Arm activity post surgery

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Physiotherapist guidance for arm activity following breast surgery Check with your doctor about relative restrictions on exercises following surgery, although most exercises can start on the day after surgery.  Your surgeon may request a physiotherapist to help you with some of the exercises initially.  It may take two to three months for you to recover full use of your arm.  If you are having specific problems with moving your shoulder, ask your doctor regarding a referral to a physiotherapist. Shoulders are made to have full movement and your arm will feel best when this is achieved.  You are encouraged to use your elbow and hand as much as possible, within the limits of your pain, from as soon as you can after surgery. For the first few days following surgery, deep breathing exercises are advised.  Lie on your back and breathe in until your lower chest expands, then exhale and relax.  Repeat three or four times to help you relax and also gently expand your chest on the operated side. “Normal” shoulder movement implies that you have the ability to reach across the top of your head to touch the opposite ear without a stretchy feeling in you armpit (axilla).  Use this as a guide to measure your progress.  Shoulders are made to have full range of movement, and you will probably only feel comfortable once you have reached your normal. Generally, it is okay to stretch your shoulder until you feel a mild pull, but no pain. Stretches should always be done slowly and smoothly.  You can stretch up to three times a day.  Consult your doctor or physiotherapist if you are unsure. The stiffness and tightness in your chest after surgery and radiation therapy will come and go for a while.   Start with activities that will assist your normal day-to-day activities: reach into cupboards, wash and dry your hair, fasten your bra. After the stitches have been removed and the wound has healed fully, you may start massaging the scar for approximately 10 minutes after a warm bath or shower.  Use circular movements to cover the scar and surrounding areas, to ensure optimal flexibility of the scar tissue. If swelling persists after surgery, elevate the arm at a 45º angle on pillows.   Apply heat packs (warm, not hot) to the limb, and do pumping exercises with the...

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What you need to know about lymphoedema

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Lymphoedema is an accumulation of excess fluid in any body part that has experienced damage to the lymphatics. After breast cancer, it is generally characterised by swelling of the hand, arm, breast, or torso on the affected side and is associated with significant physical, functional, psychosocial, and economic burden for those who develop this chronic condition. The lymphatic system is a network of glands connected throughout the body by tiny vessels called lymph vessels. Lymph vessels contain lymph. Lymph is a yellow fluid with cells called lymphocytes. Lymphocytes help fight disease. The lymph flows through the lymphatic system and eventually drains into veins. This system helps to get rid of waste products from the body. Lymphoedema is associated with surgical removal of lymph glands and radiation to the axilla. Being overweight in combination with surgery and radiation increases your chances of getting lymphoedema, so watch your weight. Lymphoedema occurrence after breast cancer treatment is estimated up to 70% and is diagnosed as late as 30 years after treatment. Early recognition and treatment of lymphoedema provide optimal outcomes and may alleviate or minimize the physical and emotional burden. Lymphoedema measurement should be done on diagnosis of cancer, before or immediately after breast cancer surgery, as a baseline measurement. Some of the signs of developing lymphoedema in your arm is a “feeling of heaviness” in the arm, a “feeling of tightness” (garments and/or jewellery), and greater difficulty with movement and daily activity. If the surgery involved removal of some or all of your lymph glands, or when you undergo radiation to your axilla, you may be at risk to develop lymphoedema. The average time of onset is approximately 3½ years, but it may start earlier or even a lot later. Guidelines to help prevent lymphoedema Minimize restrictions to lymph flow Restricting lymph flow slows clearance of fluid from the limb. Assist by not wearing tight bra’s, tight sleeves, tight jewellery, etc. Carry handbags on your non-compromised shoulder, and avoid sleeping on your operated arm if possible. Minimize exposure to heat Overheating causes the body to produce extra fluid which can build up in the limb. Avoid saunas, spa’s, long hot showers, excessive exercise, sprains and bruises. Take care in climates with high humidity. Avoid direct heat from heaters, open fires or electrical blankets left on, directly over the affected limb. Minimize sustained muscle tension Keeping your muscles contracted for any length of time (like when carrying heavy objects) can trigger lymphoedema. Repetitive actions like typing, piano playing, driving long distances, painting the house, gardening could also be culprits. Do everything in moderation. Medical treatments and your compromised limb Avoid having injections in, or blood taken from the affected limb unless it...

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Physiotherapist services for breast cancer surgery patients

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The majority of women diagnosed with breast cancer will require surgery and for those who need a mastectomy, many choose to go on to have breast reconstruction.  Physiotherapy plays an important role in recovery after breast cancer surgery. Physiotherapy treatment is aimed at restoring and maintaining normal, pain-free movement.  Some women will also require radiotherapy after surgery and physiotherapy can help women regain the movement in the arm needed to be comfortable in the position this treatment is given in.   Physiotherapy services for breast cancer treatment patients pre-operative and post-operative assessment (to attain baseline information on the shoulder and arm, and provide the patient with education regarding exercise and lymphoedema) education on the physical effects of breast cancer treatment and how to minimize post-treatment complications customized post-surgical rehabilitation programmes, based on the phase of breast cancer treatment, to restore range of motion, strength, aerobic capacity and function creation of individual home exercise programmes, with regular reassessment of progress and modification of the programme as needed instruction in scar mobilization techniques simple self-massage technique home care and education Who would benefit? Patients who have received medical treatment for breast cancer including: surgery (mastectomy, lumpectomy, axillary dissection, reconstruction) radiation chemotherapy hormonal therapy Possible physical side effects of breast cancer treatment pain decreased shoulder range of motion decreased upper extremity muscle strength decreased cardiopulmonary function soft tissue fibrosis fatigue axillary web syndrome / lymphatic cording syndrome, which is inflammation of the lymph vessels sensory loss neuropraxia lymphoedema (see later) backache, poor posture and reduced function psychosocial impacts: anxiety, depression, fears, concerns, changes in life patterns, adjusted activity These possible side effects may be reduced with education and a customized, safe exercise programme designed by a knowledgeable physiotherapist. Physiotherapists are experts in addressing these issues and can provide advice and treatment to ensure optimal recovery and promote return to normal function.     Positive effects of exercise after breast cancer surgery improved quality of life improved cardiopulmonary function improved upper extremity range of motion improved upper extremity strength decreased fatigue improved venous and lymphatic flow improved functional abilities lower risk of death from breast cancer Research studies have identified a strong association between lower levels of physical activity and higher cancer mortality. Physical activity, such as walking or cycling an average of 30 minutes / day, can improve cancer survival by 33%....

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