1.Exercise of upper limb function on the affected side
Functional exercise of the upper limb after surgery
Functional exercise is essential to restore the function of the shoulder joint and eliminate edema, but the order of gradual progress must be strictly observed, not arbitrarily in advance, so as not to affect the wound healing.
Step-by-step method.
1-2 days after surgery, practice fist clenching, finger extension, wrist flexion, etc. Liao Zigun, Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College
3-4 days after surgery, forearm extension and flexion exercises.
5-7 days after surgery, touch the opposite shoulder and ipsilateral ear with the hand on the affected side (the affected limb can be supported by the healthy limb).
8-10 days after surgery, practice shoulder elevation, extension and flexion to 90 degrees.
After 10 days postoperatively, the shoulder joint was subjected to wall climbing and apparatus exercises.
(1) The requirement for functional exercise is that the upper arm of the affected limb can be straightened and raised around the top of the head to touch the opposite ear within 2 weeks. After achieving the standard, functional exercise should be continued.
(2) Restriction of shoulder abduction within 7 days after surgery.
(3) For severe flap necrosis, avoid substantial exercise for 2 weeks after surgery.
(4) If subcutaneous fluid accumulation or drainage exceeds 50 ml 1 week after surgery, reduce the number of exercises and the range of shoulder joint movement (limit abduction).
(5) Shoulder exercises should be postponed after skin grafting and breast reconstruction with latissimus dorsi flap.
Prevention or reduction of upper limb edema
The circumference of the affected upper limb is generally considered to be less than 3 cm longer than the circumference of the contralateral upper limb as mild edema, 3-5 cm as moderate, and more than 5 cm as severe edema.
(1) Prevention of infection: Keep the skin on the affected side clean. Do not perform invasive operations on the affected arm, such as blood draws and infusions; wear loose gloves when washing to avoid prolonged contact with irritating washing solutions; avoid mosquito bites; always dress and wear jewelry or watches loosely.
(2) Avoid high temperature environment: avoid burns; do not apply hot compresses to the affected arm and do not overheat the water when bathing; avoid bright light exposure and high temperature environment.
(3) Avoid weight-bearing: avoid lifting, pulling or pushing overly heavy objects; avoid heavy physical labor or more strenuous sports activities.
(4) Other: restore arm function as soon as possible; wear an elastic cuff when traveling by airplane.
(5) Self-care methods for lymphedema: a. Mild or moderate lymphedema: elevate the arm; bottom-up centripetal massage along the lymphatic direction; do arm function restoration training; wear an elastic sleeve. b. Severe lymphedema: wear an elastic sleeve; physical therapy. If there are symptoms such as redness or abnormal hardness in the arm, or if the edema is serious, infection should be considered and anti-infection and symptomatic treatment should be given.
2.Nutrition and exercise
The progress of breast cancer disease or the adverse effects during treatment may lead to malnutrition, and overweight due to over-eating is also one of the problems faced by breast cancer patients during recovery. Cancer patients are also at high risk for second primary cancer, cardiovascular disease, diabetes and osteoporosis, so proper nutrition and a healthy lifestyle are especially important during the recovery period of breast cancer patients.
Diet and Nutrition
So far there is no evidence to prove that a certain type of food diet is associated with the recurrence or metastasis of breast cancer.
(1) Foods that are medically digestible, high in protein, high in vitamins and low in fat can be used.
(2) Foods that need to be contraindicated are: a. placenta and its products; b. health products of unknown composition.
The following are the specific contents of the preoperative and postoperative dietary attention.
(1) Both pre- and post-operatively, you can eat more seaweed, seaweed, nori, oyster, asparagus, fresh kiwi and other foods with the function of dissolving phlegm and softening hard knots.
(2) Early postoperative period: dietary regimen can be given to benefit qi and nourish blood, regulate qi and disperse knots to consolidate the therapeutic effect and promote physical recovery. Such as yam powder, glutinous rice, coix seeds, spinach, loofah, kelp, loach, crucian carp, jujube, orange, hawthorn, etc.
(3) During post-operative radiotherapy: it is advisable to eat sweet, cool and moist products, such as loquat, pear, banana, lotus root, carrot, jellyfish, etc.
(4) During post-operative chemotherapy: Because of the easy occurrence of gastrointestinal reactions and bone marrow suppression, it is advisable to consume more foods that harmonize the stomach and lower rebelliousness, benefit qi and nourish blood, such as fresh ginger juice, sugar cane juice, fresh fruit juice, tomatoes, japonica rice, white lentils, lingzhi, black fungus, etc.
(5) In addition to the above-mentioned foods, you should also eat more nutritious foods after surgery, such as crucian carp, silkworm pupae, and fresh vegetables and fresh fruits. Reduce the intake of fat, such as fatty meat, cheese, cream, etc. Avoid eating spicy food, such as chili, pepper, garlic, garlic moss, onion, onion, mustard, leek, and old pumpkin, alcoholic wine and thick taste, etc., so as not to help fire and produce phlegm.
Exercise
During the rehabilitation period, you should choose an aerobic exercise that is suitable for you and can be maintained for life. Some recommended exercises are brisk walking, cycling, swimming, tai chi and aerobic dance.
A balanced diet and aerobic exercise can strengthen the immune system, effectively reduce mental stress, improve sleep, relieve the symptoms of fatigue caused by cancer and its treatment, and increase the body’s resistance to disease.
Establish a healthy lifestyle
(1) Maintaining a normal weight.
(2) Adhere to exercise routine.
(3) Reduce the intake of alcohol and do not smoke.
(4) Use health care products carefully.
3.Adjustment of psychological state
Psychological intervention of bad emotion
The adverse emotions of breast cancer patients mainly focus on self-esteem, physical impact, anxiety and depression.
Health care workers and family members need to understand the characteristics of patients’ psychological changes and the process of psychological state adjustment in order to provide the necessary psychological interventions. Health care professionals and family members can enhance patients’ self-control in terms of cognition, decision-making, and coping skills, and guide and enlighten patients to use reasonable coping skills such as suggestion and catharsis to increase their tolerance for distress. Avoid being located in the patient’s excessive sympathy and pity, emphasize to the patient the importance of maintaining normality, and help the patient to get rid of the patient role as soon as possible and face life positively.
(1) Provide adequate information to help patients accept the fact of illness rationally. Health care workers and family members can participate in patients’ cognitive correction to help them reflect appropriately, reduce false ideas and alleviate patients’ fears.
(2) Help patients find a positive purpose for survival and build confidence in life. Health care providers and family members must promptly and correctly assess the patient’s current expectations, including the relationship and degree of dependency between the patient and his or her relatives. Help patients realize their own value and importance to other members of the family in order to increase their confidence in fighting the disease.
(3) To stimulate the patient’s sense of commitment and assist him/her in controlling his/her self effectively. Implement a patient-centered medical care and family care model to help patients give full play to their decision-making power and stimulate their sense of self-responsibility.
4. Sexual rehabilitation guidance
(1) Understand all the information about the possible effects of breast cancer and its treatment on sexual life. It is important to tell them that the sex hormone that causes women to have sex drive is androgen. About half of a woman’s androgens are produced by the adrenal glands, which are located above the kidneys, and the ovaries produce the other half of the androgens. Women need only a small amount of androgens to maintain the normal levels needed for sexual desire.
(2) Regardless of the treatment that will be used, the ability to obtain pleasure through caresses will not change.
(3) Try to enjoy other ways of feeling sexual pleasure, and partners should help each other to reach orgasm through touch and caress.
(4) Communicate with your partner about sexual problems. Silence is the biggest enemy of sexual health, and if one is never afraid to ask for advice, then there will never be relief.
Related suggestions.
(1) Improve communication with your sexual partner about sexuality.
(2) Try sensual massage.
(3) Read a good book on sex to increase knowledge and skills about sex.
(4) Increase sexual fantasies.
(5) Share your sexual fantasies with your sexual partner.
(6) Encourage your partner to be more active during sex.
(7) Tell your partner to do it in the way you like.
5.Fertility guidance
Although there is no evidence that childbirth affects the prognosis of breast cancer patients, the risk of recurrence and metastasis of the patient’s disease and the impact of treatment on the offspring must be fully considered when choosing whether and when to have children, and there should be adequate communication with the patient.
(1) Patients with carcinoma in situ of the breast can be considered for childbirth after the completion of surgery and radiation therapy.
(2) Patients with lymph node-negative invasive carcinoma of the breast can be considered for childbirth 2 years after surgery.
(3) Patients with lymph node-positive invasive breast cancer can be considered for childbirth after 5 years of surgery
(4) Patients who need adjuvant endocrine therapy should stop endocrine therapy 3 months before conception and continue endocrine therapy until the end of breastfeeding after childbirth.
6. Postoperative follow-up guidance
(1) Patients with early-stage breast cancer should be followed up regularly after surgery to understand their survival status, as well as their adherence to adjuvant therapy and adverse reactions.
(2) Follow-up period: every three months in the first two years after surgery (or after the end of adjuvant therapy), every four to six months in the third to fourth years, and every one year after the fifth year.
(3) Follow-up examinations: physical examination by palpation, liver ultrasound, biochemical routine, tumor markers and routine blood test, lung X-ray examination.
(4) Other special examinations: ultrasound of chest wall and contralateral breast and related regional lymph nodes, mammogram of contralateral breast (once a year), gynecological examination for patients taking endocrine drugs (once every six months to a year), bone density test.
(5) Bone scan, CT, MRI or PET-CT can be used in symptomatic patients, but are not recommended for routine use in asymptomatic individuals.