Post-surgery recovery for breast cancer survivors
Last week, all the gals from my office and I donned our cowboy boots and headed out to the Chicks n Chaps rodeo event at the Kootenai County Fairgrounds, to have fun learning about (and watching) the rodeo while raising money for the women in our breast cancer community.
In our office, we see our breast cancer patients when their drains are removed, 12-14 days following their surgery, when their drains are removed. Whether the surgery is a lumpectomy, mastectomy, single or bilateral, whether nodes are removed or not, we see them. We evaluate them to create a baseline for them: whether they can they reach overhead or behind their back, is their skin tight and red, are their scars healing and movable or is their skin so painful they don't want to be touched. Do they have swelling in their arm and chest wall around the surgery sites?
After breast cancer surgery, approximately 20 percent of patients will have lymphedema after surgical interventions for breast cancer — whether in their involved arm or chest wall region, according to Jean-Paul Belgrado, PT, of the Universite Libre de Bruxelles, a leading Belgian researcher in the field of lymphedema. All these things need to be addressed at the 12-14 day time frame, so they are ready and know how to care for themselves if they undergo radiation.
Here are some of the possible reasons why lymphedema and venous edema can happen after breast cancer:
1) Surgical Intervention - What type of breast cancer surgery did they have? Was there an axillary resection with lymph nodes removed? Or was it only a sentinel lymph node? If there was an axillary dissection performed, was the sheath of the axillary vein compromised when the nodes were removed? Where are the scar lines located? Are there multiple scars lines blocking the fluid flow patterns?
2) Chemotherapy- There is evidence that certain drug interventions produce an inflammatory response, and this increases the possibly of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema.
3) Radiotherapy- It has been found that fluid movement patterns can be compromised by radiation of the breast tissue and the axillary region. All patients who have had radiation need to have an evaluation to determine skin integrity and scarring in the area of radiation and surrounding tissue.
4) Scar tissue- Scar lines are significant for how the pattern of fluid can move. If they are restricted, thick, hard and immobile, then backflow of the fluid can occur around and behind the scar lines.
5) Genetic- There is evidence that there is a genetic tendency towards edema in certain groups and populations.
6) Physical Activity- What is your level of physical activity at work, home and in you community life? There must be a balance in your activity level, where you are activating the muscle pump — but not increasing the level so high, with such repetitive activities that you create an inflammation.
7) Body Mass Index- A person's level of obesity affects the amount of fluid that might occur. The higher the BMI, the greater the likelihood of edema that can occur, especially if over 30 percent.
The above list needs to be considered, and looked at to determine if you are at risk for lymphedema. Because of this, all breast cancer patients should have a baseline examination with a physical therapist trained in this type of care, as soon as their drains are removed or 12-14 days after surgery, to establish a baseline evaluation so that lymphedema and venous issues can be prevented and cared for early on if they are at risk.
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Sheree DiBiase, PT, and her staff can be reached at Lake City Physical Therapy (208) 667-1988 or in the Spokane Valley office at (509) 891-2623 for a baseline evaluation, prevention and a complete care program after Breast Cancer surgery. She has a specialization in breast cancer care and has trained at Stanford University in lymphedema. Don't wait, you are in charge of your own health care program, come and see us.