Oncology Massage and Continuing Education with Susan Shipton RMT

Susan Shipton is an RMT in Toronto, Ontario who has her masters degree in pain management through Western University. This episode with Susan Shipton covers a wealth of great topics. Among many other things, we discuss her clinical work providing massage therapy for oncology patients, and the benefits of qualitative research.

Susan has recently developed a continuing education course on oncology massage and she tells us her journey into becoming a CE provider and some of the most common and unhelpful myths associated with massage therapy and cancer.

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Transcript

0:06  
Hello and welcome to another episode of The purpose vs podcast. My name is Eric Purves. I am an RMT, course creator, continuing education provider and advocate for evidence based massage therapy. In this episode, we welcome Susan Shipton from Toronto, Ontario to discuss a number of topics including oncology massage, and continuing education for our MTS. Thanks for listening. All right, today, we have the wonderful Susan shipped in here to talk to us about being a Con Ed provider, probably amongst many other things. It should be a great conversation. I'm looking forward to it. I've known Susan Since approximately 2017. And she took a couple of courses that I taught in Toronto with a wonderful Monica noi. And since then we've become friends. And we actually run a clinical coaching and mentoring programme together, which is a lot of fun. And that's something we'll probably talk about in another episode, maybe we can talk about that programme. Tell people more about what we do with that. But today, we're going to talk to you about your journey into being a relatively new CEC an instructor professional development instructor. So just introduce yourself, Susan, tell us a little bit about you.

1:17  
All right. Well, thanks so much for having me here. So my name is Susan Shipton, and I'm a massage therapist in Toronto, coming up on my 10 year anniversary, and I've been in RMT since 2012. And my practice focuses on working with people through all stages of cancer and beyond. And interestingly, that was something that I identified that I really wanted to do when I was a student at Southern Chan School. And I can't remember exactly why it came to me. Sutherland Chan is they told us the only massage school in the world that offers for its students, a post surgical breast massage clinic. And so that serves mostly women who have been through treatment for breast cancer, but anybody who's had surgery to the breast or chest area, so we had, we have some men who had been diagnosed with breast cancer, we had some women who'd had cosmetic surgeries to their breasts. But as I said, it was largely women who had been treated for breast cancer. And I remember when I was accepted into that student clinic and was thrilled because I really, really wanted to work with this population. I think the reason I wanted to work with people with cancer was because I knew that I wanted to work with people at the confluence of the physical and the emotional that to me not to diminish other injuries or health conditions. But say somebody who ruptured injured their meniscus in a ski accident, it wasn't the same kind of experience as somebody who'd been diagnosed with cancer, and who was potentially facing a life altering disease and treatment that would take them possibly up to a year to complete and would affect them, their sense of of themselves and their mortality and their body. And with breast cancer, specifically, their sense of femininity, and their sense of sexuality and perhaps their, their maternal role in the world. And so there was a much more complex and layered experience going on for the individual than simpler, more tissue based injury and repair. And indeed, that has been my experience and, and I think that this has really made my career and I really love. I really love this.

3:40  
Oh, and so for 10 years you've been practising Have you been as your practice pretty much since day one been focused on on this population?

3:49  
No, when I first started out, I was working in a multidisciplinary clinic, offering massage for all the usual reasons people come in for massage, interestingly, in the beginning, because the one of the owners of the clinic was a naturopath who focused on women's health and infertility. I did a lot of prenatal massage, because women were coming in and they would get pregnant and then they they would seek massage. I also at that time, started working part time at an infertility clinic. So in my early days, I did a bit more of that kind of work, but I knew I did target people with cancer. As a population I wanted to work with right from the beginning, I created a brochure about the benefits of massage for people with breast cancer specifically and I tried to distribute it to the cancer network within Toronto. So patient support groups like Wellspring or Toronto Rehab, which has a breast cancer programme. I tried to approach some of the breast cancer programmes at the Toronto hospitals or local GPS in the area of my clinic to let them know that I was there and I had this specific training and interest in working with this population, and then very shortly after that, I started my training with the water school to become certified in managing lymphedema. So manual lymph drainage and compression bandaging and garments and skincare and exercise. And I completed that I did that week by week, the way they offer it, you can do it before weeks together, but I most people do one week and then one week, several months later, so it gets spread out. So I completed that in June of 2015. And at that point, in early 2015, I started working at a fantastic clinic called Toronto physiotherapy, which is well established in Toronto as a cancer we have clinic and has made great inroads with, again, the cancer community in Toronto with the patient support groups and the rehabilitation centres and oncologists and plastic surgeons and so gets a lot of referrals specifically to the clinic. And at that point, I just at least half of my practice was people with cancer or with lymphedema, you can have lymphedema, completely unrelated to cancer. And so then I just was exposed to so many different people and all kinds of different complications that result from the treatment of cancer. And that was a fantastic, fantastic learning ground. The owners of the clinic are very research and evidence based. And they write a fantastic blog, which is on the Toronto physiotherapy website. Looking at recent research into different aspects of cancer care, cancer, complications, cancer treatments. And that's a fantastic resource for patients, but also is another draw for people who are just Googling and looking for information and for care. So I, I feel really privileged that I had that opportunity to be part of that really stellar team. And as I said, I learned so much.

6:50  
Is it true that you might be moving to your own location, though now? Are you opening up your own little practice?

6:57  
It is true, it is true. January 2023, I will be launching out on my own as a sole proprietor and renting a room again, with a clinic with a physiotherapist and a chiropractor. But those two professionals don't have a focus on cancer the way the clinic that I'm at right now does. But I am planning on continuing to work with this population. And we'll make that a focus of my marketing and my outreach to the cancer community in Toronto to let them know of my new location.

7:30  
Amazing. Amazing. One thing I guess I was curious about too, would be the NREMT. And with your focus on oncology, is there specifically courses or education that you can pursue to learn more about that? Or is it more kind of like self directed, and or like just on the job kind of learning?

7:51  
Well, when I first became an RMT, at the end of 2012, and for a few years after that, there was a CTE course that was offered by Pam Hammond who's very experienced RMT and CDT combined decongestive therapist, so that's the training and managing lymphedema. She also works part time in the lymphedema clinic at Princess Margaret Hospital, which is Toronto's cancer hospital. So she used to offer a CE course, she hasn't in many, many years. And I see now a big gap in evidence based substantial education for RMTS on working with people with cancer, and that's where I'd really like to step in and fill that gap because I think, even if, unlike me, you have targeted this population. The reality is that one in five people in Canada will be diagnosed with cancer at some point in their lifetime. And so any RMT who has long term clientele will most likely work with people who have cancer. And and I think that there's so much that massage therapy can offer people with cancer through helping alleviate specific complications from the treatment to providing much needed kind, nurturing touch and and support and relaxation during what is inevitably quite a stressful and difficult time. So I really feel quite passionate about this. We have so much to offer and I want RMTS to feel a lot more confident and prepared to to help the clients who are going through cancer.

9:25  
When you did your your master's programme did you get to I know it was mostly on an interprofessional kind of pain management stuff. Were you able to do any research or any papers on oncology and massage and pain? I guess related from that?

9:41  
No, not not specifically and it's not something that I specifically pursued during that master's programme. What I think is interesting though, is when talking about pain, people often isolate cancer related pain so they might talk about non cancer pain But I didn't find in the presentations that we had in that programme that anybody talks specifically about cancer related pain. In my experience as an RMT, pain can result from the surgery to treat cancer, sometimes from the radiation to treat cancer, certainly there's, there can be a large, psycho emotional pain and distress. And a lot of people experience depression and anxiety as they go through the treatment. And that's where massage can be really beneficial. More specifically, when cancer enters the bones, whether it's a primary bone cancer, or cancer metastasis to the bones, that can be really, really very painful. And patients are usually given. They're usually treated with pharmaceuticals that their oncologists or they are referred to a pain management clinic. And they are given pharmaceuticals to manage the, the cancer, the bone cancer related pain.

10:57  
Right? Yeah, you see that all the time? And in the research, don't you you see that there's, you know, be like non malignant, back pain or no, yeah. Always, like non malignant or non cancerous pain. Like, it's like these two separate things I know. Yeah. And I don't know, actually, the first time I've really thought about why they do that. But I guess they're doing that to try to move it away from a specific known bio biological driver, maybe that's why they they label it as malignant versus non malignant. Do you know, that's probably why right. I assume.

11:29  
That's what I've always imagined. But as I said, this is a funny thing for me to say, given that my, my practice focus for my entire career has been cancer, and I have a master's degree in pain management. But I haven't actually listened to civically. But I will be doing that Eric, that is next on my list. And I will be doing that. So yeah, so I can't talk with I can't talk about a body of evidence or rationale for why the cancer pain is separated from non cancer pain in the body of research or and how people talk about it. I, I can't say specifically why.

12:07  
Yeah, I mean, we get into big philosophical discussion about you know, Pain is pain, and it's an experience and all that stuff. But we'll save that for another another episode, maybe it's a whole different. There's a whole different conversation there.

12:19  
It is a whole different different, it is a whole different conversation. But it does bring up the fact that no matter who you're working with, no matter for what reason, you're still working with the whole person, and pain is distressing. Pain is distressing, and we can help soothe somebody. And I mean, the secondary results of experiencing pain, I think are common, regardless of the reason for the pain. And that is distress, and possibly anxiety and depression and insomnia, and a withdrawal from activities or relationships that people usually engage in that they love and that they find meaningful. Those things I think can be the same, regardless of the cause of the pain. And so that's where I still feel that massage therapy can be very, can be beneficial. For sure, I don't need to be scared of working with people who have cancer related pain.

13:15  
No, and I think it's a really important thing to say to is that, you know, there's not a lot of good evidence that anything really works well for pain, whether it's, you know, pain occurring because of, you know, cancer or, or other various other reasons, we know that nothing really works very well for pain. But I think that when we're when you see it politically, if we want to just take a quick detour into like the social media discussions on these things, what we see all the time is that people like, well, exercise doesn't work well for pain, stretching doesn't work well for pain, or massage doesn't work well for pain. But I think what you often see in those situations is you see people having these conversations looking at big data, rather than but there is certain people that do respond well to the size, there are certain people that do respond well to exercise, there's people that do respond well to kind of stretching or strengthening programmes. And it seems to me that there's we need to kind of tailor the intervention to what the person wants. And the converse, that conversation is often is often missed. And, you know, so people might be listening to this and be like, well, there's no good evidence to suggest that you know, massage works well for people with cancer pain, but it might not just be the pain, it might be the experience and like you said, the soothing and the the safe place and maybe yes, their pain might not change much, but maybe their perceive their experience of their suffering or their their journey going through that treatment or that recovery might be better by being within the presence and the experience of getting a massage and that's that's a conversation that I feel is missed a lot in in these when we're looking at what's the evidence suggest that yeah, we do need to follow the evidence. We want to be evidence based, but there is a part of us that says okay, what you know, as long as we are not making wild claims that we are fixing things or that we are the best and the only option for people that have cancer related pain, then there's nothing wrong with saying that we can provide a very powerful, very real role in that person's experience of dealing with with cancer and its related complications.

15:19  
I agree with you, I think, as you said that when looking at the data, and these these large studies that the subtle nuances of an individual case or even a group of people, that that gets missed, unfortunately, and it's really unfortunate that we are missing these subtle nuances, because that's part of the complexity of being human. So let's take a look at pain. If someone is experiencing a lot of pain, they may not be sleeping very well. And we do know that good quality sleep is really important for helping somebody manage their pain. And so massage then if we can give them a really soothing, feel good experience. We know the research talks about how contextual factors are significant contributors to successful outcomes. And so somebody comes in, and they have a really good relationship with their therapist. And they come into a treatment room that has dim lighting and soothing music, and they're lying comfortably on the massage table, and they're warm, and they're cosy under the blanket, and they're able to relax. And they are able to calm the nervous system, and they are able to go home afterwards and have a really good nap. And maybe they sleep better for the next few nights after that. I do believe that that is going to improve their experience of their pain. It's not to say that it's going to take away their pain, but in terms of care, they're over the overall quality of their life, and the overall experience. Were improving some of the other things that surround that develop around that experience of pain.

17:02  
This is where it's 100% it makes sense. I love that. I love that statement right there gramme god, this is recorded. So we can come back to that, that's really, I think, also too, and tell me if I'm assuming you're going to agree. But this is where I would see that there's where our profession really would benefit from a lot of qualitative research, where we're looking more at the stories, the personal experiences, how people, how they experience getting massage in those situations, and you get that kind of data. I feel and this is, you know, my my experience in my limited research that I have done is the qualitative stuff is really, I feel where our profession should put its energies, there's not a lot of research out there and a profession, we know that specific to massage therapy. But if we had more qualitative stuff that would provide us, I think, a richer set of data to draw from rather than looking at these big data of like signing numbers to things because how you assign a number to a person's experience, I find that I just don't know, maybe some academic or some philosophical person would would would be able to, to poke a hole in that. But for our profession, which is not overly academically inclined, like we don't have a lot of PhDs or master's educated people, we have a lot of people, you know, that do great work, you know, with, with, with individuals and in the clinic every day. But to inform our kind of academic academia for the profession, we should really feel we should really be focusing on those that qualitative data because assigning a number to somebody's experience is just, it seems so dismissive.

18:46  
It does feel dismissive. It does from dismissive. And, and that bothers me at a, at a human level. If I go on in academia, and I don't know, necessarily that I will, but if I do, it will be in qualitative research. I don't have a lot of experience with qualitative research. But given that I come from the humanities, My undergraduate degree is in English and social history. And I worked in book publishing for 12 years. I am all about stories. And and what I what I understand about qualitative research is that it would be sort of similar to studying humanities where you interview a whole bunch of people. And then you take a look at the stories that they tell and you look for common themes. And that is what then provides your, your your data. And that makes a lot of sense to me. And to your point about. I think it provides a very rich data. And that includes these subtle nuances that are so important to the human experience that a more binary, numerical quantitative approach just doesn't capture it's like, it's like the richness of the human experience. slipped through the sieve of quantitative data sometimes. And I think that storytelling is important to us as humans, because it is through stories that we come to understand ourselves and our experiences. And that's where we find meaning. And I think that as we work with people, it's important for us as therapists, to understand that this is an important way for us to relate to people. And I think that storytelling far more than facts and statistics is a way to help change people's minds and to help change people's behaviour as well. So whether you're looking to help somebody reconceptualize their pain, maybe and understand that their the level of pain they feel, doesn't correlate with the level of tissue damage, or whether you're hoping to motivate somebody to be better with their rehab exercises, their self care, I think that understanding that storytelling is a better way to be effective in communicating that to them and persuading them of something than throwing a bunch of steps and stats and statistics. For sure, I even think, the anti smoking campaign that became so prevalent across Canada in the 80s, I think they found the same thing, like you can throw statistics at people about the number of smokers who develop lung cancer, and that's not as effective as a more compelling, emotional, human story that, that engages people's emotions, and that they can relate to.

21:31  
I love that, because it's true, because we are emotional creatures, we people respond more to emotions than they do to logic. You can you can know all the numbers and all that, but if it doesn't, it doesn't mean same thing to you, as if it appeals to your, your emotions and your feelings. And, and then I also like for our profession, because of how we work because of how we're educated stories to me seem more powerful than just giving numbers and data to people and, and also to for patients clients, is that the people come to seek our care is if we have, you know, if we can share with people that Oh, in people in this in your with your presentation, or let's say oncology people with cancer, this is how they this is, this is some data suggests how they benefit and you can give them like your themes, you give them stories, you can give them like little bullet points of, of what a common experiences of getting massage, maybe during post breast cancer surgery or something versus be like, well, in 30% of the cases, you know, this is blah, blah, blah, blah, blah, people like that doesn't that's not as meaningful as that story. And, and for me, you know, like my, my experience, you know, when I did my masters, I did mine in qualitative. So the little bit of research that I have done is qualitative, which was stories, so getting people's stories and developing themes. And once you get that saturation, and it gives you an idea of what people have their experience. Yeah, I love that. It's I think it's better and so good for you go finisher, go just more education. We're never finished it. Do some. So one thing I wanted to ask you, Susan, we could talk all day about this stuff, which is which is great. So maybe we have to get you on a second time. But worth time maybe, is one thing before like, I'd like I want to get into that when you tell us kind of about your journey, but being a CE provider and and kind of some of the things you want to you want to do. But I guess the first thing I think which is really important, and this is something that's really important to me, is that in our profession, we have so many myths and so many belief based systems. And we know that it's very common still, generalising here and a lot of them slash curriculums across the country, probably across the world. The way they teach, both cancer and massage are not based on evidence, what are kind of some of the main cancer myths that you think need to change and some things that I'm sure you'll be addressing in your courses?

24:05  
Well, I thought that this was an outdated myth that had gone the way of the dodo and was really surprised to hear just a couple of months ago from an RMT that I know that she had a colleague who turned a client away because the client had cancer. And so I think this woman showed up for her massage appointment and and then was sent home because the RMT said, I can't massage you because you have cancer. And that's horrifying to me. It's horrifying to me because it's factually incorrect. There's a significant body of research now that shows that massage does not spread cancer. And it's horrifying to me because this poor woman didn't I don't know why she was going in for a massage. Maybe she just wanted to have a really feel good, relaxing experience. You know, she's stressed, I don't know why, or maybe she had specific concerns that she wanted addressed. But now she's afraid to ever have a massage again, because she thinks that the massage is going to spread her cancer. And trust me, many, many people long after they have been told by their oncologist that they are now cancer free and they are in remission, they still are so afraid that the cancer is going to reappear. And so if somebody has been told by the massage therapist that besar spreads cancer, are they ever going to book another massage appointment. And that's terrible, because they're missing out on so much. Really beneficial, really good, easily accessible human care, I mean, mammals we, we are designed to be touched, we benefit so much from touch, we need to be touched. And so I was really upset to hear that. So that would be the number one myth. I want RMTS to understand that it is completely safe to massage people with cancer, of course, you need to do a thorough intake. And there are modifications that you might have to make in your massage in the treatment plan. But generally speaking, it is safe to massage people with cancer. Sometimes you still hear again, things that that are outdated, and I don't believe in any way or substantiated by current research things like you shouldn't get too close or touch somebody who's currently going through radiation treatment, because I don't know they might be radioactive. I mean, that sounds so ridiculous. I had I had I had somebody say this asked me about this, is this a problem? And I said in absolutely no way. Is it unsafe to be near or to touch somebody who's going through radiation. I do. Remember when I was a very young girl, I might have been six or seven. My neighbor's grown up daughter was going through shaman for cancer. And I remember her saying how sad it was that while she was going through radiation, she couldn't pick up her little dogs because it might make them ill. So clearly, that belief was circulating. I mean, this would have been in the early 80s. But come on, like 30 years or more beyond that. So. So let's put that to bed. I've also heard myths around when somebody is going through chemotherapy, they need to use a different bathroom in their house than the rest of their family because I don't know they might be toxic. It's hard to it's hard to say why what people are afraid might happen. And as I said, it sounds kind of ridiculous. That also is no longer true. And it is not at all unsafe to massage somebody who is actively going through chemotherapy, we're not going to pick up anything through their skin. We don't need to wear gloves when we massage them. So So those are some of the myths that I'd like to do away with. And I'd like to really educate massage therapists on all of the many benefits that massage can offer somebody who's going through cancer treatment from helping to alleviate specific complications that may arise from the treatment, I mean, surgery people may want some work on on scar tissue or restricted range of motion or a feeling of tightness. Following radiation, the tissue does sort of contract and become more leathery and radiation fibrosis can occur. As I as I've said, already, anxiety, depression, insomnia, massaging can be really good. But there's even just at this human level that I feel in my gut, and that I don't need research to tell me about, it's the benefit of coming in. And in a warm, safe place with a trusted therapist, receiving some really kind, nurturing touch. And that is just a basic human thing. And how wonderful that we can offer that to people. That's a simple thing. It's easily it's easy to access, and it goes such a long way in helping somebody in their overall well being.

29:23  
I think that's that's such a great thing to say and to really I think, thing for us to to emphasise because that's where our profession really excels compared to other musculoskeletal professions is the time that we have and that safe space we can have and this is not to diminish the impacts of other MSK providers. But what we haven't really we people will often come to see us because they don't We don't necessarily fix right people often go to see a physio or Carson because they expect this instant fix or this this this point and to get them out of their pain, whereas people can often come to see us as part of a management plan, which is kind of I think what you were saying is they come to us when we can be there to hold to be safe with them to make them feel good and to support them. Right supported self management, which is a term I love. I don't take credit for that. But when I first was first heard that term, I just like resonated with me so well, because we often see that we see people as they're going through this, this journey through this progression of whatever it is, it's going whether it's cancer, or another pain problem or anything. And we support the whole person, rather than just like, Oh, you've got pain, your low back, I'm going to, I'm going to treat your low back and we treat the human we have time for that. And the space, as well as the expectation to I believe that works in our favour as people come to see us just because they want to feel good, not because they necessarily need to have something completely alleviated. And sometimes they do things get alleviated completely, but sometimes, maybe not.

30:59  
Yeah, I agree with you completely. I know the physio College in Ontario has an emphasis on now, these are my words, not their words. So I apologise if I'm misconstruing, Missmiss conveying what I think one of their standards is, but I think that they have a focus on find the problem, fix the problem, and then discharge the patient. And, and certainly, I'm not saying that we should be encouraging a dependency on us. Quite the opposite. But to your point, Eric, that people often don't come to us because they have a specific problem that they want to resolve, maybe they do. But often people come because they really enjoy massage. And because it helps them manage stress and muscle tension that results from sitting too long from how stress manifests in their body. It helps with their mood in all kinds of reasons. And I think that sometimes we can poopoo and diminish that aspect of the human experience and how massage can legitimately help people. And, I mean, it's kind of a funny thing, I think, in a way, as massage therapy has wanted to legitimise itself and, and be taken more seriously in the health world that we have tried to follow in the footsteps of our physio colleagues as one example. And so be more focused on orthopaedic assessment and rehabilitation. And definitely, there is a really important place for that. But that's not all that there is to being human is there. And as you said, we have something to offer that no other health professional does. And let's not diminish that. So I think that we should, instead try and legitimise the benefits of I feel like I'm being repetitive, but the benefits of coming into a safe place with a trusted therapist, and having kind, nurturing touch. You know, I think it's really interesting that in maternity wards and prenatal education, there's a great emphasis on the importance of skin to skin contact for newborns. Because skin to skin contact, Foster's attachment, which is crucial for a mammals survival. Unlike lizards, or you know, other kinds of animals. Mammals are completely dependent on caregivers for their survival for the first however long of their life. And so attachment is, is it's crucial that we form healthy attachments with our caregivers. So skin to skin contact fosters attachment. It calms the nervous system. And it helps the brain form synapses and really crucial brain development in those first stages of life. So if we recognise that and skin to skin contact is part of our education for new parents, how come we don't recognise the importance of skin to skin contact throughout the lifespan? Why are we dismissing the benefits of massage? As one way that people can receive kind nurturing skin to skin contact? Why are we not acknowledging how crucially valuable this is for our well being as humans? And I think, coming out of a pandemic, where people have been isolated and made sometimes really, really isolated, I mean to remember at the beginning, we were afraid to go six feet close to somebody and we weren't leaving our houses, as well as the tremendous increased stress that we incurred because of the pandemic across many fronts. I think that the benefits of touch are even more valuable now.

34:52  
Well, I would agree 100% And it's interesting that we have these it's interesting that you know, you said if Moments ago that the profession, you know, we tried to be a lot like other MSK providers like physios with orthopaedics and stuff, which, like I agree there's a time and a place for that. But it is really interesting that, you know, our profession, you know, really worked hard to get legit to be legitimised by focusing on this kind of very biomechanical pathway, anatomical model. But really, the evidence suggests the stuff that we don't focus on actually has more value. In a lot of cases. It's so there's this this discrepancy in terms of like, how we're educated how we're supposed to treat how our colleges even actually want us to interact with the public versus what's the what's kind of best practice or what's the, the evidence suggest might suggest that yeah, some of this other stuff that we're trying to be dismissive of? It's probably better to focus on that. But it's, it's the stakeholders aren't aren't, aren't there yet, and agreeing, I guess, somehow to guide us towards towards that. So. That's something anyway, that's something I think about way too much. And

36:04  
yeah, well, I think even within the massage community itself, I think, I think, I mean, sometimes you, you pick up in online conversations among our empties, that, you know, some RMTS, kind of poopoo, the relaxation massage or poopoo, RMTS who choose to work in spas, because it's not therapeutic. And again, I think that that's a real shame. I really think that's a real shame. And I Amanda, basketball's doctoral thesis, looked at this, didn't it? Didn't she say she identified the massage profession has an identity crisis? Where even we are not sure. Are we therapeutic? Are we really health care providers working in clinics? Or are we working in spas along with estheticians? And why does it have to be one or the other? Why can't we integrate? Why can't we integrate both of those into our, into our, what we offer as massage therapists, you know, one of my, one of my guiding principles, I've said this a few times publicly, full credit to one of my teachers at Sutherland, Chan, Michele Francis Smith. One time almost in passing, she said to my class. This was in term two. And so we were learning more about specific health conditions and pathologies, and how to treat those as massage therapists. And so I know that some members of my class were wanting to do that more that sort of more advanced massage, rather than just just in quotation marks, or relaxation massage. And so Michelle said to us, every massage, every treatment should take place within the context of relaxation, because it's when we're relaxed, that we're best able to heal. And, I mean, I need to contact Michelle and tell her how foundational that has been, to me, that has been a guiding principle for me as a massage therapist for this whole past 10 years. And I firmly believe that even when I am looking to address very specific issues, in the tissues, physiological issues, I am still looking to provide that within an experience that feels good, that is soothing, that offers in these contextual ways offers an overall positive experience. I'm not a believer in the no pain, no gain mentality, I don't think that people need to be hurt in order to receive the benefits of massage. To the contrary, I think that can often be really counterproductive. So I'm in the context of relaxation camp, and then looking more specifically at what we're looking to achieve.

38:48  
And I agree with that to the no pain, no gain thing, you know, is something that is so common in in not just saw profession, and all I'm escape professions, but also in society. It's like, if it hurts, it's doing good. And this is where it gets into this very subjective thing. And in the courses I teach, I talk to us all the time, as you know, and I think I've said this before, in some of these podcasts I've done is I talked about, you know, TPN, right, or as as it was used when you put that in your article TPK touch people nicely or touch people kindly and as people kindly Yeah, and it's, it's that could be in something that depending on the person that could be a little bit harder, that could be a little bit uncomfortable for the person if that's what they feel works for them. And some people might just be light, or it might be somewhere in the middle and it could be pokey. It could be stretchy. It could be swimming techniques, it doesn't really matter as long as you're doing something that feels good, then that is should be the goal right should be soothing or feel good to the person. And yeah, and so that's when we have these conversations about like the relaxation for example, I feel that a lot of people when they hear relaxation, they think lying face down and lots of oil, just big Swedish techniques. But that could be it. And that might be what you get at a spa. But that might not be it, it could be something totally different. Because it's individual, it's based on the person. So the term relaxation, I feel is something that is really well defined, because it's, it's it's person dependent. subjective. So that's something that probably shouldn't be talked about more in the profession is when we talk about the names of what we expect for relaxation, for example, what does that mean? What does that

40:35  
I know, I know. And then you can get into the whole topic of like the menu, the massage menu, you know, when you go on a clinic website, and it's like a menu and you choose which type of massage you want. And that bugs me because, again, it's we don't need to create these silos. I mean, depending on what the massage therapist and the client discuss what the client is looking for what the massage therapists suggest, you can you can mix them all in together. I hate them in you.

41:07  
I agree with you, I hate them on YouTube, it drives me crazy. You actually when you see stuff and people like though like this is this is this is your choices, and you think we shouldn't be something that you discussed with the person, you know, like you're making them choose me to have a discussion with them and see what they want that day. And then you can give them a recommendation or like, Oh, this is what I think would work for you. And you have that person centred care. You know, you've shared decision making all those buzzwords to try and find out what works best for that person on that day. And the menu thing drives me crazy to another thing that drives me crazy. And this is my podcast, I can say whatever the hell I want. Is, is is all the named techniques of everything like that, that that drives me crazy. It's like, oh, I'm this type of therapist, and you insert their favourite acronym here. And, and that is something I feel is, I don't know, it's almost too reductionist, because you're treating a person you're not treating, you can use those techniques. But why do people advertise those techniques? And I think it's because people feel that the public really wants that. I'm sure someone's gonna listen to this and be like, Well, my patients, they come in see me because I do whatever. I'm thinking, Yeah, but that's because you advertise it, I bet you if you just said, I've, my special area of interest is in oncology, doesn't matter what techniques you use, people are going to be like, oh, I want to see this person. Because this is their area of interest or chronic pain. Or maybe it's Orthopaedics. Maybe it's sports, maybe it's whatever. Right. There's a lot of different avenues that we can go. But the name techniques in the menu, those things are top of my list. Two things drive me crazy. I would love to see those get thrown out or put in the back seat for the profession.

42:49  
Yeah, yeah, I know. And it's a slow transition away from it for not only for the public, but also for us, as therapists and how we communicate with each other. I've talked with my colleagues sometimes about, you know, myofascial release and stuff like that. And to be honest with you, I still write MFR in my treatment notes only because I know that my colleagues will, will have a general idea of what it is that I was doing. I don't actually believe that I am releasing, I don't know, adhesions between layers of fascia or something like that. But but as a, you know, as a general term for what it was that I was doing on that part of that person's body to address the issues that they said they wanted a result or a story that they wanted to be addressed in the treatment. It's a shorthand, it's a form of communication between colleagues because we have all come from a very similar kind of training and I don't just mean my massage colleagues, I mean, my physio colleagues as well. So it's going to be it's going to be a slow transition as we as we all find another way of communicating what it is that we're doing.

44:03  
I'm I'm a big fan of making up stupid acronyms for things. So I always I always joke I instead of MFR is called Triple S. T, slow stretchy skin technique. It's, you know, that's kind of what you're doing usually. So, and yeah, it works. Like it works for a lot of people. And when we look at the the neurophysiology, you know, we know, it's suggested that certain, you know, antinociceptive triggers occur when you put slow stretch into into tissue. It's not overly noxious. And anyway, I just, I think when people hear these things, this is probably the part of the problem is people hear well, we can't release fascia. And they're, they're like, but I get results. I'm like, we're not saying that you're not getting results from challenging your outcome. We're challenging your, your story and narrative about that outcome. And the reasons are not for what you think they are, but they could be for these other things. So rather than releasing fascia, let's just say you're just slowly stretching the skin and yeah, I'm impacting sensors and receptors and stuff. Magic happens in the home for the person feels better.

45:06  
Yeah, and allowing time for the person's nervous system to respond and adapt to the stimuli that you're providing.

45:12  
Yeah. Oh, yeah, I'm gonna do actually, I think I'm going to do a whole a whole series of episodes on modalities and talking about that. So I mean, I'll come back to this for anyone's listening, we'll come back to that later, I think to talk about, I'm very clear, I'm very, that's something I'm very, when I first started teaching, that was what I did is I spent so much time just kind of breaking down stories about the different things and like, there's no evidence to support this. So let's, we let's change our story about it. And that was a lot of resistance. But I think as time has moved on, you know, I've been at this for about eight years now, things are slowly starting to change. But I was really expecting change to happen quicker.

45:50  
Yeah, change was always slow. And that's, that's okay. And, you know, I think going back to what we were talking about earlier, but the power of stories, that I think it's just a human thing, that stories are how we come to understand things. And it's a tool to communicate effectively as well and persuasively. And I think that that's part of the reason why these narratives have become so entrenched. Because it's a way of explaining that makes sense to people, what we think we're doing what we think is happening when we touch people in this way. And then that story spreads, because stories do spread easily.

46:31  
Especially if it's an attractive story. And like, it's a chore if his story that sounds like really interesting. And that's really cool. That's really powerful. It's neat that you can do that. And I am a victim to those stories, too. When I first started practising and even now to write your little more scepticism, you still get attracted to certain stories, because they kind of maybe tweak your interest or confirm a bias or you like it, but you know, we have to be mindful that a story without evidence is just a story.

46:58  
Yeah, exactly. Exactly. And therefore, we have to be careful about the stories that we tell. We have, and this is something stories are powerful they are they can be powerful for the good and powerful for the bad.

47:13  
Yeah. And this is a whole thing I always talk I keep coming back to is we, as healthcare providers, if you want to be able to get providers, whether that is working in a spa, whether it is working in a clinic, or whether it's working on whatever it is, we do have an ethical obligation to be as less wrong as possible. So we shouldn't be following evidence is whenever we don't know. And if we don't know, we could say, well, in my experience, this is my anecdotal experience. This is might work, this might not work. But we don't know why. I think as long as you're honest about it with people that that's fine. But the problem I see is that when we make these wild claims, without evidence, any evidence to support it, oh, I took this course in the weekend. So they told me what to do. And so and this is a story they told, and then that story is just made up. That's what drives me crazy. And that's a problem in not just our profession, but I think in all MSK professions, and um, hopefully that stuff will start to change as we move on. But one thing, kind of like, we wanted to bring you on today to talk about was about your journey as a sea instructor. And I know you're new to it, and, and your course so let's let's just kind of go back to that. Because I think otherwise, we could just talk about other stuff, which is, I think really important. I love it. And but I think you know, let's hear a bit more about about your core. So oncology massage, do you have a title for it? Yes. What's your title? Right now? The title is oncology massage? Oh, look at that. Brilliant.

48:33  
I don't have a more specific title. But yeah, so I am I'm working on creating this course, I want to launch it in fall. 2023. So let's hope that, like I just said it publicly. So now I have to that's my, that's gonna be my, my kick in the butt to really keep going. Um, so yes, as I said, I want to what I want RMTS to take away from my course is that it is safe to massage people with cancer. And importantly, that massage is really beneficial. It's beneficial for helping to alleviate specific complications related to treatment for cancer and, and a larger picture and a more general sense for just helping support somebody through what is a really difficult time and helping with their overall well being with minimising depression and anxiety and insomnia and helping them feel better and, and providing some kind nurturing touch at a time when the other medical interventions that they're receiving are, can be kind of horrible. You know, it's, it's hard to go through surgery, and it's hard to go through chemotherapy and it's hard to go through radiation and it's hard to go through hormone therapy and here's something that that can feel good and can be helpful. So that's what I want RMTS to know. And as I said, I do see a need for this education in our profession. It's so important, I think that every RMT is going to encounter people who have been through cancer treatment. And so I want to really provide a lot of valuable evidence based information for r&d so that they can be really confident in what they're telling people and what they're offering people. So that people know that it can be beneficial. From what I hear from my patients. Sometimes they say that they really wish they had been told sooner that they should come for physio and or massage that it can be really beneficial. Sometimes they are sometimes they're told about the benefits right off the bat, and that's great. But and I don't say this to disparage physicians. But what I hear from my patients is that going through the cancer treatment, of course, the people that they're seeing are the oncologists, the medical oncologists, surgeons and radiation oncologists. And those people rightly so are focused on the cancer. And so when somebody comes to them and says, I'm feeling pain, or I can't lift my arm up, My chest feels really, really tight and uncomfortable, or any number of complications that are related to the treatment, they often feel dismissed by their oncologist. Because to the oncologist, that's not that important. And, and then colleges have very limited time. And as I said, they're focused on the cancer, that's their job, their oncologist. So being referred to other health professionals who have training, in, in helping people with these other symptoms and other experiences is really important. And I think massage therapists are really well positioned to offer tremendous care to people. So that's, that's what I want to do. And I and I, yeah, I want to empower, I want to empower aunties, wherever they are, across Canada that they can offer something so valuable.

52:01  
And it's like you said at the beginning, right, 20% of people are going to experience cancer in their lifetime. So this is not like it's a small, tiny little niche population that, you know, a couple percentage of people that get it, it's, this is a big, big concern. And there's a lot of opportunities for our profession to support and help people that and so this is, this is this is I think is really great. Now, one question, I guess I don't know the answer to which was actually agency one question. There's a lot of questions I don't know the answers to, but one thing I'm curious about for for you, is there other Is there any other oncology massage courses out there in Canada?

52:40  
Um, I'm forgetting the name. There is the online course provided by an arm TNBC. Eric, do you know who I'm talking about?

52:47  
Oh, yeah. Yeah, I'm not going to use their name. But yeah, I do know there is that? Yeah,

52:54  
I'm blanking. I know Dustin Curtin is very interested in developing some and is likely working on right now. But otherwise, I don't know of any oncology massage courses that are available in Canada for RMTS specifically, embodying the online education resource has some courses that are created by a physiotherapist, again, whose name escapes me. But she's very experienced. I know she developed the rehab programme that Toronto Rehab offers specifically for people who've been through treatment for wellspring. So I haven't taken that course. But I am sure that it's, it's well done and reputable. But again, I'm not that's created by a physiotherapist and maybe geared towards physiotherapist more more towards exercises and rehab and strengthening it's not specific to massage right so specifically from us and as you and I have said we work differently, we work differently than other health professionals to our benefit to our patients benefit. So courses on working with people with cancer that are specifically geared toward massage therapists No, there's there's really not a lot.

54:15  
Yeah, so there's a huge gap to fill here because it's a huge population. There's not a lot of education on it for empties in Canada there might be I think there is a group in the US where I've seen they do stuff on oncology massage but they're you know, they might it might be more hospital based I'm I'm not sure and so I don't want to say because I don't know by duty I'd so now you said that I do too. There is a there is a course that's taught by a group or some people here in BC. I don't know though from I don't want to get in trouble. I haven't heard that. It's very evidence based. I heard it's more about beliefs rather than like incorporating a lot of like science and best practices into it. So it's then that might just from the stuff I've heard, that's why I won't say the name because I don't want to get in trouble by throwing somebody specifically under the bus. But of course, I have heard from people have taken it that they were disappointed because it was based on personal experience, not based on like, any research to support what they were saying. Yeah,

55:18  
yeah. And that's such a shame, isn't it? I mean, that's how huge opportunity. Yeah, and that's how I miss get perpetuated as well, unfortunately, now, I will say, because I have looked into the research on massage and say, chemotherapy, or massage and radiation therapy, for example, one of the one of the obstacles that I run into when I look into the research is that often, massage is not necessarily the primary intervention that's being studied. And massage itself is not very well defined. And so what exactly is the massage therapists do it? What's the duration of the massage? What's the frequency of the massage, and so it can be hard to take the research the body of research that exists so far as being really substantial. But I think that's true for massage across many topics, that there's not as much research as there could be. Which is why we need to suggest that more and more massage therapists pursue education and pursue research because there's, there's so much that we could learn.

56:24  
And that's a way forward, I feel for the profession. We need more and more that kind of academic base to draw from. But yeah, I would say there was like, so yeah, we could talk about like, yeah, you could say that with any courses. Not a lot of, there's not a lot, a lot of specific massage therapy research for it. And we'll use cancer as an example. There's not a lot and I agree that these are little bits of stuff I've read, it says massage but doesn't like it's not there's no definition really. It's like massage therapy. But what is that massage? Are we as a profession? Is it like, what is very specific techniques or any specific areas you're working on? Like, what does that mean? But the biggest thing that I see as a problem with the CTE industry is that a lot of times people are basing it on their personal experience, which is totally fine, as long as you're honest about that. But it's oftentimes it's the narratives perpetuated, that are incorrect, that aren't based on biologically plausible principles. So let's say for example, you know, you're teaching a course on cancer for breast cancer, whatever, and you're like, oh, yeah, well, when you get cording, it's because you've got these, like, myofascial adhesions here that are locking everything up, and you're like, but there's no, that's, there's no evidence to support that. You're just making that up, because that's what you think, or that's what you want to believe, or that's what you've heard from somebody else. Or, you know, we're gonna break down scar tissue with frictions, you're like, well, that we that doesn't happen. There's no evidence to support that. So you can't say you should be saying that. But what you said is true is that people take those courses, and it's totally it's a compelling story. Yep. Very believable, very passionate educator. And then people are like, Oh, that so yeah, when you come in, you got a restricted range of motion, and you've got courting, it's because of this, and I'm gonna go and I'm gonna do this thing. And you are telling people, your clients a story that is not supported by biologically plausible principles. That's that's potentially harmful.

58:16  
It is, I think that we as professionals, need to become more comfortable with uncertainty, we need to be able to say, coding is not really well understood, we don't really understand what it is that's going on. When somebody experiences coding, we know that it can occur in this percentage of women following treatment for breast cancer, and there seems to be a correlation between thin women and cording. We don't know exactly why. And we know that there is an increased risk of developing lymphedema. If somebody has cording. Those are correlations that we've seen, but we can't say for sure why we can't say exactly what is happening physiologically or what the mechanism is at play. And I think that it's okay. And I actually think that it's better if we say the research isn't conclusive on this yet, because, at least that suggests that and hopefully, that's true, that we have investigated fairly thoroughly the body of research to date. And so we can say that with confidence that the research is not really conclusive yet. We'll keep studying and hopefully get more information.

59:27  
And that's honest, that's that it is honest, and that's being just honest, which as a seed starter, I strongly believe that you have to be honest and say, when you don't know just say you don't know. That's hard. Sometimes when you're gonna defeat a bunch of people and they ask you these questions. You think that's a good question. I don't know. And that's okay. I think people my experience, in my experience, when you are when you say you don't know, and you're like, Oh, that's a good question. I'll look into it or, you know, Can you contact me after the course and maybe we can have a discussion with them more. Those I think says a lot for you. As an educator that you're willing to listen and you're willing to accept, when you don't know when you have gaps in your knowledge, because we don't all there's lots of stuff we don't know. And the more we learn, the more we don't know. It's just the way it is. Yeah, absolutely. So, so one thing I wanted to ask you was about your course was going to keep going to finish up the conversation, what your course specifically, if you could summarise and put you on the spot here in like, two to three sentences maximum, hopefully not really long sentences. But as specific as possible, what would be kind of two to three kind of key things that people would get after taking your course, that would benefit them in practice, when treating people with cancer,

1:00:44  
they would learn the pathology of cancer and how cancer spreads. And that will help arm them for the conversation about the risk of massage spreading cancer and how we know that that doesn't take place. They will learn about what happens when somebody goes through specific treatments for cancer, surgery, chemotherapy, radiation, etc, they will learn about common complications related to those treatments for cancer, they will learn how they might need to modify their massage for somebody who is currently go or has recently been through those specific treatments. And they will learn how massage therapy can benefit somebody who may have complications from those treatments for cancer. And so, in essence, I hope that it will empower RMTS to confidently deliver safe and effective massage therapy for people through all stages of cancer, who are currently actively going through cancer treatment who have recently finished, maybe who are several years beyond beyond cancer treatment. And I will also include in the course, a little bit of talk about palliative care, because unfortunately, if you are working with people with cancer, there is always the risk that cancer will be the cause of their death. And they will continue to seek care at the end of their life. And very importantly, I'll also talk about self care for the massage therapist because it can although it can be enormously rewarding and very fulfilling to work with people through their treatment for cancer and beyond. And there is an emotional intimacy that often develops in the therapeutic relationship, we need to be careful about our boundaries. And we have to recognise when that is taking a toll on us. It is really hard to see a patient that you've become fond of decline, and maybe suffer and pass away. That can be really hard. And we need to talk about that. I think we can't pretend that that doesn't exist, it is part of the part of the work. That is

1:03:01  
such an important thing to that we don't often you don't hear about in courses is self care for you, for you as the therapist, you know, the person delivering the care and what's the impact on you. And that's actually that's something I think that'd be very, very unique for your course, which will probably be very word I'm looking for a very important piece of knowledge or awareness for people for learners to take is, is how to be more aware of and present with that experience of what you're going to feel something you're going to experience something to potentially induce, particularly in palliative cases,

1:03:41  
oh, completely. And even just as I said, working with somebody who may be suffering, I mean, I, you know, I've worked with some people at the end stage of their life and their symptoms are so advanced and they're in a lot of pain, possibly. And it can be it can be really hard, but the same. And obviously you work within what is comfortable and tolerable for the patient. You don't insist on doing things that that are just too distressing for them in some way. But it can be distressing to see somebody just hurting so much. And it's not just the physical symptoms, but you also see somebody grapple with maybe maybe resist that come to terms in whatever way they can with with the end of their life. And that can be a tremendous privilege. I think that this comes up a lot in massage, as we've already talked about because we spend a lot of time one on one with our patients in a safe, cosy warm room context where people can let their guard down and they might start to share some of the things that they're feeling and so we need to be prepared We need to recognise the limits of our scope of practice that we're not psychotherapist or psychologists. At the same time, we are humans. And we are working closely with another human who is going through a big transition and how they come to terms with what what becomes really important to them. I mean, I can share stories if you want about some of these experiences as well. I had a wonderful woman several years ago, who came to me unfortunately, she came to me because she had lymphedema in her leg. She had had a melanoma on her shin. And unfortunately, when she came to me the first time, she said, I can feel these lumps in my groyne. And I, oh, no. And it turned out, unfortunately, I don't know why it seemed to take a long time to get MRIs and things like that. But in other words, the cancer had already spread throughout her body. And so these lumps that she could feel in her groyne were the enlarged lymph nodes, I think. So she lived a few more months after that. And I helped manage the swelling in her leg, which she sometimes would describe was like dragging around a huge sack of potatoes, like her leg was just so large and uncomfortable. But I saw her, first of all, her struggle to try and really fight this. And what she talked about she was going to do, and she was she was from Germany, she was going to go back to Germany, and there was a clinic there. But it was also an opportunity to see her siblings that she hadn't seen in a long time. That trip didn't, never took place. How she worked with her granddaughter, who was about six, and her son had asked her I think to try and impart a lot of skills. And so she made a doll. And the doll was things, it was an opportunity for her to show her granddaughter and for her granddaughter to practice things like this is how you sew on a button. And this is how you mend a rip. And this is how you have a cuff. And I love that like what what an amazing opportunity for grandmother and her granddaughter for bonding and imparting almost some some family skills and family traditions. One of the stories that I found heartbreaking. She was admitted to the palliative care ward at Sunnybrook Hospital. And I saw her there several times before she passed away. And one of the last things that she did, I'm starting to, I'm starting to well up even remembering this because it's always really struck me. One of the last things that she did before she was admitted to the palliative Ward, she went out and she bought a whole bunch of underwear and socks for her husband, to make sure that he was well taken care of after she was gone. And they had been married for decades she was she celebrated her 80th birthday just before she died. So clearly, part of the relationship was that this was one of the ways in which she took care of him. And so in, in planning for her coming death, it was important to her that she makes sure that he was well taken care of and would have a good stock of socks and underwear in his drawers for after she was gone. I find that so touching. And that's just a little, a little insight into how people prepare for the end of their life and what's important to them and how they how they show love for the people around them as they come to the end of their life.

1:08:35  
Wow. Thanks for sharing that story. It's very emotional. It is, isn't it? Then you can you can just hear in your voice to that, you know, bringing that back up, bring that to the forward is is not easy.

1:08:50  
It's not easy. And you know, that woman is one of many that I that I carry with me. And I find I think I think about them often. I mean, as therapists we can be really touched and we can be profoundly changed. It's it is such a privilege to work with people through this time in their life. And of course, it just opens our eyes to what is it a universal experience. We are all going to lose people and we're all going to die ourselves. We're all going to go through that transition. And so I think it really expands our own humanity and our sense of what it is to be human. I've seen similar things with other people, you know, a woman who had pancreatic cancer and developed a Sadie's and then I think it was the SATs that caused the lymphedema in both of her legs that her abdomen was just so full that the lymphatic system got compressed and couldn't move the fluid up out of her legs. She had some very specific goals. One of her daughters was getting married. She really wanted it a few months later. She really wanted to be able to wear nice shoes with her dress to her daughter's wedding and right Now her feet were so swollen that she could only fit into, I don't know, sort of large running shoes, or Crocs or something. And so that was a really specific goal. And that's what we work towards. And we timed things. For that event, we timed compression bandaging, in order to reduce and everything so that she could feel good about how she looked and how she was able to participate in her daughter's wedding. So, again, it's a little insight into what becomes really important to people at the end of their life.

1:10:30  
And so wonderful that you've been able to help those people through those, those experiences of that time, I like to, like, it's quite an honour that somebody, you know, feels that they trust you. And that's something that's really powerful in our profession, and, you know, these people, you become part of their, you become a person, that's a rural, real high importance to them, as they're at that stage in their, their, their journey their life. So that's something that we need to really hold on to, I think, as a profession that we need to realise the important influence and role we can play. I know for me, like I practised for 16 years now, almost 17 years. And the, you know, thinking back to me, I didn't never had to focus on oncology or cancer by treating lots of people that had, you know, during their, during cancer, after surgeries, whatever. And, you know, a lot of them, you know, so after so long, a lot of people pass away, and a lot of times, no, they're elderly, they, they, you know, whether it's cancer or not, you know, people people die, and sometimes you're there, pretty close to near the end. And, you know, you maybe get a phone call from the wife, or the husband or the grandkid, or something, and oh, Jimmy, John's passed away, it's making names up, right, just. And it always it always, it always hurts, you know, there's always that kind of thinking, and that kind of, like, ah, it was so wonderful, you know, like, you know, and you start to remember your experience with them and, and you feel quite privileged that you were able to have that have that connection with them. Particularly, there's somebody that you've seen for a long time, and it's hard when they go,

1:12:08  
it is hard, and you hear so many stories, you know, you learn all about their family members. But tell you one thing that I have learned the woman who had pancreatic cancer and, and her goal was to be able to wear nice shoes to her daughter's wedding. I heard all about her two daughters and some of the special things that they did together in her in the mums. last few months. And so you really get a sense that you know, the person in the family members and then and then your patient dies. And my inclination was to write to the family and say, I thought she was an amazing woman. And it was such it was such a privilege to work with her, etc. But I didn't in that case, because I thought that that would that would be kind of weird. Like, it's a one sided thing where I have heard about them. And I have a sense that I know something about those people, even though I've never met them. But those people probably have no idea who I have. I am and probably have never heard anything about me and isn't it going to be kind of weird for me to write to them, I've since changed my mind about that I I now feel that it can be really wonderful for family members to receive a letter that just shares something about somebody else's experience with their mom or their dad or whoever, and, and how meaningful that relationship was. And so going forward, I am going to send a card to family members. If I move to I don't mean that every time but if I move to I'm not I'm not going to hold back. I think that that's okay. That's my personal. That's my personal feeling about it. I'm not saying that as a profession we should be or that any RMT. Should should do. It's entirely individual.

1:13:55  
Yeah. But I would imagine to the probably very nice for the families to to hear that. And to know that, hey, you know, here's somebody that's new mom or new dad for X number of years. And you know, this is it's always nice to hear that. Yeah. Oh, that's That's wonderful. So I guess we're probably, you know, is this where we're probably wrapping up here close to the end of this conversation. So I guess the one other thing I'd like to hear from you just before we go is this is a kind of a vague kind of big question. What kind of changes would you like to see in the CTC industry?

1:14:36  
Oh, that is a big question.

1:14:40  
Or do you want to see any changes doesn't have to be that there has to be changes?

1:14:45  
I'd like to see. My answer to that would be sort of a summary of some of the things that we've talked about already today. But I'd also like to add something that I know Eric is a motor better for you. So I'm going to start with that. I remember being really pleased one day, a long time ago, when I heard you say that you thought that massage therapists, we don't need to feel that we're at the bottom of the healthcare totem pole. And that we need to turn to physios or Kyros, or other health providers, other health professionals, for our continuing education. We have a lot of really smart, educated, capable RMTS. And we can be leaders within our own profession. And I'd like to see more of that. I'd like to see. I do think that continuing education courses need to be grounded in the evidence, I think they need to have a foundation of research. I do think that there is room for people to share their own experience and to illustrate with stories from their practice. In a way, often it's the stories the anecdotes that students might remember and take away and that then can be good, almost like pins to remember, Oh, yes, this, this was a good approach or can help them remember other things that are content from the course. So I'm not saying that anecdotes, and personal stories have no place, I think they have value. But I do, I don't think that a continuing education course can only be based on somebody's clinical experience, it does need to be grounded in the evidence. So I'd like to see more guarantees, pursue that kind of thing. And I would like to see us move away from modalities or really specific tissue based things, I think that we have to remember always that we are treating the whole person. And we can't isolate. One, we can't isolate a health condition or pathology from that person's overall experience, we need to be prepared ourselves emotionally and psychologically, to work with the whole person. So just going back to what we were just talking about, as an RMT, working with people going through profound illness and possibly end of life care, we have to be self aware enough to realise what we are comfortable with, because our own issues around death and loss, illness are going to be triggered. So maybe we need to do our own personal work on some of those things, that I think that's really important to be aware of that, that needs to be kept out of the treatment room. Our interactions with our clients are not a place for us to play out our own issues, I feel quite strongly about that. The clients come to us for their own needs. And we're the professionals. But I'd like to see more. I'd like to see professionals embrace working with the whole person. And that means all of the human experience, even though it might be a little bit messy and a little bit difficult sometimes, but that's what it is to be human.

1:18:10  
That is so well said. No. So well said. Yeah, the and this is yeah, this is obviously you know, we know each other and so we've had these conversations many times ourselves or with other people in like the mastermind group and whatnot, in the various other groups that that we're a part of, is that the the moving away from modalities and more towards population based. CCS is such an important thing. And that's why I like what you're doing, you're doing oncology massage, or focusing on a population. It's not like you're doing MLD for insert, area, breast cancer, or whatever, you know, you're, you're teaching about a population and then you're going to teach, you know, different ways of managing or approaching or, you know, the do's and don'ts kind of thing or ideas, and what's the science suggests is for this population, and we need more of that, and then that's what you said, this where you kind of you're getting it in there is like treating the entire person less than modalities and that would be the thing that I would love to see for our profession is for population based learning to be the focus because guess what, that's what every other health care profession does. So why are we one of the few that just decides to focus on you know, these acronym based learnings and these like different modalities and like, when we look at the science we know the modality is all work pretty much via the same anyway. But let's focus on learning everything can about a population. So that's what's that's, that's what I find really attractive about your your course. And what you want to do is there's a huge hole there where there's not a lot it sounds like there's hardly any if not zero, evidence based courses for massage therapists by massage therapists for oncology massage, and you're not teaching specific techniques you're teaching. What's this evidence suggest is best way to approach this profession. That's what we should be learning. Just that's not always a logical it's all So better practice?

1:20:03  
Yes. Yeah, I agree. Well, thank you so much for inviting me onto your show and giving me the opportunity to talk about this. This has been, as always, Eric, such a pleasure to chat with you talk about all these different things. And we've covered so many different topics. My goodness,

1:20:21  
yeah. Yeah. It was great today, Susan, really appreciate you taking the time to be here. That was really fun. I planned. We will I'm sure we'll be in touch with you again. So you have a good day and everybody is listening. Pay attention to Susan. In the show notes. I'm going to put her contact information. And so you can reach out to her if you want to learn more from her and fall 2023 oncology massage with the wonderful Susan shipped in becoming towards you. Thank you. Thank you. Bye. Thank you for listening. Please subscribe so you'll be notified of future episodes. Previous versus is now available on all major podcast directories. If you enjoyed this episode, please share it on your social media. If you'd like to connect with me, I can be reached my website Eric purpose.com. Or send me a DM to either Facebook or Instagram at Eric Purvis RMT

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