Safe to train post-hysterectomy

[tomskarda]

Hi Mark,

I have a family member who is about to have a hysterectomy and is being given the usual line of "you'll never lift anything heavy again."

As an avid gardener and someone who enjoys the outdoors this is a problem.

The individual in question is 72 years, multipara, and a former landscaper. The hysterectomy is for prolapse of the uterus. The procedure will involve removal of the uterus and Fallopian tubes. Ovaries will not be removed and transvaginal mesh will be applied. Meniscus is missing from one knee following knee surgery and an artificial knee was not applied.

Due to the missing meniscus, I understand how squatting could be a problem.

Is there any reason why this individual couldn't deadlift or press?

Thank you,

Tom

[Mark Rippetoe]

Are these fools actually telling the woman she can never again apply force against an external resistance as the result of perhaps the most common abdominal surgery in the world? Why don't they fix her knee under the same anesthesia and actually get something accomplished efficiently?

[Scaldrew]

Had some customer in my workplace, a bar, tell me she had a hysterectomy done. Something about it pushing on her spine causing her back pain. Said "aight". She goes "doctors say" and I smile. Then goes "I can't lift more than 5kg for 3 weeks". I say "oh". She finishes with "so I'm taking it easy right now". I go "that seems like a really arbitrary amount. Why 5? Why not 4 or 6? Or 10?" And I get a blank stare. She gives me some bullshit excuse about how it just means she has to not move around too much for some reason. I said something along the lines of doctors who say this sort of crap don't know enough about the human body in motion to give advice like this, but I can tell she's not even listening. I just shut my fucking mouth and gave non-answers at that point, like a barman is supposed to do.

So to answer your first question, Rip, yes. I can't answer the second one, though. And you better be grateful for my patience or I'll be really unsettled. I mean it. Like, don't even go there, ok?

notsrs

[tomskarda]

Yes, “no more than 10 pounds” for TWELVE weeks and “you’ll have to be really careful after that.”

The individual in question is a little scared. Being on a small farm where throwing around hay bales and 40lb bags of chicken feed is a daily requirement this is no small concern.

Frankly, I’m more pissed about the MD’s rampant fear mongering for the sake of malpractice lawsuit avoidance than anything else.

[Cliff]

I've done a lot of hysterectomies. Upon proper repair and sufficient healing, the arbitrary limitations for lifting are simply for CYA. CYA is an unfortunate reality in medicine. In reality, she will be unlikely to be able to apply enough stress to cause a vaginal vault prolapse if the repair was adequate. There are case reports of delayed vaginal cuff (scar left at the vaginal apex after hysterectomy) dehiscence and subsequent bowel prolapse following valsalva or intercourse but this is very rare. More likely with smokers and diabetics with poor wound healing. I am of the opinion that a proper valsalva with squatting or deadlifting applied over the usual linear progression of gradually increased stress actually improves pelvic floor support.

[Jeff Illingworth]

My wife had a hysterectomy about 7 years ago through the lower abdominal wall. I have no recollection of what the doctor's activity recommendations were. Her physical recovery was pretty quick and she was picking up.our fat-ass cats the day she got home. I can't remember how her lifts went after that, but I don't recall any issues. She squats, deadlifts, presses, and does all the usual stuff semi-rural people do daily.

[Mark Rippetoe]

There are case reports of delayed vaginal cuff (scar left at the vaginal apex after hysterectomy) dehiscence and subsequent bowel prolapse following valsalva or intercourse but this is very rare.

How often does this happen with a mesh repair?

[Pluripotent]

Yes, “no more than 10 pounds” for TWELVE weeks and “you’ll have to be really careful after that.”

The individual in question is a little scared. Being on a small farm where throwing around hay bales and 40lb bags of chicken feed is a daily requirement this is no small concern.

Frankly, I’m more pissed about the MD’s rampant fear mongering for the sake of malpractice lawsuit avoidance than anything else.

There is CYA and then there is utter ridiculousness. It's one thing to give an extreme healing time before business as usual (although this probably delays healing in a patient willing to train -- in patients unwilling to train -- i.e. most patients -- what can you do?), but to say that afterwards you will never have a normal life again? If surgeons cannot repair their incisions well enough for a person to be able to lift "heavy things" again, then perhaps the patient should forego the surgery entirely and just sign up for home hospice, since they are basically saying that the post-surgery quality of life will be about hospice level anyway? (are they then going to be responsible for the end-of-life frailty that this advise will undoubtedly induce, if actually followed?)

Maybe ask the surgeon, "so you don't believe that your repair of your surgical incision will be adequate for normal bodily function?" Suddenly, the surgeon might provide a different opinion.

We don't have health care in America. We have sick care. Physicians and Surgeons are used to treating sick, helpless people who have to be cajoled into doing the bare minimum just to be able to walk 10 feet without getting short of breath, or at all, since that's mostly who we see. Unfortunately, many can no longer tell the difference between those patient who will work to recover and those who won't. Advise should be tailored accordingly, but there is no incentive to do so, and every incentive to treat for the Lowest Common Denominator - i.e. the sick and dying.

[Austin Baraki]

Are they then going to be responsible for the end-of-life frailty that this advise will undoubtedly induce, if actually followed?

Maybe ask the surgeon, "so you don't believe that your repair of your surgical incision will be adequate for normal bodily function?" Suddenly, the surgeon might provide a different opinion.

We don't have health care in America. We have sick care. Physicians and Surgeons are used to treating sick, helpless people who have to be cajoled into doing the bare minimum just to be able to walk 10 feet without getting short of breath, or at all, since that's mostly who we see. Unfortunately, many can no longer tell the difference between those patient who will work to recover and those who won't. Advise should be tailored accordingly, but there is no incentive to do so, and every incentive to treat for the Lowest Common Denominator - i.e. the sick and dying.

Pluripotent nails it once again.

[tomskarda]

Thanks everyone.

I thought this was complete BS from the get go.

I’m talking with the individual in question this weekend.

I’m planning on sending her to Westminster to train. I’ll post a follow-up here as that progresses.