Kirklin Clinic Head & Neck Cancer Support Group, Birmingham, AL
distributed by American Cancer Society
Pat Sanders, Editor
NOW THAT’S A NICE SCAR!
Lessons on Scar Tissue
by Shari Aizenman, Massage Therapist
Scar tissue??? Doesn’t sound so bad, does it? I mean, we have all cut ourselves, maybe had a surgery, and, of course, it needs to heal, so what? So EVERYTHING! That’s what! Knowing the anatomy of scar tissue and what to do with it and about it can mean the difference between freedom and bondage.
Excuse me if I sound like I am on a soapbox, I am. As a massage therapist practicing for seventeen years, I have touched more scars than I can count. None of them have been exactly alike, although each of them has something in common; they want to hold on!
Scar tissue forms as a natural part of healing of all tissues in the body that have been damaged. Aren’t you surprised that a broken bone can actually heal and possibly the healed part will be stronger than the rest of the bone? All of this happens because the inherent nature of the body is to be as whole as possible and to maintain homeostasis, which is a relatively stable state of equilibrium. So, what’s the big deal?
In its desire to maintain balance, the body repair process is not as simple as it may seem. The human body’s cellular structure is so well designed. Soft tissues are designed for strength as well as flexibility, and the cellular construction is what determines both. Where more strength is needed the cells are more dense and fibrous. Where flexibility is desired, cells are less dense and less fibrous. Where strength and flexibility are both desired, the structure is even more complex.
To insure the best performance in soft tissues, the cells are designed in rows and spirals. When there is disruption in soft tissue, like a cut, for example, collagen fibers form at the injury site in a manner I compare to mayhem. These fibers have only one thing in mind: STITCH and MEND!
Again, what’s the big deal? Remember that inherent design process? When it is disrupted, the flexibility in the tissue is compromised. What does that mean to you? If you are an average healer, maybe not much, especially on superficial (close to the surface of the body) scars. But all scar tissue is not as simple as what it may seem on the surface. Scars can bind deeper tissues, tying its collagen fibers around organs and other layers of fascia, the fibrous connective tissue that surrounds all soft tissues in the body. This can mean a lifetime of bondage in some cases.
Aha! You have a scar, you say? And you want to know what to do about it? Don’t fret! All scar tissue, no matter how old, can be addressed with a special type of massage known as friction or deep friction. The definition of friction in this case is: the movement of superficial tissue over deep tissue. Friction is done by locking the superficial tissue down over the deeper tissue and moving back and forth over the affected area. Scar tissue becomes more like normal tissue through the breakdown of unnecessary collagen fibers and with repeated treatments, and the effects are cumulative.
In this treatment, no lubricant is used. After treatment, I encourage you to use pure 100% cocoa butter to rub into your scar as frequently as you like. This will soften the scar and eventually, the scar will begin to disappear. You can begin treating your scar as soon as the stitches are removed, beginning lightly on a fresh scar, deeper on an older one. Pure cocoa butter can be purchased from a beauty supply or health food store. It will be in solid form, easily melted as you rub your fingers on it or rub it directly on your scar.
Here is the first step for using the “friction” technique. Look in a mirror and know exactly where the superficial scar’s borders are. Palpate your scar. Do you have full sensation or is it numb? You need to get to know the feel to your fingers of the surrounding tissue and of the scar tissue being treated. Is your scar thick and bumpy? Or smooth in some places and irregular in others? Can you pick up your scar, as if it is free from the tissue beneath it? Or is it just stuck? The thicker and bumpier and more stuck the scar, the more work it needs.
Next, make a plan of action. If you can press your scar against a bony structure, here is the plan for you. Use your index and middle fingers to press your scar against the bony structure underneath. Using a back and forth motion, hold the scar down and move the scar over the underlying tissue. Go back and forth twenty or so times, using enough pressure to pull the scar tissue away, a little at a time, from the deeper tissue. Move two finger widths at a time over the scar until the entire scar is treated. When you are finished doing this “cross-fiber” friction, go over the scar again using a circular motion, pressing the tissue down as before.
If you can’t press the scar against a bony structure here is the plan for you. Squeeze the scar between your index finger and thumb (adding your middle finger if possible), as if pinching it, lift and roll the tissue back and forth. When you have treated the scar fully this way, roll it again in circles between your fingers. You may need to utilize two thumbs or maybe even two index fingers on with two hands. The important thing is to get the scar between two moving, opposing forces to cause a friction reaction.
How often should you treat your scar and what should you expect with continued treatments? Touch your scar daily if not more often. You cannot touch it too much. Your scar is just like every other part of your body and needs love and attention!
No matter what your skin tone, in the beginning, you may notice that your scar looks reddened, and the tissue around it may also become pinker. This is from the increased blood flow to the area. Good for you!! Increased blood flow means increased oxygen (which is carried in the blood) and faster healing. Your scar may be a little sensitive due to the increased attention. If you feel a bruised sensation, back off your treatments to every other day. Use cocoa butter daily after treatment. Your scar may be numb but that will change and sensation should gradually return to most of it and the surrounding soft tissue.
Remember that touch is the ultimate form of self-love. This is a gift to yourself!!
“WHAT IF….?” Insurance Answers [Part 2 of 3]
WHAT CAN I DO IF I got a product from a supplier and paid in full, but the supplier will not fill out a claim and send it to my insurance company to get reimbursement for me???
Background: This may seem like coldhearted behavior by a supplier, but please be aware that many of the suppliers in the laryngectomee field are small companies, selling nationwide, and that the profit margins in this special market are usually much lower than the general profit for medical markets. Since there are literally thousands of insurance companies around the country, many with their own unique forms, requirements and procedure, it is not surprising that suppliers often feel that it would be impossible, both financially and timewise, for them to obtain/figure out/fill out these forms. So what can you do?
You can make sure that you are prepared to fill out and submit your own claim forms to your insurance company with as little hassle and expense to yourself as possible. Get a supply of claim forms from your insurance company - enough to allow for throwing away mistakes and enough to have several for future needs. Study the forms and instructions so that you understand what information they require. Plan ahead. If you need a doctor’s statement, ask for it at a regular visit or check-up so you don’t have to make a special trip back.. If you are expecting to get repeat orders of a product, ask the doctor to write something indicating that you will need refills and stating how many and how often. Then get copies made so that you can send in a copy with each claim. When you order from your supplier, request enough copies of your paid invoice to use for insurance, taxes, your own records and anything else you might need copies for. (Depending on the supplier’s computer invoicing program, it is often fairly easy for a supplier to send you more copies of the invoice at the time your order is processed, but much more difficult and time consuming for them to have to generate copies at a future date, so you might have to wait longer or might be charged for the extra service. Therefore, it’s much better to ask for what you need at the time you order.) If the supplier cannot or will not give you as many copies as you want, then get copies of the originally invoice made locally. (Note: Aside from insurance - if you order supplies regularly from the same supplier and want records of all your purchase for a year for taxes, proof of expenses for subsidized housing requirements, etc. be sure to KEEP the copies of your invoices as they come in and file them carefully. If you ask your supplier for “copies of all the invoices I’ve had for the last year” because you had a fire or disaster of some sort, most companies will be happy to help you, but if you routinely throw them away or lose them and then repeated ask for copies at a later date, you cannot expect your supplier to very cheerful and prompt about the extra work or to do it at no charge.)
Also, when you order, ask your supplier for descriptive information on the product you’re submitting a claim for and include the description along with your invoice and the doctor’s statement. Again, if it is to be a repeated order, get several copies made so that you will have one to send with each claim.
WHAT CAN I DO IF my insurance company says that I must purchase from a “Preferred Provider” instead of from the company that sells a product I need? How do I find a Preferred Provider? What if they don’t carry the product.
Background: Some insurance companies have legal and financial agreements with specific providers. If you go to a provider who is not in the insurance company’s network or on their Preferred Provider list, then you may not get full insurance coverage - or may not get any coverage at all. So what can you do?
There is often a way around the Preferred Provider problem. Your insurance company will have a list of the companies they work with as providers. Check with some of those nearest to you, show them information on the product you want and provide them with contact information on the manufacturer and a couple of major suppliers. The provider may be able to buy the product and then bill your insurance company. Some manufacturers or suppliers may offer a small discount to the local Preferred Provider to help things along - and the Preferred Provider is often allowed by the insurance company to add a mark-up of a reasonable percentage - so it sometimes works out quite well all around. (The insurance company often ends up paying more this way, but they are apparently often willing to do that to have the whole process taken care of through the proper channels and procedures.)
(Note: Sometimes insurance companies or health plans have agreements with Preferred Providers that require the Preferred Provide to furnish any covered product for which the insured person had a prescription or doctor's order. Even if it means a loss for the provider, the provider must handle the sale in order to maintain its "preferred" status. An occasional loss of that sort may be worth it to the provider in order to keep its preferred status for the many routine items like diabetic supplies, incontinence supplies, etc. that are quite profitable.)
Part 3 next month
Dorothy Lennox, Luminaud, Inc.
REPRINTING OR COPYING HEADLINES
Since many of you who receive the print edition of HeadLines do not have email to write for permission to print copies for handout to others or for reprinting in your own free newsletters, I give you permission to use HeadLines for these purposes but you must include the author’s name and the publication issue: HeadLines, Month, Year.
For example, the first article in this issue would acknowledge:
by Shari Aizenman, Massage Therapist
reprinted from HeadLines, April, 2004
The Head and Neck Cancer has no author and credit is given within the notice, so copy as is.
Dorothy Lennox has written a 3 part article and, if you print only one section, the acknowledgement must be included.