Yesterday was my port-a-cath insertion surgery, and what feels like the beginning of a very long and difficult physical and emotional season.
The ride to the hospital was rough. I imagine it's how people feel on their way to check themselves into prison. When we got into the car the song "Rescue" by Lauren Daigle was playing. One day I'll go back and read the lyrics more closely and listen to that song and know that it was a well-timed message to me. But at that moment, I couldn't hear it. I tried to listen for a minute and just couldn't take it, so I turned the radio off.
We arrived at the hospital a few minutes earlier than we needed to be there, wearing our homemade COVID masks (thank you Christy Bain) as requested by the hospital.
I felt like I was having an out-of-body experience walking in there. I was totally self-absorbed and was glad there weren't a ton of people everywhere...because even the few in the lobby made me angry. Not because they did anything wrong -- no one did, and in fact we ran into a friend we haven't seen in a long time, who we think very highly of. I just was angry and felt alone and scared and not wanting to start this process. Maybe having my face covered with a mask was good. Then my expression couldn't be seen by everyone else and I didn't have to politely smile.
Once I was registered, we went into the pre-op room, where I had to strip down (including all of my jewelry, which for me makes me feel really "naked" more than anything...isn't that weird?) and put on a paper gown, hair net and grippy socks. Whoa. This is REAL surgery.
We weren't sure whether Ben would be allowed back with me, and I'm so glad he was. We sat in the pre-op room for about 3 hours waiting for the OR to be available, getting my IV, drawing blood, answering questions (3 different people asked me if I'd had a hysterectomy??), but mostly we were just waiting.
I received several nice texts from friends wishing me well and saying they were thinking about me, but I couldn't read or respond to them genuinely at that moment, because I was still just scared and angry, so mostly I put my phone away and didn't look at it. Eventually we changed the channel on the TV from HGTV (which I swear is what EVERY doctor's office, hair salon, dentists, etc. ALWAYS has playing -- why???) and found a King of Queens marathon. That's a show Ben and I love, and it was the perfect comic relief while we waited.
Finally, at about 11:30, the anesthesiologist came in and they started to get me ready to go to the OR. Ben left at that point and would meet me back in recovery after the surgery. When the anesthesiologist came in, I pretended he was Jason McKeown (my friend Tiffany's husband) -- even though he was FAR too short to be Jason -- and in a weird way, that made me feel better. He showed me a saringe and asked me if I wanted something to help me relax. My answer "Yes, give me whatever you've got."
The ride on the gurney into the OR was a very eery and scary feeling. I felt like I was in a scene from a television show. When we wheeled into the OR, I saw my surgeon, her nurse and the anesthesiologist & his nurse, lots of equipment and lights. I remember my doctor putting a few blankets over me (it was cold in that room) and then the anesthesiologist giving me a breathing mask. That's the last thing I remember.
They said I might sleep through the whole thing, or I might be in and out of consciousness throughout the surgery. Thankfully I don't remember a thing. The next thing I knew, he was waking me up and wheeling me back to the post-op area. I remember asking:
- What time is is? (12:50pm)
- Did everything go ok? (yes)
- Do I still have the IV? (yes)
They asked me if I remembered anything, and I told them no...and "wouldn't it be nice if I could sleep through the next 8 months too?
They observed me for a few minutes in a post-op bay and did a quick x-ray of my lungs (since she was working pretty close to them during surgery). My heart rate kept making the machine next to me beep -- it kept going below 50bpm, but no one seemed to concerned about that (and it's not that much lower than my normal 55-65bpm).
Before long, they moved me to a recovery room, where Ben was there waiting for me. I was able to eat (finally) some peanut butter crackers and Ben had made me a sandwich, and drink a diet coke.
Then I evaluated my physical status. Took a look at the bandage, and realized my port was IN, it was bigger than I expected (I kept hearing "quarter sized" and this looks more like a $2 stack of quarters!), and it was sore, but not excruciating. I mostly just didn't want to move my right arm, though I could...just slowly and gingerly, with less range of motion.
But, step 1 of this cancer trip was complete.
And in case you were wondering...this is what the hospital parking lot looks like during COVID quarantine:
Once I was in my own clothes (with all my earrings back in) and back home, I felt quite a bit more normal. I spent the rest of the afternoon moving very slow, sitting on the patio with Ben, Ayla & Paxton circling around while I stayed still. Kind of the opposite of normal around here.
Last night we had leftover Costa's for dinner (thank you Josh & Rachel!) and then the kids and I watched the documentary "Chasing Happiness" about the Jonas Brothers...which we all loved for our own reasons. It was a good relaxing way to hang out with the kids and do something fun.
I slept *mostly* well, but around 2am got up for more Tylenol and couldn't get comfortable. I kept wanting to stretch my arms and shoulders and back and just couldn't do it. I ended up making myself a pillow wedge so I could sleep partially sitting up, and that seemed to help for the rest of the night.
I woke up pretty stiff, but I'm slowly doing better, and even managed a shower (though I didn't dare tackle trying to wash my hair -- just putting it in a ponytail felt painful enough).
I've heard it takes 10-14 days for this port incision to heal...bandages can come off Monday. Until then, I think I'll be taking it nice and slow.
Research has shown that when triple-negative breast cancer is treated with chemotherapy before surgery — what doctors call neoadjuvant chemotherapy — and there is a pathologic complete response, disease-free survival and overall survival are better.
One way for doctors to judge the effectiveness of neoadjuvant treatment is to look at the tissue removed during surgery to see if any active cancer cells are present. If no active cancer cells are present, doctors call it a “pathologic complete response” or pCR.
Disease-free survival is how long a person lives without the cancer recurring. Overall survival is how long a person lives whether or not the cancer recurs.
Third, in our current quarantine world, everyone I know is already practicing how to keep from getting each other sick, which will be particularly important for me as I go through both rounds of chemo. The kids being "homeschooled" for the next 9 weeks may actually turn out to be a major blessing to avoid bringing home all kinds of illnesses.
Today I met with my surgeon. She comes highly recommended by several people I've talked to, and after meeting her, I feel very comfortable with her.
After seeing my MRI, she seemed confident that my lymph nodes are not involved, even though we haven't officially received results from my lymph node biopsy. That will make surgery less complicated, only needing to remove the sentinel node, rather than several lymph nodes. That's particularly good news for my left arm recovery (which since I'm left handed, is pretty darn important to me).
She also said that the tumor is localized and not invading the chest wall or nipple (sorry...we're talking about breasts here), which is good news for removal, reconstruction, and possibly avoiding radiation. The tumor also measured slightly smaller in the MRI at 15mm instead of 25mm as reported in the ultrasound. All good things.
While she said I have the option of a lumpectomy or a double-mastectomy, she had two main concerns for recurrence, which might push me toward a double-mastectomy and definitely would warrant having chemo before surgery. One, she wanted to know whether my BRCA genetic testing was positive, which we don't know yet. And two, she had concerns that because my estrogen receptor "postitive" was weakly positive, which makes her think perhaps my cancer may be acting more like a triple negative cancer instead of an estrogen receptor positive cancer. Either way, she agreed with my medical oncologist, that because of my age and the grade and size of the tumor, that chemo is the best course of action and ought to be done *before* surgery.
So that gives me plenty of time to decide about a lumpectomy vs. a double-mastectomy (though I'm leaning toward a double-mastectomy w/reconstruction, which is a 3-6 month process in itself - it's not your standard boob job!)
And then I can tackle one challenge at a time. Chemo is my first battle. Until we go through a round of chemo and the first surgery, I won't know whether I'll need chemo again or radiation after the surgery. It will just depend on what they find and how well everything works.
One of the toughest things I heard today though was that in light of all the COVID virus issues, during chemo I will be significantly immuno-suppressed. Which means regardless of whether the rest of the world is in quarantine...I will *definitely* be in strict quarantine once my chemo treatment begins. No in-person socializing, no public events, wear a mask when/if I have to go out...the whole shebang.
That's gonna be rough.
The next step is to have another meeting with my medical oncologist and see when we can get all of this started. Maybe I can do it all while the whole world is quarantined! My FOMO would certainly be relieved if that's the case...
When I hear "chemo", I immediately think of a bald head, frail muscles and bones, hollow eyes, pale skin, and a tired body.
I'm scared of the changes to the way my body feels and looks. It's vanity and it's superficial, but it's still very real.
So I'm trying to let myself go through the emotions of knowing that my body is about to undergo some major changes--some of them permanent, and letting myself be sad and scared about it before I face and tackle it. I can't know exactly what side effects and physical changes I'll go through yet, but I know some of what it *can* include, and there's just nothing "pretty" about them.
After spending the past three years trying to recover from feeling so weak and terrible when I was first diagnosed with Graves Disease, knowing that an even worse wave of physical and emotional challenges is about to hit me is really really really hard for me.
I like my curly hair. It's kind of my signature. It's going to be hard to see it go...and then have to start all over.
I like being strong and fit and physically capable. I do burpees for fun. My workout is my favorite part of every day. Having muscle and endurance is a big part of what makes me feel confident and resilient.
I like dressing up and accessorizing and wearing high heels when it's not practical. I don't always dress for comfort -- I like the wow factor, the sparkle and the shine.
Can you wear heels to chemo? Will I want to?
I know it's not forever. I know it's not the end of the world and in the grand scheme, it's a small thing to be doing what I can to be cancer-free. But when I look at my body in the mirror today, I like what I see, and so I'm scared and sad and angry at what I know is coming.
I'll do what I can to make the best of it. I'll rock a fedora and funky earrings with my bald head, and learn makeup tricks to try not to look so pale and hollow. I might even end up with a fancy and perky new set of ta-tas at the end of all this.
But getting there is going to be tough. And I'm not going to pretend it won't affect me. It will. It already has. So today I'm sad about it.
First -- I received a phone call this morning from Kristi with my MRI results. The imaging doesn't indicate any lymph node involvement (GREAT news) or any cancer on the right side or anywhere else they weren't expecting to see it. It appears we are currently dealing with a localized tumor (also GREAT news).
But still...we were going to go ahead with the axillary lymph node biopsy just be certain. So I headed into the hospital for that procedure this morning. The hospital was even MORE empty this time. We were screened for Coronavirus before being allowed into the hospital. Ben wasn't allowed to come back with me at all and ended up having to wait in the car. Things are getting straight other-worldly out there!
I had the same team of nurses & doctor from my first biopsy, and the process (while slow) went fine. It's awkward and a little uncomfortable, but not painful. And I was able to watch on the ultrasound the entire time so I could see what they were doing and what the lymph node looked like.
This time of course they all KNEW I have cancer (and they knew *I* knew) so they were much more forthcoming about what they were seeing. Or maybe I asked better questions. In any case, we all knew I was now an *actual* cancer patient.
Based on what they saw on the ultrasound of my lymph node and the information from my MRI results, the doctor said he thought it was very likely the biopsy results would show no cancer cells.
So we're hoping that's true.
I have an appointment with a surgeon on Wednesday when I hope to have more information about the order of events and severity of the surgery portion of the process.
My bilateral contrast MRI was this morning. That means I got to go to a nearly empty hospital (bizarre) and get an IV of dye (had to be stuck twice to get it right) and take a really really loud 25 minute nap on the weirdest massage table (without a massage) ever.
None of it was painful or even that uncomfortable, but that dye going through my veins was crazy strange --it feels COLD.
I'm hopeful the images they get will tell us more about whether my cancer has reached any lymph nodes or not...and hopefully it hasn't!
Telling people that I have breast cancer, before it's obvious that I do, is a strange and surreal feeling. Because *I* don't totally believe it yet. But I decided early on I want to be open and forthcoming about it. I wanted people to be comfortable asking me questions, and feel as un-awkward about interacting with me as possible. I know what it's like to feel like you don't want to upset or offend someone by bringing up a sensitive subject, and I don't want people to NOT talk to me because they don't know how to interact with me.
So here's my disclaimer:
If you're curious, ask me about it. Talk to me about it. I don't mind, and that lets me know you care about me. And if I'm not in the mood to talk about it, I'll let you know. And we can talk about it later. Deal?
I started with calling all of our family -- my parents & siblings. Then a handful of close friends, both local and all over the country. Then we told Ayla and Paxton, which we were nervous about, but which went well. Then church friends, and co-workers, and bible study groups...the circle widened.
Each time I told a new person or group of people, I was so thankful that I had done it. While everyone had slightly different responses and reactions that matched their own personalities and life experiences, they were ALL so kind and caring, heartbroken for me and offered unconditional support and assistance in any way they could. Some people cried. Many people were speechless and shocked. Everyone was genuine. I have never felt so loved by so many people in my entire life.
Because our world is so physically separated right now with the coronavirus quarantine, I've only been able to tell Ayla & Paxton in person. Ben told his parents in person. But everyone else has been over the phone or through a text message. While the text messaging method isn't always *right* for something like this, it did mean that I was able to keep a written record of how so many of my people responded--and for the scrapbooker/journaler in me that is a priceless keepsake for me to have.
What's really weird about all of this happening with a backdrop of a worldwide pandemic is that other than my immediate family, I have not (and probably won't) receive a hug from anyone else, maybe in months. That's all kinds of strange, and a little sad.
Instead of hugs, I guess I'm getting gifts!
Little treats keep showing up on my doorstep from my friends and family.
Things to cheer us up, things that will be helpful down the road, and things that are just plain silly and "extra" because -- well, it's for me -- and I'm a little extra sometimes. :)
I don't think I really ever fully realized how wonderful my tribe is.
Ben came with me to my meeting with Kristi and the medical oncologist this morning. We left the kids at home in quarantine and braved the outside world (that's really how it felt) and took ourselves to the hospital. Signs everywhere warning you to wash your hands, not to enter if you're feeling sick, people trying their best to stand far away from each other. That was the first time I'd been out since the previous Friday afternoon, and my anxiety was definitely elevated and I was overstimulated with everything around me.
Kristi is wonderful. She's kind and assuring, and gave us all kinds of great information and I believe she will be an advocate for me to get the best care I can possibly get. She is also going through breast cancer herself and recently had a lumpectomy and is about to begin her own radiation treatment. So most of what she described sounded like a surgery & radiation treatment plan--a few months. Not great news of course, but not too terrible either, and definitely treatable and beatable.
She administered the BRCA gene mutation blood test as soon as we got there, but unfortunately we won't have results from that for a few weeks.
Then (after an eery parking lot waiting room and coronavirus temperature and questionnairre screening before we were allowed into the building) we met with the medical oncologist in the Cancer Center, who talked more specifically about MY tumor and situation. While he too, was very kind and gave us detailed information that was almost all brand new to us...he seemed much more concerned about my situation than anyone had up to this point.
He used words like "I worry" and "I'm concerned" in regard to my age (young), the tumor size (2.5cm) and the growth grade of the tumor (grade 3).
He also dropped the chemo bomb. Which I was not expecting. And which immediately sent my body into a fearful panicky feeling.
He said because of those factors, he wanted to kill the seed, not just pull the weed (he had a long lawn care analogy to go with his recommendation that resonated perfectly with Ben). Surgery could remove the tumor (weed), but if the seed (cancer cells) were out there where you couldn't see them and you didn't kill them, you'd end up with more cancer in other places later on. Particularly if the BRCA genetic test came back positive, and particularly because I am only 40, which leaves a lot more time left in my life for recurrence.
He didn't care whether I chose a lumpectomy or a mastectomy. That was up to me. But he wanted to kill the cancer cells with chemo -- probably before surgery ever happened. The surgery & radiation treatment plan I'd been expecting went from 2-3 months to the better part of a year, plus all the chemo side-effects no one wants to experience.
Then he started talking lymph nodes. I have an axillary lymph node under my left arm that feels like a little pea-sized knob. It's been there as long as I can remember. But since he could feel it, he wanted to have it biopsied to see if the cancer had spread to my lymph nodes. Until he had that information, he said he couldn't stage the cancer. And lymph node involvement would mean a more difficult surgery, higher risk of lymphedema (which I learned more about later and is frankly more scary to me than chemo--because it's permanent and would affect my dominant arm).
After that, we were essentially sent on our way with an appointment for an MRI & a lymph node biopsy & a meeting with a surgeon for within the next week and a half.
And now, I have a new reading companion, the Breast Cancer Treatment Handbook (which is VERY informative and a must-have if you are ever diagnosed) and a very long journey ahead of me that I wasn't expecting at all.
So, I received some pretty upsetting news today. I've been diagnosed with Breast Cancer. In the middle of a coronavirus quarantine, when *everyone's life* is in a strange state, my own life has been turned completely upside down.
But let me back up to the beginning.
First, I found a lump in my left breast--I don't remember exactly when it was. Maybe January? Maybe February? I didn't think much about it, but made note of it. When Ben noticed it a few days (or weeks?) later, I decided it was maybe more prominently noticeable than I thought. So I called to see if I should have my mammogram a few weeks earlier than scheduled, just to check it out and make sure it was nothing. I'd had a baseline mammogram at 35 years old. But this was going to be my first one since then. Last year I wasn't quite 40 when I had my annual exam, so my doctor said it was fine to have it at my next year appointment instead. So, since I was scheduled to have one anyway in mid-April this year, I wasn't too concerned about bumping that date up a little. No big deal. They scheduled a mammogram and ultrasound for me right away.
The mammogram went fine. They did lots of imaging on the left side where I'd found a lump, regular imaging on the right. Everyone said, "oh, it's moveable, so that's a good sign." and no one seemed overly concerned. There were lots of things that it could be.
I had an ultrasound, and could see where the mass was and what it looked like. It wasn't *totally* round, but it looked oval to me, which seemed like it could definitely be a cyst or a fibroadenoma (I'd been googling).
A few days later, I got a call that said they wanted to do some extra mammogram imaging on the RIGHT side because of some dense tissue and asymetry between my original scan and the current ones. They also wanted to schedule a biopsy on the mass in my left breast to test it to see exactly what it was.
That had me a little concerned. Mostly about the right breast, honestly, because it sounded like they were concerned about it if they wanted to see more imaging.
And then I remembered my dad mentioning a long time ago in passing that his mother died fairly young of breast cancer. We don't talk about his family or childhood much, so it wasn't information that is just "known" in our family. But breast cancer *can* be genetic (although only 5%-10% of breast cancer diagnoses are genetically based). And, in light of that, things started feeling a little more serious at that point. What if it *was* cancer? But still, I wasn't going to worry until there was something to worry about. So, I went to the next mammogram for my right breast (which turned out to be fine) and then had a biopsy on the mass in my left breast.
As I was watching the ultrasound and listening to the doctor and nurses talk about what they saw, it sounded like a mass that looked partially cystic and partially solid (a complex cystic mass). No one said cancer. No one acted concerned. It wasn't painful, just odd and a little uncomfortable, and watching the needle jab away at me on the ultrasound certainly looked like it SHOULD hurt, but it really didn't. They just took the samples and kindly told me to put some ice on the injection spot because it would be a little swollen and sore and I'd hear results in a few days. They didn't seem worried or alarmed. So, I didn't worry.
That was on Thursday, March 12th. The next several days were a blur of coronavirus talk, school being closed for three weeks, a volleyball tournament being canceled, everyone starting to get scared about the virus and what that meant, learning about social distancing, and canceling EVERYTHING in our lives...so I put the biopsy in the back of my mind until Monday afternoon, when I still hadn't heard anything. I called this morning (St. Patrick's Day) to see if there was any information for me, but had to leave a message. So I went back to work...
When my phone rang this afternoon and I saw it was from my doctor's office, my stomach did a little drop. I answered and Kristi (my Breast Care Navigator) told me, my biopsy results were in, and unfortunately, it was cancer.
That was NOT what I expected to hear.
I hardly remember the rest of my conversation with her and I was shaking so much I could hardly read what I had written down as she was talking. Here's what I wrote:
- It's Invasive Ductal Carcinoma.
- It's HER2 negative, PR negative, and ER+ (mild to moderately).
- I would need to meet with Kristi tomorrow as well as with a medical oncologist to go over my results, treatment and receive a book to tell me all about the entire process.
- I'd need to have a BRCA genetic test to see if I have the breast cancer gene in my DNA.
- I'd need to have a bilateral contrast MRI in the next week or two.
- I'd need to schedule an appointment with a surgeon to discuss removal options.
- Surgery would be necessary.
- Medication would be necessary.
- Radiation would be necessary.
- Chemo was not a guranteed necessity.
Floored. I was completely floored. Especially because I feel healthier and stronger now physically than I have in the past three years after dealing with Graves Disease through most of 2018 and finally (mostly) healing my elbow that was injured the majority of 2019. I was finally back to my "peak" performance self. Cancer was not on my radar.
But, it is now.
I hurt my elbow at the beginning of July, taking apart a huge fence for my sign wood. It's been diagnosed as "golfer's elbow". I've tried modifying, resting, icing, anti-inflammatories, physical therapy and a cortisone shot. But, 5 and 1/2 months later, it's still not any better.
So, next step...Platelet Rich Plasma Therapy and a *hope* that this will kickstart the healing process.
I'll continue to update the healing process here...
Day 1 (12/19/19) - Can't use my left arm for anything. Throbbing, aching, and sometimes shooting pain. I'm really glad Ben drove me to my appointment. I never would have been able to drive home.
Day 4 (12/22/19) - I'm doing my best to avoid using my left arm at all. Any pressure or weight on or in that hand hurts. Still taking tylenol and occasional Tramadol. Range of motion is slightly better than it was immediately after the injection, but I have trouble and paint when bending it to touch my face, or straightening it to reach for something. I find myself constantly thinking about it and protecting it around other people, which has been tiring.
Day 9 (12/27/19)- I don't feel like I need to protect my arm quite as much today and it hasn't dominated my every thought all day long. I have only taken tylenol once in the past 24 hours. While it's still tender and stiff, my range of motion is much better, and I can do most normal activities without much pain, though I'm still not lifting more than a pound or so with that arm. Still difficult to use a fork with my left hand, wash my face, put my hair in a ponytail, etc. Mobility and strength is still is not even to where it was right *before* the PRP injection, so doesn't feel healed in any way, but it's not SO much worse and unuseable like it has been over the past week.
2 Weeks (1/2/2020) - I'm able to do most normal movement. I still have pain when my arm is fully extended or fully bent. Putting pressure on anything still triggers pain, and my elbow is still tender to the touch. BUT, it's closer (though still a little worse) to how it was before I went in for PRP two weeks ago. Still taking tylenol once a day. Still trying not to lift anything with my left arm (when I forget, I switch hands). It's stiff in the morning, but feels much better when I'm exercising and it has warmed up. I've done some walking, bike riding and a few non-arm-using HIIT workouts.
3 Weeks (1/9/2020) - Not taking tylenol regularly anymore. Am much more comfortable driving. Wearing a wrist brace when doing a lot of phone-holding, typing or writing to remind myself to keep my wrist neutral. Range of motion is nearly full, but still hurts some at fully extended and fully bent. Putting pressure on anything is still painful. But I can at least partially brush my teeth with my left hand, which is pretty exciting (the motion and fully-bent angle is rough). Forearm muscle is starting to hurt some, which probably means I'm using my arm too much. Doing some fist-squeezing exercises throughout the day to start strengthening it, which may be making that muscle tweak.
5 1/2 weeks (1/28/2020) - Started physical therapy again last week. Initially it felt stronger after two days of therapy. Then very sore for two days. Then stronger and less irritated today. So, pressing on... At my doctor's visit last week, she said that if in two weeks we aren't noticing improvements, we may need to talk surgery. But if the therapy seems to be helping even some, it would be worth pressing through on that. Still not painting and trying to keep from doing any lifting or repetitive activities. Still having pain when brushing teeth, washing face, opening & closing doors, typing, etc.
7 weeks (2/5/2020) - Started painting again this week, although I'm not sure there's been much significant healing progress beyond where I was before the PRP injection. While my arm muscles seem to be getting stronger again (though they have severely weakened in the past 7 months from lack of use), the tendon injury itself is still very tender and sensitive to even slight pressure. Maybe my expectations are too high? Maybe it'll never be better? Maybe I need surgery? Maybe I'm just impatient. But at this point, I'm getting used to it just hurting and modifying everything that I do to accomodate it.
8 weeks (2/14/2020) - Well, what do you know? Within the last week, I've finally noticed significant improvement. Physical therapy exercises twice a day, and lots of firm pressure massage on the muscle in my forearm seem to finally be making an impact. I feel much stronger than I have in a long long time, and have worked up to 5lb weights when I'm doing my PT exercises. Full extension and bending of my arm just *barely* hurts now, and I can even put weight on my arm in a plank position without irritating it much (though I'm doing that VERY sparingly right now to ease back in). I can carry groceries in that arm now, close the car door with that hand, hold a plate, wash my face, brush my teeth, and boost myself up off a chair or the floor using that arm (at least partially) without feeling like it was straining my elbow.
11 weeks (3/6/2020) - This is the first week that I've felt like I could do almost all my normal-life activities without thinking about my arm. Including a full week of HIIT workouts. Because my upper body strength has diminished and my elbow is still slowly gaining strength, I'm still modifying pushups, burpees, and using lighter weights. BUT, I could *do* almost everything to some capacity. While I still have a nagging soreness or pain occasionally, it's definitely healing.