Preparing for and Coming Back from BRCA-Related Surgeries
BRCA-related surgeries, like prophylactic mastectomies and oophorectomies, require thoughtful preparation and recovery. In this recorded session, Janet Sprague, an experienced Physiotherapist and Lymphedema Therapist from Go! Physiotherapy, shares essential strategies for navigating this journey.
In the session, Janet covers:
Physical Preparation: Strengthening exercises before surgery and recovery techniques afterward.
Lymphedema Management: Risk prevention and effective strategies.
Emotional Resilience: Approaching surgery with confidence and mental readiness.
You can find the recording here.
Transcript of Q&A with Janet Sprague
Tess
so, Janet, I've had a couple of questions that have come right to me that I'll start with. This is somebody noting why can’t information like this be routinely provided for pre-OP? And why can't Physio be included free of cost, as it’s not affordable for everyone.
Janet
I totally agree, in a perfect world, and I've talked to a couple of surgeons about this, who often would also agree with that. The idea would be to have at least 3 sessions, a pre-OP, a post-OP, And one as needed down the road just at a very minimum, would just be so beneficial for everyone, but hopefully someday.
Tess
And a few more questions coming in. How soon after surgery is it okay to start scar tissue massage?
Janet
That's probably a question for the surgeon, but it's once the scar is well healed, at least 6 weeks, sometimes a little bit longer. So you can start doing your range of motion, and so on, but depending on how well the scar itself is healing, you can work sometimes a little bit above and below it. But to be directly on it, you just want to be careful. And just if you have a therapist that knows and can help you. That's 1 thing. If you're trying to figure it on your own, I would just get some guidance from your actual surgeon.
Tess
Thank you, Janet. Okay, I'm going to combine a couple questions here. This is somebody saying, it’s probably wishful thinking, but is there any financial support for accessing Pt Post-surgery if complications come up. And someone else asking, Is there anything physiotherapy wise, covered by Msp, if you don't have personal coverage?
Janet: People who have, who are eligible for Msp, they get 12 visits with a healthcare provider for per year, but that includes massage, therapy, chiropractor, physio, and I can't remember what else. But if you say, use 4 massage therapy visits, then you still have 8 left that you can use for Physio, but it only covers about 25 bucks. Generally a Physio treatment is at least 100, so it only covers about 25.
Janet
I often tell people if finances are a real struggle, just see if you can get one treatment in. Even that, we can cover a lot in one treatment just to educate you and get you started. BC Cancer agency in Vancouver now has 2 physios who are like 4 days a week, each of them. So if you're at the BC Cancer agency in Vancouver, you can get your oncologist to refer you to them, and that would be covered. They can't do an extensive amount of treatment, because they just have so many patients, but they can certainly direct you and get you started on what you need.
Tess
And another question wondering how would you go about finding a Physio with experience in this area
Janet
Yeah. Bc, lymphedema Association has a website that has healthcare providers. Pretty much all the physios that are in there. There are also lymphedema therapists, but they also do breast cancer rehab. So I think that's a pretty reliable source. Having said that, I know there's 2 physios in Victoria that are not on that website. So if you live in Victoria and you want a name of a physiotherapist in Victoria, I have 2 that I can recommend, and you can just email me directly, and I'll pass that on to you.
Tess
Wonderful. Okay, And this person is saying, they say they have had a lumpectomy, radiation, axilla, seroma, and then axillary cording. They say, even 2 years post-OP, I can still feel occasional tight nervy pull down the inner arm. Will this eventually resolve?
Janet
You're going to need to work on it and stretch it at the end range. And usually they can resolve. They do need sometimes a bit of bit of work, but it has to be at end range. You have to get it stretched out at and work on it while it's in a stretched position.
Tess
Thank you for that. And you maybe already answered this one. But someone else saying, When should I start working on full range of motion? And I think they're saying they're currently on week 2 after mastectomy.
Janet
Yeah. So 0 to 2, you want to be really careful, not working much beyond 90 degrees, and then from 2 to 4 weeks, you're still being careful, but you're slowly nudging into ranges that are achievable. might hurt a little bit while you're while you're doing it. But once you come out of it. It shouldn't be like, Oh, now I need a Tylenol. Then you've maybe overdone it a little bit, so just let pain be your guide, sometimes using a pulley or a stick to help you with the range of motion.
Janet
I like that wall, climb up the wall. That's a good one as well, just slowly and then incrementally, adding a little bit more range and using your deep breath with each one like, I kind of showed in the video. So if you're doing like a wall climb, you're going to your comfortable Max. You're holding it there. You're taking your deep breath on the exhale. Maybe you're crawling up a little bit more. Stop another deep breath, maybe a little bit more, taking a break, and then repeating that, and just slowly, over the next week or 2 you'll be amazed that the range of motion will start to come back
Janet
If you're really struggling or developing a frozen shoulder, then you might need to see someone. But usually just doing those exercises on your own can be really helpful, but don't overdo it like 2 weeks is still early.
Tess
Okay and a question asking how long after removal of stitches should one start massage, scar tissue fibrosis techniques? And this person's noting that in their case they had a double mastectomy with reconstruction, and no expanders.
Janet
Okay So again depends how many weeks. generally, you don't do a lot of scar tissue work until at least 6 weeks, depending on how the scar itself looks, and often direction from the plastic surgeon. Sometimes they don't want you working on that area at all for a couple of months, but generally once the tissue and the scar is healed, we can start some real gentle scar tissue massage, but without looking at it and seeing what stage of healing you're at, I can't really say. but I would wait at least 6 weeks and make sure that it's all the incisions are nicely healed before you're working on it, and instead, just work on your posture, your range of motion, your deep breathing.
Tess
And one person wondering how soon after surgery should you reach out to a physiotherapist
Janet
I start to see people once the drains are out. So usually anytime after 2, 3 weeks, and you're comfortable enough to come into the clinic. So once the drains are removed, we can get started. So that's at the earliest that we usually see people anytime after that
Tess
And this person is wondering, do you know of any current legislation or research that's looking into supporting or changing that status quo around Physio being covered as part of cancer care
Janet
Well supportive care is finally getting on the table. Everything they do at BC cancer and a cancer agency has to be research based. So they're actually doing more and more education on does supportive care actually help people. And people are living a lot longer with surgeries and radiation and treatments now, but they're suffering with these side effects. So they're realizing the importance of supportive care. So they're getting the research now to prove that supportive care is a very necessary part of recovery, which means eventually the funding will come for it. But it's slow, it's slow. So a lot of it is trying to advocate for yourself and figuring out where you can get the help you need, and just trying to be active. And yeah.
Tess
Alright, and this person appreciating your information, saying, this information is incredibly helpful, is it possible to get more information on pre-surgical physio and preparation options more than a few weeks in advance. This person's noting, they imagine prepping for months might make a big difference for those who might have that time being on wait lists, perhaps due to gene mutations.
Jane
Yeah, I mean, really, ideally, all you can do is that prehab that I kind of went over just getting yourself physically strong, fit, well slept. Get your nutrition tweaked, mentally prepare yourself. Really, that's the most important thing that you can do. I can't really think of any other tidbits of information prehab that I can really share
Tess
Thank you, Janet. Okay, I think I'm through the questions that I had stored and the ones I can see here, folks. If I accidentally skipped over your question, please copy and paste it again, or if anyone else has another question lingering, feel free to pop it in, we certainly still have a couple more minutes.
Tess
Okay one more coming up here. So this person saying, calling 811 you can talk to someone about exercises? So I think, wondering, can you talk to someone about exercise by calling 811.
Janet
Yes, I did have that up on that slide, and I didn't mention it. So 811 It's just a service that's offered, and you can ask to talk to an exercise physiologist, a pharmacist, a nurse, those different professions.
Janet
If you had a question, again inspire health, they have counselors, they have exercise physiologists, they have nutritionists as well. So I also highly recommend you have a look at their website and all the supportive care services that they offer as well. I give a breast cancer, rehab talk every second month very similar to what I did tonight. I just did it today, so it won't be for another 2 months. It's been really well received, too, and they're hoping we can increase that to at least once a month now, too. So it's just trying to get word out there. And yeah.
Tess
Thanks Janet and I have our the contact information for inspire health and others in a moment, folks. I know Janet had that you had that on your slide, and it'll pop up once more in the couple of resources we put up after this.