Saturday, January 22, 2011

Physical Therapy

So, I found myself back at the old familiar medical complex - the place I'd hoped to get a month-long vacation from. I was there for my first physical therapy session in the hopes of restoring movement and reducing pain in my shoulder. I arrived late, because as many times as I'd been there, I couldn't find this particular office.

I'd never experienced physical therapy before and wasn't sure what to expect. The therapist, a pretty, granola-ish California type, did some measuring of my range of motion, or ROM as they say in both the computer and PT business. She moved my arm in certain directions, had me put my arms behind my back and see how high I could reach them up my back. My good arm could scratch between the shoulder blades, my bad arm hovered around my waist. Clearly, it is an under-achiever.

She gave me a free massage, which was much appreciated, and then had me lie down on my back with ice on my shoulder and a tens unit. For those who don't know, a tens unit is an electrical muscle stimulator that is supposed to disrupt the pain pathway on your nerves. She turned it high enough to make my muscles jump and then lowered it just under that threshold, and left me there for 15 minutes.

Long-time readers of my blog will know what happened next. Yes, I fell asleep.

I have finally found my true talent - falling asleep during medical procedures.

A bell woke me up and it was time to go. She felt I had something called impingement syndrome, with a possible rotator cuff tear, although she said there was so much inflammation it was hard to tell. There had been a "hitch" in my movement she thought indicated ripped muscles - and not ripped in the bodybuilding sense. She gave me some very mild stretching exercises to do, and I went home.

A day later, I felt much worse.

First, let me rant a bit about that stupid pain scale that every medical professional uses. "Describe your pain on a scale of 1 to 10, with 10 being the worst pain you have ever experienced."

Well, those of us who are Barbie number phobic have a hard time with this. Pain doesn't equal numbers, it equals words. I want to use my own scale:

It doesn't bug me
Okay, it's there but I'll live with it.
Hmmm....maybe I need to soak in a hot tub.
Hi, do you have a spare vicodin?
Hi, do you have two spare vicodin?
Why are you talking to me, can't you see I'm suffering?!
Hey MoFo, give me some oxycontin or I'm going to rip your head off!
Yes, I'm crying, what's it to you?
Oh God, why me?
You #@%&*ing piece of !*^( Get the #$%^& away from me you #&$^%@

I don't handle pain well.

So, my pain had gone from a "hi, do you have two spare vicodins" to "Oh God, why me" in a couple of days. It also feels like it's pulling out of the socket now, and I have the attractive habit of holding my arm on with my other hand.

I went back to PT, and I had a new, yet similarly granola-ey therapist. This one was nice as well although just a teeny bit condescending. When I told her that it had progressed to feeling like it was pulling out of the socket, she told me, "Dear, shoulders don't dislocate that easily." Um, I didn't mean it was ACTUALLY coming out, just that was the feeling. I also told her I'd made an appointment with a doctor to get a cortisone shot and she seemed absolutely shocked that a layman such as myself knew what a cortisone shot was. However, she was very gentle with me physically, and understanding of my discomfort. She was very careful not to hurt me. I suppose it's possible that most of the people she deals with are pretty ignorant of medical terminology and treatments. I wasn't before cancer and certainly am not now.

It was time for the ice and tens, and instead of having me lie down, she left me sitting up, which made it pretty hard to nap.

Hard, but not impossible. Remember, I'm very talented.

Anyway, since the pain is now at swear word levels, and I'm tired of doing everything with my left hand (which makes it really hard to drive and talk on the phone) I decided to give in and see an orthopedic surgeon. I'm requesting a cortisone shot on Monday.

Just by chance, the doctor I'm going to see is an orthopedic oncologist. It was a fluke, since I never mentioned cancer during the request for an appointment. I don't know if that's a good thing or a bad thing. I know my problem has nothing to do with cancer, except in the peripheral sense, but due to his specialty, he may decide he wants to check for it anyway. I specifically said I don't want any more x-rays as I've had enough radiation for quite a while. On the other hand, he'll be well aware of the complications of breast cancer surgery, which often include shoulder problems.

Considering I only finished herceptin a month ago, and my shoulder injury happened immediately after my last surgery, the chances of it being cancer that metastasized to the shoulder, on a scale of 1 to 10, are: "it doesn't bug me."

This is one time I'm 100% certain it's not a recurrence.

I'm sure he knows that too so maybe I can skip the scans. I'll see him Monday at 3:00.



  1. Gosh, I'm so sorry about your shoulder problems on top of everything else. I don't know if this will be helpful or not, but I'll share my experience ... just in case.

    I, too, started having shoulder problems shortly after I finished breast cancer treatments (surgery, chemo, radiation). It really hurt ... such sharp pain when I tried to move my arm. I was diagnosed with "impingement syndrome" but it quickly progressed to "frozen shoulder". First in one shoulder and then in the other. It was very painful for a while and then it was less painful but just really limited range of motion. I saw physical therapists and massage therapists. The massage really helped, I think, though I really just had to wait for my shoulder to thaw before I could start working on improving my range of motion. While my shoulders were frozen I had a lot of trouble with dressing myself ... and undressing myself. I sometimes got stuck in my clothes and often needed help getting jackets and shirts on and off. I learned to wear mostly stretchy things which improved the odds of me getting them on and off myelf. It took about 8 months for my shoulders to start thawing. As it is now, I've recovered a lot of range (thought not all) in my right shoulder and while there are definite improvements in my left shoulder, it is still quite restricted. It's the side I had surgery and radiation on. I'm now working at trying to improve my range of motion with exercises and massage.

    I read that it is very common for women who have breast cancer and bc treatments to get frozen shoulder(s).

    I don't know if this is what's plaguing you and, if it were, I'm sure your physical therapist would have identified it. It can't hurt to ask, though.

    Good luck!

  2. Thanks Heather. I am surprised at how common shoulder problems are after mastectomy/reconstruction. Seems like physical therapy should be a routine part of the process. However, I think that I did it after my surgery trying to maneuver myself out of bed. Not easy to do with fresh cuts in your chest muscles and I know I got in an awkward position.

    I don't know if my shoulder is frozen yet but it gets worse and worse. I have been able to close my bra but not normally. I'm at the point where I can't anymore and tomorrow I'm going to buy some front closing ones. Driving is the hardest part - I can only drive with my left hand. I work less than a mile from my house, the grocery store is blocks, so I'm fortunate that way. Longer drives, like to the doctor, which is five miles away, is hard. I'm also having trouble turning my head since my muscles are getting stiff.

    I know that cortisone shot will help quickly though and then I can keep doing PT.

    Obviously, when you have major bodily changes, you are going to have troubles. They don't cut off somebody's foot without recommending PT, not sure why they cut off a breast and open up our chest muscles and put implants under without requiring PT. It's strange - it should be a part of every therapy. Guess that's my next blog post. :)

  3. Oh, God, I can totally relate to the painful shoulder. I'm so sorry that you're going through this now ... and you're absolutely right: it's absurd that PT isn't a routine part of treatment after bc surgery.

    I found massage & acupuncture to help the most when I had frozen shoulder, altho I did benefit from some good PT after jumping thru hoops to find such an anomaly. The best PT I've ever had was in a warm water pool -- maybe you could get access to one?

    Your sense of humor will carry you through, along with the strong support of this blogging community. I love reading your posts -- even with the pain, you find a way to make parts of the experience funny.

    I know you won't take any s#*t from the doctor on Monday. I hope he is helpful & respectful.

  4. P.S. I just found a pilates program for women who have gone thru breast cancer surgery. The woman who created it said, ""After my surgery, I couldn't believe there wasn't a standard for rehab," so she created one herself.

    There are 500 certified instructors in the U.S.

  5. Go look for the Pink Program. Its offered at some YMCA's around here and is based on this book. I am taking the classes at a local Y but I am not sure they are available nationally. If you can find this book and there is a second one without exercises in it, you can start the exercises slowly. add a few more every week. There are workout programs for different surgery rehabs - mastectomy, lumpectomy, etc. I feel much better and my shoulder hurts less. And it has helped my lymphedema. Good luck.
    PS I call Physical therapists, physical terrorists!

  6. Wow, thanks for the suggestions. I'll look into those - hope there is one in my area. I know that I'll never be able to exercise normally again and this will help. Ironically,the only exercise I ever really enjoyed was weightlifting and I think that is out for me. I'm not sure my chest muscles can handle that,even stuff like opening a jar feels weird. A special program for beast cancer survivors is what I need.

  7. I absolutely LOVE your pain level word scale. I need to adopt it as my own because it's perfect. You might try giving it to your doctor to use instead of the 1-10 number thing. But I do hate that you're having so much pain in your shoulder. from recently reading all your old posts, I have no doubt that it was caused from your surgery. What a shame. But getting it fixed is all that matters now. If you see my sister Susan in admissions at Mercy, remind her to me very nice (and to make you laugh). Tell her you're reporting any bad behavior straight to me. HA! -Megan-

  8. Good luck with the appointment today. Your description of the pain scale was right on target. I'm also numbers challenged, but I tend to fudge the numbers, depending on what pain killers I want.

    I hated PT; I had it for lymphedema several times, and it really stunk. I hated having to make time for it. My being a control freak, it's tough when cancer and its effects come into the picture and try to control one's very life.

  9. Must be the season for frozen shoulders. I had a lumpectomy on my left breast at the end of Dec 2009, followed by radiation in March 2010. Interesting that it is my right shoulder that was frozen. I had the 'inconvenient' pain in the fall, was unable to sleep on my shoulder, but could live with it..that is, until I woke up one morning with pain that wouldn't leave, became progressively worse during the day, and ended up with a frozen shoulder. My diagnosis was bursitis. Cortizone shot to the rescue, followed by PT. Swimming has also provided a lot of relief. Good luck!

  10. Physical therapy helps in more ways than one.There are many pains and aches that are sometimes cured and treated through this therapy.


Thank you for commenting. If the post is over 14 days old, the comment will be moderated and will approved later. This is a spam prevention technique - but I love to hear from you!