PA is telling this fitness addict NOT to exercise!

hamfam

Ladies, I am a 34-year-old about 7 weeks post BMX. I currently have my expanders in and will be done with the expansions in 3-4 weeks, but won't have the swap surgery until March or April. I was VERY active pre-surgery and shared that with my doctors. I ran, did cross training, high impact aerobics, weight lifting, obstacle races, etc. I was assured that I would be able to return to activity "as soon as my body felt like it." Even the PA said I could jog at 4 weeks post-op as long as I wore a good bra. Physically I feel great and I believe I'm perfectly capable of doing many of my previous activities.

At my visit last week however, the PA said that she doesn't want me doing ANYTHING that causes bouncing. She said no running, aerobics, push-ups, lifting. NOTHING. She said I could only walk until 4 weeks after my swap surgery in APRIL!! She said that bouncing would put me at risk for an exposed implant. This was news to me, as I had already run a 5k last week! I wore a good bra and two layers and didn't experience any soreness at all.

I believe it's worth mentioning that the PA is very overweight and was not even familiar with the equipment that I was asking permission to use (like stationary bikes in a spin class). I think she feels like I'm arguing with her, but that's not my intention. Most post BMX literature is not based on healthy 34-year-old women. I think they're treating me by the book, and I'd like to be treated as an individual. I don't know why the rules are changing unless I've somehow made her angry.

There are no other PS or PA's in this entire area, so I can't get a second medical opionion, although I do intend to chew my onco's ear about it Friday. But I want to know what types of exercise you were able to successfully undertake at 7 weeks post-op with expanders. I just don't think the elliptical and bike are going to cut it for 5 more months!!

BikerLee

i've had a similar experience with rules changing… but, i also had a health care team that was super supportive of me exercising throughout chemo and soon after surgery… but i ride bikes ( a lot - like a lot a lot!!!)…

a little of what i do know - i'm no expert - just someone who has had a double mx as well as hip surgery soon thereafter because i crashed my bike darn hard… anyway…. depending on what you're doing, exercise / bounce can cause scars to thicken and spread. the implants go under muscle, so i imagine that the scars in and amongst the muscle tissue might also thicken and spread, which could cause some problems down the road. my scars thickened, and that was probably because i had to use crutches for 3 months after my double mx because of the hip break (three pins, zero weight bearing for 6 weeks followed by partial weight bearing for 6 more - imagine that suffer-fest!). i had forearm crutches, but i was USING my upper body - a lot… the surgeon who did my mx agrees that this probably lead to the thickening of my scars. i did NOT have recon, so no muscles or anything were involved. in contrast, the hip scar is flat… no keloiding… i attribute that to 6 weeks of zero weight bearing...

docs hear all about patients' good intentions with regard to exercise… but when they realize that they are actually dealing with an athlete, i think sometimes they do actually change their tune a bit. and probably reasonably so, right? i mean, how many of my friends say "i exercise"!!!! only i later learn that they mean they walk or do an elliptical for around 20 min a few times per week… and that's all they do. those friends of mine and i are totally different…. and the advice we should hear is totally different. i NEED to be told to hold back somewhat. i do NOT have a normal relationship to pain… i KNOW how to suffer… and i like it. hence - i race bikes….

right right - i asked about exercise - oh yes - do as much as you like… they said... listen to your body yada yada yada… they said...

how about racing - i asked. wait … what? is it possible you'll crash, they asked? of course, i responded… tune changed up pretty quick… they wanted a lot more information - how much training did i do? how often might i crash? and more. they quickly counseled me against taking risks that might lead to crashes… and suggested i keep the training aerobic… i was impressed, actually, by how they discussed it. they also said that i'd really benefit from riding - helps with fatigue, mental health, and more.

so - now - the advice. ask why for each of the recommendations…. for women who have reconstruction, there are pretty strict guidelines about how to maintain strength and range of motion.. and some of those restrictions make a lot of sense. keep in mind that if you end up with thickened scars, you'll have them for a really really long time. but, you can handle a few months of training in different ways. how about stairs - double up, single down, no bounce. on the double up, sprint without bouncing… this brings intensity, i promise you! and it's a great workout for a cyclocrosser… one of my favorites…

and how about biking??? i mean - not just an indoor bike - but like actually hitting the road! i realize that the temps are dropping… and you're in the midwest, but winter biking is not as daunting as it may seem. with the right clothing and foot/hand wear, it's surprisingly … well … awesome. and i live in minnesota. in fact, i just rode this morning - the long way to work - about 2.5 hours with friends in about mid-20s temp. it was gloriously lovely.

last bit - i think i'd go crazy if i spend all my workout hours inside. maybe you are similar? how about switching things up! the advice is to walk? do it on trails! hit new trails every week of your 5 months (ish)… that could be 20 new places to enjoy nature… do hills with long strides… do hilly trails… climb stairs - lots and lots of stairs…

well - those are the thoughts that popped into my mind when i read your post. you're right that a lot of the recs are not for young and athletic women… but some of those recs are to be minded… the trick, of course, is figuring out which recs are the ones to mind… good luck!

mdg

I am a fitness instructor and my doc's were strange about what I could/could not do.  I worked with a physical therapist when I had my TE's in so I would make sure my range of motion was not compromised. I asked my PS for a referral so I could go.  I think that is why I have no tightness in my chest at all and do so well with my implants.  I did the stair climber, elliptical, walking, weights for lets and arms (but I avoided chest/back) all with TE's.  Three weeks post chemo I returned to teaching aerobics classes...I had my TE's in.  I would talk to the PS himself/herself.  I have found the PA's don't know what the heck they are talking about most of the time.  The PA's at my MO's office gave me a hard time about exercising during chemo....I was given so much crap I finally said something to my MO directly.  When I told her she made them back off and she said if they discussed my exercise habits with me again to let her know.  Maybe the PS does not know....

kdoole01

Talking directly to PS as mdg advised is excellent advice. But do not be surprised if you are told that there are restrictions to your activites. Gentle stretching is great as it helps you feel better. But explantation of the expander (or later on with your permanent implant) is an actual possibility as it has happened to me. I subsequently had radiation, the wound could not heal, and believe me was a nightmare in a nutshell. Talk to PS as he/she knows exactly what they did when they were inside of you, they meet the patients that have developed problems, and have the most experience. The PA may be a surgical PA that rotates between surgical services, thus having vast experience as a second assist in the OR, but they are not the doctor. Exercise is obviously very important to you and it will make you feel better/have more energy. But you also do not want to have complications. Be very specific in what you do during your normal exercise routines. Make sure you tell them that you ran and leave nothing out. If you lift weights, say so. Believe me you do not want to have a surgical complication, especially if you have chemo next as that would delay the start of your treatment. While I was in chemo I did not ski that winter because I knew that if I fell unexpectedly and sustained an injury, that having a trip to the OR would delay my chemo. You have to ask yourself is it worth that price tag?

You will not be in treatment forever, and I promise the time will pass quickly enough. Your doc has the most experience and will guide you correctly. Good luck!

NatsFan

Ham - others have mentioned the potential harm you can do to yourself by ignoring the activity restrictions, but here's another consideration - did you have any nodes removed? If so, then you are at an increased risk for lymphedema. Like you, I was a fitness addict. Unfortunately, no one in my surgeon's office was knowledgeable enough to put restrictions on me. After 3 months I was given the all clear to exercise - and I got back into it with a vengeance - weight lifting, fitness classes, aerobics, yoga, pilates, etc. I didn't ease back in nor did I take a lot of time to work back up to my previous levels - I went full tilt as soon as I could just because it felt great to get back into it!!! Now I have arm and truncal lymphedema and will have it the rest of my life.

I know the restrictions are tough, but I wish I'd been given more restrictions and information about how to get back into an exercise program safely while minimizing my risk of lymphedema. Here's some great guidelines from the Step Up Speak Out website about getting started back on your exercise program - start slow and small, and work up gradually. Breast Cancer and Exercise

As kdoole says, you won't be in treatment forever. I know it's tough, but cutting back and obeying restrictions now is going to be so much better for you in the long run.

BigT16

I'm a Clinical Exercise Physiologist/Licensed Athletic Trainer and avid exerciser (road & mountain biking, martial artist and weight lifter). It is killing me as well not to be able to return to full activities.

After a 7 week lay off period your have to ease backing to your routine. De-conditioning occurs after just 2 weeks. With TE, lay-off any weighted exercises for the pects (push-up or bench press).

Returning to aerobic activities, monitor your heart rate(HR) closely. You will find your heart rate excesses your age related max HR (220-age) with very little effort. My stressing your heart above this level will decrease your immune system and increase the risk of colds/flues. Which can be dangerous if undergoing chemo.

This can really put you at risk if chemo is involved. The American College of Sports Medicine has set guidelines for exercise and cancer. During cancer treatment, they recommend 30-60 minutes only at a low to moderate intensity. It was recommended for marathon runners undergoing tx for cancer to run 3-4 miles/day.

Long endurance exercising greater than 1 hour will lower your immune system as well.

Know your blood work numbers for red and white cells.  A reduction in red blood cells( oxygen carring) will decrease the amount of oxygen the heart and muscles will receive during exercise. Some symptoms maybe heart racing, palpitations, dizziness/lightheaded  Low white blood cell (fight off infections) can be lowered by chemo, high intensity and endurance (>90 minutes) activities.

American College of Sports Medicine has published ACSM's Guide to Exercise and Cancer Survivorship.

Be safe and healthy.