I had my physical therapy evaluation yesterday and it went in a much different direction than I thought it would.
If you recall, I have been in and out of physical therapy twice since my first surgery back in May 2010. I had a lot of tightness in my skin around the mastectomy areas and I had been treated for Auxiliary Web Syndrome – more commonly known as cording. Cording is thought to be hardening of the lymphatic fluid. Mostly likely, in my case, it is from the trauma during my auxiliary lymph node dissection back when I had my mastectomy and the 33 radiation treatments I had. The best way to imagine/picture this is an extremely tight rope that starts under my arm and goes down to my wrist. My cording is pretty deep, but other people who suffer from this may have more visible signs since they are closer to the surface. They also call it webbing because in some people it can look like a spider web from these “ropes”. It usually limits ones range of motion and can cause massive pain.
In my opinion, the cording really never went away. I figured that if two rounds of P/T would not break this cord up than I will just have to deal with it. I have been able to manage it with pretty well by stretching- that was up until recently. The ‘scar tissue’ that I have been referring to lately is under my arm at the scar line where they took out a pocket of 18 lymph nodes. The scar tissue has spread south down over my ribs and hardened. That was the area of concern this past week. I have been having sharp pains that start under my arm; go through my ribs and across my breast. I also have shooting pains that go down to my elbow and continues down to my wrist. Of course my surgeons all say that I do not have cording since I have such good range of motion. The only reason I have any range of motion at all is from the constant stretching that I do on my own and with my Pilates instructor. I always ask- If I do not have cording, what the heck is it? No one can answer me.
I met with the new therapist and during my physical evaluation she asked me a lot of questions about my medical history, treatments, my activity and what I like to do with my time. She really checked in on my lifestyle which I appreciated. As I explained where the pain was, she stretched my arm out and pushed on the scar area. This is when I about jumped off the table! Sorry about that. You have a big cord- did you know that? My reply: No kidding?! I knew it! I instantly felt a sense of validation. As she moved further down my arm continuing to press and follow this cord she said: You have it all the way to your wrist. There are 3 of them actually but one really big one that starts under your arm.
So, there you have it. The good news is she actually believes she can help me with this and for the first time, I feel hopeful about this problem.
We discussed this mass of scaring on my rib cage area near my breast-her prognosis was that she will try to work it out as long as I can stand it. She seems to think that the scar tissue has hardened and attached itself to my ribs. It may have to be released surgically- I am not into that for a couple of reasons. It is more surgery that increases my risk of lymphedema. It may be too difficult to manual release that area but she did feel that we can release the arm pit scar and cording so it may help take some of the pain away.
As part of my evaluation, she measured both arms to check for any sign of lymphedema swelling- all looks normal. Of course my right arm is a bit larger than my left but that is my dominant arm and I favor it for obvious reasons. She did notice a bit of swelling in my rib cage area but she did not seem too concerned about it.
This ‘new’ diagnosis of cording has landed me 2 hours of p/t a week for the next two weeks. I was a bit surprised that she was going to work on me for 1 hour at a time but maybe that is what needs to happen to loosen up my arm. I do not want to give up these extra hours in my week for more appointments but I will make room and remain hopeful that the pain will lessen. And with any luck, it will go away.
The weather forecast looks like it will be in the 60’s for the next ten days so I plan on starting off my weekend with some good long rides. Of course I will follow it up with some stretching.
Have a great weekend!