Becca Torns-Barker, owner of BodyWorks Massage outside Hartford, Connecticut, was massaging a client when she thought she saw a freckle on the client’s shoulder blade.
But then she noticed that the “freckle” was actually standing up a little away from her client’s skin.
She told her client there was something on her back that she wanted to look at more closely, then flipped on the overhead lights. She brushed her finger lightly over the spot and that’s when she knew she was looking at an embedded, although not engorged, tick.
The chances you, like Torns-Barker, will find a tick on your client’s body during a session are growing; however, changes are higher for some massage therapists than others, depending on location. Ticks are especially prevalent in the Eastern states.
The state of New York, for example, had the second-highest rate of confirmed cases of Lyme disease in 2016, following only New Jersey, according to the U.S. Centers for Disease Control & Prevention.
A look at the Lyme disease cases reported in New York City (946) and five New York counties illuminates the scope of this disease:
- Suffolk: 644
- Orange: 531
- Rensselaer: 497
- Columbia: 391
- Dutchess: 386
What this means for massage therapists—in New York and throughout the U.S.—is that knowledge of ticks and the diseases they carry, as well as what to do if a tick is found on a client, is increasingly important information to have.
Tick season runs from spring through early fall. The CDC says ticks and tick-borne diseases are on the rise across the U.S, mainly the Northeast and Midwest, where Lyme disease has become a scourge.
Tick-borne diseases are at best a nuisance and at worst, fatal. You may be your client’s first line of defense. What do you do if you find a tick on your client’s body during a session?
It almost goes without saying that you must communicate with your client, said Charlie Peebles, the interim director of the massage therapy program at Indiana State University. “That’s always kind of standard procedure,” he said. Tell your client what you’re seeing and the degree to which the tick is embedded, or not.
Once Torns-Barker realized a tick was on her client’s body, she immediately informed her client and explained that it was loosely attached and she thought she could safely remove it.
She asked her client if she wanted her to remove the tick immediately or if she wanted to end the session, so she could see a healthcare professional to have it removed. The client opted to have Torns-Barker remove the tick in the office and then continue the session.
Torns-Barker lives in a location where the incidence of Lyme disease is high, especially during tick season, and so awareness of ticks is commonplace.
The Northeast has also seen an increase in cases of Powassan virus. Carried by three types of ticks, Powassan can lead to long-term neurological damage and can even be fatal if it causes encephalitis. There is no specific treatment for the disease.
Torns-Barker has a tick kit— tweezers or a tick removal tool, such as Ticked Off, rubbing alcohol, gloves, containers for putting the tick in, a bright flashlight, a magnifying glass—in her office in case she needs it. She recommends reading about ticks and their diseases and knowing the CDC’s tick removal and handling guidelines before you find one on your client, so you can manage the situation safely and professionally.
It’s also good to know the symptoms of tick bites, says Staci Groves, who is the co-owner of Brunswick Massage and Wellness in Brunswick, Maine. While she hasn’t seen many ticks on her clients’ bodies, she has seen the bull’s eye rash associated with Lyme disease.
“I’ve definitely sent people to the doctor’s when I’ve seen the bull’s eye on the body,” she said. It is not unusual for a rash, like a tick, to appear on parts of the body that a client can’t see, she noted.
When she has found bull’s eye rashes on her clients, she’s told them and advised them to contact their health care provider.
“I always tell people they should go see their doctor regardless [of whether she has found a tick or a rash] because that kind of releases me from any responsibility,” she said. She also documents everything, which is standard procedure for each massage session she does.
Ticks can cause serious problems for your client, but you can be exposed—from health and liability perspectives—too. “When you’re thrown in the moment of [finding] a tick [during a session] and you’re like ‘aaahhh!,’ you don’t always think about yourself. You’re worried about your client on the table,” said Groves.
From the perspective of protecting your own health, she recommends if you handle the tick with your bare hands (experts recommend using gloves), wash your hands thoroughly with rubbing alcohol or soap and water after handling the tick. You can also use rubbing alcohol to swab the bite site on your client.
Before you remove a tick, you need to assess whether you should offer to remove it or if you should refer your client to a doctor for removal.
This is a serious decision to make because the length of time a tick is embedded in a person can have serious, sometimes fatal, consequences. Experts recommend removing a tick as soon as possible. However, you may not be the appropriate person to do the removing.
“If the tick is embedded, meaning it’s engorged, it’s got blood, it’s got its teeth in, it’s red and messy—that person needs to go to the doctor because they’re probably going to need antibiotics or some diagnosis as to what’s going on and how long it’s been in,” said Nancy Dail, a massage therapist since 1974 and owner of Downeast School of Massage on the coast of Maine.
“If it’s walking along [the client’s body], it’s a service to take the thing off. If it’s just slightly attached and it can be easily removed with a tick removal kit and you have the permission of the client, then that’s what I would do,” Dail said. “But if there’s any instrument that you need to remove it other than a tick removal kit, then don’t touch it.”
If you do remove a tick, put the tick in a sealed plastic bag or container with some rubbing alcohol to kill it and offer to give the tick to the client for testing. If the client doesn’t want the tick, you can flush it—without the plastic bag or container—down the toilet after it has been killed by submerging it in rubbing alcohol.
As for limiting your liability, communication is the primary thing, said Peebles. “Anytime you’re dealing with a client where you run across something a little unusual you have to be communicating with them and err on the side of caution. I always say, when in doubt, refer out.”
He also recommends knowing what your insurance policy covers and knowing your state laws. For example, Torns-Barker feels she has a certain level of protection because the state (Connecticut) she lives and works in has Good Samaritan laws.
Regardless, it is always a good idea to have a liability insurance policy because you never know when an accident will happen. MASSAGE Magazine Insurance Plus has you covered with more than 350 modalities.
Most states have some form of law protecting those who provide reasonable assistant to people in peril, but the degree of protection varies from state to state. New York, for instance, has a Good Samaritan law, and offers legal protection to people who give assistance to people they believe are in peril, incapacitated, ill or injured.
“A massage therapist provides a valuable service to everyone because we see the body,” Dail said. “I think it’s up to us to pay attention to things we can refer well for. An embedded tick is one of those things.
About the Author
Stephanie Bouchard is a freelance writer and editor based on the coast of Maine.
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