The MT's FEAR of diagnosing

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Many states now require a massage therapist to have many hours of anatomy and pathology education before ever applying for state certification. Massage therapists should know quite a bit more about the signs and symptoms of many common pathologies. Unfortunately, I have found many massage therapist donโ€™t feel comfortable using this knowledge or didnโ€™t acquire a level of competence in these areas during school.
Some MTโ€™s seem to be reluctant or downright militant about not discussing health issues with their clients. These folks also seem hesitant to call a physicianโ€™s, chiropractor or physical therapists office to discuss a shared clients treatment. In both cases the common comment is โ€œif I say or do X I would be out of scope of practice and/or diagnosingโ€
So why the hours of training in pathologiesโ€ฆ? Few of them affect or require changes to the performance of a simple Swedish relaxation massage. How does knowing about the endocrine system, reproductive system or urinary system actually affect the job of doing massage? Many MTโ€™s and students of massage therapy ask the exact same question. If the job simply entails asking if the client is allergic to nuts or oils, what kind of music they like and then performing a general relaxation massage, followed by recommending they drink water and sending the client on their wayโ€ฆthere is no need for such education.
I call chiropractors, P.T.s and physicians offices regularly. I have found other healthcare providers in the allopathic medical system more than willing to work as a team for the betterment of our shared client. Often I have a lot more time with the client and gather more information that other healthcare providers do not get a chance to hear about in their shorter appointment time. I forward the information either directly or through the client to the other healthcare providers who may then ignore or investigate the information further.
Massage therapy increase relaxation, reduces pain and can make the symptoms of an underlying pathology more tolerable, which may in turn cause the client not to seek other more appropriate medical treatment because the symptoms are reduced by the massage treatment.
Letโ€™s consider the following case (several versions of which have occurred in my practice) the client comes in because they have aches and pains in their arms and feet sometimes their back. The Client also states that they need โ€œdeep tissueโ€ especially on their lower legs because many massage therapists donโ€™t โ€œgo hard enoughโ€ for them to notice. Their health history reveals they have had several urinary infections over the past few years. The client is obviously overweight and during the massage the therapist notices some cracking of the skin near the heels and a sore on one of the clients elbow. The clientโ€™s lower legs also have obvious edema.

So what do you doโ€ฆ?
Do the massage, which they love, telling you they feel much better and will be back next week. Suggest they drink some water. To which they reply, โ€œoh I drink tons of waterโ€



Do you ask if they have a family history of diabetes and ask if they have had their blood sugar checked? What do you do if they have a family history of diabetes and havenโ€™t had their blood sugar checked?

Do you explain that the client has several signs and symptoms that may indicate they could have an underlying health concern that should be assessed by a physician? To which every single client will ask โ€œwhat symptoms and what possible health concernโ€ Do you tell them that for example reoccurring urinary infection, the reduced sensation and excess fluid in the legs and the skin abrasions/sores can all be signs of diabetes or possibly some other pathology. Do you tell them that only a physician can determine/diagnose such conditions for sure and that they can do it quickly with a simple blood sugar test? Do you tell them that it is very important to go to a doctor to check this out because the sooner conditions are identified the more effective the treatments are?

If the client does have undiagnosed type II diabetes but delays getting it checked because the massage reduces the aches, pains fatigue and stress of the disorder has the massage therapist acted in the best interest of the client? The MT may get a lot more money because that person comes infrequently. The MTโ€™s ego may get built up because the client tells them how wonderfully relaxing the massage is. The big question is what is in the best interest of the client.

Iโ€™ve had this occur and when asking doctors about my scope of practice and whether I was diagnosing.their response has always been no โ€ฆactually not just no but โ€œhell noโ€ Iโ€™ve been told that referring a client WITH CAUSE when ANY healthcare professional notices possible signs and symptoms of a serious pathology is EXACTLY the job of EVERY health care professionalโ€ฆby the way โ€œwith causeโ€ means you explain why you are referring outโ€ฆthe signs and symptoms and suspected pathologyโ€ฆ.

Now if you still think this is crossing a legal boundary donโ€™t take my word or the word of any other massage therapist. Talk to a malpractice lawyer. The ones that sue people for malpracticeโ€ฆI haveโ€ฆand been told that Iโ€™m more likely to get sued if I chart all those symptoms but never mention their possible importance and never refer them outโ€ฆ


If we want to be accepted and taken seriously by the healthcare system we must take it and our responsibilities with in it seriouslyโ€ฆ


Just something to think about
 


i have no problem with giving an evaluation, with the disclaimer that one should see their doctor, chiro, acupuncturist, because i am not a doctor.
i will not diagnose. i know it's semantics, to a certain degree, but let's give a big HELL no for me. let's not play with the all-seeing-eyes of my state board, or the AMA, i say.

for example, if the client has, what i suspect is a lipoma, and they say, "hey, what's that lumpy thing back there?"
i'll say, "it is most likely a lipoma (with definition). i've had many a client with these, and i understand they can be excised, but they may grow back. if you're concerned, you should speak to your doctor or dermatologist." i then may go on to discuss the effectiveness of massage on lipomas, and ask them if there is any pain or discomfort (which might indicate that there is something else going on here)."

i'm also known to say, "my hands feel 'this'. and that could be an indication of 'that'. you could talk to your doctor/acupuncturist/etc blah blah blah."

diagnose. no thanks.
 
Semantics

I agree it's all about communication..I think that it is critically important to refer out with as much information as posible...

Like moogie..said refering out when you have a suspected rotator cuff tear indicated by a a palpable gap in the tissue inflammation a recent trauma etc is very important...

There are only a few pathologies that require some minor adjustments to relaxation massage..sever typeII diabetes for example only requires lighter pressure if neuropathy is present...pretty minor...

Now if you are a massage therapist who uses proprioneurofaciliatated stretching techniques (PNF) myofascial trigger point therpay techniques, heat/cold/cotnrast therapy, deep transverse friction etc...
specific modifications for individual pathologies are substantial..

My orginal point is simply that I have run into many massage therapists who do not do technical work...which is fine the more massage the better...But some of the these massage therapist say that ANY communication about specific assessment and symptoms is out of scope and daignosis....this causes alot of communication problems for new massage therapists and clients...

I would simply prefer they say that they do not do the technical work and and they do not feel knowledgable enough to discuss these issues....
and stop telling clients and new massage therapsits that these conversations are "diagnosing"...

Thanks for the post moogie
 
Semantics

bodyinspirit said:
and stop telling clients and new massage therapsits that these conversations are "diagnosing"...

Nope, what we{the collective we} witness here , on other boards, and in day to day life comes WAY TOO CLOSE to diagnosing which is clearly outside our scope.

Newbies(and oldbies), just don't do it.
It is also OK to tell your client that you DO NOT KNOW....and to suggest further investigation on their part.
If a client is seeing your for anything other than "relaxation" massage then they are playing a larger part in their own health care{afterall, they sought you out} and most likely will research appropriately.

Telling MT's to not tread near diagnosing isn't frivolous, it's good practice.
If anyone wants to argue the point, go ahead, I like (friendly) debate. I suggest you do it in an Ethics class though....

Robyn
 


A few years ago, I did a 300 hour Symptomatology and Diagnosis subject (I thought I wanted to be a naturopath)

I still do not diagnose, just assess and refer if appropriate.

Diagnosis is not easy, even for a doctor with all the tools available to him including bood tests, Xrays, ultrasound etc. All we have available are signs, symptoms and palpation.

If someone comes to me with a sprained ankle, I dont send them off for a diagnosis (unless there are indications of fracture or complete tear), I asess pain and function and treat the area affectsed appropriately.
There are the occasional clients, I send away to their doctor without more than palpation
 


The longer I am in practice the more wary I am of naming a "suspected pathology." Unless it's strictly a soft-tissue situation (which I can assess and address), I feel most comfortable saying that a set of reviewed symptoms (together with observed signs) are good things to consult a doc (chiro/PT/etc) about. "Just to make sure there's no underlying problem."

But who's going to be satisfied with that? I know I wouldn't if I were on the receiving end. So when pressed, I do try to say something like "A few different health concerns have the XYZ symptoms you're showing, and I know enough to point it out to you but not enough to guess whether there's a problem." And I force myself not to guess aloud what those might be. Sometimes I have silently guessed the same as a doc; sometimes I have been WAY off.

Of course then there are the clients who won't have anything to do w/AMA medicine and sort of hope we will try to dx because they trust us . . . fortunately I haven't had one of those whose massage would have required a different approach depending on diagnosis, but I know that day will eventually come.

I agree w/Robyn - I don't think we have to second-guess our assess-&-address skills for soft-tissue situations, but I know too many MTs who sound way more free and easy with the pathology opinions than I feel comfortable doing.
 
A couple of points

As I said my opinion comes from speaking with MD's, two surgeons, several PT's and chiropractors...

and most importantly a lawyer specializing in medical malpractice...

As long as your charting and communication with the client are clear..that the condition is "suspected" followed by a referal to the appropriate medical profesional who is qualified to "diagnosis" there is no danger of diagnosis....

But not refering out or refering out but not telling your client exactly what signs, symptoms are concerning and why..could get you into trouble....

To be honest there are very few lawsuits involving massage therapists unless there is extreme gross negligence...

there is a literature review of cases of massage therapy malpractice over 10 or 15 years...I think I have the abstract on my website...I've got the full text somewhere on my office computer...

I will track down the tittle of it ...it's very interesting reading..
All of the cases involve some pretty ridiculous behavior on the part of the massage therapist...

Like one rolfer doing deep transeverse friction and applying heat to a clients neck the day after a whiplash injury before she had seen a physcian....

My goal is to notice the things I can notice and get my clients to the right medical professional with as much information as possible...they can then make a decision with that MD etc as to a course of action..(i.e. informed consent)...

As to discussing this on an ethics thread..I have clear guidence from a leagal professional who has decades of experience in the field of medical malpractice..the line is pretty clear leagally...

I think the ethics conversation would come into play... for those who have not looked for a clear leagal distinction...

I have yet to encounter a problem with a client , or doctor etc...
just other MT's...

Dale
 


Well, to each their own. I'm not acting out of "FEAR" in this situation as your thread title shouts; I've just come to a different conclusion than you about how I will phrase things. This hardly ever comes up for me when I really stay focused on the soft-tissue work anyway.
 
FEAR OF DIAGNOSING

Hi i agree with you in a way where i think massage therapist should take all out anatomy knowlege to "REFER" client to the doctor in case where our knowlegde indicates our client may have a medical condition...

i agree on all that...but i think we still cannot be diagnosing people . we may know what it is that they have but we can just tell them for sure that they have certain medical condition thats md's job....

however very good point i guess we should be afraid od diagnosing people becasue we are not md's..but we shouldn;t be afraid of refering people to the adequate health care provider
 
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    Add bookmark #400 Blackpink Wellness โ™ฅ๏ธโ™ฅ๏ธ90 Marycroft Ave. Unit #2, Vaughan, ๐Ÿญ๐ŸฌON L4L 5Y1 (647) 395-3188. BEAUTIFUL AND SEXY GIRLS TODAY: ๐ŸŒนSuperstar Julie and Beautiful Tiffany on duty๐ŸŒน.
  27. DareDevil:
    ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILLโ™ฅ๏ธโ™ฅ๏ธ,647-222-5683 (PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Young Beautiful Girls : New Girls Cici and Joy, Ellagant Ella, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! BUY 10 HOURS (GET 11 HOURS) **TODAY'S PICK OF THE DAY ARE๐Ÿฌ๐ŸญCici or Ella๐Ÿฌ๐Ÿญ
  28. wonderspa:
    wonderspa: wonderspa: ๐ŸŒบ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy very young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,young very beautiful new girl Cici, back walk ,body slide,amazing the end,give you warm and comfortable time must try๐Ÿ”ฅ
  29. EMSpa_schedule:
    Tomorrow's sneak peek: On Friday May 2, 2025, our attendants will be Ada ๐Ÿฅฐ, Carla โค, Vicky ๐Ÿฅฐ, Opal ๐Ÿฅฐ and Cici ๐Ÿ˜. Call us at โ˜Ž๏ธ(905) 479-6668โ˜Ž๏ธ to book!
  30. Lilyspa1:
    Lily Spa :๐Ÿ’•๐Ÿ’•Thursday Schedule ๐Ÿ‡ฎ๐Ÿ‡ณ๐Ÿ‡ฎ๐Ÿ‡ณSana 23, , Punjabi girl , very pretty 36 DDD ๐Ÿ˜ˆGFE โค๏ธElena ( Latino ) Big Nature Boobs & SuSu ( Asian )Slim , ๐Ÿ˜๐Ÿ˜Porn Service ๐Ÿ”ฅDuo ๐Ÿ”ฅ,โ˜Ž๏ธ 6475318288
  31. Soul Relax Spa:
    โœจ Looking for a relaxing escape? โœ… Click Here Meet๐ŸŒธLuna๐ŸŒธValentina๐ŸŒธKellyCall us today for the best treatment and service experience. Click on our Username and FOLLOW US for updates ! Call now โ˜Ž 289 - 298 - 5662โ˜Ž๏ธ Your ultimate relaxation awaits! โœจ
  32. bnwellness_wilson:
    We have 4 young girls are working today, young cite Taiwanese Victoria 25โ€™s slime open mind and young flirty Tina 30โ€™s with sexy body open mind, sexy Coco and sweet GFE Ella are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
  33. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls๏ผŒNina ใ€Cindy ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, Mia sexy girl 1.65 M.pretty boobs 36D๐Ÿ˜˜Superb service ๐Ÿ‘ massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring you a little surpr
  34. AliceSpa:
    THURSDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—”.4915 Steeles Ave. E, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿฎ๐Ÿต๐Ÿด-๐Ÿฌ๐Ÿด๐Ÿต๐Ÿด. 3 girls here today at ALICE SPA. Open 10am to 9pm: BEBE is a young slim Vietnamese girl with a beauty face, C Cup, 5'2" & 100 Lbs, student and model looks, vg at fs multiple positions, bbbj ymmv must be clean and respectful. KITTY (12pm-9pm) is a new Korean girl, super busty, small body, new to the business.
  35. Moneylee:
    All season wellness center: Young girl big boobs beautiful face deep massage Midi,Young girl big boobs beautiful face deep massage Tina ,Young girl big breasted beautiful buttocks charming temperament big boobs Cindy ,Student big boobs buttocks Vicky, Enchanting sexy petite deep massage Sherry ,๐Ÿ address: #5-30 Rambler dr Brampton ,Ontario L6W 1E2โ˜Ž๏ธ4376655510 ๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿฆต๐Ÿฆต๐Ÿ‘…๐Ÿ‘…๐Ÿ‘„๐Ÿ‘„
  36. SL East Spa:
    ๐Ÿ’†โ€โ™€๐Ÿ’–Terrific Thursday ๐Ÿ’– Ultimate destination for Asian massages๐ŸŽ‰ Two fab spots: SL Richmond Hill & SL West Oakville โœจ Your passport to paradise with 9 enchanting girls fr China, HK โ€” ๐Ÿ†•Tiffany, Joey, Julie, Aaliyah, Coco, Yui, Meghan, Julia & New 34D Jasmineโ€”โ€” ready to pamper you๐ŸŽ๐Ÿ Ring us ๐Ÿ“ž647-695-6354 or text us ๐Ÿ“ฑ647-578-8169โœจ 160 East Beaver Cr., Unit 12, RichmondHill ๐Ÿ’ฐWhere Eastern charm meets Western comfort - your bliss awaits๐Ÿ™Œ
  37. Moneylee:
    Full season wellness center: young girl pretty face nice figure Thai deep massage Vivian , pretty face nice figure Thai deep massage Yuki ,Young girl big breasted beautiful buttocks charming temperament big boobs Anjoo ,Young girl Big breasted saucy naughty Ella,Enchanting sexy petite deep massage Mary. 2560 Shepard ave Mississauga unit 1 .โ˜Ž๏ธ4379857899๐Ÿ‘…๐Ÿ‘…๐Ÿˆต๏ธ๐Ÿˆต๏ธ๐Ÿ‘„๐Ÿ‘„๐Ÿฆต๐Ÿฆต
  38. Lilyspa1:
    Lily Spa :๐Ÿ’•๐Ÿ’•Thursday Schedule ๐Ÿ‡ฎ๐Ÿ‡ณ๐Ÿ‡ฎ๐Ÿ‡ณSana 23, , Punjabi girl , very pretty 36 DDD ๐Ÿ˜ˆGFE โค๏ธElena ( Latino ) Big Nature Boobs & SuSu ( Asian )Slim , ๐Ÿ˜๐Ÿ˜Porn Service ๐Ÿ”ฅDuo ๐Ÿ”ฅ,โ˜Ž๏ธ 6475318288
  39. Golden Flower Spa:
  40. BlueXado Therapy & Spa:
  41. Pink Flower Spa:
  42. Golden Sunshine Spa:
    โœจClick on our Username and FOLLOW US for updates and special services ! โœ… Click Here Today๐ŸŒธCassy๐ŸŒธAkame๐ŸŒธIsabella๐ŸŒธVivian๐ŸŒธCindy Call us โ˜Ž 905 - 265 - 2158โ˜Ž๏ธ Your ultimate service awaits! โœจ
  43. HollywoodSpa:
    ๐ŸŽญ๐—›๐—ข๐—Ÿ๐—Ÿ๐—ฌ๐—ช๐—ข๐—ข๐—— ๐—ฆ๐—ฃ๐—”๐ŸŽญ is now CLOSED as of April 30, 2025, due to land use changes. Thanks to all our loyal clients. We hope to reopen soon in a new location. ๐Ÿคž๐Ÿ™
  44. ForeverWarden:
    Thursday at ๐Ÿซฆโค๏ธ๐Ÿ”ด๐ŸŸฅโ™พ๏ธ๐“•๐“ž๐“ก๐“”๐“ฅ๐“”๐“ก ๐“ข๐“Ÿ๐“โ™พ๏ธ๐ŸŸฅ๐Ÿ”ดโค๏ธ๐Ÿซฆ๐Ÿซฆ2190 Warden Ave, Unit 201, Scarborough ๐Ÿฐ๐Ÿญ๐Ÿฒ-๐Ÿด๐Ÿฌ๐Ÿฌ-๐Ÿณ๐Ÿด๐Ÿด๐Ÿณ: Cindy, Sophia & Tracy. Cindy is a slim beauty, 5โ€™4โ€, natural C Cups. Her massage is nice, her services will drive you wild & her finish is a dream come true. Sophia is a sweet & pretty Chinese lady with natural B Cups and an awe-inspiring smooth rounded ass. Sophia can provide top notch services
  45. wilson holistic centre:
    new girl Tina works at ๐Ÿ’‹535 Evans Ave today ๐Ÿ’•๐Ÿ’•๐Ÿ’•โ˜Ž๏ธโ˜Ž๏ธ416-531-6969โ˜Ž๏ธโ˜Ž๏ธ
  46. HolidaySpa:
    Thursday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: ANGELA, LUCY & CINDY. Angela is versatile and responsive. LUCY is a beautiful and slim Asian lady with a happy disposition and great services. CINDY is a slim & incredibly sexy lady with a smile that will melt your heart, & an ass that will fire up your spirit.
  47. SugarLoveSpa:
    Thursday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: LUNA, MIA, SARA & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž LUNA is a slim, VERY PETITE and capable Vietnamese beauty, nice natural 34C Cups. Luna can do everything. MIA is a young & slim ๐™Ž๐™‹๐™„๐™‰๐™‰๐™€๐™, very PRETTY & PETITE Vietnamese beauty with perfect natural A Cups, 5โ€™1โ€ & 90 Lbs, very versatile. Come and enjoy.
  48. wonderspa:
    ๐ŸŒบwelcome to wonder spaโ˜Ž๏ธ416-5000-800,L6a4H8๏ผŒopen10 to10.on Thursday ,Ensuit shower available ๐Ÿ…beautiful Jessica come back,deep tissue to relax massage and nice body slide๐Ÿ…sunny very good looking,big breasted sweet sensual touch really popular ๐ŸŒนlong hair young beautiful Lucy,friendly smile,back walk ,strong massage,hot stone,got more experience,relief your stress๐Ÿ”ฅmust try
  49. Annie Spa:
    Our famous sexy superstar Suki is BACK @ ANNIE SPA and working today Thursday May 1st with busty 36DD new young girl Bobo, Sexy Little Kitten Kitty and Sweet Sensual Busty Coco๐Ÿ”ฅ๐Ÿ˜˜ Suki only works on Thursdays and her schedule gets booked up very quickly so book your appointments well in advanceโ€ฆitโ€™s always a very special and busy day at Annie Spa when Suki is working ๐Ÿ’ฏ๐Ÿ˜˜โค๏ธ๐Ÿฅฐ Call Annie Spa and ask for May to book appointments ๐Ÿ’ฏโค๏ธ๐Ÿ™๐Ÿป 1001 Sandhurst Circle Unit #7 Finch and McCowan
  50. Jennyโ€™s Spa:
    ๐ŸŽ‰๐Ÿ’JENNYโ€™S SPA๐ŸŽ‰๐Ÿ’ โœ…5170 DUNDAS STREET WESTโœ… ๐Ÿ‘ŒETOBICOKE ONTARIO M9A 1C4๐Ÿ‘Œ โ˜Ž๏ธ( 647-893-5196)โ˜Ž๏ธCall or Text โ˜Ž๏ธ( 437-888-3759)โ˜Ž๏ธCall Only (ETOBICOKE) OPEN 10am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…GRAND OPENING๐Ÿ’ฏNEW GIRLS EVERYDAY๐Ÿ”ฅEXCELLENT MASSAGE + SERVICE QUEENS NOW AVAILABLE AT JENNYโ€™S SPA FOR ALL YOUR MASSAGE AND SPECIAL EXTRA NEEDS๐Ÿ”ฅ๐Ÿ’ฏ๐Ÿ˜˜๐Ÿ”ฅโค๏ธ๐Ÿ‘Œ ๐Ÿ”ฅTWO BEAUTIFUL NEW YOUNG ASIAN GIRLS EVERYDAY๐Ÿ”ฅ ๐Ÿ’ฏREAL PICTURES OF ATTENDANTS๐Ÿ’ฏ ๐Ÿ”ฅ๐Ÿ’‹Limited Time Special Promotion๐Ÿ”ฅ๐Ÿ’‹ โœ…๐Ÿ’ฆ30 Minutes Nude Mass
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