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Posted by Jacqueline Bowyer, Sep 25 2007 11:41AM

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Diabetic & one kidney

I have just agreed to see a new client who has quite serious health problems. Amongst other things she is diabetic and has one kidney. Her Dr's attitute, when seeking his approval for massage treatment was ' for goodness sake, you aren't an invalid - go and enjoy it and stop molly-coddling yourself'. I am rather nervous though as this is my first diabetic client. Clearly, I need to keep en eye on her sugar levels/BP etc during the massage(fruit drink handy). She has fluid retention from her kidney and her legs are quite large. I'm anticipating giving a nice gentle relaxing massage (avoiding any insulin injection site) which aims to help alleviate her fluid retention and aid stress relief. I'd appreciate any advice
Samantha Colverd
Sep 26 2007 4:01PM
I don't think you have anything to worry about as you seem to be familiar with potential problems. Check they have taken their medication on the day of treatment and that they're feeling ok. As with any patient, ask them to give feedback throughout and listen to and act on what they say and be vigilant yourself for any changes in condition. Go gentle and when they come for the second appointment, ask them how they felt in the days after the first treatment - good, bad or indifferent. It is nerve-wracking when you get your first patient with medical problems but keep calm and use your common sense - remember your cautions and contraindications and you'll be fine! Good luck!

Sam
Jacqueline Bowyer
Sep 27 2007 8:01AM
Thanks Sam. I appreciate your advice and encouragement! I realised afterwards that I should have put this on the forum board, so pleased to hear from you.
Susan Birnie
Sep 27 2007 5:49PM
hi jaqueline just browsing through and saw your message. i am a therapist myself swedish body, aromatheray and reflex. i am also type 2 diabetic, so am fully aware of giving treatments and having them myself. you dont have much to worry about just remember all the contraindications and listen to your instincts and listen to youor client. like all other conditions make sure they are well, have eaten, taken their medication and have something near to hand. i tend to take my time with my diabetic clients giving them longer to get up from lying down as i myself have a problem with postural hypotension(not sure if i spelt right!) where you can get dizzy as you get up,it can be a problem with some diabetics. having said this if you get up slowly its fine.also check if they are well hydrated. good luck youll be fine sue.
Jacqueline Bowyer
Sep 28 2007 10:35AM
Thanks Susan for your reasurrances. I do feel a whole lot more confident now and know that by each of us following common sense precautions we should be fine. I will be extra vigilent, as you reiterate, and keep plenty of water and juice nearby, and allow her plenty of 'recovery' time. I was even thinking of running her home, as she lives nearby, for my own peace of mind as much as hers!!! Actually, I'm quite looking forward to doing it now that my apprehensions have been alleviated somewhat, so thanks again for reviving my confidence!
Angela Rawlins
Oct 1 2007 5:29PM
Thanks Jacqueline

Nice to hear about treatments for diabetics. I haven't treated anyone yet, but I do have a friend who had and the lady had a hypo on the table! She was really calm and telephone the lady's husband - GOOD TIP make sure you have a contact number for a relative just in case:))
Elizabeth Temperton
Dec 3 2007 11:46AM
Hi Jacqueline,

This is my first foray onto the forums and I happened to read your post and it piqued my interest. When you say this lady has large legs, do you mean they are swollen? If so, it would be a good idea to get a diagnosis as to the cause of the swelling. Any limb (or part of the body for that matter) which shows signs of oedema should be avoided with traditional massage, especially if there is alot of swelling or it is a lymphoedema. The reason for this is that massage increases filtration of fluid from the blood capillary into the interstitium. If there is any degree of lymphatic insufficiency, this extra fluid will simply add to the swelling and pressure in the tissues and potentially cause further problems. I have dealt with lymphoedema and diabetic leg ulcers in the course of my work, lymphoedema can cause long term skin changes which in a diabetic can lead to further problems due to the fragility of the skin. If there is oedema, you may be better to refer her to an MLD therapist for treatment of the legs and look after the rest of her with massage.

When I trained in massage I was unaware of the above and it wasn't until I trained in MLD that I realised how detrimental massage can be to limbs which are oedematous. I hope that this is some help to you. Best Wishes and good luck with your client. Liz
Jacqueline Bowyer
Dec 3 2007 4:41PM
Many thanks for your comments and observations. My client has been now and we had a very successful massage. Fluid retention was minimal so not a contra on this occassion. It was good to get encouragement and support from other therapists on-line and I will be much more confident as a result.

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