My major goal during cancer treatment was to teach in August. My mastectomy was scheduled for the end of June, and the surgeon assured me that I would be able to meet my goal. I knew teaching during the remainder of my chemotherapy and radiation treatments would be difficult, but I was confident that I could manage. Then I hit a roadblock: After surgery, I couldn’t get my arm high enough to write on the board.
Like many people, I underestimated how complicated a mastectomy can be, and how it can affect range of motion. My surgery was more extensive than most, so it shouldn’t have surprised me that I might encounter problems. Inflammatory breast cancer patients are not eligible for a sentinel node biopsy, which meant I had many lymph nodes removed from under my arm. Then, during surgery, the surgeon found two tumors on my chest wall, meaning they had to remove muscles usually left in place during a modified radical mastectomy.
How did I finally manage to lift my arm high enough to write the date and homework assignment at the top right of the board? Baby steps!
Shoulder pain is a common problem
I was not alone in my problem. In an article in The ASCO Post, Jesuel Pedro-Guzman, M.D., states that about 60 percent of breast cancer patients experience shoulder pain. The problem is not just from surgery, but also from the radiation that is often part of breast cancer treatment. He says, “When movement of the shoulder is reduced, it causes contraction and/or inflammation of the shoulder joint capsule and may result in the condition known as frozen shoulder.” To avoid frozen shoulder and other shoulder problems, he emphasizes the importance of proper diagnosis and appropriate exercises.
Stretching after surgery
Exercise after surgery starts with simple stretches. The post-mastectomy stretch I started with, and the one I see mentioned most often, is the wall climb or wall walker.
To do the wall climb, you stand with your arms touching a wall at a comfortable level. Then you let your fingers walk up the wall like a spider until you get to the level of discomfort. You repeat this as often as suggested by your surgeon or physical therapist. The next time you repeat the exercise, you try to go a little higher.
My doctor suggested the wall climb plus a couple of other stretches, but at the end of three weeks, I still couldn’t get my arm over my head. That’s when I asked for a referral to a physical therapist. A new set of stretches finally worked.
The one I found most useful was the wand lift. I lay on the floor holding a yardstick in both hands at hip level. Then I lifted the yardstick as high as I could. My good left arm was doing the work while my right side just went along for the ride. The goal was to end with arms outstretched over my head on the floor. Gravity was supposed to do the work of the final part as the yardstick descended. At first, it was too painful to get my arm completely outstretched, but eventually I got there. Once I could do that, I knew that I would be able to write on the board.
Resources to help
The American Cancer Society has a wonderful list of post-mastectomy exercises to give you an idea of what to do. Another good resource is this video from Memorial Sloan Kettering Cancer Center. However, it is important to consult with your surgeon about the exact stretches recommended for you. Each person is different. Your doctor may want you to wait until your stitches and drains are out before exercising.
If you do not see progress, ask for a referral to a physical therapist experienced with working with mastectomy patients. Having someone guide you through the exercises and make sure you are doing them correctly can make all the difference between complete recovery and a frozen shoulder.
I have found it important to continue doing my stretches even though I am many years out from my treatment. Whenever I stop, I get muscle cramps in my side and pain in my collarbone and shoulder. A mastectomy can have long-term effects on posture and muscle strength, so continued vigilance is necessary.
I did return to the classroom on schedule, able to write on the board. I got through that whole year despite the fatigue from chemo and radiation. Today, when I’m confronted with difficult problems, I remember with pride how I used baby steps to learn to raise my arm, and I know that I can conquer new problems too.
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Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.