Guest Blog: Journey through the scars

As far back as I can remember I have had a small 1cm scar right on the inside of my ankle. I was told it was a remnant of medical procedures resulting from my drowning accident. I never thought too much about it. Now I have 10 more, I cannot exactly ignore the subject.

It all started with my back…

About 8 years ago I got bad back issues. I have tried rehab, physiotherapy, regular exercise, no exercise, painkillers, ice treatment, hot patches, osteopaths and chiropractors and nothing would make things better. I felt as if I had a big metal brace around my hips squeezing them day and night. It got so bad I had to work from home for almost three months. The only position I could be in was lying down on a hard floor with my knees bent.

Finally, my chiropractor referred me for an MRI scan and when he saw the images, he said there was nothing else he could do. The disc between L4 & L5 was sticking out and pressing so far into the spinal cord, it would be contraindicated to continue with any therapy, and it had to be corrected surgically.

Spinal Surgery

I had the surgery a week later. It was to simply “shave off” the bit that was sticking out causing the compression. I was scared but I had run out of options by that point.

When I came round my first thought was that they had amputated my legs as I felt nothing – no pain. When you live with severe chronic pain for months, you get used to it and get on with your life. As a result, the scale of 1-10 that the doctors keep referring to when asking you how you feel, is a moving target. I thought I was on 8. Only when I was pain free, I realised that it had been more like 11.

Now the pain was gone, it was time for rehab. Starting with a physiotherapist, then going to the gym for some gentle exercise. As far as my 10cm scar was concerned, I could not see it because of its location. At that time, I had no knowledge of scar treatment and generally thought scars to be a cosmetic issue. Out of sight out of mind.

Rehabilitation

I hired a swimming teacher as part of my rehab. I started cycling indoors. The first 12 months were tough. My issue had been so severe, my body created protective mechanisms. Old neuropathways were overwritten, and new ones created. My body would overwrite some of my conscious decisions regarding how I wanted it to move if they posed a threat to its integrity.

What I mean is that if I wanted to move in a way the body considered too dangerous, it just would not follow my command. For example, I wanted to do a bunny hop over a bench. The conscious brain would send the command, but the body would not comply. When it was safe, it would allow me to walk over that bench one leg at a time. It did not matter what I wanted. I found all this fascinating and my scar was not on my mind.

It took two years before I could wake up in the morning and sit up without thinking about my back. However, as the years went by, I would still struggle with standing or walking for long periods. I continued with sports massage sessions as much as I could.

Change my career path

Following that surgery I became an indoor cycling instructor, spending many hours on a bike followed by more hours seated at my desk in my office job.

I was so fascinated with my body that I decided to become a sports massage therapist. This is where I first heard of scar treatment and I learnt that most scars are not only superficial and that what you see is the least of your problems. It is about the trauma that cutting through your tissues has caused internally. I learned about how a scar on your back can cause a problem with your shoulder. It was so logical yet mind-blowing. My scar has become a door to another level of understanding the complexity of my body.

And when I next saw my massage therapist, Andreea Ivanov, I told her about it, and it turned out she was indeed a qualified ScarWork therapist and through her I heard of Emma Holly.

New health concerns

In May 2018 I found a lump in my breast. Everything moved quickly and on 3 July I had a mastectomy with reconstruction on my left breast and a lumpectomy on the right. Talking about scars – this was like a car crash. I had a cut from under my left armpit almost all the way to the sternum, plus a little cut to remove 2 lymph nodes. I also had two holes in my abdomen from where the drains had been inserted. On the right there was almost an invisible scar around the lines of the nipple where the cut was made, and the lump removed.

The breast with an implant was a sight. The nipple was black for days and I thought it would not survive. There was a huge adhesion between the nipple and the bottom of the breast where the skin was stuck and hardened and it was not moving at all.

To be honest since I have never been too focused on my appearance, I did not find it hard to look at. I was almost detached and it was as though I was looking at it through the eyes of a soft tissue therapist. I religiously followed my physio plan to regain my range of motion. Functionality was the name of the game for me.

I also had this instinctive need to work on my left pectoral muscles using techniques I learnt as a therapist. Finally, I knew that scar tissue treatment is often about getting the skin unstuck from whatever lies below. And this is what I was doing. As I watched a movie, I would just massage gently the bit that was super stuck. Using bio oil I would try steadily to soften the whole breast.

When allowed, I went to my first session of scar therapy with my trusted therapist, Andreea Ivanov. The treatment was very gentle which, combined with my total lack of sensation in that breast, meant that I had to look at my therapist to see if she was doing anything. She was using these featherlike strokes and I remember thinking: I am paying £60 an hour – that must be around £1 per stroke! It had better work!

What helped me stick through it was that I had full trust in Andreea. With every session the breast would feel softer and more natural. My main scar was under the breast – so not immediately visible. It was getting thinner and softer, too.

The reconstruction of my breast felt like an alien body

In my case of mastectomy and reconstruction, the recovery has been much more than about the scars. You lose sensation in whole areas of your body for months which is your internal self-preservation mechanism kicking in – if you could feel everything you would be in an unimaginable pain.

Now it was time to reacquaint myself with my new body parts where I had no feeling. To shave my left armpit, I had to look in the mirror, otherwise I had no idea where the shaver was. I had to wear my sports bra constantly for weeks on end and I could not sleep on either side for the first few months in order not to displace or misshape my implant.

I think that the fact I was not grossed out by the scarring or the initial gruesome look of my new breast, and my background as a massage therapist, helped me with recovery physically as well as psychologically. I focused on bringing my left arm and the rest of my body back to full functionality and this meant adhering religiously to the physiotherapy regime and self-administered massage and professional scar therapy.

Struggling to do exercise

For a long time, I struggled doing any chest exercises because of the implant position. It sits right under the pectoral muscles so every time I tried to do a chest press or a push up it would get squeezed and distorted and hiked up, flattening like a pancake. The sensation was so overwhelming and alien, that it would put me off this type of exercise. Lying down on my front also felt weird as I felt an alien pressure on my implant and my body could not decide if it was OK, safe or if we should not do it.

Two years down the line it still feels the same. Will it ever change? I do not think so. Will I be able to be less aware of it? Probably, but it is early days. I spent 41 years with actual breasts and only two with the fake one, so I need to give it time.

Functional vs symmetrical 

I remember going for one of my check-ups with my surgeon and being all excited to show him how I had managed to get back to 95% of my range of motion and feeling utterly disappointed when he took no notice and instead focused on the fact that there was an area on my breast (where the really bad adhesion post op was) where there was a slight dip which was making the breast visually uneven. On every subsequent check-up he would bring that point up and reiterate that we could inject some fat in that area to make it all nice and round.

I only had one question: would this require a full anaesthetic and more cutting/surgery? The answer was yes. To which my reaction was: no, thanks. If I change my mind a few years down the line, I will let you know but for now, after all I have been through, to let anyone chop me up even more just to make my breast look a bit rounder when, let’s be honest, since my right breast has no implant, it is more susceptible to the gravitational forces so in a few years’ time it will differ greatly from the left, I am fine with what it looks like now. No more surgery.

Yet more surgery is required

Famous last words. A year later I found myself under the knife again having my gallbladder removed through a keyhole surgery. It was under full anaesthetic, but it was done in the evening and I was home the next day. And just like that I gained four more scars on my abdomen with the biggest one just under the belly button.

These scars are tiny – superficially – but knowing how much trauma my body went through internally, what with being pumped up full of gas to help the tissues to separate and make it easier for the surgeon to manoeuvre, I wonder whether I will be paying a higher price for that than as a result of the breast surgery.

Knowing how each muscle and organ is wrapped in multiple layers of fascia and how as a result everything is connected to everything, I appreciate how having those multiple points where things have been disturbed, cut through, cut out, stitched up etc have caused those layers and other tissue to thicken, impeding their ability to move freely as intended. Rehab has been an ongoing thing.

Holistic approach

What I have learnt through all my surgeries is that your body must be treated as a whole, by any therapist or a medical professional. We cannot simply say: mastectomy and gallbladder removal have been done by specialist surgeons, no more symptoms occur therefore you are now 100% back to normal and provided that your external scars heal nicely there will be no consequences of either of the intervention. Unfortunately, because the western medicine is so specialised, there is no consideration for what any interventions will mean for the body as a whole. Yes, you can live without a gallbladder, but it does have a function (or evolution would get rid of it by now), so what will take on the function once it is gone? Your body will compensate for it somehow – it is clever like that – but it will be at a cost.

We need to change western medical professionals’ perception of what happens when you intervene with the human body using sharp instruments. Every smallest interference will have a multifaceted impact on that body. Anyone who has undergone a surgery, particularly a serious one like a mastectomy, should be made aware of the importance of scar therapy. Not only from the point of view of how beneficial it is from the aesthetical point of view or regaining range of motion, but the fact that the scar is being touched by someone who is not repelled by it, and it is not being ignored or treated like something you should hide or be ashamed of. Scar Therapy is going to help with the patient’s body confidence and psychological recovery. I continue to access ScarWork therapy through Paul’s Cancer Support Centre.

How do I feel about my scars?

I have always been a matter-of-fact person when it comes to my body, so I have had no issues volunteering as a “body” for students on ScarWork and oncology massage courses. With my knowledge as a therapist and a frequent attendee at the free supervised scar clinics Emma Holly runs, I have the understanding and right language to give the trainee therapist pointers on their skills.

Am I proud of my scars? I do not think that is the right word. I do not love them or hate them. They are simply a part of me, and their changing look fascinates me. I am also aware that the main challenge is the scars you cannot see.

Moving on

Getting the breast cancer gave me a kick up the proverbial behind and I finally got to write the book on teaching indoor cycling that I have been meaning to write for years. The book “Ride and Shine” is my proudest achievement of my life so far.

About the author

Izabela Ruprik is a dynamic no-nonsense woman. I met her in 2018 when she first attended a course clinic, and it has been wonderful to see her move forward with her life. I know she will achieve the success she deserves with her book and as an indoor cycling instructor – she is currently the only qualified PD Cycle Coach in the UK – teaching indoor cycling to people with Parkinson’s. Part time Izabela works as accountant and she is an avid traveller.