A complete archive of pathology-related podcast episodes featuring Ruth Werner.
|Ep. 133||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||7/23/21||Happy Birthday to . . . Us!||From appendicitis to vertigo: a quick tour through the first year of I Have a Client Who . . . episodes in alphabetical order. I am so grateful to our listeners and podcast hosts and sponsors who have made all this possible, and I’m looking forward to another great year of I Have a Client Who . . . stories!|
|Ep. 130||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||7/16/21||Substance Use Disorder and Interoception, A Conversation with Dr. Cynthia Price||“There’s so much power in the very, very simple things.” Dr. Cynthia Price shares her “I Have a Client Who . . . ” story about a woman under treatment for substance use disorder, who is learning positive things about her body for the first time. It’s a beautiful story that will remind us about why we do this work. Plus, there’s information on how you can work with Dr. Price to do the kind of manual therapy that helps stressed clients find their way to positive awareness.|
|Ep. 128||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||07/09/21||Infected Olecranon Bursitis||Student’s elbow? Popeye’s elbow? Whatever you call it, an infected olecranon bursa is no joke. Lots of people have to go through several attempts to treat it, culminating in surgery to remove it. When is massage therapy safe?|
|Ep. 125||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||7/02/21||Kienböck’s Disease||What happens when a bone that forms a major pivot point in the wrist falls apart? A friend of a massage therapist is looking for some self-massage ideas as she recovers from a pioneering surgery on her wrist to repair damage from a rare and painful condition called Kienböck’s disease. Or lunatomalacia. Or avascular necrosis of the lunate. Kienböck’s disease? What is it? And why does it lead to wrist reconstruction surgery? And will massage therapy make this worse?|
|Ep. 123||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||6/25/21||The Complexity of Dermatomyositis||Listen for an exploration of an extraordinarily complex autoimmune disorder with elements of lupus, scleroderma, and muscle inflammation. Includes short tangents on the etymology of the term pathognomonic and CREST syndrome (no, not the toothpaste.) Can massage help? Or is it off the table?|
|Ep. 120||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||6/18/21||Brain Surgery and Spasms||A client had brain surgery and now has severe and painful spasms in their back. Is this a complication of surgery? Is this a precursor to total paralysis? Will massage make it worse? Listen for a brisk review of nervous system function and what happens when parts of the nervous system are injured. Upper or lower motor neurons—it makes a difference!|
|Ep. 118||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||6/11/21||Shingles||In this episode we do a deep dive into varicella zoster virus and the many confusions about chickenpox, shingles, and a weird invisible form of shingles. Is shingles contagious? Can you get it more than once? Where does the chickenpox vaccine fit? It can be very confusing! Tune in for some useful clarifications.|
|Ep. 115||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||6/4/21||Restless Leg Syndrome||A client comes back to the massage table after a long pandemic-related break. Her therapist notices something new: as the client relaxed, her legs began to twitch and jump, and she felt “tingling” on the top of her foot. What is going on, and can massage therapy help?|
|Ep. 113||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||5/28/21||Seizures and Action Plans||A client who has never had massage before calls to make an appointment. He has a history of “grand mal” seizures. What does the massage therapist need to know to be safe with this client? We go through a short list of important questions.|
|Ep. 110||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||5/21/21||Obesity Pressures||An obese client wants help with low-back pain, but she can’t take deep pressure. What to do? Ruth might get a little strident in this discussion of weight, health, judgmental language, and hands-on options.|
|Ep. 108||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||5/14/21||Rhabdomyolysis||A young woman has lots of muscle pain after her soccer game. A great time to receive massage, right? Not this time. Listen in for a case where massage could cause renal damage.|
|Ep. 105||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||5/7/21||Pregnancy Surprise||A pregnant client has pain and numbness in her hands. It is NOT what you think. In this conversation with pregnancy massage expert Carole Osborne, we take a look at a common pregnancy-related complaint, and see how it can offer some surprises!|
|Ep. 103||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||4/30/21||Pseudogout||A client wants deep work in his hamstrings, but he has a couple of situations that might make it questionable: Parkinson’s disease and a recent onset of a new condition for him called pseudogout. What is pseudogout, how is it different from traditional gout, and what can this massage therapist do in this complex situation?|
|Ep. 100||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||4/23/21||MRSA||A client with a complex health history reveals he has recently been exposed to methicillin-resistant Staphylococcus aureus. During his session, his massage therapist finds lots of little scabs on his body—yikes! Good news: this is not nearly so scary as it seems. The hygienic practices we already use provide us with good protection from MRSA colonization, but that needs to happen on purpose, and not by accident. Also, you might want to keep some gloves and masks around.|
|Ep. 98||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||4/16/21||Marfan Syndrome||A client has Marfan syndrome—what does it mean for him? And what does it mean for massage? Listen in as we review what autosomal dominant means, and we enjoy some new vocabulary: dolichostenomelia (abnormally long, thin limbs) and arachnodactyly (spider-digits). We also learn about the potentially life-threatening complications of this genetic disorder.|
|Ep. 95||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||4/9/21||Eating Disorders||This story is a delicate one. The client has an eating disorder that the massage therapist thinks is pretty advanced, and may be getting worse. This episode dives into some of the serious consequences of eating disorders and the important role massage therapy may play. It may be upsetting for people who struggle with eating disorders, so please consider this a trigger warning.|
|Ep. 93||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||4/2/21||A Failure to Communicate About a Failure of the Liver||A client didn’t share an important piece of information—and the therapist didn’t ask. The result: a serious situation that massage could have made much worse. In this episode, we talk about a surprising relationship between bariatric surgery and liver failure—and about the need to ask open-ended, inviting questions that will help us get a clear and full understanding of our clients’ health challenges.|
|Ep. 90||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||3/26/21||Lots o' Clots, Part 2||Another episode about DVT and pulmonary embolism—but this one looks really different from last week!
New client says, “I want to make you aware of my pulmonary embolism this week . . . my hospitalist says massage will be OK”
Encouragement to do massage
Encouragement NOT to do massage
What to do??? In the face of contradictory advice, we walk through this decision-making process, discussing the difference between information and permission along the way.
|Ep. 88||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||3/19/21||Lots o' Clots, Part 1||A client with a complicated health history (including cancer and newly adjusted chemotherapy) has a medical emergency: deep vein thrombosis and pulmonary emboli. Now she wants massage. There’s a lot to balance in this decision, which is not as clear-cut as it seems. In this episode, we consider some of the variables about massage for a person with this medical history and find a way to get to a good conclusion.|
|Ep. 85||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||3/12/21||Fem-Pop Follow-up||In episode 77, from February 19, 2021, a client with “critical limb ischemia” wants massage while he awaits corrective surgery for an occluded artery. So, we talked about peripheral artery disease and talked about the risks and reasons to be cautious in this situation. In this follow-up episode, we find the client was in better shape than I thought, and the massage therapist shares her treatment choices and rationales for a really hopeful outcome. This is yet another example of how important it is to treat the person, not the diagnosis.|
|Ep. 82||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||3/5/21||Corticobasal Syndrome||A client with corticobasal syndrome wants to improve her range of motion in her right arm. Nothing seems to work so far—sessions with her personal trainer and two massage sessions haven’t made any significant changes. What is corticobasal syndrome? Well, it’s complicated. And what treatment options have the most promise? (You might be surprised.) And most importantly, what is a realistic expectation for this client?|
|Ep. 79||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||2/26/21||Toxic Mold Syndrome||A new client calls for a manual lymph drainage session, and they have a diagnosis the massage therapist has never heard of—toxic mold syndrome. Information online about this condition is confusing and inconsistent. What is toxic mold syndrome? Does it even exist? Why is it so controversial? And most of all, what can we do to help this client?|
|Ep. 77||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||2/19/21||Femoral Popliteal Bypass||A client with a serious circulatory problem—a failed femoral-popliteal bypass, or “fem-pop” surgery—wants a massage while he’s waiting for his next procedure. There’s no data on massage and failed fem-pops at all. What can this massage therapist do? In this episode, we look at fem-pop surgeries and the reasons why a person might need it. Then, we take apart some of the variables that go into making decisions about massage therapy for this client. It’s a critical-thinking exercise with immediate repercussions for this client and his health and comfort.|
|Ep. 75||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||2/12/21||Kidney Donor||A contributor has an unusual question: how soon can I work with someone who recently donated a kidney? We have lots of information about massage therapy for people on dialysis, and known cautions for transplant recipients, but we don’t know much about how to help living donors. In this episode, we take a look at what it’s like to give up a kidney and what kinds of accommodations for massage that requires.|
|Ep. 73||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||2/5/21||Pregnant and Hand Pain||A client is seven months pregnant and has severe pain in both hands and wrists. Is it carpal tunnel? Can massage help? The answers are yes, maybe, AND—watch out for a significant risk.|
|Ep. 71||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||1/29/21||Frozen Shoulder and the Super Drug||A client has frozen shoulder: a painful, limiting condition, and she is prescribed a powerful drug (methylprednisolone) to help manage it. When it is appropriate for massage to enter this situation?|
|Ep. 69||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||1/22/21||Vertigo||A young client has had dizzy spells and neck pain with stiffness for three years. His doctor can’t find anything wrong, and—huzzah!—suggests massage therapy to help. What is the source of his vertigo? Can massage help?|
|Ep. 67||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||1/15/21||Parkinson’s Disease vs Normal Pressure Hydrocephalus||In this episode, I explore a condition that is completely new to me, and you get to come along for the ride. A long-time client shows signs of some complicated neurological problems. Is it Parkinson’s? Is it hydrocephalus? Why not both?|
|Ep. 65||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||1/8/21||Eustachian Tubes||Today we take a deep dive . . . into the ear. We look at a client who had a sinus infection with lingering ear stuffiness. Magically, it resolved with massage! The MT naturally wants to know, “What happened? And can I make it happen again?”|
|Ep. 60||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||12/25/20||Appendicitis||A massage therapist gets an early lesson on who is ultimately responsible for making decisions about client safety—hint: it is not always the doctor or the client! Sometimes our clinical decisions should be out of alignment with our client’s health-care providers.|
|Ep. 58||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||12/18/20||Just a Bruise?||A client training for a big event takes a fall and bruises his thigh. Now he wonders if foam rolling would help, and he has also convinced himself it’s a serious condition: compartment syndrome. He wants advice from his favorite provider. What’s a massage therapist/personal trainer to do?|
|Ep. 56||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||12/11/20||Olecranon Bursitis||A myofascial massage therapist develops a work-related injury. No one warned us about this one! In an effort to save his thumbs and wrists, he developed bursitis on his elbow. Listen for what he did to deal with it and preserve his career.|
|Ep. 54||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||12/4/20||Scoliosis||A competitive barrel racer has multiple back surgeries for scoliosis. She has spinal fusions and Harrington rods that stabilize and immobilize her spine from her sacrum all the way up to T2. With her massage therapist’s help, she makes a big discovery about her function. Human bodies are amazing!|
|Ep. 51||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||11/24/20||COVID-19 Vaccines: What We Know||On the heels of the encouraging information from the past two weeks, and information about Pfizer’s and Moderna’s COVID-19 vaccines and their effectiveness, we wanted to check in with our good friend Ruth Werner to get her opinion on a range of topics: the current vaccines in production and the new technology used behind their speedy creation, the potential for long-term effectiveness, virus mutation, and more.|
|Ep. 50||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||11/20/20||Ultrasound Ears||In this episode, I revisit a previous podcast with a surprising outcome, I share a story-within-a-story, and I say some things that are sometimes hard to hear. This “I Have a Client Who ...” has surprises, uncomfortable truths, and a wish for my very own massage therapy super-power: ultrasound ears.|
|Ep. 48||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||11/13/20||Tourette’s Syndrome||An adult client has Tourette’s syndrome with tics that include various jumps and vocalizations. Her massage therapist notices a surprising change with supine neck work and a traditional craniosacral hold. What is Tourette’s syndrome? What are tics? And why might massage therapy have any kind of influence here? This is a mystery that deserves some attention.|
|Ep. 46||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||11/06/20||Pregnancy Pass Out||A pregnant client vomits and loses consciousness in the middle of a massage. The therapist shows remarkable presence of mind and everything worked out fine—but what on earth happened? Would it have been possible to predict such a thing? Carole Osborne, author of Pre- and Perinatal Massage Therapy, A Comprehensive Guide to Prenatal, Labor, and Postpartum Practice, took some time to talk me through this so I could bring some true expertise to this discussion.|
|Ep. 44||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||10/30/20||Flu Vaccines and Massage||A massage therapist has an opinion about when to work after a client’s flu shot. Her colleague has a different opinion. Who is right, and based on what data? Join me for a discussion of flu shots, appropriate delays (or not) for massage therapy, and intriguing possibilities for future research.|
|Ep. 42||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||10/23/20||Deep Vein Thrombosis||Two clients. Two left legs that are swollen and hot. Two surprising outcomes. We explore deep vein thrombosis, pulmonary embolism, and venous thromboembolism, and even take a quick peek at aortic aneurysm. Lots of long words in this one, and lots of opinions from me.|
|Ep. 38||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||10/16/20||Bunions||Bunions? Calcifications? Does it make a difference? A massage therapist isn’t sure what’s going on with her client’s foot and wants to know if it even matters. We will unpeel the layers of this situation to revisit bunions, Wolff’s law, osteoarthritis, and more. Come explore this gynglimoarthrodial joint with me—and no, I didn’t make up that word!|
|Ep. 36||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||10/09/20||Psoriatic Arthritis||A massage therapist is in a rather severe bike accident, being hit by a vehicle—on purpose. In addition to his other injuries, he develops a sudden onset of episodes of skin lesions and severe joint pain that persists to this day. What in the world is going on here, and what can he do about it? This is an inspiring story of remarkable resilience.|
|Ep. 34||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||10/02/20||Spinal Fusion||A client has chronic low-back pain, headaches, migraines, and a history of some serious surgeries. We take a close look at one of them: spinal fusion at L4-L5. What is this massage therapist doing now? What might he do in the future? It turns out there are a lot of options!|
|Ep. 30||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||09/17/20||Logorrhea, or Patience and Presence with People with Communication Challenges||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.|
|Ep. 28||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||09/11/20||Can This Relationship Be Saved?||In this episode, a client might be disappointed. A therapist is very concerned. And we don’t know what will happen next.
When a “pinched nerve” that has been quiet for six months suddenly creates symptoms in the middle of a massage, what’s a therapist to do? We will talk about what could be going on here (including some fascinating things about nerve-generated pain) and what the best next steps could be.
|Ep. 26||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||09/03/20||Hernia||Guess the pathology: an egg-sized lump in the groin. In this episode of “I Have a Client Who …” a massage therapist describes a client who comes in asking for groin work—to help with a “knot.”
What on earth is going on?
It turns out to be simple, but way, way outside our scope of practice—to label, or to treat.
Inguinal hernias are common injuries in men, because the passage of the spermatic cord into the abdomen creates a structural weak spot at the inguinal ring. When that spot gets stressed and stretched, loops of the small intestine can bulge through. This can be a minor issue, or it can become serious very quickly—and the only permanent solution is surgery.
|Ep. 32||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||09/02/20||Lipedema||In this episode, a client has lipedema—a painful condition with enlarged fat cells that won’t ever shrink or go away by themselves, and it’s probably going to get worse. It turns out that massage therapy could be helpful with the right kind of education and background. Fortunately, we found a great resource!|
|Ep. 24||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||08/27/20||Patent Foramen Ovale||A man has a stroke at age 35. He fully recovers, but is put on a lifelong prescription of anticoagulants. What is going on, and will he ever be able to receive the deep massage he wants?
In this episode of “I Have a Client Who …” we look at a common anomaly called patent foramen ovale. We discuss its connection to cryptogenic stroke (and we even dive into migraine for a hot second). Finally, we talk about some variables that inform the safety of massage therapy for clients taking anticoagulant drugs.
|Ep. 22||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||08/21/20||Fractured Sternum||A client who was recently in a motor vehicle accident experienced pain during her massage session, even with lightened pressure. Even though she had been “cleared for massage” by her primary care provider (PCP), it turns out she had no X-rays, and unfortunately she had sustained a fracture to her sternum during the accident. Getting massage “clearance” from a PCP are fighting words for Ruth, because according to her “They don’t know your massage.” Listen as Ruth dives into the complexities of the situation and the nuances of this particular case that make it a fascinating example of an experience that MTs are likely to see in their practices.|
|Ep. 20||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||08/14/20||Undiagnosed Rash: What Do You Think It Is?||An older long-time client is on the table, midway through her massage. When the MT undrapes her leg, she finds a string of red blisters from the client’s buttock down the leg. “Oh, yeah, it’s kind of itchy,” says the client. In this episode, we talk about undiagnosed skin lesions, how carefully we need to communicate to clients about them, and take a deeper dive into shingles: what causes it, what the risks are, and whether massage therapists might catch it from clients.|
|Ep. 18||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||08/07/20||Shoulder Injury—Or Is It?||The wrong choices can lead to unforeseen repercussions. Listen as pathology expert Ruth Werner shares a story of one of her neighbors who was complaining of seemingly uncomplicated shoulder pain—that turned out not to be shoulder pain.|
|Ep. 16||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||07/31/20||Essential Tremor||Ruth Werner discusses the complex overlap of conditions in a longtime client: already affected by heart disease and diabetes, this client now has developed essential tremor. Is there a safe way to help him, given his medical history? How do we balance all the variables in this situation to offer safe, effective massage? What kinds of work might be most helpful? What, if anything, does the research say? You might be surprised.|
|Ep. 14||ABMP “I Have a Client Who …” Pathology Conversations with Ruth Werner||07/24/20||A Stroke Survivor’s Prognosis||This story with a description of stroke, how it affects function, and the role of massage therapy is a complicated situation that also involves ethical boundaries, communication skills, and some ideas for options that practitioners might pursue for their clients with central nervous system injury.|
|Ep. 3||ABMP - Conversations in Quarantine with Ruth Werner||04/28/20||Conversations in Quarantine with Ruth Werner||Ruth Werner, author of A Massage Therapist’s Guide to Pathology, discusses her recent article “What Will It Look Like When We Go Back to Work?” Werner gives an update on COVID research, testing, and weighs the risks vs. benefits of reopening practices.|