But I’m fatigued multiple times a day, and I’m still taking pain medication twice a day. Mostly for the lower back, though the other pains rotate through on their own schedule. This week has been my knees.
Luckily, my head, neck, and shoulders are no longer welded together the way they were before surgery. Still, I’m stiff everywhere, and I’ve started wondering whether I’m far enough along for some gentle, stretchy yoga. Weights are still two more weeks away. That started me down the path of researching what’s healing underneath the hood, because the body looks alright.
* * *
The Cut
The cut down my abdomen went through the linea alba — the sheet of dense collagen that runs down your midline and holds your abdominal wall together. It’s the load-bearing wall of your torso.
It heals in three phases:
- Inflammation (days 0–4). Clot, immune cleanup, zero strength. The sutures hold everything.
- Proliferation (day 4 to week 3). Fibroblasts lay down type III collagen — fast to produce, mechanically weak. Scaffolding, not steel.
- Remodeling (week 3 to about a year). Type III gets replaced by type I collagen, cross-linked and realigned along the lines of stress. This is the slow strength gain.
The strength curve:
- Three weeks: roughly 20%.
- Six weeks: 50–60% — me, today.
- Three months: 70–80%. And then it stops.
Scar fascia plateaus at about 80% of its original strength. Permanently. It never gets back to 100%.
This is why my surgeon’s rule was no sport for sixty days. The scaffolding needs time before you hang weight on it.
The Lining, the Liver, and the Nerves
The heated chemo bath — ninety minutes of mitomycin C sloshing around at 42°C — killed the entire inner lining of my abdominal cavity. That’s the point. HIPEC is a scorched-earth strategy against microscopic cancer cells, and the lining is collateral damage.
So for a while, my insides were essentially one giant open wound.
The stripped peritoneum — along the diaphragm, around the liver and kidney, down in the pelvis — re-surfaced within a couple of weeks. Done.
The three deposits shaved off the surface of my liver? The liver is the body’s best regenerator. Healed in weeks. Non-issue.
And the slowest project of all: nerves. The pelvic dissection ran near the autonomic nerve bundles, and nerves regrow at about a millimeter a day. That timeline is measured in one to two years, not weeks. It runs quietly in the background.
The Fatigue
This was my real question. Fatigue is the sum of every system that’s still rebuilding, so it can’t clear until the slowest one does.
All that internal healing tissue pumps out inflammatory signals — the same molecules that make you feel wrecked during a flu. The chemo bath got absorbed into my bloodstream and knocked down my bone marrow, with the low point hitting somewhere around weeks three to six. Major surgery also flips the body into breakdown mode, and I lost real muscle in the hospital — muscle that rebuilds at maybe one or two percent a week, best case. Stack deconditioning and lousy sleep on top of that.
The scar heals whether I feel good or not. Energy needs everything to come back online.
And after 21 rounds of chemo — nine in this last batch — my baseline wasn’t exactly fresh off the showroom floor either.
The Rebuild
Now through week eight: walking, and lots of it — the best recovery tool there is. Plus yin-style yoga: long, easy holds to start unwinding two years of chemo tightness.
Weeks eight to twelve: light resistance and the sneaky core exercises — dead bugs, bird dogs, side planks — that strengthen the muscle corset around the scar without bending against it. That corset is my real hernia insurance, since the scar itself tops out at 80%.
Months three to six: progressive strength work, compound lifts, rebuilding the mass I lost. The target hasn’t changed: the gym in September, then tennis, then a week of hiking the Dolomites next summer.
The scar will still be a scar at 80%. The rest of me doesn’t have to settle for that.