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n No visitors-blame the evil therapist—give them
our phone number and we will explain that we are trying to help get you healed up quickly and
prevent lymphedema.
You will feel guilty and you
will “have” to be up for your visitors- i.e. fix tea, get showered, put on makeup, make the
bed, clean the house
Visitors will bring in their
germs from the outside and you are at really high risk of infection after
surgery
Visitors can bring their
awful stories of how someone else who had the same procedure did so
horribly
If you have a special friend
who can come in and see you with uncombed hair, who is not sick and you will let them mother
you---they can come in.
n Significant restriction in activity level-as
any activity or even stress increases cardiac output-thereby putting more fluid into the
body. This will put more pressure on the inside of the
surgical wound which causes more pain and increases risk of the wound opening up or getting an
infection.
No help with household
chores or cooking. You are already getting up to
use bathroom…this is good enough activity to do frequently during the
day.
Have someone else walk the
dog or take care of pets. Your main job with the
pets is to put your hand on them and let the snuggle to keep your blood pressure
down
Avoid exercise for
cardiovascular conditioning or weight loss—you will be going back to that fairly quickly but
if you do too much too soon you will increase risk of infection and make the drain stay in
place longer.
Ideally find comfy clothes
to just live in so you are not changing-try to sleep in the same outfit you spend your day in
unless you have to leave the house.
n Look at your drainage output chart with any increase determine what activity you
may have done that increased the fluid load and avoid that activity.
n Typically drain stays in place until reduced to 20-25 cc per 24 hours for 2 days
in a row
n We tend to not eat a lot when not
feeling well or having just had surgery-however you really need to increase caloric
intake. It takes 1.25-1.5g protein + 25-30 calories per kg of body weight/day, about 1000 cal per
day to heal the wound alone. If you do not eat
enough the wound will not heal and you will continue to be very fatigued: Eat things like peanut butter, cheese, jerky-NO diet foods
n Manual Lymphatic Drainage (MLD) massage 4-6
times a day or any time you notice increase discomfort in the chest or arm likely due to fluid
pushing on the nerves. Ideally if you have a partner
who can help do this-that it best.
n Arm immobilization-especially no moving arm away from body until drain is out
plus 5 more days-avoid muscle guarding-tensing anticipating pain. Best way to do this is use a safety pin on the inside of a
shirt sleeve to pin the elbow next to the body-this will remind you. If you pull the arm out to the side this can cause ripping
of the healing that is occurring in the lymphatic collecting vessels that are trying to
reconnect through the armpit where the lymph nodes may have been removed and where the skin
was cut which would have cut through those vessels. Until they reconnect fluid gets dumped into the armpit and
can collect causing need for aspiriations to pull this out with needle and can increase risk
of developing lymphedema-swelling which can require need to wear a sleeve on the arm during
the day the rest of your life.
n Once you can move easily enough to leave the house, you can come see the
physical therapists who can do the massage on you to help get the fluid rerouted to another
area and this can help get the drain out sooner.
n After drain is out-we will work on increasing shoulder range of motion (ROM)
using stretching techniques in the office and then you will stretch at home to keep the
increase that you get in treatment.
n You will also be instructed in a gradual increase in
activity level and eventually exercises for strengthening and cardiovascular
conditioning.
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