HAYC EP 16 - Surgery is over - Now What
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Bree Allred: [00:00:05] [00:00:10] [00:00:15] [00:00:20] [00:00:25] Welcome to this episode of Healing at Your Core. This month, as has been Breast [00:00:30] Cancer Awareness Month in October, we've been covering a lot of the things that will happen [00:00:35] after breast cancer treatments. But women, they hear, "Everything's healed. You're looking great. [00:00:40] It's going fine." And yet she may be thinking, "Why can't I lift my [00:00:45] arm?
Why am I still having pain? Why is my breast kind of lumping up and kinda looking [00:00:50] funny? Um, why is there stiffness in my hands where they're feeling like they're swollen all the [00:00:55] time?" So there can be some issues where, um, physical therapy can be really [00:01:00] helpful for these issues after breast cancer.
During breast cancer surgeries, a lot [00:01:05] of things are going on. Our body is trying to heal skin, reestablish blood [00:01:10] supply, heal wounds where they've kind of pulled things apart. It's trying to form a little [00:01:15] bit of a capsule around the implant, or it's healing from multiple surgeries from [00:01:20] where maybe they've taken tissue to reconstruct the breast from your own tissue.
[00:01:25] So it... There's a lot of things going on. There's also muscle. Your pec [00:01:30] muscle is, um, the breast tissue sits right over top of your pectoralis muscles. [00:01:35] Um, and in those instances, those pec muscles can get tight. [00:01:40] Um, the pec muscle does come over and attach at your shoulder, so it can limit range of motion as [00:01:45] well, and there can be a lot of things going on from, like, um...
There's a [00:01:50] condition called cording that can happen, where scar tissue can create lines [00:01:55] almost all the way down the arm There is lymphedema, where if you had a [00:02:00] lot of lymph node involvement where they were doing some biopsies or lymph node removal, [00:02:05] or maybe there was cancer in the lymph nodes and they're removing a lot of lymph nodes.
We can get some [00:02:10] lymphedema, which is kind of some swelling in the hands, and physical therapy can help with all of these things. [00:02:15] Oftentimes we'll see changes in the muscles or a tendency for us to kind [00:02:20] of guard, meaning we've had a surgical site and our body will guard and protect it with some [00:02:25] muscle tension, and that can eventually limit movement as things heal in a, [00:02:30] um, contracted or shortened position.
And so then we have to work to stretch those [00:02:35] things out. The pec muscles can also struggle with some strength after treatment, as well [00:02:40] as kind of issues within our, in our shoulders as well. Another thing that I found [00:02:45] after my surgeries is that I have a little bit more back tension. Um, I think [00:02:50] just from some postures that I have adopted and just life, right?
Life lives [00:02:55] in front of us now, at computers, and we tend to be hunched over a little bit more, and we're [00:03:00] less active in pulling back on our back muscles. But I feel as my body has tried to protect [00:03:05] my implants, that my back and my spine have been a little bit more stiff as well. So [00:03:10] if we're dealing with shoulder mobility issues, especially from a female standpoint, uh, [00:03:15] we may have some deficits or difficulties with our hair.
Um, either it be a bathing [00:03:20] and washing or, um, doing our own hair. Maybe zipping up a [00:03:25] zipper of a dress behind you or doing up your bra in the back as well. We [00:03:30] may be seeing inabilities to really reach fully overhead. Um, to get something [00:03:35] out of a tall cabinet, you might be noticing some restrictions or tension or tightness there.
Occasionally [00:03:40] sometimes w- people will see difficulty sleeping comfortably as well if we're having some shoulder [00:03:45] restrictions just because of how it limits the mobility in the shoulder. The shoulder gets stiff when [00:03:50] surgery wasn't actually on the shoulder because of its connections through the, um, pec [00:03:55] muscle and not wanting to move through a full range of motion.
Also kind of guarding and protecting through that [00:04:00] after surgery can cause everything to tighten up after a surgery. There may also be [00:04:05] some hormonal changes, like frozen shoulder is very common in women with menopause. So if [00:04:10] you've been through treatments that may have halted your menstrual cycle or put you into menopause for a [00:04:15] timeframe, um, we may have some joint stiffness and frozen shoulder tendencies, [00:04:20] even kind of correlated with that associated with your breast cancers and recovery.
Another complaint that [00:04:25] people may deal with is chest wall tightness. Chest wall tightness may be because [00:04:30] of the limited movement that we've had kind of rotating, um, not wanting to compress the [00:04:35] surgical area. Um, going into that kind of protection mode, we tend to kind of [00:04:40] arch forward and that can limit our chest mobility.
There can also be, as our [00:04:45] implants are there and healing, that we're, we're not wanting to kind of move those implants around [00:04:50] Oftentimes we'll just see lack of mobility. Sometimes it'll affect the ribs and the [00:04:55] ribcage mobility as well, um, from those guarding and protection responses, as well as the healing [00:05:00] responses.
Often sometimes too, as we're guarding and protecting here, we'll get chest wall tightness because we're not [00:05:05] taking big and deep breaths. Some people may be struggling with [00:05:10] scar mobility and sensitivity. So when we get a scar, I'll often use an example [00:05:15] here that it's like, okay, you need to be able to move the skin and [00:05:20] tissues.
Do you know what I mean? They should wiggle and move, and sometimes a scar will actually adhere to the tissues underneath it. [00:05:25] And if they went into the same scar twice, like they went in there for the [00:05:30] mastectomy originally, and then they re-go in to, um, put your implant in, or maybe you've [00:05:35] had, um, an implant replacement and they've gone in through the same scar tissue as well, [00:05:40] sometimes that can increase the chances of forming more scar tissue and having restrictions and mobility [00:05:45] issues from the scar tissue.
Um, occasionally the scars can be extra sensitive as well as far... [00:05:50] especially when nerves start to reconnect. Um [00:05:55] Your body is used to not having sensation here, and as things kinda wake up, they can be a little bit more [00:06:00] sensitive. Um, my sensation has not fully ever returned, but every year [00:06:05] I get more and more pressure sensations.
Sometimes I'll get some weird little white lightning shocks. It's, [00:06:10] um, as nerves have kinda reconnected. Nothing for me that's lasted, but it can be common to have that [00:06:15] sensitivity within the chest and breast area as well, over scar tissue, or just [00:06:20] around the areas nerves are reconnecting. So the scar tissue can actually be healed, but the [00:06:25] scar itself can still be causing issues.
And in physical therapy we can do scar mobility, we can [00:06:30] work with ultrasound in helping to kinda soften that scar tissue and allow us to be able [00:06:35] to remodel it so that it will move and glide and slide the way that it needs to, and not [00:06:40] produce more restricted or painful movement. A breast cancer surgery, um, or a [00:06:45] breast surgery doesn't just affect the breast.
When we're talking about the [00:06:50] chest wall restriction and not wanting to take a big, deep breath, when a woman goes to the hospital and [00:06:55] has surgery, she doesn't leave the rest of her body at home. And when our breath is restricted, it changes what [00:07:00] happens within our core, and it can change what happens within our pelvic floor.
Now, not to mention [00:07:05] radiation, in addition to this, can cause additional scarring, additional, additional restriction. [00:07:10] Um, tissues with radiated, um, skin tend to be more tight, more [00:07:15] leathery, not as forgiving, and that can affect things. Um, the pelvic floor can [00:07:20] definitely be affected, and the rest of our body can be affected by the lack of mobility, um, in our chest, [00:07:25] uh, especially.
When we're talking about cancer treatment, we're also looking at the whole [00:07:30] person when we're talking about rehab. We're looking at shoulder range of motion. We're looking at [00:07:35] chest mobility, ribcage mobility, and that ribcage mobility affects how pressure is mitigated within the [00:07:40] abdominals and within the pelvic floor.
Um, we're also looking at people maybe going through [00:07:45] menopause based on treatments or age at this time, and those can affect pelvic [00:07:50] symptoms. Painful intercourse can become an issue. Um, fatigue, d- general [00:07:55] deconditioning, strength changes are all things that we can be focusing on in rehab. I know there's some initial [00:08:00] fear about when you can start moving after breast cancer surgeries, and as we talked a little bit [00:08:05] with, um, Whitney Collins, the nurse practitioner, she really [00:08:10] says, "Okay Take it easy for a couple weeks, and then after that you can start moving, doing [00:08:15] more lower body work, doing different things to keep your body as healthy as it can be.[00:08:20]
And I would recommend the same. Um, two weeks is a pretty good time to kind [00:08:25] of take it easy after surgery. Your body is doing a lot of healing, it's burning a lot of calories on the [00:08:30] back end of that, and we're wanting to save your energy to promote towards your healing. After that, [00:08:35] doing some movement, getting some walks in, getting some cardiovascular stuff that's not doing a [00:08:40] lot of arm movement with it.
But then you can also start, do you know what I mean, reaching overhead, starting [00:08:45] to move your arms, stretching lightly, very lightly into those pec muscles, getting some [00:08:50] of the rotational movements back in through the chest cavity. Um, and then [00:08:55] we're waiting until we get that clearance at six weeks for the lifting restrictions to be lifted to do a [00:09:00] little bit more from a body weight perspective, um, and from a weightlifting perspective to [00:09:05] help with the muscular changes.
But I don't want you to be afraid to move your body. It is one of those [00:09:10] things where just listen to it, and I know it sounds an interesting thing, again, you know your feel, that you [00:09:15] know, right? You know instinctually a little bit what's good and what's not for your body. So we recommend that [00:09:20] you try some movements.
We see how your body responds. Is there a lot of pain associated with it? We don't want a [00:09:25] lot of pain. We want to do just some gradual movements and start getting things, um, [00:09:30] moving in pain-free ranges, and starting to then maybe get some light stretches, and gradual [00:09:35] building on that is what is best for our bodies.
Now, there are some questions about if you've [00:09:40] had, um, lymph nodes removed, and we're a little bit more cautious, we go a little more [00:09:45] gentle. We just want to wait and make sure how the lymph responds to movements. Little [00:09:50] things can set off swelling responses in your body, and with limited lymph nodes to help clear [00:09:55] and remove that, it can cause some issues.
So we just go gradual, but we don't want you to be fearful. [00:10:00] Maybe using a little bit of compression, being educated on some light lymphedema massage can be very [00:10:05] helpful for a lot of women, um, to help just things not be stagnant, and to help keep that lymph [00:10:10] fluid moving. Surgical techniques continue to get better and better so that we're preserving lymph, [00:10:15] um, nodes as much as we can, and we're learning more and more about how to [00:10:20] prevent lymphedema issues.
So don't let that be a big fear of yours, [00:10:25] but also just be cautious. I think a lot of it is just doing a little bit, watching how your body [00:10:30] responds, and then being able to add, um, progressive movement. Not [00:10:35] going back to lifting and yard work and doing things that you were doing before. It is more of a [00:10:40] gradual return to that.
And physical therapy can be a great resource for that [00:10:45] progressive load. That's one of the things physical therapists are really good at, is knowing when healing [00:10:50] allows for appropriate loading of tissues, and being able to have exercises that meet your phase of [00:10:55] healing and your current status. If I could redesign the system for patients after [00:11:00] breast cancer rehabilitation or for breast cancer rehabilitation for patients after [00:11:05] surgery, I really want to see them to be monitored a little bit more for lymphedema.
I want them to be [00:11:10] monitored for lack of range of motion, and having a little bit more guidance on [00:11:15] knowing what they can do when. I feel like that's the biggest thing is the unknown and fear [00:11:20] that limits people from moving their bodies in safe ways, and that can lead to further [00:11:25] dysfunction. And I think we can prevent a lot of things if we're just having a session or two early on [00:11:30] and being able to educate people on what they need to do with their bodies.
We're really hoping that rehab can become [00:11:35] an integral part of breast cancer rehabilitation or just even that breast cancer care [00:11:40] pathway, that idea of, do you know what I mean, when you have this, this happens, this happens, this happens, [00:11:45] this happens. And we're screening, and we're looking at fatigue levels, and we're looking at tolerance levels, and just [00:11:50] knowing that rehab can happen along any point in this pathway.
It's never [00:11:55] too late to get help. It's never too late to strengthen muscles. It's never too late to address scar [00:12:00] tissue, and it's never too late to address range of motion. The biggest concern for me is more the range of [00:12:05] motion. It is harder the later that we do rehab on this if we're seeing some stiffness, [00:12:10] so the earlier the better for those types of conditions.
Okay, we're gonna do [00:12:15] normal healing or time to get help for a few questions. I can't fully raise my arm three [00:12:20] months after surgery. This isn't normal. You should be getting help for this if you still can't raise your arm [00:12:25] three months after surgery. My scar still feels tight a year later. This is definitely, [00:12:30] again, something you should be seeking help for.
And your scar tissue does go through remodeling [00:12:35] processes. I still feel my breast tissue kinda tighten down and scar just a little bit [00:12:40] almost every six months, and sometimes when I start a new activity, I'll feel it respond a little bit differently. But [00:12:45] if you're still feeling scar tissue tightness, it's absolutely something that you should get help with and get [00:12:50] checked out by a physical therapist.
My arm feels heavy. Now, [00:12:55] obviously, a year after surgery we would want this to be looked at and throughout the process, but there may [00:13:00] be some reasons. It's going through recovery. Maybe there's a little bit of the extra lymph fluid there. [00:13:05] And so if it didn't feel that way before, it's usually not normal afterwards, and we're [00:13:10] wanting to look at why it feels- I'm afraid to lift more than 10 pounds.
[00:13:15] Now, once you're past your six-week mark and those ri- lifting restrictions are taken [00:13:20] away, uh, by your physician, knowing that tissues have healed and that we've got a good [00:13:25] capsule around the implant that's keeping its position where we want it to be, then it's perfectly [00:13:30] safe to start progressively lifting.
If you're afraid, then I recommend that you have some guidance and a [00:13:35] professional to help you along the way. But otherwise, doing things where it's like, "Okay, I can, can lift [00:13:40] 10 pounds now," go ahead and lift it. Put a little thing on the scale if you don't have... I mean, you [00:13:45] could fill up a gallon milk jug that you've cleaned out.
You could fill out a, a water bottle. You could put a backpack [00:13:50] with rocks and put it on the scale and see, "Okay, this weighs 10 pounds. How do I feel [00:13:55] lifting here?" And if it's still too heavy, then you can start back and it's like, "Okay, let's lift five pounds [00:14:00] consistently and then work our way back up to 10."
Once you're at 10, go to 12. Once you're at 12, go to 15. [00:14:05] Small incremental steps make this much more doable along the way. My chest feels tight when I take [00:14:10] a deep breath. This is one of the major concerns for me as a pelvic floor th- physical therapist [00:14:15] because our rib cage changes pressures in our body.
And when we're talking about [00:14:20] long-standing pelvic floor issues, we want to make sure that we've got adequate pressure mitigation through the [00:14:25] chest wall. So if you're still feeling tension or tightness within your chest, like you can't take a [00:14:30] full deep breath, then we're gonna be wanting to do some mobility and looking at the restrictions that exist in order [00:14:35] to allow that to happen.
My breast or chest is numb. This is normal [00:14:40] after a mastectomy. They've taken the tissue out from underneath, which also included the [00:14:45] nerves, and your body does reconnect nerve tissue, but it is the slowest growing tissue, [00:14:50] and so it will take a while. I am now three years after my most recent surgeries, [00:14:55] and I'm still numb, and every...
I'd say every month I get a little bit more [00:15:00] sensation back, but it is still numb, and it's normal for those tissues to remain numb [00:15:05] for Ever, honestly. I don't think it ever but 100% goes back to normal after [00:15:10] that nerve injury. My scar hurts when clothing touches it. This is not normal [00:15:15] and is something that we really need to be looking at.
There's likely some nerve entrapment or some nerves [00:15:20] that are hypersensitive there, and a physical therapist can guide you through the process of [00:15:25] desensitizing those nerve tissues and desensitizing the scar [00:15:30] and getting it moving better. Sex became painful after cancer treatments. This can be due to a lot [00:15:35] of factors, um, typically due to hormonal changes associated with cancers, [00:15:40] and it is going to be something that you can talk to your provider about.
For some women, that may [00:15:45] be some local estrogen treatments based on your cancer type and if it was fed by estrogen. [00:15:50] It can also be discussions about vaginal moisturizers and [00:15:55] lubrications, hyaluronic acid, supplements like Membrasin. Um, so there's options [00:16:00] out there that can help with painful intimacy, and we're looking at is it muscularly caused, is [00:16:05] it more related to hormone issues, and treatments exist to help with that.
It is not normal. [00:16:10] I've stopped exercising because I'm afraid I'll hurt something. I can totally understand this. Our [00:16:15] fatigue is different. Your sensation may be different. Sometimes we'll get, um... After chemotherapy [00:16:20] treatments, sometimes we will get, um, neuropathy in our hands and our feet, and so that can make you a little bit more [00:16:25] likely to, um, not feel where you are in space with your feet, and sometimes you're at [00:16:30] higher risk for falls.
So doing so in safe environments, a physical therapist can guide you [00:16:35] if you'd like more guidance, but, um, just being a little bit safer of if you're really nervous [00:16:40] about hurting yourself or falls or things that way, using an assistive device like a walker, a [00:16:45] cane, something like that can- hiking sticks can be helpful to give you a little bit better, [00:16:50] um, awareness of where your body is in space.
The other thing is just I think having a [00:16:55] professional guide you through the process can really help with those fears if you're afraid of movement. They can reassure [00:17:00] you through the process of what's normal and what's not normal and what you're feeling and be able to [00:17:05] guide you from their expert opinion and give you reassurance on what's safe and not.
My surgery was [00:17:10] five years ago. Is it too late re- for rehab? One of the greatest things is that it's never too [00:17:15] late for rehab. We can always work to improve tissue mobility. We can always work to improve scar [00:17:20] tissue. We can always work to improve strength in the body. The only thing that's a [00:17:25] little bit trickier is range of motion, as the longer that it's been, uh, having a [00:17:30] restriction, the more kind of taut and, um, [00:17:35] stubborn that tissue gets.
And so rehabbing range of motion can be a little bit more difficult. It's [00:17:40] always still possible. It just usually takes a little bit longer and may be a little bit more [00:17:45] painful as you're stretching out those tissues. What's one symptom that women after breast [00:17:50] cancer wait too long to get addressed? I would say any of them, but I think the biggest one, um, [00:17:55] is feeling some tension in their shoulders and chest.
But they often don't [00:18:00] address, or the scar tissue. I'd say it's the other one people don't address as often as I think they should. One thing [00:18:05] I would tell women after breast cancer surgery, especially if you're thinking that it's too late, is that it's [00:18:10] never too late to get help. If you're not feeling like yourself, if you're feeling like [00:18:15] something's off in your body, if you're not feeling you can move the way that you want to, there's [00:18:20] always time to get help.
No matter how long it's been, no matter what the symptoms are, there's somebody to [00:18:25] help guide you along that process. One thing that I wish every woman knew prior to going [00:18:30] into breast cancer surgery is that movement is safe, and you just need to listen [00:18:35] to your body and work within the ranges that are pain-free initially.
And the further out from healing [00:18:40] that you get, the more vigorous you can be with stretching. And the more [00:18:45] movements you can do, the more you can lift and rehab and get back to what you're wanting to do. Successful [00:18:50] breast cancer rehabilitation to me looks like you're back to doing everything that you want to do without [00:18:55] pain, without hesitation, without concerns that you're going to hurt or injure yourself.
[00:19:00] It's that you are back to being you. One thing that I want women to know after breast cancer [00:19:05] is that just because you're alive doesn't mean that you have to be grateful for everything that cancer has [00:19:10] given you. There are things that are frustrating, there are things that we don't have to [00:19:15] accept, and there's very few things that should limit your ability to function.
We [00:19:20] can become ourselves again after breast cancer, and we can show up as a [00:19:25] survivor and not a victim of this disease. We can live our life to the fullest, and that [00:19:30] we can restore what was once lost. And I'm so [00:19:35] grateful to have been able to share this journey with you, and am passionate about helping women [00:19:40] with breast cancer recover and become their best selves.
We at Aylara Pelvic [00:19:45] Health would love to be a clinic to help you through this journey if it's something that you're [00:19:50] seeking. Thanks again for joining us for this, this series this month. We're [00:19:55] at Healing at Your Core on breast cancer rehab, and for listening to my story along the journey. [00:20:00] And would love to connect with anybody who has questions or concerns about breast cancer.[00:20:05]
You can reach us on our Instagram at Aylara Pelvic Health.
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