Four month update – Becoming a better physio

I’m now four months and one week post op and I have made some significant gains over the past two weeks.

In terms of work, I am now up to an 18 hour work week.  I work three afternoon/evening shifts a week.  While I am at work, it feels like nothing much has changed in terms of my physical capabilities.  I am able to do everything that I was able to do before surgery (although, I do have a lighter caseload).  However, when I come home, the adrenaline fades away and as the week goes on, I become progressively more fatigued.  This happened a little bit at the end of last week and more so at the end of this week.  It’s an odd fatigue though.  It doesn’t feel like I need to go to bed and sleep.  It’s more like you feel slow and sluggish although you look just fine.  I have a feeling that this is a combination of building endurance for work and being nutritionally deficient.  Since I am a do-er, I can’t help myself but just keep pushing through it.

More frequently over the last two weeks, I have been feeling mild upper/mid thoracic pain. As a physio, you can’t help but try self diagnose yourself.  There could be many reasons but I have come up with a couple of explanations:

1)   To avoid a large anatomy/physiology lecture, I will stick with the Coles notes version.  Basically, the nerve supply to the stomach originates between your 6th and 9-10th thoracic vertebrae.  If there are issues with your stomach you may have referred pain.  See diagram below:

2) It may also stem from a combination of weak musculature through my thoracic spine (secondary to sitting on the couch and poor posture during the first couple of months of recovery) and a weak core.

My mom had the same thing after surgery and I am wondering how many other people post total gastrectomy also experience the same thing.  I think it would be a great research paper to write…maybe I should start a study? Haha.   Anyways, I have made a point to do a series of upper back exercises and core exercises every day to see if this will solve the problem.  I have also started seeing a registered massage therapist to help complement my home exercises.

Speaking of exercises, I am now  able to complete a full thirty second plank AND I challenge myself by lifting my feet off the ground one at a time. I am also able to complete three full push-ups.  Woo Hoo, three is better than none!  There are a series of other exercises that I am doing at home to help  me build up strength and they are getting easier each day.  I am more motivated to complete my home exercises now that I am back at work telling people to do their home exercises.  Lead by example, right?

Before surgery, I would hear my patients say, “I am going crazy not working” or “I just want to be able to walk 5 minutes”.  I would watch them try to roll over on the bed and have difficulty.  I would see the pain in their faces as they flex their knee after having a total knee replacement.  I thought I was a understanding physio before I had my surgery, I now know, I had a lot more to learn because I have and I still am living it.  I now know what it is like to be off of work for a prolonged period of time.  I know how hard it is to just get out of bed when you are in pain.  I know that sometimes exercises will hurt but they are necessary for recovery.   Although I may not be as strong as before, I know that I am returning to work a better physiotherapist than I was four months ago.  Yet another unexpected perk.

Eating update

In terms of eating, I am doing well with what I’ve got.  The stricture is still present and I know that it is still closing.  Unfortunately, I am back to spitting up food 1-2x a day. Often, it’s due to me swallowing too much at a time because there is less space for the bolus to pass through.  I was used to swallowing more at a time so now I have to go back to what I was doing before the last stretch.  I also have started to experience the infamous esophageal spasm.  I describe it as a pain on the left side of my abdomen that feels like a deep constriction which then radiates into my left shoulder and sometimes up my neck.  It lasts about two to three seconds.  I still haven’t been called for an appointment for the stricture dilation but I am following up with my surgeon on Wed so we will see what happens.  Despite this little set back, I am able to eat a larger quantity of food in one sitting.   It takes me about half of an hour to forty five minutes but I am now able to polish off a side plate worth of food.   This has been very exciting and I hope that it keeps going! Once there is no more stricture, I should be able to finish it a lot faster.

I am more bold in my food choices and purchased a box of Oreo’s at the grocery store.  I ate one last night before bed and that way if anything bad happened, I would be sleeping…haha.  I also tried to eat a quarter cup of chocolate chip mint ice cream.  After three spoonfuls I started to feel uncomfortable so I stopped.

Bread still continues to be an issue.  Anything that is white and processed (like Wonderbread), it makes me feel awful afterwards.  However, anything that has been freshly baked or gluten free has been a lot better.   I believe that it has something to do with the sugar content in the white breads.   I make sure I load something with protein on top as well (like cheese).   I continue to experiment.  I am not ready to say goodbye to bread yet, so I keep trying.  What doesn’t work one week, may work the week after.

I feel thirsty a lot but I have trouble staying hydrated.  Before surgery I was able to drink up to two litres of water in a day!  Now I am lucky to drink one glass.  I have started to put a slice of lemon in my water to help break the surface tension in the water and make it easier to swallow.  Lemon also aids digestion so it’s a win/win.

Weight update

I am at my lowest weight yet, 105.6lbs.  But I am still above 105! Yahoo!

Since I have returned to work I am now  building more muscle.  I am also building muscle from my strengthening program. This is a great thing.  But it comes with a steep cost.  More muscle = more calories burned at rest.  Clearly, I am not keeping up with my caloric intake.

I would love to return to the gym for some yoga or zumba classes but I am worried that this will cause me to lose even more weight.  I know that my cardiovascular endurance is horrendous right now and needs some serious help.  There is a 5km Santa run at the end of November that Brandon and I participate in annually and I am hoping that I will be able to participate in it once again this year.  I don’t know if I will be able to run 5km but I have my fingers crossed that I can at least run/walk it!

So that about sums up my four month update!  I will keep you all posted on what happens after my surgical follow-up on Wednesday.













Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s