Download Information about Pathology of the Immune System and Lymphatics

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.
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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.
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
System
Roberta L. Wolff, LMT, LMTI
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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
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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.
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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
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Narrowing of coronary arteries by atherosclerosis (classic)
Spasm of coronary arteries (variant type)
Abnormal oxygen demand (aortic stenosis, hypertrophy of heart)
Signs and Symptoms
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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.
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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
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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
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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.
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
System
Roberta L. Wolff, LMT, LMTI
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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
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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.
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
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Roberta L. Wolff, LMT, LMTI
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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.
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
System
Roberta L. Wolff, LMT, LMTI
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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
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
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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
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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
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Information about Pathology of the Immune System and Lymphatics and CardioVascular
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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
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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)
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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.
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