Ep 30 – Logorrhea, or Patience and Presence with People with Communication Challenges, “I Have a Client Who …” with Ruth Werner

A blackboard crammed with words written messily in chalk

This episode tells the story of a client who is approaching the end of her life. Cancer metastasis to her brain has led to some language difficulties. We will talk a bit about oncology massage therapy, palliative care, CyberKnife surgery, and cerebral shunts. But the main lesson here is about patience and presence with people who have some communication challenges.

Author Images: 
Author Bio: 

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner’s books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com


This podcast sponsored by Books of Discovery and Anatomy Trains.

Full Transcript: 

00:00 Speaker 1: Ruth Werner's best-selling book, A Massage Therapist's Guide to Pathology, is a highly regarded comprehensive resource that sets the standard for pathology education. Written for massage therapy students and practitioners, this groundbreaking resource serves up a comprehensive review of the pathophysiology, signs, symptoms and treatment of more than 500 diseases and disorders. Learn more at booksofdiscovery.com.


00:39 Speaker 2: Hi and welcome to I Have a Client Who, pathology conversations with Ruth Werner, the podcast where I will discuss your real-life stories about clients with conditions that are perplexing or confusing. I'm Ruth Werner, author of A Massage Therapist Guide to Pathology. And I have spent decades studying, writing about and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice. And sometimes as we have all learned, that is harder than it looks.

01:24 S2: In this episode, we have a massage therapist from Kentucky who works primarily with oncology patients, and she shares this story. "I have a client who's about 68 years old. She has cancer metastasis to her brain, either from lung or breast cancer, she has both, and this has caused some problems with language. In particular, she sometimes has aphasia. She loses a word or two. And then she has an inability to stop talking. It's like she gets on a roll and she can't stop the words from coming out of her mouth, and it just goes on and on and on. Here's my note. I looked this up and there's a name for this. This is called logorrhea. Logos for word, rrhea for flowing."

02:11 S2: "So a couple of years ago, she had CyberKnife surgery to treat the tumors in her brain. More recently, she went in for her regular scans and her doctor thought they saw signs of new tumor growth, so she went through another laser-guided surgery to get at them. And to do this, she told me they had to screw metal bits into her skull to use like a GPS. And they found that, in fact, it was not new tumors. It was radiation necrosis, dead tissue related to her previous radiation therapy and then this can stimulate some responses that create a lot of problems. What's really amazing is that she had the surgery on a Thursday and I talked to her about it on Friday. Now she has a shunt that drains excess fluid from her skull into her belly. I love this client. She's a delightful, wacky old lady, a retired psych nurse. She knows that she's approaching the end of her life and she's making arrangements to enter hospice care, but she's still pretty active and she comes to me for her massage.

03:15 S2: Before we explore this situation, let me give my special thanks to this massage therapist who was so generous to share her story with us. And if you have a story to share, I invite you to send it to ihaveaclientwho@abmp.com. That's ihaveaclientwho, all one word, all lowercase @abmp.com. So let's talk about our delightful, wacky, old lady. I have to tell you, I love this story, I love this client. We don't have any specific questions about massage and pathology, although there are a couple of things I wanna talk about. But mainly, what I get from this is how much this therapist adores this lady. And there's a bit more that I'll share with you about that in a little bit that'll have an impact on the way this therapist will approach many other clients that are in her life. But our primary job here is pathology education. So let's talk a little bit about oncology massage therapy, palliative care and cerebral shunts.

04:26 S2: So oncology massage therapy is a field of work that requires some special education. Every now and then on Facebook. I will see someone post something like, "I have a new client who's recovering from breast cancer surgery, so what do you think I should do?" And what I wanna say is refer them to someone with appropriate expertise, go get some education and stop looking on Facebook for answers to questions like this, but I don't. Oncology massage therapy is not for dabblers. It is a calling that can radically improve a person's quality of life. But if it's done carelessly, then it can be really, really risky. Not so much because we might spread cancer, although that's not impossible, but because the complications related to both cancer and cancer treatments contraindicate lots of types of massage therapy. So if this is a population that you would like to work with, please, I'm begging you, get appropriate education, and I will put some of my favorite resources in the show notes.

05:29 S2: Now, let's say a few words about palliative care because here's the thing, after millennia of efforts by the most brilliant and motivated minds on the planet, the human race still has a 100% mortality rate. Everybody is going to die. Dying is simply effect of life and massage therapy can have a beautiful place in the process as a person makes the transition from this plane to the next. If you are interested in caring for people who are at the end of life, again, this is a field that requires some advanced education. The fact that someone is dying does not mean you can just give them any kind of massage that they want, which is another piece of advice I have seen shared on Facebook. Palliative care is care that is given simply to improve the experience of people who are very, very ill or who are approaching the end of life.

06:35 S2: The client in this story received two bouts of brain surgery not to cure her cancer, but to improve her symptoms so that she could live her life with the best possible quality. In that context, CyberKnife surgery is palliative care for her, and so is massage. If we are given the privilege of working with people in this phase of their life, we need to do that in conjunction and communication with the rest of their care providers. Let's bear in mind that circulatory systems may be challenged, bones may be fragile, sensation may be impaired, organs may be failing, and all of these things must impact decisions about massage therapy. This is not a project to be undertaken lightly. But with the right education and an open heart, it can be tremendously fulfilling and such an honor to be part of someone's passing.

07:32 S2: Finally, let's talk for a moment about something a little more technical, CyberKnife surgery and brain shunts. It turns out that the term CyberKnife, I just learned today in preparing for this podcast, refers to a specific trademarked radiation tool. It's a brand name, like Kleenex as opposed to tissue. A CyberKnife is a robotic device that uses stereotactic, that means using three-dimensional mapping, that uses stereotactic radiation therapy to deliver precise doses of radiation in precise locations. And in this way, the tumor cells can be killed with only minimal damage to other tissues and without all the trauma that's engaged with open surgery. And you can imagine that, especially in use for brain tumors, this is a really important factor. But CyberKnife surgery is used for lots of other types of cancer and problems as well.

08:32 S2: This client developed a complication called radiation necrosis, which can happen sometimes with brain surgery, with CyberKnife tools. And this can cause local swelling and headaches, maybe seizures and a bunch of other problems, so it's important to treat it. In this case, part of her treatment involved the insertion of a brain shunt. This is a tube to drain excess fluid out of her brain. The tube passes down the neck into the thorax and then releases the fluid into the peritoneal space. If anyone is interested, I will put some links to the information about the CyberKnife technology and some great stuff on brain shunts in the show notes as well. Because this particular massage therapist work so frequently with oncology patients and others who are medically frail or compromised, the prospect of having a client with a brain shunt is not especially intimidating. This piece of equipment requires some care, about how we position people and we have to be careful about how we move her neck. But because of COVID and mask wearing right now, she's not doing a lot of work around the face and head anyway, so the presence of the cerebral shunt is really not a big issue for her. However, it might be a big issue for you if you have experience with a client with cerebral shunts that you'd like to share. Send it to me and we can do a podcast about that.

10:02 S2: What this client really brought to this massage therapist's awareness is the need to be able to adapt her typical communication style. This is a therapist who is used to talking with people really, in a really matter of fact and plain and simple and loving way about their life and their experiences. But this client's bouts of aphasia, word loss, mixed with logorrhea, those streams of words has just go on and on and on in a sort of helpless attempt to try to find her way back to her central thought. This brought the massage therapist to be aware of the deep importance of kindness and patience and appreciation for how hard it can be for someone to get their ideas across to us. It takes so much courage for a person with a language problem to try to communicate and it's our responsibility, it's our privilege to be open to that and to do whatever we can to make that as easy and as friction-free as possible. This client will not be with us for much longer. And the massage therapist tells me that she will really miss her when she's gone. But a lasting legacy from this woman's experience will be that her massage therapist will look differently at future clients whose methods of communication might be very different from her own. And I think that's a great lesson for all of us.

11:44 S2: Hey everybody, thanks for listening to I Have a Client Who Pathology conversations with Ruth Werner. Remember, you can send me your I Have a Client Who stories to ihaveaclientwho@abmp.com. That's ihaveaclientwho, all one word, all lowercase @abmp.com. I can't wait to see what you send me and I'll see you next time.

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