nor do I believe this is the end of it. While I'm temporarily shutting this set of doors, I'm keeping other doors open for new opportunities.

Thank you for your support. Be safe and be well.

Saturday, May 9, 2020

Hindsight Will Be... 2020

Around the end of April, Maine's Governor, Janet Mills, announced her plan to "Restart Maine's Economy" with a multiphase process of reopening specific businesses and industries over the next few months. With this announcement came the excitement of life returning to some semblance of "business as usual."

For me, however... I'm hesitant to jump on the bandwagon.

The novel coronavirus that is causing the disease COVID-19 has rampaged its way across the world, leaving 275,000 dead in its wake as of this writing. Whenever you hear or see the word "novel," in this context, remember that it is an adjective meaning "new or unusual."

Previous coronaviruses have been or are still in the process of being studied, with researchers finding patterns and being able to predict how they will change and affect those that contract them.

This new, unusual, novel coronavirus has been unpredictable. There is new information almost daily about its disease symptoms, number of strains, how long it survives on various surfaces, and its movements through communities. It is mutating at a rapid rate and it remains unclear if antibodies are preventing reinfections. It is affecting populations both young and old and every age in-between.

There is still so much we don't know.

Perhaps the most jarring development came around April 22, 2020 -- my 32nd birthday: the discovery that people ages 30-60 were dropping from strokes, even when they had seemed otherwise healthy.

A stroke is a cerebrovascular accident caused by interrupted blood flow to one or more parts of the brain. In these cases, we are looking at ischemic strokes -- where the development of a blood clot along an arterial wall (thrombus) blocks the blood flow or a "loose" clot (embolus) travels through the blood stream before getting lodged into too-small a space.

Anticoagulants -- drugs that prevent or limit the blood from clotting -- are useful treatments in the short-term, but can cause bleeding, bruising, and other problems in patients already dealing with a compromised system. Furthermore, the "risk of recurrent stroke is likely to be elevated (and lifelong)." (Tracy Walton's Medical Conditions and Massage Therapy: A Decision Tree Approach, 2011.)

There is a lot more science and research around conditions like pulmonary embolism, atherosclerosis, and deep vein thrombosis -- I couldn't possibly cover all of them enough to do them justice. This is why I rely on current research and the advice of massage industry leaders who have experience in pathology.

Their bottom line: "Any disorder associated with the potential for lodged or traveling clots contraindicates circulatory massage." (Ruth Werner's A Massage Therapist's Guide to Pathology, Fourth Edition, 2009.)

Many patients that test positive for the novel coronavirus are asymptomatic -- meaning, they appear perfectly healthy without a fever, shortness of breath, loss of taste or smell, or other symptoms. Again, we are seeing reports of new and unusual symptoms almost daily.

So where does that leave us?

If we go back to the governor's plan, Maine is currently on-track to reopen massage facilities in Stage 3 -- around July and August, should everything go well. The state is slowly rolling out industry-specific COVID-19 Prevention Checklists. There isn't one for massage, yet, but browsing the considerations for hair salons -- as I've had previous experience working in one -- is overwhelming and disheartening.

I also watched Healwell's free resource of "Back to Practice Guidelines (In Practice)," which is massage-specific.

It's depressing.

As I sat in my office and looked around, I experienced a visceral grief response to all the things I would have to change.

A lot of the little things that made my office into my own little sanctuary are not in-compliance with current infection prevention guidelines. My cloth effects -- the wall hangings and curtains -- will have to come down. Extra knick-knacks will have to be put away or put out-of-reach. I can't have a bowl of mints out on the side table. I need to buy new covers for my table and face rest, along with a HEPA filter. I will have to use more single-use materials, such as gloves -- if I can even find them for purchase. I will have to buy new clothing -- items that button- or snap-up -- and change them between each client. I may have to buy and wear goggles. There's going to be a lot more laundry to be done.

I'm going to have to ask a lot of my clients, too. You will have to wear a mask, even when you are face-down. You may have to walk across a towel or some other floor covering between the chair and the massage table. You might not be able to receive massage to your hands or scalp.

With new policies and new procedures, do I have you fill out digital forms or paper forms?

With all of the extra, new expenses, are you willing to pay more for your massage services?

And if I receive the call that a previous client tested positive for the coronavirus, what is that going to mean for you? What might that mean for your loved ones?

"But Massage is Essential!"

You are not going to die from not having a massage.

My work as a massage therapist is not even close to the same echelon as my cousin's work as a medical assistant.

It is my ethical responsibility to first, do no harm.

I cannot reasonably guarantee that my work will do no harm, nor can I reasonably guarantee that any and all precautions I put into place will keep all of us safe while you're in my office. I can't control or sanitize the world outside my doors.

I can only make my office as "COVID-safe as possible." I want to be able to say, "I did everything I could do."

In the meantime... I wait. I learn and I observe. I watch colleagues give their notices to their landlords because it's not safe for them to massage. I watch other colleagues rail against their governing bodies to have massage facilities open up sooner.

It has been a wholly polarizing experience.

There is still so much we don't know.

I can only make decisions for myself and the sake of my clients. Right now, I am choosing to wait. If you decide to take your business elsewhere, I understand. Please reach out to me if you have any outstanding gift certificate balances.

I appreciate your patience during these tumultuous times. Stay safe, and stay well.

Sunday, March 15, 2020

I Need Serenity, So I'm Temporarily Closed

Yep, you probably already know what this is about.

I've been turning myself inside out all week, trying to stay calm and be proactive while fielding information from local school departments and the greater massage community. I summed up my internal conflict as such: Does the potential/perceived benefit of performing massage therapy outweigh the potential risk to my own health, my clients' health, and the general public's health?

It's important to note that this virus is contagious even as the carrier is asymptomatic. Symptoms may not appear until 1-14 days after infection. It is spread through "respiratory droplets," and so can be present on clothes and fabric materials as well as other surfaces. There is no way of knowing, right now, if we have potentially come into contact with others carrying this virus. This week my massage mentor, Allissa Haines, said, "No matter how good we are with cleaning, being in a small room together, breathing the same air, is not consistent with the need for social distancing to slow this pandemic."

Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness. As someone who has watched a loved one succumb to complications from such chronic medical conditions, I cannot -- in good conscience -- risk putting my clients and other loved ones at risk.

I Knead Serenity will be closed from March 16 through March 30, 2020, at which time the situation will be reevaluated. On-line scheduling and gift certificate purchases will also be unavailable. I apologize for any inconvenience this may cause, but I hope to see you in good health on the other side of this pandemic.

Take care, stay safe, and I hope to see you, soon.

Bethany A. Ingraham
Licensed Massage Therapist
(207) 370-4222

Monday, November 5, 2018

What Do We Really Know About Pain?

Photo by Asdrubal luna on Unsplash

Pain is one of those “you know it when you feel it” kind of sensations. But it’s also a strange phenomenon, when you think about it. A snowball is cold, and so it feels cold when you touch it. A block of concrete is rough, so it feels rough when you touch it. But a knife isn’t painful on its own. Neither is a pot of boiling water or the leg of a table. We handle these things safely all the time, and experience their mass and temperature and texture. But pain exists only in the body, and even more specifically (as people who’ve experienced anesthesia know firsthand) in our minds. But that doesn’t make it less real! So what exactly is happening when we feel pain, and how do we stop it from negatively impacting our lives?

How does pain work?

There are three primary types of pain, and each of them works a slightly different way.

Nociceptive pain (tissue pain)

There are many different kinds of sense receptors in the body. Some are sensitive to heat or cold, some to touch or pressure. Others, called free nerve endings, aren’t specialized for any one type of stimulus. When a significant stimulus triggers these nerve endings, they send a message through the spinal cord and up to the brain indicating that something potentially dangerous has happened. The brain then decides (without consulting the part involved in conscious thought, alas) whether this is something to ignore or brush off or if it seems likely that damage has occurred. A message is sent back down to the affected part of the body.

If the message is, “No big deal -- ‘tis but a scratch,” then you’ll most likely shake yourself off and forget the incident even happened. If it’s, “WHOA, THIS SEEMS LIKE A PROBLEM,” then you experience this as pain.

This is useful! Just ask someone with CIPA, or congenital insensitivity to pain with anhidrosis, a disease that leaves people insensitive to pain. Imagine not noticing a bit of grit in your eye until it damages your cornea, developing stress fractures in your feet because nothing is telling you it’s time to sit down, or ending up with burns in your mouth and throat because you don’t realize your coffee is scalding hot. Pain stops us from trying to walk on a sprained ankle or to go for a run when we have a fever. Tissue damage, high temperatures, low pH, and capsaicin (the active ingredient in hot peppers) are all common triggers for this process.

But brains aren’t always correct when it comes to assessing danger. Lorimer Moseley gives a brilliant example of this in his TEDx talk. What’s the difference between the pain from a scratch on the leg and the pain from a nearly-fatal snake bite? Spoiler: it’s whatever your brain is expecting. That’s why you might feel little pain after a bicycle accident, but be in agony when getting the wound stitched up two hours later. Pain is weird.

Neuropathic pain (nerve pain)

This is pain that results from an issue with the nervous system itself, rather than surrounding tissues. If you’ve ever banged your funny bone, you know this feeling well. Common forms of neuropathic pain include:

  • Sciatica: pain in the sciatic nerve running through the hip and down into the leg and foot.
  • Diabetic neuropathy: nerve damage resulting from fluctuating blood sugar levels.
  • Carpal tunnel syndrome: pain resulting from the compression of the nerves that run through the wrist into the hand.

Less common forms include phantom limb pain (pain that feels like it originates in an amputated limb) and postherpetic neuralgia, which occurs as a result of getting shingles.

Neuropathic pain can be especially frustrating because the normal things we do to reduce pain are often useless when it comes to pain originating in the nervous system. Moving or not moving our muscles, applying heat or ice -- these can have a relatively small impact on nerve pain.

What’s more, nerves don’t heal as well as muscles and skin do, which makes nerve pain more likely to become chronic pain.

Other pain (A terrible, fake category name)

Pain is messy, and a lot of it doesn’t fall into either of the two categories above. Fibromyalgia is a great example of this. Is it pain resulting from tissue damage? Nope. What about nerve damage? Not as far as we can tell. It’s caused by the nervous system malfunctioning, sometimes in horrible ways, but doesn't result from actual nerve damage. The world of medicine is still trying to figure out why.

So, how do we alleviate pain?

There are several different options.

  • If the pain is caused by some kind of physical injury or stimulus, you can work on fixing that. If your hand is being burned on a lightbulb, you can remove your hand, which will make most of that pain go away. If you’re experiencing a muscle cramp in your foot, you can flex the foot (manually, if necessary). If you’re experiencing pain from sitting in the same position for too long, you can move around and shake out your legs. If the cause of the pain is inflammation, anti-inflammatories and ice can reduce that. This is perhaps the ideal form of pain relief, although it’s not always in the realm of the possible.
  • You can block the messages that tell your brain you’re in pain. This is how many painkillers work. Ice can also numb nerve endings.
  • You can convince your brain that you’re not in any real danger. This is a tough one, because the brain doesn’t just listen when you tell it things. But it’s well documented that fear, stress, and anxiety lead to increased pain perception. And of course, pain leads to stress, which leads to pain … General relaxation techniques—from meditation, to light exercise, to getting a massage—can all be helpful in turning the brain’s pain-alarms down a notch. Physical therapy (practicing certain motions in a way that isn’t painful) and talk therapy can also be useful here.

How can massage help with pain?

Sometimes the issue is one that massage can help manage on a physical level. More often, massage gives the brain a chance to let down its guard and experience something non-painful and even pleasant in the body. While there’s no silver bullet for pain, it can mean a lot for people whose pain has defied more straightforward treatments and whose injuries or illnesses are already healed.

Feeling the hurt yourself? There’s a massage with your name on it. Book your next one today.

Saturday, June 9, 2018

Summertime! And the Living is Easy!

It's here! The warm weather is finally here!

The sun is shining, birds are singing, flowers are blooming -- on days like these, kids like mine are clamoring for summer vacation. Good thing for them, the Bonny Eagle school district's last day is June 18.

Beginning Tuesday, June 19, 2018, I will be offering extended summer hours for weeknights and Saturdays:
  • Tuesday, Wednesday, Thursday 4:00pm-8:00pm
  • Saturdays 10:00am-4:00pm

Other days and times will be subject to availability. This schedule will be in effect until August 18, 2018.

Speaking of scheduling, have you checked out my new on-line scheduling service? I quietly made the move a month or so ago; there may still be a few bugs that need to be worked out. Explore it for yourself and contact me with any questions!