Monday, 7 July 2014

12. Scars in the swimming pool

Hurray! I’ve been swimming!

A mere 15 minutes and a gentle 20 lengths, but still, this is progress.

I am well aware that July is going to be my best month this side of 2015, physically. I have no idea how chemotherapy will affect me. It’s completely different for each person, apparently – hence my determination not to read any more grim first-person-accounts of fellow patients, lest my courage fails me.

But I cannot imagine it being a walk in the park. Or a swim in the pool, for that matter. So I’ll be trying to clock up as many walks and swims as possible before the avalanche of chemo side effects.

In an attempt to answer your How are you? question, here is the physical update.

I am still very tired, but I am also beginning to make an effort to rise from the sofa and do things. I plan them carefully, because I know I cannot do more than a few things each day. These things have recently included cooking evening meals, walking to the school gate and the supermarket, a 20 minute bike ride to the hospital (although cycling, I have always felt, doesn’t really count as exercise, because you can sit down whilst you’re doing it), playing the guitar and singing into the church microphone (I was rather pleased with that effort yesterday) and, having failed to attend any rehearsals, being an appreciative audience of my choir’s concert on Saturday night.

I can do these things again. I can pretend to be normal, at least for an hour or two. That’s a lovely feeling. It tires me out and I have to rest a lot before and after, but it is nice to feel that I am building up some slow strength.

Swimming was missing from this list. In recent years, I have established a habit of going to the pool several times a week (as well as starting Pilates classes) in order to cope with a sedentary job and a dodgy back.

I defied my breast care nurse’s advice following the lumpectomy (“Better not do swimming yet, that’s far too strenuous. Stick with walking”) and was back in the pool two weeks after the operation. My energy levels were boosted instantly.

So I was rather disappointed when I was visited by a hospital physiotherapist, the day after the mastectomy, who told me that my right arm should avoid any weight bearing exercise for at least six weeks. (“Oops”, I said, as I’d just pulled the heavy bedside table towards me. Well, what else could I do? It was on that side of the bed, it had my tea on it, and turning over to use my other arm was too painful.)

“Swimming?” I asked hopefully.

“No swimming,” she warned. “That puts far too much strain on the arm.”

The issue, apparently, is the avoidance of lymphoedema.

I have had many patients with lymphoedema during my hospice days, and it is not to be envied. This harmless but extremely uncomfortable arm swelling can happen to women who, like me, have had the lymph nodes under their arm removed. The lymphatic fluid in the arm can navigate its way around this problem, but if there is too much of it, the system becomes overloaded and the arm swells alarmingly. Once this starts, you’re scuppered for life.

It has been my biggest fear (well, apart from the minor matter of finding more cancer cells in my body, and dying as a result). I am worried about living a future with a swollen arm and hand, which would interfere with my ability to play the cello, sew more owls and wag a finger at my children.

So I’ve been very careful to exercise my right arm gently, encouraging the lymphatic fluid to be pumped back nicely. I have also been very careful not to overload the arm, not to get any cuts or grazes or insect stings or sunburn (which would send extra quantities of lymphatic fluid rushing to the scene, with its infection-busting properties). I hadn’t realised that strenuous exercise also increases the load of lymphatic fluid.

Thankfully, I have friends and colleagues who are either experts in cancer, or who can beat a quick path to such experts. One of my work contacts asked a nurse consultant in the lymphoedema clinic of a major cancer centre, who sent a reassuring email:

"It is absolutely fine for Irene to go for a gentle swim as long as the wound has fully healed. [It has.] Swimming and any movement in the water is not weight bearing and will encourage lymph drainage, but I would advise against anything too exertive and to 'listen' to her body."

I am not looking for a third opinion. I tend to stop looking once I've found the advice that suits me. A gently swim will suit me nicely.

So here is the next question: What to wear in the swimming pool?

I had pondered this before. Apparently there is a whole world out there, titled “mastectomy swimwear”, but I had already decided that I wouldn't bother with it.

This dismissal is possible because I am not blessed (or burdened, as the case may be) with anything more than an A-cup, so I won’t have vast quantities of redundant fabric flapping around my chest. Furthermore, my swimming costume is made for swimming, not for sauntering along the sea shore. It tends to streamline any A-cup into oblivion, so my thinking was that the difference between left and right would be a mere blip on the surface.

Still, I hadn’t tested this theory, so I put on the swimming costume last night and went in search of an opinion. I found my husband and my older daughter hanging out the washing and groped my way through the wet sheets, emerging on the other side: “What do you think?”

My older daughter was puzzled. “What do you mean?” she asked, in a way that said “What’s so new about that costume? You’ve had it for years.” Which was promising. I think we are all getting used to my new shape, and are already beginning to be blind to it. Or perhaps it was due to the disguising properties of swirly patterns?

Once the issue was explained (“Well, look, it’s flat here”) they both thought that it was definitely noticeable but people were unlikely to stop and stare.

“Except children,” my older daughter thought. “They will notice.”

I thought about this, and asked: “Well, so what?”

My older daughter shrugged her shoulders. “They’ll just look at it, that’s all.”

For completeness, I checked with my younger daughter before setting off to the pool this morning. She clearly belongs to the above-mentioned “children” category, because she did indeed notice.

“Mum, you can see the scars,” she said disapprovingly.

(You can. I'm sure you've spotted them too. There are two: a long one from the mastectomy-and-lymph-node-clearance-surgery, and a short one above it, courtesy of the initial lymph node testing.)

“Yes, well, never mind about those. What if I didn’t have any scars?”

“It looks flat,” she pronounced.

“Does it matter?”

“Yes! It looks weird.”

For all of three seconds, I considered bringing my Softie along. Then I remembered the story of a friend, about someone whose breast inserts floated away from her in the pool. Given the expert’s warning that I shouldn’t swim with too much exertion, I decided that racing to catch up with an errant fake breast was probably inadvisable.

Quite apart from the untested properties of wet Brain Fluff, which could, I feared, mimic those of the gravity-sensitive, hand-knitted swimming trunks of my toddler years. (Whenever Bear has a bath, his fluff gets so heavy that it needs two of us to haul him out. I might sink, swimming with my Brain Fluff Softie.)

I also remembered how upset this very same daughter had been when (a) I had braces put onto my teeth (I don’t want an ugly mother!) and (b) the braces were removed from my teeth 18 months later (You don’t look like mummy anymore!).

So off I went to the pool, breastless.

It was bliss. I couldn't see properly without my glasses, but I don't think anybody stared. If they had, I wouldn't have cared.

Well, for the sake of honesty: I probably I would have cared, but I think it would also have made me even more determined to get used to it. I made a point of using the public rather than the private showers. In at the deep end. I am planning to go swimming every morning from now on.

Now all I have left to ponder is whether I will need my swimming cap when I’m bald.

I’ll get back to you on that one.


  1. This nearly made me cry. My mom had breast cancer nearly 15 years ago and had a mastectomy. I remember the first time she went swimming afterwards- years and years afterwards, she felt so self-conscious. All her girls went with her and basically formed an honour guard around her. She's fine swimming now. Hope all goes well for you.

    Bernice Cunningham @ Guardian Industries

  2. Congratulations on your best month ever. I have to tell you that I would have never thought that swimming would help, but you really made a believer out of me. I recently was in a car accident and physical therapy helps, but I am looking at pool treatments because they work so many of the muscle groups at the same time.