Physical therapy is hard work. I've had physical therapy before, for my knees, and I've been advised by a physical therapist on exercises and stretches to do at home for knees, neck, feet.. you name it. I've been sore from the physical manipulations. I've whined and complained that "this stretch" or "that weight" hurts. Frankly, I had no idea what "hurt" was. Yesterday, I found out.
I've been complaining about the pain on my left side since I came home from surgery. The extender on that side feels really hard and often feels like it's sliding into my armpit. Dr. Kays reassured me this is normal b/c there is a second cavity (not the cavity created from the mastectomy) from the axillary lymph node dissection which is about the size of a tennis ball. The extender has a smooth coating and apparently it shifts around in there. That movement "hurts" and feels really strange. Most of the time it's felt like there's a thick rubber band inside my arm and left torso. If I tried to move my left arm at all, I felt a strong pulling sensation and that was coupled by extreme pain if my arm, particularly my upper arm, was touched at all. The "pain to the touch" issue has started to improve over the past few days. In fact, there are very few spots left on my upper arm that hurt when touched lightly and I only feel sore now when touched with more pressure (more like a bruise, less like a sunburn). I've not been able to straighten my arm fully and I've adopted a protective stance, hunching forward and coddling that left arm and my chest as if I were protecting them from unforeseen impact. This posture, of course, has caused a fairly constant soreness in my lower back and across my shoulder blades. Overall, though, I've moved from constant pain to constant soreness and occasional pain, a welcome improvement. I felt ready for physical therapy. I really want to regain a full range of motion in my left arm. I felt ready to do the work that would get me there. And, since Dr. Kays removed my last drain on Monday (YAY!!!), I'm cleared to start physical therapy. All of this is great news.
I met with Beth at Bodies in Balance on Tuesday. At first we just talked about what I was feeling. Then she started to assess my range of motion. She asked me to stand straight and raise both arms out in front of me (like when you pretend to be Frankenstein). I only had a 40 degree range of motion in my left arm (and I had to keep my elbow slightly bent). I am experiencing what is known as cording. Basically (as I understand it), cording occurs when the lymph channel is inflamed (from the removal of nodes) and starts to build scar tissue around itself along the length of the channel. I have pretty significant cording in my left arm, basically from my wrist, up the length of my arm, into my armpit and down my torso, and some minor cording on the right side, too. That scar tissue, or cording, needs to be broken in order for me to regain full use of my arm. You can actually hear popping as it breaks. Breaking this scar tissue HURTS. The visit wasn't anything like what I expected. I think I was prepared for a great deal of discomfort. This pain easily ranks with some of the worst I've felt. Beth only worked a small area of my forearm and she has a gentle (but firm) touch. All at once it burns, stings, pulls and pops. My legs curled up. I wanted to mash my teeth together, actually yearned for something to bear down on with my teeth. I yelled out and then cried. Sobbed, really. Beth brought me a tissue and mused that when her practice took on cancer patients, she'd had no idea she'd be inflicting so much pain on them. She joked that we wouldn't do too much more because we were in a room near the waiting room and I might scare off her other clients. She showed me some useful modalities I could work on at home; crawling my hand up a wall or across a desk, clasping my hands together and working to lift them over my head, making a butterfly with my arms around my head and working to push my elbows down... Beth asked me to repeat the range of motion assessment before I left. I can straighten my elbow completely and I now have 105 degrees of motion in my left arm, a 65 degree improvement in less than an hour, with little effort on my part, but with significant pain. We all felt pretty enthusiastic about the improvement. Beth reassured me with visible excitement, her broad smile stretched across her face, joy in her eyes. There's definitely more hesitation in my enthusiasm, though. I made an appointment to return on Friday, just before the surgery to place my Power-Port. I want so badly to move normally. I want to get back to taking my arms for granted. But the idea of that pain, knowing I will have to continue to face it until all of the scar tissue is broken, hits me in the gut, makes me feel physically ill. Physical therapy is hard work, physically and mentally.
I wasn't really sore at all after the appointment. I went home in good spirits and moved around a lot. By bedtime I was a little sore and really tired, which likely preempted the range of emotions that followed. I've stopped taking pain meds and haven't taken the muscle relaxers or Ambien on any consistent basis. I don't like to take pills if I can avoid it. I've been managing ok. In bed last night, I worked on stretching out my arm, tried to do some of the exercises Beth had shown me. I kept running my fingers along the length of my arm. You can actually feel the cording just beneath the skin, particularly where it crosses in the crook of my elbow. I started to think about the next appointment, how much it will hurt, how badly I just want to avoid that pain, but the alternative isn't an option I care to think about either. There is this palpable tension, I've felt it before. No choice seems right. I want to question everything. I want to know, but I don't. I just want to go back in time. I want to start over at some point before the genes mutated, before the cancer started to grow. I want to know and to change whatever it was that I did or that happened that led to this. It seems really childish to say, really naïve, but this isn't fair! And then I realized that I had wandered into "Why me" territory. It's a normal, probably expected place to go when you are faced with a serious, life altering change. I've visited there before and realized that I never came out with anything useful or productive. So, why visit again? I've tried to stay away from there. Surely those of you who've read this blog from the beginning can tell that. But as I lay in bed, thinking about the pain, I started to realize how easy it is to fall into a depression, how easily terrible thoughts can enter and leave our minds, how appealing avoidance can seem, how quickly dark thoughts can overcome the light. It scared me, honestly. Doug came in and he could tell I was struggling with something. He asked me to talk about it, but I struggled to find the words. My jaw got tight and my lips trembled. I started to cry and I had to leave the room, come back and just think about breathing before I could talk about what had just happened in my mind.
I'm so lucky to have Doug, and people like him, in my life. People willing to listen, to try and understand, to hold me when I cry, hold my hand when life hurts. He talked me through that dark spot last night. And then, this morning, I Skyped with my very wise friend, Natalie, who reminded me of the tree metaphor, of how the seed breaks before new life can sprout. Then I thought about how cold it is, really and metaphorically, and how spring is around the corner. I'll be finishing chemo late in the spring, when the weather is warm and new life is sprouting all around, and I can't wait to enjoy the sunshine and the light and leave these dark, cold times behind.
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