day 217 – hurts so good – physical therapy post-mastectomy

I wrote a couple of weeks ago (day 191) about the rather surprising change in my body, post-surgery: the abrupt loss of the ability to feel touch, while still feeling pressure, around the scar area is most prominent and unlikely to change. And then there is the fact that my arm doesn’t quite work the way it used to, but this one can be fixed and is something I am working on with my physical therapist.

Once the drains were out at the 2 week post-surgery mark I met with my surgeon, and she recommended that I go to physical therapy to help with the range of motion issue. The most urgent need is to be able to get the arm above my head so that I can be properly positioned for radiation therapy. Of course, more long-term is the desire to get the arm back to what it was before, or close to it.

I had already been given a sheet of exercises by the surgical team right after the operation, and had been doing these with some success at home, even while the drains were still in. These included pressing against a door frame and rotating my shoulders and moving my arms up and down at various angles from the body. So I did not expect much more than that from physical therapy – perhaps some new exercises to add to the repertoire. I couldn’t have been more mistaken. In fact I saw immediate results on the first visit, in exchange for some good pain 🙂 and feel that my therapist is a key member of my health care team.

My therapist does amazing things with my arm. She has me lie down on my back, with my right arm over the side and is herself on a rolling stool next to me. She then takes my arm, and places it many different positions, such as over her shoulder, or under her arm and at various angles to my torso. With skilled fingers she then finds and eliminates the cording. Cording is the lines of scar tissue that form at various depths from the connective tissue and lymphatics that are affected by the surgery. They feel like ropes in your arm that are less elastic than your muscles, and at certain angles can even be clearly visible under the skin. You can read more about them here http://www.breastcancer.org/treatment/side_effects/aws

So my therapist likes to get one of these cords under tension, and then pop it, by pressing on it with her fingers or thumbs (I am not watching this). Sometimes you can hear the pop, and I can almost always feel the pops as the tension is released. Once you get away from the mental image of something in your arm tearing, it is really rewarding. Honest. And it usually hurts, if even for just a short instance but I have to say, in a good way. Its more akin to rubbing a sore muscle than anything else. The relief from the tension and the increase in motion range is instantaneous also. My therapist likes to mark each one she gets with a small comment of shared accomplishment, usually “There’s one” or “Did you feel that one?”. Yes. Yes, I did. She often asks me if I am OK, just to make sure 🙂 which I appreciate.

In comparison to these sessions, which mark real progress, my personal exercises are more modest . What is remarkable to me is that after I complete the morning set, my right arm can reach pretty much as far up as my left can. By mid-day, much of that has stiffened up again, and it feels awkward. Now my range today is way better than two weeks ago, but I have to give most of the credit to my therapist.

I am learning that the exercises are really something that has to become more a way of life than something that I do for a few weeks and then move on. They are particularly important for these next several weeks, as my physicians have warned me, because radiation can contribute to the stiffening of tissue. I want to keep the progress I have made. In the meantime I look forward to my remaining physical therapy sessions, and popping a few more cords!