Although I frequently work with riders recovering from injury or surgery, or living with an illness or disability, breast cancer is not something I have personally experienced or been very close to. While riders coming back from surgery or struggling with an illness do have similar needs and experiences, this one is special. It hits those affected in unexpected ways that are not usually talked about openly in fitness and riding literature.
For this month?s piece, I was able to interview lifetime rider, Level III Centered Riding Instructor and breast cancer survivor, Mary Trafford.
Mary lives and practices in the Ottawa area in Canada. She was first certified as a Centered Riding Instructor in 1986, training under Sally Swift. Eventually, Mary worked her way to Level III which qualifies her to conduct Centered Riding clinics. She was also certified in 1989 by the Canadian Therapeutic Riding Association in therapeutic riding instruction. She balances her teaching and involvement with horses, with a full-time job as a speech-writer in the federal public service.
Heather Sansom: Tell me what happened when you found out about your diagnosis. What went through your mind?
Mary Trafford: It was 1998. I was riding at the time. When I heard the news, I was shocked. I was about to leave on vacation to go to Texas, and it was one of those situations where I had gone through a routine mammogram. They called me from the hospital and told me I needed to cancel the vacation. Then I knew it was pretty serious. It was ductal carcinoma in situ (DCIS). Luckily, as I went through the different levels of the diagnostic process, they discovered it was fairly localized. I only needed a mastectomy. It hadn?t gone to the lymph nodes, so I did not need chemotherapy, radiation, or removal of part of the pectoralis muscle. I was very lucky!
The operation leaves you with a certain amount of tightness in the shoulder area. I wasn?t riding that much at the time, but I did make a conscious effort to be with horses because I found it therapeutic. I got a lot of strength and comfort from the horses. I just felt better when I was with them, and it was really important to me to be with them.
Right after the operation, I had to rest. I also use crutches because I'm an amputee, and the doctor told me I couldn?t use them because it put strain on the area. So I had to stay home for a couple of weeks.
Heather Sansom: How did you start getting back to your activities? What were some of the challenges?
Mary Trafford: I was able to start being more active after about two weeks. I had come through a hard time just before being diagnosed. My sister had died due to a brain tumor. I had been working really hard at my job. When I got the diagnosis, everything stopped. All of a sudden, I was off work. It took me five months before I felt well enough to go back to work. Part of it was physical, and part of it was emotional. During my time off, I participated in a Centered Riding update clinic, which really encouraged me.
The general anaesthetic really does strange things. I think it takes some time for your body to detoxify from it. You?re tired. The actual surgery leaves you with tight-feeling skin. It hurts to move your arm, so a lot of women have problems with mobility of their arm afterwards. Those who have had lymph nodes removed may also have a problem with lymphedema, which is abnormal swelling of the tissues caused by stagnant lymph. After breast-cancer surgery, it can lead to uncomfortable and hard-to-control swelling of the arm. The lymphatic system works with the circulatory system to move fluid and infectious cells in your body, so when the nodes are removed, that system is interrupted. In these cases, the women have to wear a compression sleeve over the arm to keep the swelling under control. Too much swelling is not only uncomfortable, it can increase chances of infection in the arm. Exercise can help drain the lymphedema and help the process along.
When riding, there can be some discomfort because of surgery.
I gradually started to do some light exercises. I did some strength training with 2-5lb weights, using a strength-training program that included a range of exercises, such as overhead presses, light chest flies and bench presses. The program also included work with the legs and abs, and a lot of work for the upper body. I was doing it because I was interested in joining a dragon-boat team for breast cancer survivors and I needed to develop more upper body strength. After the surgery, just lifting my arm to the side hurt. It is really important to gradually nudge the range of motion because if you don't, your skin and the muscles stay tight. I also did a lot of stretching, as well as strengthening the whole shoulder-girdle area.
Heather Sansom: Was it easy to get active again? Why did you pick up exercise again so quickly?
Mary Trafford: It was a little uncomfortable at first, but I found it fairly easy. I have very good upper-body strength anyway, but this exerice regime gave me something concrete to aim for, and it gave me a sense of well-being. I felt that through the training, I was moving forward from the breast cancer to wellness.
They tell you to really take it easy for the first couple of weeks. But after that they suggest you get started. If I had been having radiation or chemo-therapy it would have been a slower process because those treatments have such a negative effect on your energy and sense of wellness. Coming out of a simple surgery, I found that it wasn?t as complicated for me.
Heather Sansom: How long after your surgery did you ride?
Mary Trafford: It was probably about two to three months before I got on a horse. It was more of an access issue, since I didn't have my own horse at the time. I think I could have ridden about a month afterwards. It's important not to do anything too vigorously afterwards so that you don't damage the incision. And you need to have the energy for whatever activity you undertake. You don't want to get out there, and suddenly feel faint or overdo it. You should be able to do some good walking already and have some stamina before you get back in the saddle.
You shouldn?t push yourself to the point of causing pain, but you do need to move your exercise program along in increments. It's not a good idea to tear muscle fibers from exercising too hard, especially early on.
If someone has had one breast removed and they had larger breasts, there may also be balance issues. The medical professionals generally recommend that you shouldn?t get fitted for a breast prosthesis until six months after surgery, to permit full healing and to allow any swelling to disappear. So, for the interim period, you just basically stuff your bra with light-weight material you can get from the Canadian Cancer Society, and you are a bit unbalanced. You also don't look as good, cosmetically, because your breasts aren?t even. That can throw you off in your riding, too. Besides creating an asymmetry in your body that you might compensate for on the horse, there is also the issue of feeling self-conscious.
A breast can weigh a couple of pounds. A couple of pounds in asymmetry is a lot of difference to a horse.
Heather Sansom is the author of rider fitness ebooks Complete Core Workout for Riders, and a regular columnist in several equestrian publications including Dressage Today. Equifitt.com offers personalized coaching through clinics and convenient online coaching available anywhere. Clinics available include fitness, yoga and fitness, and sport-psychology and fitness. You can get a free subscription to monthly rider fit tips, or download the ebooks at Equifitt.com.