'The guy she goes to for Watsu said that "warm water is no longer a no-no for MS patients.."'
In the area of helping-or-healing, by which I mean any practice or offering intended to alleviate or improve someone's suffering - misunderstanding and misrepresentation can lead to the very opposite of that good intention. Aquatic bodywork methods like Watsu are no exception. Especially for the novice and non-clinical practitioner, there are two valuable guidelines:
- Know what you don't know (don't pretend or guess)
- Be wary of second-hand information (research facts)
My personal preference has been to avoid medical terminology and to make sure that those I am working with who have medical conditions do have the support of medically trained people, and ideally the approval of these professionals for their sessions with me. Such relationships have enabled me to work with people facing terminal diagnoses; absence of them reminded me to decline work with people whose degree of emotional distress I did not feel qualified to support.
I do not think that conventional medicine has all the answers nor all the solutions, and I do think that quite often science overlooks and sidelines potentially powerful therapeutic options which have not been proven by currently accepted means. But I feel very uncomfortable when someone unqualified to do so adopts a quasi-medical stance in order to persuade potential clients of the value of their therapy services.
A recent discussion (17,18 Nov.) in the public area of an online support community, called Neurotalk, for people with various health problems illustrates the danger of making pseudoclinical claims as a Watsu practitioner (someone who in this case was perhaps not from a non-medical background). The issue (multiple sclerosis and heat sensitivity) is one that remains unclear and therefore warrants extra caution.
You can read the full discussion here under 'Hot Water'.
The initial posting reads:
A friend just emailed me and said that the guy she goes to for Watsu (I think that's what it's called) said that "warm water is no longer a no-no for MS patients" and that he "did the research and found that out."
What did I miss? The last I knew, some of us are more sensitive to heat than others, but I don't remember seeing any recent research that changed the basic facts.
I wonder if he meant that the symptoms exacerbated by raised body temperature are usually transient? Anybody hear anything I didn't??
Several MS sufferers then wrote in to recount their varying responses to temperature. I too had a friend who when she developed MS found even mild heat very uncomfortable. The original post author concluded:
I don't know if the Watsu guy phrased it the way she quoted him or not, but my first thought was "Oh thanks a LOT! Now folks will think we're faking or over-cautious if we say we can't do this or that because of the way the heat affects us."
Especially the fact that she told me that he said "according to the latest research". That kind of ruffled my feathers, so I sent her a copy/paste from the NMSS on heat & MS symptoms, and told her that they (NMSS) are pretty much up to date on the latest research.
I asked her if she knew where he got the information/research, and she forwarded from him some news article about hydrotherapy being good for MS patients. Well, I already knew that, but I read the whole article, word by word, and never once was the TEMPERATURE of the water addressed.
I'm hoping that there was just a semantical glitch or misunderstanding, but I don't want the "education" getting spread around that overheating the body is "no longer a no-no" for MSers. That might be true for some, but it is a very big NUH-UH, NO WAY for me and others I know.
And another writer added:
The MS Research Center here has a big poster on the wall about heat and MS, and it says that some people are not at all affected, whereas others can experience "temporary" difficulty from it. It does say very clearly that it won't cause "damage", just symptoms . . . but advice on these kind of matters seem to change as often as the wind.
I know that "fever" bothers most, if not all of us . . . and can even set off a full blown attack for some. I think that has more to do with white count from infection though ....
Amazing how people can totally misinterpret information though, eh?
It is generally agreed that fatigue is one of the most common symptoms of MS, and this can be worsened by heat and humidity. For this reason, people with MS are often advised to take extra precautions to stay cool. It is true that this adverse heat effect, known as Uhthoff's phenomenon, is not an established relapse trigger. The obvious observation here is that not all people are affected and how serious that effect is for the condition is not certain. That doesn't mean it's OK to proceed without caution and clarity of intent.
When it comes to warm water pool sessions, the ability to adjust (in this case lower) the water temperature (such as with private small pools) could be a great asset and make all the difference to the comfort of the particular person. If you can't do this and the person tells you that they either can't take heat or are worried that it might make them feel worse, please don't persuade them otherwise by quoting unsubstantiated research. Respecting someone's limits (or their perception of those limits) is essential for trust.
General knowledge about MS, feedback from the person in question, and a great deal of common sense when it comes to what, how much, and for how long, are all good. A very clear article by Andrea Salzman on aquatic therapy training credentials points out that treatment approaches which do not meet accepted standards are not necessarily invalid treatment alternatives, just unproven ones. However, she doesn't mean that unproven equals valid.
When an aquatic training course or an aquatic practice (or any other kind of health offering) announces that a certain treatment approach is a panacea for all sorts of conditions, it's a warning sign! The cause-and-effect of multiple sclerosis, fibromyalgia and mechanical spine pain, for example, are different. It would follow that the approaches used to treat these different populations should also be adjusted to suit that particular condition and person.
My conclusion:
Do not base your advice to someone or your willingness to work with them on second-hand information. This is especially important where reports vary, and if the person is facing a potentially severely debilitating and progressive illness (such as MS). Also, whether or not you have direct knowledge and experience, it is never advisable to persuade someone that something is good for them when they remain unconvinced.
This is good practice and is written into the ethics guidelines of many training schools. I've found it valuable to re-read these guidelines (and those from related therapy bodies) after a few months or years in practice. A novice who is enthusiastic and longing to share, does not always understand or respect that often these apparently restrictive 'rules' come out of experience that would have been best avoided. An experienced practitioner may also become complacent about what they know - and don't know.
I should add that clinical research is being done into the value of Watsu and will hopefully continue to support the application of this powerful aquatic therapy in many different medical conditions. For a recent example of research showing the positive effect of Watsu as a rehabilitation method for hemiparetic patients with stroke click here. Even so, non-clinically trained people need to be careful about claiming ability to work with 'patients' without appropriate support.
If you have examples of similar situations, and ideas about how best to handle these, please do share them by commenting below.
