Reflexology footnotes

December 2008
Closing the Gap on Integrating Reflexology into the Clinical Setting

By Theresa Carr, RAA Research Chair and Past President Reflexology Assoc. of CT (RACT)

The Integrative Medicine Services of Memorial Sloan Kettering Cancer Center held its
first “Reflexology for the Cancer Patient” training course on June 14 and 15, 2008 in
New York City. A little more than a year before that, it was only a pipedream.
Back in early spring of 2007, a Connecticut colleague, Julie Innocenzi and I were
discussing precautions when working with cancer patients. She casually questioned skin-
to-skin contact precautions for Reflexologists working with patients who are actively
receiving chemotherapy. She had heard that certain chemo drugs could be excreted
through the patient’s skin within 24 hours of injection, thus posing a potential hazard.
Julie is an LPN and is experienced in working with pediatric oncology patients at Yale
New Haven Hospital.
Another Reflexologist here in CT who was studying for Oncology nursing certification
saw a non-descript statement in reading materials that cautioned the use of gloves when
touch therapists are working with cancer patients receiving chemo drugs thru IV. What
was the reason for this precaution, I wondered.
I needed to find some answers, because I was working with in-patients at our community
hospital and training volunteers to give hand and foot rubs to patients there.
It struck me like a thunderbolt, that non-clinical Reflexologists have little or no
specialized training when it comes to working with cancer patients in particular. My own
initial Reflexology training very briefly touched upon the subject of working with clients
or patients whose health is seriously compromised. In addition, my search for specific
Reflexology continuing education on the topic turned up empty handed. I felt there was a
serious need fill the gap for quality continuing education that could train Reflexologists
to work safely and effectively with cancer patients in a clinical environment. Where does
one go to get clinical training? Is there a hospital/clinic that would provide professional
Reflexologists this type of training? Would the training be recognized by other medical
Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008 I began to do some investigation into this, sending out email queries to several clinicians for further documentation. In addition, I searched my copy of Gayle MacDonald’s book, “Medicine Hands: Massage Therapy for People with Cancer” 1 and read that; “… thiotepa (thioplex) and cyclophosphamide (cytoxan, neosar or procytox) had been proven to exit the body via sweat glands. Furthermore, that “although the risk is minimal, it was prudent to wear gloves when there is skin-to-skin contact with a person who had received either drug within 24 hours, including the time of infusion.” Gayle MacDonald, M.S., LMT responded quickly and thoroughly to my email question on chemo excretion precautions. She sited additional material from her updated newer version of “Medicine Hands”. “Thiotepa is the uncommon drug, found mainly on bone marrow transplant units, for which gloving is standard nursing practice. Cytoxan, which is not immediately excreted through the skin, is very common. Comprehensive information on skin excretion and other routes of worker exposure are not readily available or known, so there is an element of uncertainty about massage and gloving. It is important that practitioners be at ease when giving massage. If donning gloves gives them peace of mind, they should not hesitate to wear them.” Ms. MacDonald further mentioned a future Oncology Massage Conference in Ohio and Oncology Massage training courses taught by Tracy Walton in our area. Ms. MacDonald offers weekend training courses in “Massage for People Living with Cancer” and a 5-day in hospital course called, “Massage in a Oncology Setting”. After receiving a response from Jane Greene, RN and Reflexologist at MSKCC, I asked if she and perhaps another staff member from the Integrative Therapies Service could give a presentation or mini-workshop on the proper protocols and precautions for Reflexologists working with cancer patients. I sited the recent and ongoing studies on Reflexology for Cancer patients being conducted at Michigan State University by Prof. Gwen Wyatt (Reflexology: An Intervention for Advanced Breast Cancer) and also at East Carolina University by Prof. Nancy Stephenson (Partner-Delivered Reflexology: Effects on Cancer Pain). I further stated that there are many Reflexologists like myself, who work with cancer patients. I was not aware of any continuing education programs or workshops that emphasize proper protocols and precautions for Reflexologists working with cancer patients. I chose to ask Ms. Greene and MSKCC because my massage therapist husband, Michael, had taken the course on “Medical Massage for Cancer Patients” in April 2003 and the advanced training in November 2005. Michael’s enthusiastic endorsement of the high level of training he received there gave me the impetus to take the next step. Sometimes an idea takes a more dramatic path than what was first imagined. I continued corresponding with Wendy Miner, Massage Therapy Manager at MSKCC. She said a few years prior they considered adding a Reflexology course to their curriculum, but somehow the idea got placed on the back burner. We all seemed to be on the same wavelength that the timing was right to take a serious look into putting a professional curriculum together. Thus, the pilot light was lit and the gears began to turn with enthusiasm. Wendy suggested a seminar at the NYC location, so they could draw on their resources of experts and deliver a top-notch program. The list of prospective Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008 students grew beyond my RACT colleagues and spread to other professionals throughout RAA and other state Reflexology association. I provided the link within our Reflexology community by sending out emails to gauge the level of initial interest in the MSKCC course. People were excited to hear of the potential course being offered by a premier cancer center. The responses validated the high level of interest and need for a specialized course. I was asked, and subsequently provided Wendy my “wish list” of topics for the proposed course. I was hoping that they would be able to include a hospital observation in the curriculum. I knew this would be a big draw for students and the thought of touring an oncology floor at MSKCC would be memorable. Wendy and her staff of experts in the Integrative Medicine Services held continuous meetings, planning and developing the course. Things took off from that point and subsequently developed into a well-rounded 2-day weekend program. I felt that this would prove to be a very worthwhile investment. Once the final course date was confirmed and sent out, I wasn’t all that surprised by the tremendous outpouring of interested responses. The 30 seats were filled faster than a New York minute. Sue Berenson, RN and ARCB Reflexologist on MSKCC staff, submitted an article re: Integrative Medicine Service at MSKCC for RAA magazine. The course proved everything and more that I expected. The first day lecture was intense, according to Julie Innocenzi (CT), it was “an extreme amount of information for people to absorb especially Day 1, but for people to not feel that they have to absorb it all and comprehend it all at once.” Joan Myers (CT) added, “The value of the workshop on Reflexology and Cancer Patients was immeasurable. I learned ever so much about cancer: the disease itself, types of cancer, chemotherapies and how medications may impact patients, the effects of different complementary therapies, and on and on. The amount of information presented was immense. However, the real 'value' of this training for me is the confidence I now have when dealing with clients who have cancer. Not overconfidence, but a realistic assurance that what I do in a session will help, not harm, them.” The course was definitely worth every penny according to Rita Painchaud (CT), who enthusiastically stated, “I do believe we got bang for our buck with this course. I thought the presentation had an excellent flow. They started with the basics, which helped us understand our role in a clinical environment. The beginning was very clinical which I loved. The one thing that I would have enjoyed seeing would be a tour of their outpatient facility. It looked beautiful in the pictures.” The hospital observation proved to be a highlight of the weekend. “I loved going to the floor to observe. It was both interesting and inspiring to be with the patients. All in all, it was well worth the time and money for me. It was a life-altering weekend for me,” said Rita. The education we received will have a long-standing impact on each student. Joan Myers reported, “The protocol we learned is fantastic, can be basic and yet individualized for each client. I originally thought the most powerful part was the in-hospital time. This Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008 was indeed potent - to see the almost immediate positive changes in patients was so
moving. But perhaps the most powerful part for me was learning and using the
protocols. It's most likely these two things together - seeing the impact of reflexology on
patients and learning the protocol - that were so powerful for me.
There is always room for improvement, as commented by Julie Innocenzi. “I think it
would have been better to teach/show people how to dress for contact/universal
precautions, to practice charting, maybe break up into groups and be given a fake patient
with a certain type of illness and come up with a treatment plan and charting. I think all
in all it was a good starting point, this was this first time that they have offered this to
Reflexologists, and as with anything else improvements, fine tuning can always be made.
Also, it would have been nice to talk about pricing, marketing this service to
potential clients and facilities.”
My personal thoughts on the course; I applaud the 11 staff members and presenters of the
Reflexology course. The attention to every detail and contagious enthusiasm was evident
during the weekend course. It was a pleasure to meet some of the members of the
Integrative Medicine Services staff. Each person seemed to put so much thought and
energy into the professional presentations and the course handbook. Outstanding! I've
been using the protocols with growing confidence and success. I thank you all so very
much for making this highly anticipated course come to fruition.
What a difference a year makes!
Here are few additional comments from other participants of the first class:
“It was a well designed, highly educational program that addressed the audience as
intelligent CAM practitioners. The lectures, given by a variety of hospital staff members;
doctors, pharmacy, social work, nursing, ect. offered a body-mind-spirit approach to
patient care that is rarely seen in an institutional setting. This kind of teamwork, support
and respect serves as a model for the reflexology community at large. As CAM
professionals, we can use the MSKCC model to educate, promote and expand reflexology
into more traditional healthcare settings. The energy is out there and the time is ripe for
moving forward. The MSKCC workshop drove home that point”.
Susan Raskin, RN, ARCB Certified Reflexologist (NY)

“The highlight for me was the hospital visit. The last patient we saw was one of the most
incredible, spiritual experiences for me. The energy between the reflexologist and the
patient was fantastic and the difference in the patient was amazing. I took away a better
understanding and knowledge of cancer and how to better work with the cancer patient.
Most importantly, how incredibly gentle and effective the work is”.
Geri Karr, LR, NBCR (NC)

“The things I valued from the workshop are having a clear understanding of what the
body goes through with the different forms of cancer we reviewed and how the
Chemo/Radiation effects the body. Covering not only the physical but also the possible
emotional and mental effects. MSKCC gave us descriptive, clear protocol guides listed
Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008 by cancer diagnoses and by symptom experienced. This to me is golden! I appreciate
their preparation put into the binder, the professionalism in the event organization, the
venue and the expert, hands-on knowledge of the presenters. Thank you to Susan
Berenson for the thorough workshop and handouts and for including Reflexologists in the
professionals invited.
Angelique Clarke, CRT (NY)

“I thank you and Sue for having made this possible and for the incredible amount of work
that you invested in this conference. I was so motivated and excited on my return home. I
am on staff at the Dana-Farber Cancer Center in Milford, Ma and I have to say that the
training has encouraged me to become more involved with the nursing staff in asking
more questions concerning the conditions and symptoms of patients. I refer to the
protocols frequently and use them for my private clientele as well. I will be meeting with
the nursing director in the near future to discuss the conference. I would love to
participate in the neuropathy case studies”.
Marilyn Alling, ARCB Certified Reflexologist (MA)

“The Reflexology Course that we took has been so beneficial to me. The day after our
course I was asked to work on the Oncology Floor at LIJ (Long Island Jewish). I am a
Holistic Nurse who has been hired 5 hours a week to give Reflexology treatments to
patients prior to receiving Chemotherapy (outpatients). A few days after the workshop, I
began sharing my time between the Ambulatory and the Floor patients
The protocols that I have been using have been so very helpful to all my patients. My
techniques have fine-tuned. I have been so inspired by the work that I do and it is very
gratifying to hear the about the different levels of comfort and relaxation that is given
through Reflexology”.
“On a personal note, I have to say, that the workshop gave so much valuable information
and the I have found the protocols very useful. I found the visits to the floors at the
hospital inspiring. I even think back to them many times since June as I treat different
patients!! The whole experience was AWESOME!!! The Workshop has truly added
much to my growth and professional development as a Reflexologist and Holistic Nurse.
Sue (Berenson) inspired me to become a Reflexologist thru an article in the Nursing
Spectrum. She still continues to be an inspiration to many of us and I am deeply grateful
to her for all her hard work”!
Linda Bardekoff, RN, ARCB Certified Reflexologist (NY)

Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008 Postscript:
Contact Memorial Sloan-Kettering Cancer Center, Integrative Medicine Service for information
regarding future reflexology workshops. website: ; email
or call 212-639-4915.
1 MacDonald, G. Medicine Hands: Massage Therapy for People with Cancer, Findhorn
Press 1999. 2nd edition January 2007, ISBN 9781844090907
MacDonald, G. Massage for the Hospital Patient and Medically Frail Client, Lippincott
Williams & Wilkins 2005. ISBN 0781747058

This Article was brought to you by the Reflexology Association of Connecticut (RACT) 205 Wolcott Road, Wolcott, CT 06716 Reflexology Footnotes: Closing the Gap on Integrating Reflexology into the Clinical Setting December 2008


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