Week 5 & AMAZING Physical Therapy

This has truly been my best week by far!

Monday, I started physical therapy and I couldn't wait to get there. My great friend, Laura (who happens to share my Plastic Surgeon and is getting her implant exchange next week!), told me all about her experience with PT and the "new" technique that is used for mastectomy patients.

I made an appointment with my therapist, Peggy, for 10:15am. I got there at 10 so I would have plenty of time to fill out more paperwork. She took me back and we had a quick intro, medical history, and how the mastectomy has affected me. She measured how many degrees I could lift my arms from a sitting position and then a laying position. Full range is 180 degrees. (Remember your protractor?)

My measurements were:
Sitting-right arm: 161 degrees
Lying down-right arm: 168 degrees

Sitting-left arm: 142 degrees
Lying down-left arm: 146 degrees

Obviously, I have some work to do. After measuring, Peggy explained that she would use a technique called "Myofascial Release" before we started any exercises. I never heard of that before, it sounds kind of fancy, so I was curious to what this entailed.

Before I explain this technique, let me update you real quick on how I feel. The lymph node dissection that they performed in my left arm pit has affected my left arm's range of motion more than I ever thought it would. It has been a struggle since surgery to even wrangle a cami over my shoulders because I couldn't lift my arm very far at all. In general, I felt tight. It's so hard to describe but the best I can compare it to is that it feels like I have a sports bra on, that's at least 2 sizes too small, ALL the time. It is uncomfortable, not necessarily painful. This extreme tightness encompasses my entire torso, my underarms, sides, and the upper half of my left arm. When I have a muscle spasm, it's even worse. I sleep in the recliner still, and I only recently (over the weekend) took a shower or dressed by myself. I was able to start driving over the weekend, but it is difficult for me to turn & look behind me, to turn the wheel with my left arm, and I learned that my seat belt really hurts my left side. Thank goodness for little pillows!

Alright, so back to PT. From Peggy's trainer's myofascial release website, it says that "Myofascial Release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the Myofascial connective tissue restrictions to eliminate pain and restore motion".

So what is myofascial tissue you ask?

Myofascial tissue is "Fascia is a specialized system of the body that has an appearance similar to a spider's web or a sweater. Fascia is very densely woven, covering and interpenetrating every muscle, bone, nerve, artery and vein, as well as, all of our internal organs including the heart, lungs, brain and spinal cord. The most interesting aspect of the fascial system is that it is not just a system of separate coverings. It is actually one continuous structure that exists from head to toe without interruption."

The way that the physical therapist explained it to me was that fascia was very similar to the "thin film covering" that we often remove off of a chicken breast before we prepare it. That "film" is one continuous structure in our body. When we have trauma to our body, such as mastectomy surgery, that myofascial tissue locks down and tightens as a defense.

Here's the scientific explanation of that: "Trauma, inflammatory responses, and/or surgical procedures create Myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch...".

As Peggy explained all this, I really got excited because it made PERFECT sense. She told me that it was like a massage when she started, and it felt like one. She started in the center of my chest, with gentle pressure. At first, it felt like she was just pushing her hand down on my sore sternum, but after a little bit, her hand started to slide down. I could feel the tension releasing! She moved to my left side, which scared me.

It scared me because I am so sore & tight. I've never been scared to move or have someone touch my body before, and it's not a great feeling.

As she worked on my left breast, side, underarm, and arm, I could feel things start to loosen up and it felt wonderful! After the "massage", we moved to the equipment room and she showed me some simple stretches for me to do at home. I felt wonderful!

After that, she took measurements again. The progress I had in just one session is nothing less than AMAZING!

Sitting-right arm: 172 degrees
Lying down-right arm: 175 degrees

Sitting-left arm: 160 degrees
Lying down-left arm: 165 degrees

I will go to PT twice a week. Since she was booked for the rest of this week, I was able to slide into a lunch-time slot yesterday. I made even more progress with my range of motion. Lying down, I was able to extend my right arm a full 180 degrees.

I was SO excited to show Ward what I can do! Peggy told me that she would have me comfortable enough to finally sleep in the bed again! I still have some work to do and strength to gain, but I am so grateful that this opportunity was available to me! My first fill is Friday, so naturally, I'm nervous. BUT....I feel like I have an advantage with PT. She has relieved so much pressure and tightness in my chest that I feel like I have room for the expansion.

I am so impressed with the myofascial release! I think it could help so many problems that we have with our bodies sometimes. I became a believer on Monday morning because I could literally feel my body "let go" of that tension. It was truly incredible.

I'm ready for some cleavage! :0)

Week 4 & the little things

Week 4 has been both an uneventful and an eventful week, all rolled in one. Uneventful in the regard of no setbacks!  It's been eventful because there has been a lot of mini-milestones for me. All these little accomplishments have been very encouraging and I feel excited about it.

I saw my favorite plastic surgeon twice this week. On Monday, he was able to see the results of his debridement procedure and I never thought I would be so excited to show my doctor my boobs! I swear, I couldn't get those dressings off fast enough. I was so relived that Dr. Appel was just as happy about the healing progress as I was. My left side looks absolutely amazing- the incision has healed into a perfectly smooth scar. My right side is quickly catching up. He took a few minutes to inspect the wound underneath the stitches and decided that I would return in a few days to take the stitches out. He does "play it safe" when it comes to healing and I am so very grateful for that.

He asked Ward about my drain output, which has been barely anything, so he asks if I'm ready to get this last literal pain in my side removed. Um....YES I AM! I have to be brutally honest here- I am a huge baby when it comes to pain. I'm a whiner! I think it's truly the anticipation of the unknown that allows my inner-baby to come out. As happy as I am knowing that the last drain is going to be gone, I am petrified that it is going to be very painful.

I do have some validation for this fear because this has been the drain that has bothered me the most. I don't know why, but it has been very tender and has given me shooting, searing pains randomly through my recovery. As I lay on that table reflecting all this, Dr. A asks me if I'm ready and I can barely grab Ward's hand in time before he starts clipping the stitches. Before I knew it, he yanked it out. IT HURT. The left one didn't hurt like that, but of course, it was removed during last week's surgery and I was a bit distracted. Although there was a lot of pain, the relief of it being gone overcame any discomfort I had.

On Friday, we came back to see Dr. A. It was a quick visit and it took him no time at all to take the stitches out on my right side. I didn't feel it at all because I'm still completely numb. He decided to put a steri-strip over the incision for a little extra support. I just leave it on until it comes off or until I see him again next Friday.

I've officially gotten over this healing hurdle and next week, I will begin my reconstruction. I get my first fill next Friday! These temporary expanders that have been placed under my chest muscles will begin to do their job. He will insert a needle in a port that is located in the expander and begin filling it with saline. As the expander fills, my chest muscles and skin will expand and stretch. No more underarm caves! YAY! The great part about this type of reconstruction is that I can choose the size of my breasts. How cool is that?!?!! It will create a good support pocket for a silicone implant that I'll get sometime next year in an out-patient procedure.

I'm really excited (and anxious) about this. As of now, I have about 250cc's of fluid each expander. Dr. Appel told me Friday that I am a large "A" cup. Since I want to be close to where I was before, at least a large "C" cup, my expansion goal is to have between 550cc's - 600cc's of fluid in each expander. As I've researched this type of reconstruction, I learned that most patients usually have between 50cc's - 60'ccs injected during each "fill". Sometimes it takes months for some women to expand to the size they want.

Dr. Appel doesn't take the "slow & easy" approach with expansion as long as his patient can tolerate it. Our goal is to have 100cc's of fluid placed into my expanders at each session. If I can stand it, the amount of time that it will take to reach my desired size will be so much shorter. That would mean that I could possibly be finished filling in January and could have my exchange surgery as early as late February or early March.

The catch to all this growing?? Pain, tightness, and discomfort. The goal is to stretch out muscle and skin, so it has to hurt. I have friends that have done this and I've heard about their experiences. Although they all handle pain differently and have different experiences during the filling process, I am hoping and praying that I can be tough through this, not acknowledge that inner-baby, and get it done. I agree with Dr. A's game plan. I would rather do big fills now and deal with a few days of big discomfort rather than dragging this process out for months.

I think I will be able to be successful at these big fills because I get to begin physical therapy on Monday. I am SO excited about this!! The PT that I will be doing is specialized just for mastectomy patients. It is a combination of deep tissue massage, stretching, and exercises. Not only will this therapy help with the discomfort of the expander process, it will also help me regain my range of motion. Dr. A has warned me that although I will get close, I probably won't regain all of the range of motion I had in my left side due to the lymph node dissection. We'll see about that!

I do, however, have to admit that the impact of the lymph node dissection really affected me more that I thought it would. My pain is very tolerable right now and I am taking minimal pain medicine. I do take muscle relaxers regularly to help with the muscle spasms that I have. My range of motion of my right side is way better than it is on the left. I really can't lift my left arm past my shoulders and I have numbness, tingles, tightness, & discomfort from my elbow to my underarm and side. It's such a weird sensation, but I can move both arms enough to take a shower by myself. That was a big accomplishment this weekend!

I had received the OK to drive last week, but didn't really want to at that time. Friday afternoon, I drove a short distance with Ward and became frustrated almost immediately because I didn't think about a seat belt strapped across my left side. It just plain hurt to have the shoulder strap go across that area. I could turn the steering wheel pretty easily, so I did well. I did have problems turning to look when I was backing out of our driving the way I always do, so I will have to be extra careful when doing that.

I drove more on Saturday and will tomorrow, too. When I was discharged from the hospital after the mastectomy, I received a little pillow to place under my seat belt. It helped a lot when I remembered that I had it for yesterday's drive. It really made a huge difference in the seat belt pain I had on Friday! Who knew?! ( Ha ha!) I will be taking the kids to school this week and driving myself to my PT appointment tomorrow.

One of the biggest & best milestones happened last night. Ward & I went to a Christmas party. It was such a HUGE boost for me to get out of this house (and not at a doctor's office) and see my friends! I had an absolute blast! There was food & fellowship everywhere. Some people knew that we were coming, but there were quite a few people who were floored to see me out. I haven't seen our friends, outside of the some visits at the hospital & home, since the wedding. There were even more people I hadn't seen since early October.

I took a while to get ready last night-shower, hair, make-up. I sported jewelry & perfume. I felt really good about myself last night. All this time before the surgery, I obsessed about how the hell I could ever handle being in public during the reconstruction process with no breasts. I just couldn't imagine being out of the house flat-chested since I have always been rather busty. I was so scared that my self-esteem would tank. Now that I am on the other side of the mastectomy surgery and all that's happened since, it doesn't bother me. Not at all, not one little bit.  I'm so surprised, relieved, and excited that those pre-surgery fears were just that.....fear.

I was just so happy to be at the party and see my friends. They were happy to see me. Some are following my Face Book posts, some are following my blog. Some friends have asked questions. They all know what's happened. I don't feel less-than nor do I feel embarrassment like I was fearful I would. I am so grateful that my God answered those prayers that I said during the time I spent dwelling on the procedure. He really did give me the strength I asked for and probably a few little bonus gift, too. Not only am I excited about the new fake boobs that I'll have (which by the way- I'm super excited about the fact that I will NEVER have to wear a bra again & the new girls will always be perky! Hello tank tops & sundresses this summer!), but I also feel relieved going forward now because I don't have to always worry about lumps, extensive monitoring & testing, and breast cancer for the rest of my life.

Kinda makes a girl feel good! :)


The picture below was taken at the end of week 4. As the expansion process progresses, the expanders will fill and stretch my muscles & skin. This is the phase where my chest will be lumpy, bumpy, and uneven as we reconstruct.