It’s definitely a weird feeling to go from running 10-15 miles/week to having a restriction of no running for a minimum of 3-4 weeks. But that’s the reality of recovery from a robotic hysterectomy. I feel remarkably better than I expected, but I’m very conscious that my body has a major healing project underway. I am hungry – all the time – something I usually only associate with the significant mileage build leading up to a race.
I’ve become fascinated with learning about wound healing and what exactly my body is doing as I spend most of my time alternating between my favorite chair and bed, with an occasional walk to break up this new routine.
Because a robotic hysterectomy leaves you with five tiny incisions (this can vary from 1-5 depending on your procedure), it’s easy to forget that each of these entry points transects your abdominal wall. Or as my BFF put it so elegantly, ‘basically you’ve been stabbed in the stomach five times!’ She’s not wrong.
There are nine layers to the abdominal wall and the first weeks following surgery is when these layers are busy working through the beginning stages of wound healing: hemostasis, inflammation, proliferation, and remodeling.
The first two are easy to grasp — and visible to the naked eye — while the last two are less obvious but equally critical. In short, proliferation is the process that happens as your wound closes — new skin grows, capillaries are formed, and collagen is laid down — it is the beginning of that pink scar at the incision site. In the remodelling phase, some of the new capillaries regress and the new collagen re-orders itself to look more like normal tissue — your scar fades and slowly starts to look more like your normal skin. This same process is also happening below the surface as the rest of the layers repair themselves after surgery.
If you’ve run any amount, you’ve probably had a bout of plantar fasciitis — that painful pulling in the bottom of your foot caused by overuse of the fascia that runs between your heel and the ball of your foot. Or you might have a better acquaintance with your IT band, the fascia that runs from your hip to your knee.
In the case of hysterectomy recovery, fascia makes up two of the nine layers of your abdominal wall, and the deep fascia that supports your uterus and other internal organs is directly involved — both as the organs are removed and to close the top of the vagina after surgery. These layers regain their integrity slowly as they move through the proliferation and remodeling phases of healing. It takes 2-4 weeks for fascia repair to become self-supporting, and 6-8 weeks before it regains 60–80% of its original strength.
The data nerd in me wishes explaining this was part of the standard ‘don’t carry anything over 10 lbs for six weeks’ advice you get for post-surgery care. It’s the why that puts this restriction in context. When I’m tempted to push beyond what I probably should, the fragility of this new fascia, and where it is in its repair timeline, reminds me that care is most important.
Fueling tissue repair during recovery
It’s taken a lot of reading and sense-making for me to understand the generic ‘your body is doing a lot of internal healing after major surgery,’ and at the same time, a clearer picture has formed as to why I wake up hungry. It was news, but not surprising, to me that your body does it’s best work on healing while you are asleep.
Fascia and tissue repair requires a lot of raw materials for this process to happen efficiently. Recovery is not the time to think about calorie restriction because your activity level is lower. In fact, the reverse is true.
Beyond carb-loading before surgery, and the switch to eating solid food as soon as tolerated after, your body needs additional calories to produce the raw materials it’s using to repair itself. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends that you consume 1.5g of protein/kg and 25-30kcal/kg per day to maintain muscle mass post-surgery. For me, that translates to 130 grams of protein over a day that includes 2250-2700 calories overall. That’s a lot!
I had a couple of good protein habits going into surgery. I’m not a breakfast person, so my first food of the day is French-pressed coffee frothed with a scoop of vanilla-flavored protein powder — it delivers my caffeine hit and 20g of protein in one mug. And because I’m a night-owl, my evening snack is often a slice of multigrain bread with peanut butter and jam — 9g of protein and 30g of carbs.
In between, I eat homemade Greek yogurt on an almost daily basis, make breakfast burritos with eggs, my favorite muesli is made almost entirely of nuts, and vegetarian or turkey chili is a staple in my dinner rotation. I recently discovered a homemade protein bar that’s a new go-to when I need an energy pick me up.
Still, even after adding in snacks to keep my hunger cues at bay — current favorites have been celery and hummus or brie and a pear — I’ve needed to work to get my protein intake above 90g/day. Nutritional supplement shakes are now part of my daily routine — Ensure Protein Max comes in chocolate and vanilla flavors and delivers 30g of protein along with 27 vitamins and minerals, including vitamins A and D, critical for wound healing and building muscle.
I’m using MyFitnessPal to track my nutrition, both for calories and macro makeup. Is it perfect? No. But it is intentional as I work through what recovery looks like for me.
My follow-up appointment is scheduled with my surgeon for 12 March. That will be 4.5 weeks post-surgery. I’m hopeful, based on how I’m feeling now, and what I’m learning as I go, that she’ll clear me to move beyond walking and get back to the running habit that feeds both my body and my soul.
What’s next
I said I wasn’t going to race this spring, and I’m still not likely to tackle anything that will trigger my competitive reflex, so I’m staying away from in-person meet-ups. But I have started looking at local races that will let me translate my walking habit into more intentional movement. Despite it’s name, the 21K de Montréal has both 5k and 10k distances, and the virtual option gives me until the 31 May to post my results. So if I’m cleared at the beginning of March, I can program a training block that is 8-10 weeks in length, building on my base of walking that is bridging where I was pre-surgery to where I’m going next. It’s an idea that is growing on me.
Stay tuned.
Running from hysteria 
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