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Caregiver Syndrome

My husband was diagnosed with Stage IV cancer a few months ago. Last Friday, he had the last of his 35 radiation treatments. Two days ago, he had the last of 6 chemotherapy treatments.

A few moments ago, I Googled “caregiver syndrome.” I wasn’t sure whether or not that actually existed, but I figured I was suffering from it if it did. It does, and I am. According to CNN, the symptoms are depression, anxiety, anger, and declining health. Let’s throw in exhaustion and fear while we’re at it.  While this condition is also referred to caregiver burnout, it didn’t take me any time at all to get burned out. Except for the exhaustion, it was all there for me as soon as I heard the word “cancer” and my husband’s name in the same breath. Within just a few weeks of starting to navigate the cancer maze, exhaustion did in fact set in, and I haven’t had time to get over it yet. It will be three months before the next PET scan to see if the cancer is really gone.  I don’t think my depression, anxiety, and anger are going to magically disappear in the next day or two.

As for my own declining health, I have been suffering greatly from A Knot in the Pit of My Stomach. I don’t think that’s an actual medical condition, but it’s been real to me, accompanied by chronic diarrhea, and by chronic I mean a dozen times a day, with intermittent bouts of nausea when Fear Takes Over. I diagnosed myself with Irritable Bowel Syndrome, although I tried to jokingly think of it as Scared Shitless Syndrome. There’s nothing like hearing that the love of your life is seriously ill and knowing that he might die.

Yes, it made me depressed, anxious, and angry. I am not the crying type. I have gone years at a time without crying over anything, but in the past few months, I’ve probably shed more tears than I have in the rest of my life all put together. I’ve been angry…angry that Champ had cancer, and angry at the insurance company for jacking us around, and angry that people who are already under stress have to have the added stress of dealing with them.

I’ve been paranoid that he wouldn’t get well. I’ve been paranoid that we wouldn’t have enough money to survive the experience. I’ve been paranoid at little things. For instance, naps. For our whole life together, my husband would often come home from work, sit down in his recliner, and take a nap. It was just his habit. But after he was diagnosed, if I came home and he was taking a nap, in my head I would be going “Oh my god, he’s taking a nap! Is he sick? Is he okay? Is he breathing?” I know it’s ridiculous, but I couldn’t help it.

And in the meantime, the world kept turning. Work had to be done. Business had to go on. Deadlines had to be met. Bills had to be paid. Appointments had to be kept. All together, Champ has had a total of 7 doctors involved in his treatment, which was complicated by his life-long condition of having extremely low platelets. Since his initial diagnosis, he has had a total of 75 doctor visits, and I have accompanied him to all of them except two radiations and one platelet transfusion.

I’ve always believed that helping someone else is a good way to get your mind off your own troubles. I started a Cancer Caregiver support group, for the also-selfish reason of having others who were going through what I was going through to talk to. I also got some anti-anxiety medication, but after reading all the side effects, decided not to take it. We’ve gotten a lot of comfort and support from friends and family, and from FB friends. One friend, who is a long-time cancer survivor herself, called Champ one day and said “I just wanted to call and say this is not all about you. Your wife is going through a lot, too, and you need to understand that. ”

Caregiver syndrome is common among those who are caring for their elderly parents or other family members with dementia and chronic diseases. It’s very easy  for other people to say “You have to take care of yourself. You have to make time for yourself.” That’s all true, but there were weeks when that was a joke, and I know the other caregivers out there know exactly what I mean. Since my husband’s medication was causing him to nap all day, he didn’t sleep at night. He kept me awake at night, and I would be exhausted during the day when I was trying to work. I would literally be ready to go to bed at 7 pm because I was just so tired. On the few occasions when I could squeeze in a massage, I just passed out cold on the table. Playing music is my stress relief, and I had some months of not being able to do that due to nerve damage in my hand. That was depressing to me on top of everything else, and I just wanted to stay in bed and cover up my head, or drink myself into oblivion.

When the sick person has to stop working, their disability insurance may not be any where near the amount of money they were used to making, and while insurance may be covering the sick person’s care, there are still deductibles, out of pocket expenses, over-the-counter drugs, various things that insurance will refuse to pay for that you end  up having to pay yourself, special foods and/or supplements, travel to and from doctor’s appointments, and the like that can be overwhelming. You may think you’re saving for retirement, but if your retirement plan doesn’t contain built-in accommodations for a sick family member that you may have to act as the caregiver for, you can be prepared to see a lot of money circling down the drain. Being a caregiver is not a disability, and neither your own insurance nor unemployment insurance is going to be there to help you. Caregivers frequently either have to miss a lot of work, or give up their jobs altogether, in order to provide care. If you’re self-employed, like I am, and you actively work in your business, you may have to pay someone to take your place, like I  have.

So yes, as a caregiver, you do have to take care of yourself, and that’s hard to do when your focus is on taking care of someone else.

I personally found out that what I needed more than anything was just help with every day things, and I think that’s probably true for everyone. A caregiver will appreciate someone cleaning their house, or doing their laundry, running errands for them, or bringing them a home-cooked meal. Some caregivers might appreciate having someone give their patient a ride to doctor’s appointments. Although people offered to do that, I personally did not want that because I wanted to be there for all of my husband’s appointments. Unless the caregivers you know are independently wealthy, gifts of money, prepaid credit cards, or gift cards to gas stations, local grocery stores, restaurants, or stores are always welcomed. A gift certificate for a massage, or a night away in a hotel–even a local one–is a good gift. Volunteering to stay with the sick person for a few hours, if they need constant attendance, is a good idea.

One complaint that I hear repeatedly from other caregivers is along the lines of  “My sister/brother never helps with my mother.” If one of your siblings is caring for your parent(s) or another sibling, and you haven’t been physically participating in that, then you need to do something else to help, instead of leaving it all on your siblings to deal with. Help them financially, or get off your butt and go spend the weekend doing what they do all the time, or pay for a home health care service to do it, so they can have a break. If you haven’t personally been a caregiver, don’t say “I know how it is.” No, you don’t. You don’t have any idea.

I have been very fortunate that my husband has maintained such a beautiful attitude during this entire ordeal. He took it all like the Champ he is. He has always appreciated me and always shown that, and this experience brought us even closer together. It was just six months ago that he was acting as the caretaker for me, when I was very sick with double pneumonia, a UTI that went systemic, and a gall bladder that needed emergency removal. That’s what we do, we take care of each other.

I expect that I am going to continue to have anxiety until his PET scan comes out clear. And the doctors have said he’ll continue to be regularly checked for the next five years. My depression is situational, and I hope to feel better myself as I see him feeling better and better. I’ll probably remain angry at the insurance company, and have to continue spending my time dealing with them. Based on some of what I’ve had to go through with them, I feel sorry for sick people who don’t have a witch like me in their corner to advocate for them. Our almost-daily doctor appointments are over now, so hopefully I will start feeling less exhausted.

I appreciate all the support, encouragement, cards and letters, gifts, and prayers and well-wishes that we’ve received. It has meant a lot to both of us, and were it not for that support, my caregiver syndrome would probably be a lot worse than it has been. Thank you all. And please, do whatever you can to help the people in your lives who are caregivers, and if you are the caregiver, don’t be afraid to say “I need help.”

 

 

 

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Priorities

I’ve been writing about the goings-on in the world of massage since 2007, reporting on what’s going on with regulations, the associations, scams and so forth, along with a healthy dose of my opinion about it. I’ve written somewhere in the vicinity of 300 blogs (my whole blogroll is on Massage Magazine’s website). I’ve slowed down lately. There are always things going on in the massage profession that are news-worthy, and I’m not hanging it up on the blog, but I am taking a little break.

Around the first of December, my husband, Champ, was diagnosed with Stage IV cancer in his tonsils and three lymph nodes on his neck. Our life was changed in the blink of an eye. I now think of it as BC (Before Cancer) and AC (After Cancer). Our life revolves around his treatment. He’s getting radiation 5 days a week (today ends week #3 out of 7 weeks the doctor has planned). Today he’s getting chemo #2 and the doctor has not yet made the final call on how many he’ll be receiving. Maybe as few as 4, or as many as 7. We’ll cross that bridge when we come to it.

Champ has a life-long platelet condition that complicates things. Most people have a platelet count of between 150,000-400,000. His are normally less that 20,000. They have been as low as 3,000. Right now, thanks to a platelet-building drug called Promacta, they’re up to about 40,000. Chemo knocks platelets down, so they’re monitoring his blood a couple of times a week to make sure he can withstand the chemo.

I’ve spent a lot of time on the phone with the insurance company. They want you to have pre-approval to sneeze. They want all referrals to come from the person they think it should come from. They want to get out of paying whenever possible. I’m not taking that lying down, and it’s time-consuming and stressful. Nothing, however, prepares you for the stress of seeing the love of your life sick with a life-threatening disease. I lie awake at night and worry. Then I’m tired during the daytime. I cry. I stress over things that are beyond my control, and I have frequent meltdowns. Our friends and family have rallied around  and the emotional support is invaluable. It has spurred me to start hosting a Cancer Caregiver Support Group at my office, and to start a campaign to provide cancer caregivers with free massage.

Champ is getting the best of care. Janet Powell, Nurse Practitioner; Dr. Patric Ferguson, ENT; Dr. Zvonimir Milas, Surgeon; Dr. Mary Ann Knovich, Director of Blood Disorders at Levine Cancer Institute; Dr. Diego Pavone, Surgeon; Dr. Jeffrey Roberts, Oncology Radiologist, and Dr. Matt Rees, Oncologist/Hematologist, are all involved in his care. The nurses are wonderful. Everyone has moved as quickly as possible to take care of his needs.

So at the moment, my priority is seeing my husband get well. If something earth-shaking happens in massage-land, I usually mention that on my Facebook page, which you’re welcome to follow. We really appreciate all who have sent us messages, cards, called us on the phone, offered us food, financial help, prayers and well-wishes. Thank you all.

A lot of people have asked me if I have set up a gofundme page or something for Champ. I have not, and it isn’t that we don’t need help, but people were kind to us to donate to the silent auction that was held for me and send contributions to us last fall when I was the one who was sick, and I haven’t wanted to take advantage of people’s generosity.

Another thing has hit home to me since Champ has been sick, and that is the amount of stress that caregivers are under. Every morning when I go with Champ to his radiation treatments, I talk with the other caregivers who are in the waiting room. They are all in the same boat I am, trying to navigate the cancer maze, while dealing with fear, uncertainty, and the misery of seeing their loved ones sick. I want to offer them all a free massage, and I can’t. I am usually the receptionist/maid/laundry person at our office, and I have missed a lot of work and had to pay someone to do that while I go with Champ to all his appointments, and needless to say he cannot work right now, either. It has been a strain. So I have had the idea that instead of a gofundme, I would ask people to buy a gift certificate from our business for a cancer caregiver. The profit will help me pay for the people who are covering the office, and we’ll be able to provide some massage for people who need it. If you feel led to contribute to that, you can go to our online gift certificate. In the area that says recipient, put CANCER CAREGIVER and for the email address, put therassage@bellsouth.net. If you’re a local person, please consider giving a gift certificate to any cancer caregiver (or other caregiver) you might personally know. We appreciate the support, and we appreciate the emotional support. Thank you so much. https://thera.boomtime.com/lgift.

To those who are going through the same thing, don’t go through it alone. Join a support group–or start one. I’ve had to let go of some things. The world isn’t going to come to an end if my house isn’t clean, or if I don’t make it to the Chamber of Commerce meeting, or if the paperwork is piled higher than usual at the office. At the end of life, no one is going to wish they had spent more time cleaning or working. We will all wish that we had spent more time with our loved ones. That’s my priority.

 

 

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Board Certification: Just Do the Right Thing

In my last blog, I was critical of the fact that  the NCBTMB‘s new Board Certification exam has been adopted by VA and CA for licensing purposes. I have heard through the grapevine that Oregon intends to do the same, but nothing is on their website to that effect yet.

After the blog was released, I was contacted by the NCBTMB’s CEO, Steve Kirin, and Board Chair Leena Guptha, who were upset with my criticism and wanted to set the record straight. Kirin sent me a timeline of the events leading up to the acceptance of the exam by the states, stated to me that the NCBTMB had no prior knowledge that it was going to happen, and that they notified the FSMTB as soon as these developments came to their attention. I appreciate that they contacted me. I appreciate that they notified the Federation; it was the right thing to do.

They also stated to me that the NCBTMB has no control over the state boards, and that’s very true; the NCBTMB is not a regulatory agency, and has never been one.

However, the NCBTMB can and should take control of this situation by putting some controls in place with Pearson Vue, the vendor that administers the exam, and I stated this directly to Kirin and Dr. Guptha during our conference call.

Board Certification was introduced as “the highest voluntary credential attainable to massage therapists and bodyworkers in the profession today. Board Certification demonstrates a much higher level of achievement beyond entry level licensure—including completing more education, hands-on experience, and a background check—that will be a differentiator for you as you advance through your career, especially in a time where health care and other pivotal third-party professions require Board Certification in order to fill stable and rewarding positions.” From the NCBTMB’s website, here are the qualifications:

  • Pass the Board Certification exam
  • Complete 750 hours of education*
  • Complete 250 hours of professional hands-on experience**
  • Pass a thorough national background check
  • Maintain a current CPR certification
  • Signed commitment to the NCBTMB’s Standards of Practice and Code of Ethics
  • Signed commitment to opposing Human Trafficking

It’s my opinion that the NCBTMB should put the policy in place that if a candidate wants to take the Board Certification exam, they should have to demonstrate proof that they have completed the other requirements. VA and CA both require 500 hours of education, and in fact, as is the case with the MBLEx, people can take it while still a student. That does nothing to indicate advanced practice.

I became Nationally Certified in Therapeutic Massage & Bodywork in 2000, and I have maintained it ever since. I transitioned to Board Certification when the new credential was introduced. I allowed it to expire a couple of weeks ago, after these new developments came to my attention. My own state, NC, is also a 500-hour state. The school I attended was 525 hours, and in the past 15 years, I have taken more than enough continuing education to meet the 750-hour requirement. And that’s my complaint: I’ve met the requirements. It is just my opinion that allowing people who have not met those requirements to take the exam is minimizing this credential.

This is easily fixable. No, the NCBTMB cannot control the states. But they can control what happens to their credential, by the simple act of having applicants submit proof of meeting all the other the requirements to the NCBTMB, and then issuing them permission to test.

The NCBTMB’s agreement with the FSMTB put the NCBTMB out of the licensing exam business. While I appreciate the fact that the NCBTMB had no prior knowledge of what happened with the exam (and will continue to happen, if the controls aren’t put in place), I urge them not to sit on their hands.  I am dismayed that this happened at all, because if the stipulations had been put in place to begin with, this situation could have been avoided. I implore the NCBTMB to just do the right thing. Seize control of your exam, if you really want it to mean anything above being an entry-level licensing exam.

 

 

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Exam Wars: The Sequel

As I reported in my blogs of October 3 and October 20, 2014, FSMTB and NCBTMB reached an agreement where “…NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs.” That’s a direct quote from the joint press release issued by both organizations.

In the wake of this news, cheers were heard ’round the profession, as it signaled an end to the ugly and costly “exam wars” between the two organizations. In case you forgot, NCBTMB darn near bankrupted itself trying to fight the FSMTB and their upstart licensing exam. The fact is that the Federation offered the better testing solution for state massage boards, and the profession has migrated to the MBLEx – leaving NCBTMB with ever-shrinking exam revenues.

With so few people taking their rebranded National Certification exams for state licensure, NCBTMB was compelled to strike a deal with the FSMTB to throw in the towel in exchange for some amount of money. And we don’t know how much cash, because the terms have not been made public. As part of this agreement, NCBTMB said it was going to stop taking new applications for its National Certification Exams on November 1, 2014, and will cease administering these two tests on February 1, 2015.

Sounds like we’re finally moving towards the single licensing exam solution for the massage therapy profession, doesn’t it? Well, don’t head for the lobby to get your tub of buttered popcorn yet, because the next installment of Exam Wars is heating up!

NCBTMB may be bringing down the curtain on the two National Certification exams, but they are now reported to be offering their Board Certification Exam for state licensure purposes. Doesn’t that fly in the face of the agreement with FSMTB?

In October 2014, the Massage Therapy Advisory Committee of the Virginia Board of Nursing voted to accept NCB’s Board Cert exam to meet their statutory certification requirements (in place of the sunsetting National Cert exams). On December 11, 2014, the California Massage Therapy Council voted to accept NCB’s Board Cert exam, along with the MBLEx and the two NCB National Cert exams taken before 2/1/15.
If that weren’t bad enough, NCBTMB is now allowing people to take the Board Cert exam BEFORE they have met all eligibility requirements for Board Certification. Since NCBTMB is touting it as the “highest voluntary credential attainable to massage therapists and bodyworkers in the profession today”, this policy cheapens the credential. It’s already a stretch for NCBTMB to make these claims, but their use of the Board Cert exam to stay in the state licensure game is a real howler. In fact, I think it cheapens it to the point that I will not renew mine in a few days when it expires. I don’t have anything to prove. And after 15 years of practice, I am not going to spend my money to maintain a voluntary credential that is supposed to indicate you are an advanced practitioner that someone fresh out of massage school is being allowed to get. It doesn’t say anything about my knowledge and years of experience at all. It’s apparently turning into just another entry-level credential instead of what it was designed to be, and that truly distresses me.

Are NCB’s actions in violation of their agreement with FSMTB? That may have to get worked out between the attorneys for each side. Whatever the agreement actually says, we’re headed right back to the same old conflicts between FSMTB and NCBTMB. And we didn’t even have to wait long for the Sequel!

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An Interview with Paul Ingraham

A few years ago, I came across a website that has become one of my favorites. It’s at www.PainScience.com, and the writer behind it is Paul Ingraham.

Ingraham is a former Registered Massage Therapist from Vancouver, Canada. He practiced for ten years in downtown Vancouver, taking as many difficult chronic pain cases as he could. Since 2009, he has been the assistant editor for ScienceBasedMedicine.org. I recently had the chance to ask him a few questions about his life and work:

LA: Paul, one of the reasons I find you so interesting is because we share the circumstance of formerly being into energy work, and all sorts of things along those lines that we no longer embrace. Was there a defining moment when you decided to leave that behind and become the skeptic you are today?

PI: It was a series of defining moments, a gradual process, many things chipping away at my faith. For instance, I had a colleague who I shared some beliefs with. We both did energy work and talked shop about it. For me it was more like art and poetry, while for him it was much more literal and real, like he thought he was a Jedi in training or something, and he shredded his credibility with increasingly bizarre belief and overconfidence — like healing over the phone — until I one day I thought, “Wow, way too far. That is just not quality thinking!”

There were many more little disappointments like that over the years. Some were bigger. I remember a workshop taught by someone I greatly admired. I went in beaming, but came out rolling my eyes — a whole day of fringe science and sloppy, self-serving “logic.”

When I started questioning this stuff publicly, I got hate mail, even about stuff I thought was no big deal to question. And that finished the job. Seeing a steady stream of incoherent arguments from unhinged true believers — never calm, never gracious, never “balanced” — finally turned me into an actual card-carrying skeptic. It took about a decade to go from true believer to doubter to curmudgeonly skeptical gadfly.

LA: For years, your website was known as SaveYourself.ca. What precipitated your recent name change?

PI: PainScience.com is more serious and dignified. And just more descriptive of what I do.

I never really cared for the connotations of “save.” Some people immediately think of Jesus when they think of being saved. And I didn’t want to imply that anything I write can “save” anyone — it smacks of the same kind of unethical over-promising that I often criticize in health care.

PainScience fits great. It feels like putting on a nice suit after years of doing business in a Hawaiian shirt.
LA: I’ve seen a few snarky comments from people on the Internet concerning the fact that you’re not a scientist, but you write about science. What are your qualifications, and what do you say to your critics?

PI: Yes, that comes up a lot. And they’re half right: I am not a scientist! But of course hardly any science news and reporting comes directly from scientists, and it can’t, because scientists are busy doing their jobs. And hardly anyone outside of science actually reads scientific papers (least of all the kinds of people who complain that I’m not a scientist).

I am a writer, and my job is to understand and translate science as well as I possibly can — to be a liaison between scientists and clinicians and patients. It’s a tough job, but I care deeply about it and work my hind end off to do it right.

Information about the implications of science can and should only be judged on its own merits. It doesn’t matter who wrote it. Is it good? Is it reasonable and referenced?
LA: One thing I have always admired about your writing is that you provide footnotes for everything. How much time do you spend researching and preparing an article?

PI: It never ends! I never stop editing and upgrading articles, because science is a moving target. They need to change. This is a distinctive thing about PainScience.com: I don’t publish stuff and then just leave it there to rot on the server forever.

But a first draft of a typical 2500-word delve into a topic is usually about a 40-hour project, assuming I’m really going for it. The main way to distinguish yourself online these days is quality. You can’t just write a lot — you’ve got to write well. Serious polish. So I really get into making an article as good as I can possibly make it. It’s not unusual to thoroughly edit at least five or six times.
LA: Like my own blog, some of your articles have generated controversy and even gotten you some hate mail. Is there an article that stands out in your mind for that?

PI: By far the most hate-mail generating article I’ve ever published is Does Chiropractic Work? The modern version of it is more diplomatic and generates much less hate mail, while the original was somewhat snarky and made a lot of heads explode. But I still stand behind any statement I ever made there.

But the most interesting hate mail generator is this one: Trigger Point Doubts. It doesn’t generate a lot of hate mail, but some people just go bonkers when they think they’ve caught me in a contradiction. That is, criticizing “trigger points” while also selling a book about trigger points. Even though the article tackles this so-called contradiction head on. And of course it’s very intellectually healthy to question your own ideas. But I get mail from people who are just furious with me: they take me for a trigger point guru and then freak out when they find out I have concerns about trigger point science being half-assed.

LA: Painscience.com gets about 30,000 hits a day. I notice there’s no advertising on your site, but my guess is you’ve been offered plenty of deals; is that so? What’s your reason for running an ad-free site?

PI: I just like it better. Classier. Different than most of the rest of the internet. And I can generate enough revenue with e-book sales.

LA: You’ve written quite a few e-books. What is the focus of those?

PI: So far I have written eight books about eight musculoskeletal pain problems that are often puzzling and stubborn, like patellofemoral pain or chronic low back pain. The goal of the books is to explore the puzzle with the reader, who can be a patient or a professional: to dive into the interesting mysteries and try to figure out what works, what doesn’t, and why. My goal is to simply teach the reader as much as I possibly can about the condition. In the absence of proven treatments, good information is the next best thing.

LA: What’s the most gratifying thing about what you do?

PI: Oh, that’s easy: email from people who like my sense of humour! Best people in the world! Or librarians who recognize the mad genius of my bibliography.

But seriously, of course it’s the readers who feel that something they learned from me has really helped them. I do love that. That’s the whole point.

LA: Is there anything you haven’t accomplished yet that you plan to do? What’s next for Paul Ingraham?

PI: Lots! It’s taken me a few years to get PainScience.com going and prove that it can pay the bills. I’ve had to do a lot of technology work to get it to that point, which often distracted me from writing in a big way. Now it’s time to get back to the writing, and lots of it, both professional and personal. I’d like to get going on my first novel. And some other technology business projects with a genius buddy of mine, for the diversification and fun of it. Going to be a busy couple decades!

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Deal, or No Deal?

In my last blog, The Good, the Bad and the Ugly, I reported that the only good thing that came out of the recent FSMTB Annual Meeting was the announcement that NCBTMB and FSMTB had reached an agreement on licensing exams, which promised to spell the end of the long “exam wars”. FSMTB trumpeted this news in their October 3rd press release, which stated:

“FSMTB and the NCBTMB have worked cooperatively to reach an agreement that the NCBTMB will no longer provide examinations for licensure purposes and will now focus exclusively on delivering quality certification programs. This supports the common goal of the FSMTB, Associated Bodywork and Massage Professionals (ABMP), American Massage Therapy Association (AMTA) and the Alliance for Massage Therapy Education (AFMTE), for the Massage & Bodywork Licensing Examination (MBLEx) to be utilized as the sole licensure exam for the profession, thus facilitating licensure portability for therapists.”

Too bad that we really can’t celebrate this news because the so-called “agreement” did not include the Approved Continuing Education Provider Program operated by NCBTMB (which 27 state massage boards use in one way or another). Like rubbing salt in the wound, the FSMTB turned right around and passed a resolution to create their very own CE approval program–as if NCBTMB didn’t exist.

It actually gets worse. I received word that at last week’s Florida Board of Massage Therapy meeting in Orlando, it was stated publicly that there was really only a “letter of intention” between the two organizations that was signed before the FSMTB Annual Meeting, and that the details of this letter would be worked out later in a formal agreement.

Now I’m no attorney, but a letter of intention is NOT the same thing as a legally-binding agreement. It’s more like putting a small deposit down on a house to get the process started, with the purchase contract and the mortgage money to come later. A lot can happen between those two steps.

So I’m confused here… is there a deal, or is it no deal? For the FSMTB to send out a national press release with the subject line “FSMTB AND NCBTMB REACH AGREEMENT” when no final document appears to have been signed, raises all kinds of red flags and ethical questions.

We never needed two competing licensing exams, and we sure as blazes don’t need two competing national CE approval programs. Looks like it’s time for the heads of these two organizations to get back to the negotiating table and work out the rest of this deal, for the benefit of the CE community and the profession as a whole.  And don’t come out until you get it settled!

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The Good, the Bad, and the Ugly

With apologies to Clint Eastwood, I’m using the title of his classic Western to talk about three major announcements from the Federation of State Massage Therapy Boards, and what they mean to the rest of the profession. This all came down at the recent FSMTB Annual Meeting, held in Tucson on October 3-4.

The Good: FSMTB and NCBTMB reach an agreement on licensing exams.
Woo hoo! Praise the Lord and pass me the MBLEx! After six years of costly and damaging “exam wars” between the two organizations, NCB was unable to keep its market share of the entry-level testing business. As FSMTB’s exam revenue grew each year, NCB’s declined. NCB finally saw the handwriting on the wall and agreed to stop offering its national certification exams for state licensure as of November 1, 2014 – in exchange for an unspecified amount of money.

This is a huge benefit for the profession, as we can finally move towards having a single licensing exam that is under the direct oversight of state massage boards. (Only Hawaii and New York are still hanging on to their own state exams.) It means less confusion for students and massage schools, and a boon to portability of licensure in the future. This has been a long and painful struggle between FSMTB and NCB, and I for one am thrilled to see it come to a peaceful end.

The Bad: FSMTB adopts CE standards and license renewal recommendations.
Two years ago, FSMTB proposed a radical shift to the continuing education landscape, as outlined in their Maintenance of Core Competency proposal. The MOCC was slammed by organizations, schools, CE providers and individual therapists alike – and yet, the worst of it has made its way into FSMTB’s new continuing education and license renewal standards.

This is a classic case of “If it ain’t broke, then don’t try to fix it.” Overall, our existing CE system works reasonably well, so the last thing we need is yet another organization coming in with an agenda to transform and/or grab control of it. Last year, we suffered through an attempt by NCB to do just that. After a massive grassroots effort, NCB toned down most of the unacceptable changes they were trying to force on providers and sponsors of continuing education. They’ve been behaving themselves since then, and their CE approval processes have been operating more smoothly, although personally some of the classes they have approved are still an issue with me. I’d like to see some sort of designation for those of us who don’t practice or teach pseudoscience and don’t want to be lumped in the same category as those who do.

Now we have the FSMTB trying to flex its muscles. It’s like we just got King Kong calmed down, and now we have to do the same with Godzilla!

At the recent FSMTB Annual Meeting, state board reps passed a resolution from their CE Task Force to “implement a program that provides reliable, unbiased and appropriate vetting of continuing education providers and the classes offered to the consuming public.” That sounds high and mighty, but there is no reference to NCB and their existing national Approved CE Provider program in the resolution, and there was no mention of NCB when this resolution and the license renewal standards were presented to the Delegate Assembly for consideration. Did they think that no one would notice this sin of omission?
The LAST thing we need is another CE approval program! FSMTB could have easily solved their delegation of authority issue by entering into a partnership agreement with NCB to use their existing program. This should have gotten rolled into the exam deal between the two organizations, so that CE approvals could be consolidated.

It’s hard to believe, but the resolution was passed without any details on how FSMTB actually plans to vet CE providers and classes. Why should we trust that FSMTB can do this in an effective manner? They’ve been offering the MBLEx for six years now, and they still don’t have an online practice exam and exam study guide for massage students. The very worst of it is that FSMTB’s plan for CE and license renewal centers on “public safety”, while minimizing the role of CE for “professional development”. The problem is that there is no evidence that we have a widespread “public safety” crisis in our profession, so there’s no factual basis for what FSMTB is trying to do. (There are a lot of specific flaws in the CE standards and license renewal recommendations FSMTB has adopted. I’ll detail those in a future blog.)

What I can see from all this is a major threat to the existing CE provider and sponsor system in our field. FSMTB’s proposal is so completely out-of-synch with how CE is organized and delivered, and FSMTB stands to consolidate even more money and power if this model is adopted by state massage boards. We’re just coming out of a period where NCB tried to dominate the field. Now FSMTB is acting like they’ve picked up the NCB playbook and are trying to run with it.

The Ugly: FSMTB publishes the Model Massage Therapy Practice Act (MPA).
As I wrote about in my previous blog, the MPA was released after three years of behind-the-scenes work and two rounds of public comment. Most of its content is the kind of standard stuff found in all templates for occupational licensure. However, FSMTB really blew it in a number of key areas, and the final version contains both technical errors and some awful policy decisions. As FSMTB’s leaders had final say, the responsibility for correcting these fatal flaws rests on them.

Judging from how few comments were made on the three blogs I posted about the MPA, it looks like it doesn’t register as all that important. Wake up people! A model practice act is one of the bedrock components of a profession. It contains the Scope of Practice definition and other essential elements that influence both education and practice. If you haven’t taken time to read our new MPA, I urge you to get familiar with it and keep up the pressure on FSMTB to fix it. Remember that it doesn’t become law unless it’s adopted by a state legislature.

Let’s celebrate the Good, and get to work on the Bad and the Ugly!

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Final Draft of Model Practice Act Released

The Model Practice Act was released in its final draft this week, after more than three years of work on it and two periods of public comment. The introduction does state that it will be an evolving document as changing times and circumstances dictate, but as of now, it still has many of the school owners on my social media pages up in arms.

The language requiring accreditation from previous drafts (Section 103(B) ) was modified to say “Approved Massage Therapy Education Program means a school or educational program that meets the criteria established in rule by the Board, at a minimum includes 625 Clock Hours, and is both authorized in the jurisdiction in which it is located and that reflects a curriculum acceptable to an accrediting body recognized by the U.S. Department of Education…” While the requirement has been downgraded to a suggestion, the comment section makes it clear that the eventual goal is required accreditation for one and all.

Personally, I have some mixed feelings on this. Accreditation is a process of quality control–to a point. (Disclosure: I am a peer reviewer for COMTA). Obtaining accreditation is not cheap, it’s rigorous and it’s time-consuming. It sends the message that you have voluntarily gone over and above what the state requires. Other health care professions require it. And therein lies the clincher.

There are no other health professions that I am aware of accrediting programs that teach psuedoscience, and many massage school programs, including those accredited by COMTA and other accrediting bodies–and in the case of community colleges, even the regional accrediting bodies–do. So what does that really mean? Is it really a hallmark of excellence when we accredit things that have no basis in fact, just because it’s tradition, and been around for a long time, even though it’s been shot down by science?

I am not a school owner, but if I was, I wouldn’t be hitting the panic button just yet. The FSMTB has no power of legislation and they can’t lobby. In order for accreditation to become the law of the land, that’s what will have to happen: it will have to become the law of the land, literally, through legislative changes. There may be some FSMTB member states who are gung-ho to see it happen, but remember, state boards can’t lobby, either. That is the domain of the professional associations. In my state, our AMTA chapter has paid a lobbyist for many years. Since the chapter fees are now optional, I have heard that he volunteered to continue working at a lesser fee, but I bet some of the state chapters have lost their lobbyist altogether, if they had one to start with. The wheels of government don’t turn that quickly unless they’re greased.

The MPA is a template for the states. It isn’t the law and it may never be. For the few unregulated states, should they finally get out of the Dark Ages and decide to regulate, this will be very time-saving for them. It isn’t perfect; nothing is. Obviously a lot of work went into it. Only time will tell what effect it is really going to have.

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NCBTMB and FSMTB: Long-awaited Collaboration in the Works

The NCBTMB and the FSMTB made a joint announcement this morning that I have long been hoping for. Leena Guptha, Chair of the NCBTMB, confirmed to me that the NCB will sign a letter of intent to withdraw completely from licensing examinations, which will mean the MBLEx will be the only licensing exam in the US, excepting New York and Hawaii, which both have their own state exams. This change is taking place November 1.

The FSMTB will support Board Certification, according to Guptha. “We are getting back to the roots of certification,” she stated, “honoring our original purpose.” Further details will be forthcoming soon, but for now, Guptha expressed to me that she hopes that the other massage organizations and the profession at large will support this action. I hope they do, too.

 

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To the Edge and Back

I’ve been quiet for the past few weeks because I’ve been ill. On August 17, I wasn’t feeling too well, not really full-blown sick, but on the puny side, and I told my husband Champ I wanted him to cover our office the next day and let me stay home. I felt a little worse on Tuesday, and stayed home again. I had terrible diarrhea all night and was constantly thirsty. On Wednesday morning, I woke up in a state of extreme illness and confusion. Champ asked me if I knew the signs of a stroke. Of course I do, but I looked at him blankly and said “no.” He asked if I knew who he was. That was another “no.” He asked if I knew who I was. When I answered “no” to that, he took me to the ER.

After a few blood tests, x-rays and the like, a doctor came in and informed me I was being admitted with a severe urinary tract infection, which I had not had any of the usual symptoms of, and that it had gone systemic. I also had pneumonia in both lungs–something I just went though in March of 2013. They admitted me to the hospital and started pumping me full of antibiotics. The diarrhea lasted four more days to the point where I was reduced to wearing a diaper in the hospital. That’s a rather humbling experience. A friend of ours who is a pharmacist told Champ that another day or two without the antibiotics and IV fluids, and I would have died.

I was released after a week in the hospital, which included two days in the ICU. My mom came to take care of me. She is 75 and I could never in a million years have had a better mother than what she has been to me. I turned 55 while I was sick. She was wiping my butt just like I was baby, so was Champ, and for all intents and purposes, I was one. She made me some homemade soup the day after I came home. I ate a half a bowl (it was delicious vegetable soup). About an hour later, my stomach got very bloated and hard. I was vomiting, and the next morning, I told Champ I thought I had better go to the ER.

Low and behold, another x-ray revealed that I was full of gall stones. They admitted me again and  took out my gall bladder early the next morning. After another week in the hospital, I came home again last Thursday.

My hormones and electrolytes were screwy in the hospital, and I had to go to the doctor for a checkup yesterday. I also spent last night at the Sleep Center–not a restful place at all. I haven’t gotten those results yet, but I had been placed on a BiPap in the hospital because I was retaining too much carbon dioxide. They woke me up in the middle of the night and put me on a CPAP. I expect I’ll hear all about it later today.

On my birthday, all I could say was “55 and still alive.”

I have been overwhelmed at the outpouring of love and compassion from everybody. FB friends I have never even met sent me cards and gifts. Several people sent me money in amounts from $5 to $500, which just made me cry in gratitude and disbelief at the kindness. People sent flowers and fruit baskets. Local people have delivered food to my house. Restaurant owners have refused to take any money when Champ went to get takeout.

Since I’m known for pissing people off with some of my commentaries, I might as well not pass up this opportunity to say thank God for Obamacare. Last year, when I was stricken with pneumonia the first time, we had given up our health insurance. It had gone to over $600 a month. Champ was not working much, our business was struggling in our local economy, which is still very depressed, and we simply couldn’t pay for it anymore. It was either give that up or give up eating. We also had a $5000 deductible. My hospital bill was over $10,000, which I am still working to pay off. On January 1, I got us signed up for Obamacare. We are now insured with a $500 deductible, not $5000, and we are paying $235 a month. My prescriptions have cost me $5 each. The nebulizer I had to get to take breathing treatments at home four times a day was free. Before anyone jumps on taxpayers subsidizing that, let me say that I got my first job at the age of 13, and I have worked every day of my life since, so I have paid my share in taxes and I continue to do so. It feels good to me not to have to worry that I am going to lose my home or my business over healthcare expenses. So there. I appreciate it whether anyone else does or not.

Champ’s social security kicks in this month, so we can breathe a little easier on that front, as well. I am taking a few weeks off from work to gain my strength back. I am sapped. I have seen some of my FB friends spreading the suggestion that people buy my books in order to help my finances, and I really appreciate that more than I can say, along with everything else people have done for me during this time. So in a fit of shameless self-promotion, I will list them here in case you are led to purchase one.

The first one is one I finished last year while I was in the hospital with the first round of pneumonia. It’s about death and dying and the wonderful Nina McIntosh, author of The Educated Heart. I watched Nina get her affairs in order while she was suffering from ALS. When I was in the hospital, I had the thought that I might not be leaving there alive, and that I needed to get my own affairs in order. We all do, while we’re able to, instead of leaving it for our grief-stricken family to do. The last part of the book walks you through that. It’s called The Days Still Left.

My most recent book is Excuse me, exactly how does that work? Hocus Pocus in Holistic Health Care. I didn’t question anything I was taught in massage school, and I should have. Part memoir, partly an examination of some of the things that are heavily marketed to massage therapists, who then turn around and market to the unknowing public. Yes, it will step on a few toes, but my hope is that it makes people THINK.

Massage is my second career. In my first life, I cooked for the public for more than 20 years. My little cook book is full of great Southern recipes and funny stories that happened to me in the restaurant business. Nothin’ Fancy, Good Food and a Few Funny Stories.

In 2012, The Massage Nerd, aka Ryan Hoyme, and I collaborated on the Manual for Massage Therapy Educators. This is NOT meant to be a textbook. We were both unceremoniously foisted onto our first class of massage students, and this is just the practical advice of the things we wish we had known when we started out and what we’ve learned along the way.

The Plain and Simple Guide to Therapeutic Massage & Bodywork Examinations 2nd ed.   Get ready to pass the MBLEx or NCBTMB exams. The inside cover has a scratch-off password to a website filled with practice questions and learning games.  Great teacher ancillaries, too. I am very proud to say this book is sold in hundreds of massage schools.

One Year to a Successful Massage Therapy Practice is full of low-cost and no-cost ways to get your practice off the ground or revitalize an older one.

I’m proud of this book because I didn’t try to sell it to LWW; they asked me to write it, and I was happy to oblige. The inside cover has a password for a website with dozens of useful forms. It covers everything from your business plan to retirement and in between.             A Massage Therapist’s guide to Business also has great instructor ancillaries.

That’s it, although I do have a few more in the works. Thank you for your support.