Shoulder Pain after Treatment for Breast Cancer

 Shoulder pain and discomfort are common side effects of breast cancer surgery and treatment that can persist for years. I have finally began to experience this and am working hard to avoid this from being debilitating to me and my profession.

Key Takeaways from a great website (PT author):

• You don't have to accept shoulder pain after breast cancer as your new normal.
• Developing a consistent exercise routine can help you alleviate shoulder pain and improve your range of motion.

The Causes of Shoulder Pain After Breast Cancer Treatment

 Shoulder pain after breast cancer treatment can result from various factors associated with breast cancer surgery and other breast cancer procedures. Common causes include:

• Lymph Node Removal: Breast cancer procedures that involve the removal of lymph nodes, such as axillary lymph node dissection, can impact the surrounding tissues and contribute to shoulder pain.
• Radiation Therapy: Radiation therapy to treat cancer cells can cause changes in the tissues, leading to stiffness, inflammation, and discomfort in the shoulder area.
• Surgical Scars: The presence of surgical scars, especially in procedures like mastectomy, can contribute to pain and discomfort in the shoulder region.
• Nerve Damage: Surgical procedures may result in nerve damage, leading to pain, tingling, numbness, or weakness in the shoulder and surrounding areas.
• Muscle and Tissue Trauma: The trauma associated with breast cancer surgery and the disruption of normal tissue structures can contribute to muscle soreness and pain.
• Postoperative Immobility: The period of postoperative immobility and restricted movement during recovery can lead to stiffness and pain in the shoulder. 

 It's important to note that the causes of shoulder pain after breast cancer treatment often overlap, and breast cancer patients may experience a combination of these factors.

 Many people will need (and should) see a physical and/or occupational therapist to recover from this debilitating symptom, but the author of the website above recommends the following exercises to decrease shoulder pain post-treatment for breast cancer:

• Pectoralis Stretch
  
• Pectoralis Stretch on your side (you can do this lying on your side or in standing)
• Latissimus Dorsi Stretch

  
• Scapular Squeeze
• Scapular Wall Slide

  
• Ceiling Punches (for your serratus anterior)

  

  
  
• Modified Push Ups

  

  
  
   For stretches, the goal is to hold up to 15 seconds and repeat three to five times. For exercises, the goal is to work up to 15 repetitions and peering three times. 
  

Cycle 10 is a go!

 Literally and figuratively. Chemo session 10 is a go! Staying right on schedule. We're killing any of those little buggers that still exist inside of me.

 KADCYLA session 10 of 14 and total chemo 16 of 20! I'm much further than halfway done and I'm looking forward to the other side of all of this.

 

More on Vital Tears

  Autologous serum tears are a very underutilized dry eye treatment which may have very successful results. This article goes into depth but here are the highlights:

• Autologous serum is a blood-derived eye drop that can be used to treat a variety of ocular surface diseases.
• The mechanism of action of autologous serum drops is to mimic the biochemical properties of natural basal tears in order to heal the ocular surface epithelium.
• Barriers to using autologous serum include cost and chair time, but patients tend to have better and quicker improvement compared with use of traditional dry eye drops.
• When clinicians do recommend autologous serum tears to patients, they are typically implemented only as an end-stage therapy, when patients could have benefitted from using them much earlier. 

 Reflex tears are the tears we experience when we cry. 

 Basal tears are continuously produced to provide lubrication to the ocular surface. 

 Both types of natural tears consist of lots of stuff (water, mucin, lipids, proteins (lysozyme, lactoferrin, lipocalin, immunoglobulins, and peroxidase), electrolytes (sodium, potassium, chloride, bicarbonate, magnesium, and calcium), growth factors (epidermal growth factor), cytokines, and glucose).

 The serum is created by extracting blood from the patient, clotting, centrifuging, and diluting with sterile saline, and is then stored in the freezer. These drops should be stored in the freezer until use, and then stored in the refrigerator once opened.

 This makes for one cold eye drop! 

The mechanism of action of autologous serum eye drops is to mimic the biochemical properties of natural basal tears in order to heal the ocular surface epithelium. Which is just truly fascinating.

 My eyes are no worse but not exponentially better... yet. I believe in these tears and hope for good things soon. 

 Just like your tear layers:

Fires and Persistence

 I was gifted this book of poetry by a close colleague when I was transitioning from full time to part time. I love the way this poet writes. Here are a couple that hit home. 

Staying in the Present

 

 Today is Monday. Today is January 13, 2025. There is so much power in staying in the now and while planning is fun and important, not missing our today and our now is beneficial.

 

Feeling it

  Today I’m feeling the, I did a lot of things yesterday. I’m still not used to not having a never ending supply of energy. 

 Some things I could use today:

 Some things I need to remember:

 Time to get

Fortunate

  A friend and I were talking yesterday and she reminded me of how fortunate I am to have not required any hospitalizations. She is surrounded by loved ones with cancer and almost all have required admissions. It gave me an opportunity to practice gratitude for my health despite my disease. Then, just today, I spoke with a patient about how she was the person who has a disease, not an “enter your disease here” patient. I need to remember to take my own advice now and then. 

It’s okay

 

Vital Tears are a go!

  Vital Tears are autologous serum eye drops (ASEDs) or autologous serum tears (AST) which are eye drops made from a patient's own blood. 

Here's how ASEDs are made:

1. A patient's blood is drawn (7 vials for a 6 month supply) and separated into serum and other components. 
2. The serum is diluted with saline or hyaluronic acid. 
3. The drops are dispensed into dropper bottles and returned to the patient. 

 ASEDs are similar to natural tears because they contain many of the same growth factors, lipids, antioxidants, and proteins. They are also well-tolerated and can help eyes heal better. 

 ASEDs are not commonly covered by insurance so it does require a significant out of pocket cost. For me, this investment is essential, as I still cannot see clearly and it effects my every day abilities.

 Imagine this:

 

Tamoxifen

  Search tamoxifen and you’ll see stories of how bad the side effects are and how people stop taking it for those reasons. Those stories scared me and almost made me jump to an aromatase inhibitor (which could negatively impact my heart and bone health due to my age) when tamoxifen was the right choice for now. 

 It may be due to my treatment course which involved Herceptin and Perjeta since January 29, 2024 and continuation of Herceptin as part of KADCYLA that I’ve remained in chemically induced menopause and therefore tamoxifens side effects have not been as extreme as they’ve followed the course I was already on. Without Herceptin and Perjeta, the immediate blockage of estrogen could be a shocker, so I can’t speak to those on other treatment plans. So far, Veozah has been a lifesaver for hot flashes and the medications I take for the side effects of the medications I take for side effects are working. I may look like a pharmacy with all my meds, but it keeps me functional and living with cancer. 

In the Suppression of Ovarian Function Trial (SOFT) and the Tamoxifen and Exemestane Trial (TEXT), the 5-year rates of recurrence of breast cancer were significantly lower among premenopausal women who received the aromatase inhibitor exemestane plus ovarian suppression than among those who received tamoxifen plus ovarian suppression. The addition of ovarian suppression to tamoxifen did not result in significantly lower recurrence rates than those with tamoxifen alone.

In SOFT, the 8-year disease-free survival rate was 78.9% with tamoxifen alone, 83.2% with tamoxifen plus ovarian suppression, and 85.9% with exemestane plus ovarian suppression. The 8-year rate of overall survival was 91.5% with tamoxifen alone, 93.3% with tamoxifen plus ovarian suppression, and 92.1% with exemestane plus ovarian suppression.

 We may switch me to exemestane plus ovarian suppression after my KADCYLA is complete in April, but we'll see what happens between now and then.