Tag Archives: range of motion

Healing well

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WARNING: NSFW / graphic content below.

Elephant on chestSo far, so good. Things are looking good and healing well after my latest surgery two weeks ago when a tissue expander was placed on my right side. I am not loving the discomfort I have. Feeling no pain, but the tightness is definitely there! It is that elephant-on-your-chest feeling. Not as bad as after original mastectomy, but still very uncomfortable.

I have not been doing my stretching and range of motion exercises on a regular basis, so time to get back to those at least once per day. No lazy days! I am a fan of the Coach Casey Eischen post-mastectomy exercise program. She designed it specifically for women recovering from breast cancer related surgeries after she had her own PBM and noticed a void in this area. Check out FoobieFitness.com for exercise tips, videos, and nutritional information. Here is the video with level 1 & 2 exercises. These helped me a lot after my original surgery two years ago and each one after that.

And here’s my progress pic: two weeks after tissue expander placement on my right side (left in pic).

First expansion: March 4. Exchange surgery: July 23, 2015.

Post-op resistance training

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Level 3 exercises are here!

I’ve mentioned in a couple of previous posts, that I began doing simple range of motion exercises while still in the hospital bed on the day of the prophylactic bilateral mastectomy. I was following Casey Eischen’s program. Casey is a fitness expert and nutrition coach that is certified in training women who are recovering from breast cancer and related treatment or surgery.

If you have not yet seen Casey’s first video or want to learn more about her, see: Post-op exercises or Foobie Fitness.

Here is the next video in the series with level 3 exercises. It is for those that are at least six weeks out from their mastectomy and includes more stretches plus a great resistance training routine.

As with starting any diet or exercise program, always consult with your doctor.

Fourth expansion

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WARNING: NSFW / graphic content below.

Another fill behind me. We took it back down a notch from 75 and added 50ccs to each expander, for a total of 350ccs/side. I’m not sure that you can see much of the difference in the photo, whic is at the bottom of this post.

I must say that I feel better after this fill than I did after the previous three. Typically I wake up on Saturday and it takes me a while to get going. This morning I didn’t feel much pain at all – no ibuprofen needed. I went food shopping and cleaned the whole house. I hope I don’t regret this tomorrow! Fingers crossed that this continues for the next four fills.

To celebrate my over-the-hump expansion (four down, four to go), I present to you: t-rex. In a previous post (see: Shower time) I joked that I had t-rex arms because of my limited range of motion right after the mastectomy. I could barely scratch my head (or butt) for a few days. I got this shirt shortly after. Enjoy!

Ask me about my t-rex

2013_5_10 fills

100 + 50 +75 +75 + 50 = 350ccs

They’re growing – first expansion

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WARNING: NSFW / graphic content below.

Goodbye ugly scab, hello first fill!

The scab that has been living on my left boob has finally fallen off! Can I get a “woo hoo”? It has been two full months since my prophylactic mastectomy on January 22 and the start of my adventure with resulting skin/nipple necrosis. Today I had my first fill. 50ccs of saline were injected into each tissue expander, bringing the total to 150ccs/side.

Tissue expanderWhat are tissue expanders, you ask? The type of breast reconstruction I chose is two-staged: tissue expanders first, followed by silicone breast implants. The tissue expanders, which were implanted underneath my pectoralis major muscle during the mastectomy, get filled with saline on a regular basis to stretch said muscle and the skin that covers it, until the desired volume is reached. They are like “pre-implants.” Similar shape, but more rigid, unnatural, and uncomfortable. They have a round magnetic port in the top half, which allows for insertion of a needle, without compromising the expander.

Breast Reconstruction Guidebook Figure 7.1

The process of filling the tissue expanders is pretty quick and uneventful. First the nurse uses a little plastic contraption with a metal pin at the end to find the magnetic port in the tissue expander. Once the center of the port is identified, the nurse sanitizes the area and injects the needle attached to a syringe holding the saline. She then slowly pushes the plunger until all 50ccs of fluid have been injected into the expander. This takes less than one minute. After completing the fill, she places a little round band-aid over the injection site. Same story on the other side.

This procedure is overall painless (based on just the first fill). The only sensation was a brief sting as the needle was inserted into the port through the skin.Three hours later, I feel a little bit of that now-familiar pressure on the muscle and skin stretched over the expanders. As soon as I got home, I popped an ibuprofen, did some stretches, and smeared my chest with Palmer’s cocoa butter oil.

As I look down at my chest, I can see that my foobs are bigger. It is a small difference, but it’s there. It will be interesting to watch these things grow. I can already tell that it won’t be pretty. The expanders didn’t settle exactly the same way: one sits higher and the other one is a bit twisted. The asymmetry seems to be normal based on my plastic surgeon’s feedback and the photos other women have shared. Enjoy the visual!

Fills 2013_3_29

100 + 50 = 150ccs

The fills will continue every two weeks at 50ccs/side. At this point, I have not yet decided how big I want to go (one of my friends joked: “go big or go home!”). However, I did find out that my breast surgeon removed 184 grams of breast tissue/side, which translates to roughly 184ccs, so one more fill and I will be back to pre-op size. Next appointment: April 12.

Source of Figure 7.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

Back to work

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So it has been over six weeks since my prophylactic mastectomy and I feel great. My recovery has gone relatively smoothly and I am enjoying the return of full range of motion, exercising, lifting the kitties, scratching the middle of my back, vacuuming (maybe “enjoying” is a bit too strong of a word for this one), and I’m finally back to work.

slouchingI have a desk job, so it isn’t very physically demanding, but I did feel completely pooped after my second day back. Sitting in one spot for most of eight hours is much different than lounging on the couch and it caught up with me. I find that the tightness across my chest, while not painful, is uncomfortable, so my shoulders droop to relieve the pressure and I slouch. Although I’m more comfortable that way, it makes my whole body ache at the end of the day. It’s just awkward. I must admit that I was getting kind of bored at home, though, so the return to work was good for me. I missed the face-to-face interaction with my friends and co-workers.

heartsOn the healing end of things: I still have a scab on lefty (about the size of a dime). Expander fills have been delayed until all is well and the scab falls off on its own. My next appointment with the plastic surgeon is scheduled for March 29th, so I am hoping healing will be complete by then and we can begin the expansion process.

Not much else going on in post-mastectomy land.

One month later

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It has been one month since my prophylactic nipple-sparing bilateral mastectomy. How am I doing? Here’s an update:

  • Mario kartI am now driving and no longer need a chauffeur.
  • Sneezing still hurts.
  • Got clearance to resume aerobic exercise, but no running or jumping.
  • Planning on going back to work in less than two weeks. Eek!
  • I am not a fan of these expanders. They are hard as rocks.
  • Still no expansions/fills. We are waiting for the necrotic area to heal. The large scab is slowly lifting at the edges. I trim it so it doesn’t get caught on clothes.
  • Had the 14th and last hyperbaric treatment today. Not sure how much of the healing can be attributed to the treatments, though. The wound has definitely gotten better, not worse, so it didn’t hurt. My breast surgeon believes that it saved Dusky!
  • Some bruising has developed on my right side, right over the fill port, so I stopped massaging the skin and expanders. Still using the cocoa butter oil with vitamin E.
  • Making progress in getting back full range of motion. I am happy to report a small victory – I can now bring my arms all the way to the floor during the floor/towel exercise at 13:10 in this post-op exercise video. Big accomplishment!Coins
  • Haven’t gotten any bills yet, but I know they’ll be pouring in soon.

Overall my recovery has been going great! The complications I’ve had are relatively minor and I am happy that it has not been worse.

Foobie Fitness

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Fitness, nutrition, and your health

Speaking of exercise … post-mastectomy exercises are crucial to a full, healthy, and speedy recovery. I keep mentioning Casey Eischen’s program, because it really is a great one and has been working well for me. Every day I do exercises and every day I get further than the day before.

Casey EischenClick here if you’re interested in learning more or contacting Casey Eischen. This amazing lady 1. is a fitness expert and nutrition coach that is certified in training women who are recovering from breast cancer and related treatment or surgery, 2. she underwent a prophylactic bilateral mastectomy herself in November ’12, and 3. she took some time to provide invaluable feedback for this post. Also, be sure to visit (and like) Foobie Fitness, a FaceBook community page run by Casey Eischen.

NotePost-op workouts are one thing. Preparing your body before the procedure is another, and just as important. It is the #1 item on my preparing for surgery checklist: get in the best physical shape you can manage before the surgery. The healthier the body, the more tolerant it is to trauma, and the faster it recovers. I workout on a regular basis, however, I’m no fitness guru, so I would advise discussing exercise with your doctor and/or a certified trainer.

In addition to physical fitness, nutrition is extremely important to aid healing and keep a hand on inflammation. According to Casey, Inflammation is attributed to the improper functioning of the immune system. Check out this meal plan she designed for Simple/Clean Nutrition.

Something that should go without saying – smoking is a big NO-NO.

Details

Pectoralis major, serratus anterior

The breast reconstruction procedure utilizing expanders, and ultimately implants, wreaks havoc on the pectoralis major muscle. The nerves feeding the muscle are snipped when the pocket is created (note: this was the case with my PBM, but may not be the standard procedure for all plastic surgeons, so please talk to your doctor). This causes the muscle to atrophy and lose some of its functionality. The more developed the pec major, the more difficult (read: painful) the expansion process and following recovery will be. A few months before my prophylactic mastectomy, once I knew it was in my future, I began altering my routine. I stayed away from push ups and flys and instead focused on core and legs. After the procedure, because pec major is traumatized, core and legs must pick up the slack.

I’ve fallen and I can’t get up

Maya

Maya

My abs got me out of trouble on day three after the mastectomy. I was sitting on the floor petting a cat and decided it would be a good idea to lay down flat on the floor. That was fine and dandy until it was time to get up. No matter which way I tried to get up, I felt pain. Couldn’t roll over to my side, because I still had surgical drains coming out of me and I couldn’t use my arm to prop myself up if I ever got there. Bending at the waist was not working – my serratus was screaming. I finally wedged my feet under the couch and then used the leverage and my lower abs to bend at the waist.

It was scary as I was laying there helpless, but as soon as I managed to get up, I said to my self outloud: YOU F$@#ING IDIOT! It’s funny now, but wasn’t then. Moral of the story: don’t lie flat on your back three days after surgery, stupid.

Shower time

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Taking a shower after a prophylactic bilateral mastectomy can be a challenge. For the first few days after the procedure, it is not a good idea, because of limits on mobility/range of motion, weakness, and the presence of surgical drains. Some doctors instruct their patients not to shower until the drains have been removed. Until that time, sponge baths are the way to go. I got clearance from my doctor to take a shower four days after my procedure. I almost hugged him when he uttered those words.

The magical day was Saturday (surgery was Tuesday). I waited until about 30 minutes after taking a dose of pain meds, so they had a chance to work their magic. My equipment:

  • Someone to help
  • Shower chair or a small cooler with a towel draped over it
  • Antibacterial soap
  • Shampoo/conditioner
  • Regular pouf
  • Back brush/pouf

The whole process took somewhere around 30 minutes, with most of it spent on undressing and then putting clothing back on in what seemed like slow motion. I wore my underpants and clipped my drains to them (washed my butt last:)). An alternative is to wear a shoestring or a lanyard around the neck and clip the drains to that.

Yoshi

Yoshi: my fav t-rex

I sat on the cooler facing away from the shower head and let the water run down my back rather than directly onto my incision sites and boobies. I insisted on doing the washing, including my hair. It was tough to reach up and scrub – taking it slow and noting when it was too much was the key. The back bush helped with the hard-to-reach places. It was a much needed extension of my t-rex arms. I put antibac soap directly on my hands and gently washed the incision sites, the armpits where the drains exited, and the rest of the chest. After showering, I patted the chest dry with a clean, sanitized towel. This was a much needed refresher!

Sasquatch xing

Sasquatch xing

In one week, I progressed from the sit-down shower or a bath (water level below the chest) to my first real, solo, stand-up shower. The day I wrote this post, nine days post-op, I felt limber enough to shave my legs. Someone release the marching band! My armpits are still a bit sasqutch-esque, because the drain tube holes haven’t completely healed, so I’ll hold off shaving them.

Post-op exercises

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Check out this awesome video from Casey Eischen, BS, CSCS, CPT, CES, Health/Fitness Expert and Nutrition Coach, providing levels 1 & 2 of a great exercise program for women who have undergone a prophylactic bilateral mastectomy. More to come!

Exercises to Recovery from Phophylactic Mastectomy/Reconstruction

2/1: Check out a more recent post about exercise and nutrition: Foobie Fitness

Last details

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  • Insurance pre-authorization: confirmed
  • Disability and FMLA forms: completed
  • Consent forms: signed
  • Pre-op instructions: received
  • Pain medications: prescribed

All that’s left to do now is to get through the items on my Preparing for surgery list, think positive, and avoid getting sick! It just got real. It’s the final countdown.

Went to see the plastic surgeon for the last pre-op appointment. We discussed a few last details:

  • QuestionsSome ladies are told not to shave, as it may increase chance of infection. Is shaving OK before the surgery? Yes, it’s fine.
  • Will I get a pain pump implanted or IV-type pain medication while at the hospital? The pain medication will be administered via IV, not a pump. Implanting the pump creates additional surgical/wound sites and isn’t necessary for this type of procedure.
  • How soon after surgery do I start follow ups? I will meet with the surgeons before leaving the hospital. If there are issues after leaving, may see the plastic surgeon every day, may not see him for a few days. Depends on how things go. Will keep in touch.
  • How soon will the first MRI need to be completed? The MRI is done two years after the implants are in, so nothing to worry about in the immediate future (especially since this will be a staged reconstruction, which means the final exchange of implants for expanders will not take place until about six months after mastectomy). These screenings will be monitored by the plastic surgeon. Breast cancer screenings will continue via clinical exams from the breast surgeon/OB-GYN/PCP.
  • Is physical therapy recommended? Not typically. Some women are back to normal fast, some take a few weeks. Try to do things without help from others (within reason). Brush your own hair the day you get back from the hospital. When you can shower, wash your hair yourself. Do some range of motion exercises. If not making progress, PT may be recommended to help with the recovery.

Added 1/19: Check out this awesome video from Casey Eischen, BS, CSCS, CPT, CES, Health/Fitness Expert and Nutrition Coach, providing levels 1 & 2 of a great exercise program for women who have undergone a prophylactic bilateral mastectomy. More to come!

Exercises to Recovery from Phophylactic Mastectomy/Reconstruction