A Massage Therapists Guide to Pathology Chapter One

A Massage Therapist’s Guide to Pathology Chapter One Fundamental Concepts in Pathology Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction • Part I: Terminology • Part II: Hygienic Practices • Part III: Infectious Agents • Part IV: The Inflammatory Process Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminology • A- , an-: without • Cep-, Ceph-: head, brain • Acro-: extremity • Chole: bile • Adeno-: glandular • Com-, con-: with, together • -Algia: pain • Contra-: against • Angio-: blood or lymph vessels • Cyst: hollow organ • Arthr-: joint • Derm-: skin • Brady-: slow • Carcin-: crab (cancer) • Cardio-: heart • Demo-: people • Dia-: through • Dys-: difficulty • Cervi-, cervico- : neck • Ecto-, -ectomy: outside, removal • -Cele: swelling, hernia • -Emia: blood Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminology • Endo-: inside • Hyper-: above, too much. • Epi- upon • Hypo-: below, too little • Erythr-: red • -Itis: inflammation • Ex-: out of • -Lepsis: seizure • -Gen: beginning, producing • Leuko-: white • Lipo-: fat • Glyco-: relating to sugar • -Graphy: recording, writing • Litho-: rock • -Logy: study • Hemo-: blood • Hemi-: one-half • -Lysis, -lyso: destruction • Hepat-: liver • Mega-: large • Hydro-: water • Meno-: month Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminology • Metr-: mother (uterus) • Onco-: tumor • Micro-: small • Orchi-: testes • Myco-: fungus • -Osis: pathologic condition • Mye-: marrow or spinal cord • Osteo-: bone • Myo-: muscle • Para-: alongside, near • Narco-: stupor • Peri-: around • Necro-: death • Phagia-: eating • Neo-: new • -Philia: affinity • Nephro-: kidney • Phleb-: vein • Neuro-: nerve • Phyto-: plants • -Oid: resembles • -Plasia: growth • -Oma: tumor • -Plasm, -plasma: formed Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminology • Patho-: disease state • Spondy-: spine • Physio-: nature • -Stasis: stagnation, standing still • Pseudo-: false • Stoma-: an opening; mouth • Psych-: the mind, mental • Syn-, Sym-: with • Ren-: kidney • Thrombo-: clot • -Rrhagia, -rrhea: flowing • Therm-: temperature • Rhino-: nose • Sarco-: flesh • -Trophy, -trophic: nutrition, growth • Sclero-: hardness, scarring • Vaso-: blood vessel Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Terminology • Acute • Lesion • Chronic • Morbidity • Complication • Mortality • Contraindicated • Pandemic • Demographic • Prevalence • Diagnosis • Prognosis • Endemic • Sign • Epidemic • Stenosis • Idiopathic • Subacute • Incidence • Symptom • Indication • Syndrome • Trauma Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents Pathogen: disease-causing organism • Resistance is based on genetics, virulence, and lifestyle habits Five basic classes: • Prions • Viruses • Bacteria • Fungi • Animals Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Prions No DNA, RNA Grow within CNS Spread through eating contaminated tissue, contaminated blood, transplant tissue, surgical tools – BSE (“mad cow”), CJD, kuru… Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Viruses Packets of DNA, RNA wrapped in capsid (protein coat) Cannot replicate outside a host Reprogram target cell to produce virus Infected cells rupture, releasing viral copies Many disintegrate outside a host Some are stable, especially herpes simplex, hepatitis B, hepatitis C Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Bacteria Single-celled microorganisms Can survive outside a host Not all pathogenic; some are beneficial Pathogenic bacteria attack cells/ release toxic wastes that damage cells Antibiotics interfere with bacterial reproduction (Slow-growing infections less responsive) Some bacteria have “spore”: tough waxy coat TB, tentanus, anthrax Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Types of bacteria: – Cocci: spherical • Diplococci • Staphylococci • Associated with localized skin infections • Some are becoming antibioticresistant Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents – Streptococci • Associated with systemic infections – Bacilli: elongated, rod-shaped (most likely to form spores) – Spirochetes: spiral-shaped – Mycoplasma: very tiny Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Fungi – Yeasts and molds • Internal: associated with imbalance between yeasts and bacteria • External: skin infections Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents • Animal parasites – Single or multi-cellular organisms – Live in or on a host – Can be vector for other diseases • Protozoa (Giardia, crypto) • Helminths and roundworms • Arthropods Head lice, crab lice, mites • Others Mosquitoes, ticks, fleas don’t live on or in host, but can spread disease Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious agents Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Definition of terms – Cleaning – Disinfection – Sterilization – Sanitation – Plain soap – Antimicrobial soap – Detergent – Alcohol- based hand rub Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Universal and Standard Precautions Protection from infectious fluids: Semen Vaginal secretions Breast milk Cerebrospinal fluid Synovial fluid Pleural fluid Pericardial fluid Amniotic fluid Blood-tinged saliva Vomit (emesis) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Hand washing – Work to preserve lipid layer, skin health • • – Transient bacteria: superficial, easy to remove Resident bacteria: deep, harder to remove (generally less aggressive) Running warm water, plain soap, 30 seconds • • Liquid soap is preferable Antimicrobial soap more likely to cause allergic reaction (Watching for increased bacterial resistance) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Alcohol-based gels – Can be faster, more convenient – Doesn’t remove dirt – Use according to manufacturers’ recommendations • Alcohol-soaked towelettes not adequate • Moisturizing lotions are important Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Other Hand Care – Hang nails and other lesions • Cuticle nippers, cover sores – Trim, clean fingernails Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Care of surfaces, equipment – Goal: create an environment where nothing that one client touches directly or indirectly is touched by another client before it is cleaned Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Fabrics – All surfaces touched by client or therapist must be cleaned or replaced with each appointment – Linens, face cradle covers, bolster/pillow covers, etc. – Therapist clothing: consider changing shirt or apron with each client Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Laundering: – Professional laundering services use water that is 160º F (71º C), 25 minutes of agitation – 71 -77º F (21. 6 -25º C) with adequate detergent for anti-microbial effect – Bleach is most active at 135 -145º F (57. 262. 7º C), ratio of 50 -150 ppm (parts per million) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices – Thoroughly rinse bleached laundry – Never leave laundry damp – Dry on high heat; iron for extra protection – Wrap, isolate clean laundry • Laundry services rent out sheets: little quality control • Other items must be laundered at home: – Clothing, bolster covers, face cradle covers, etc. • Watch for “seepage” of fluids through to fabrics usually covered by linens Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Other equipment • Swab massage tables, face cradles, vinyl-covered furniture – CDC recommends 10% bleach solution Loses potency quickly: replace often Alcohol evaporates too quickly to be useful – Isolate massage lubricants Solid at room temperature: individual dispensers – Wash oil/lotion bottles with hands – Keep bottles off floor, other contaminated surfaces Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hygienic practices • Other items: – Hot or cold rocks and crystals may be sterilized – Tools, hot/cold packs, etc: wash contacting surfaces • The massage environment – Curtains, upholstery, carpets probably not major vectors Can harbor allergens: vacuum regularly If carpet gets wet, can grow mold: replace – Other surfaces should be cleaned frequently: Door knobs, switch plates, bathroom surfaces, telephones, etc. – Cash is often contaminated Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • What is inflammation? • Response to tissue damage or the threat of invasion by antigens – Triggered by Physical trauma Invasion with foreign bodies Hormonal changes, Autoimmune activity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Purpose: – Protect from pathogenic invasion – Limit range of contamination – Prepare damaged area for healing • Outcomes: – Complete resolution with no scar tissue – Accumulation of scar tissue – Formation of cysts/abscesses – Chronic inflammation • See the. Point. lwww/Werner 5 e for more on inflammation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Components of inflammation: vascular activity – Vasoconstriction • Protective response, short-lived – Vasodilation • Chemicals released by damaged endothelium and mast cells Increase permeability of capillaries Reinforce capillary dilation Attract platelets Slow blood flow away from area – May last several minutes to hours or days Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • (See Figure 1. 10 a and 1. 10 b) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Components of inflammation: cellular activity – Many cells are recruited to manage tissue damage and contamination risk with injury. • Endothelial cells: – Release chemicals to activate platelets, allow WBCs to migrate out of capillaries – Proliferate to grow new capillary beds in later stages • Platelets: – Become jagged and sticky, adhere to damaged area – Release chemicals to bind with plasma proteins to create fibrin, blood clots Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • White blood cells: – Several types involved: • Granulocytes: • Smallest, fastest • Neutrophils 1 st on the scene for bacterial infection, musculoskeletal injury • Eosinophils for allergies, parasites • Basophils for allergies and histamine release Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Mast cells: – Located in tissues vulnerable to injury – Release histamine to prolong inflammatory response • Monocytes and macrophages: – Monocytes = large, mobile white blood cells – Can become permanently fixed macrophages – Associated with late-stage inflammation to clean up debris • Lymphocytes: – Work with macrophages to clean up debris, promote scar tissue, angiogenesis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Fibroblasts – Produce collagen, extracellular matrix – Drawn to local blood clots, may proliferate to form more scar tissue Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Chemical mediators – Many sources of chemical mediators that help coordinate cellular activity: • Suspended in plasma, from platelets, mast cells, basophils, endothelial cells… Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process Stages of healing • Acute stage – Damaged cells release chemicals – Edema develops – Platelets, early WBCs arrive – Tissue exudate begins to form – Time: depends on severity (1 -3 days, usually) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Subacute stage – AKA proliferative stage – Cells accumulate to fill in damaged area • Endothelial cells grow new capillaries • Fibroblasts create collagen fibers – Slower WBCs arrive to start clean-up – Time: depends; 2 -3 weeks Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Postacute stage – AKA maturation stage – Collagen becomes denser and aligns according to force Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Chronic inflammation – Inflammatory process is not successful • Pathogens/irritants not removed (leads to cysts, abscesses) • Excessive scar tissue interferes with organ function • Sinuses or fistulae develop • Musculoskeletal structures never regain full function: tendinosis • Excessive external scar tissue Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process Signs and symptoms: • Pain, heat, redness, swelling, and sometimes loss of function – Dolor (pain) – Calor (heat) – Rubor (redness) – Tumor (swelling) and – Functio Laesa (loss of function) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Treatment: – Anti-inflammatory drugs • Medications: – OTC anti-inflammatories – Prescription NSAIDs – Prescription steroidal anti-inflammatories Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

The inflammatory process • Massage – Risks: Acute localized infections locally contraindicate circulatory massage – Benefits: Post acute, maturation phase can benefit from fluid turnover, mechanical influence on scar tissue Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins