Client Corner. 'Exercise has been my lifeline during treatment for bowel cancer'. Melissa's Story.

In this series of blog posts, I am privileged to share the stories of some of my wonderful clients.

I’m hugely thankful to them for sharing their stories and experiences, but more so for putting their trust in me and allowing me to work with them at a time when they were at their most vulnerable.

As a clinical exercise specialist, working with patients with cancer or after surgery is an enormous responsibility, but equally a huge honour and it brings me so much satisfaction.

I can’t describe the joy I get from watching people transform from feeling vulnerable and fearful (just after surgery or after their treatment), to a place of self-confidence, strength and empowerment. All through the process of exercise and rehabilitation. It’s why I specialise in working with clients with cancer or after stoma surgery and it’s why I love what I do.

But this is not about me. These blogs are about some amazing people and how they embraced the power of movement and exercise to help them recover and get back to their lives.

Here are their stories.

Melissa – Colorectal Cancer

Yoga teacher, civil servant and mum of 2, Melissa was diagnosed with colorectal cancer in June 2020, right in the middle of the Covid pandemic. In July 2020 she underwent open surgery to remove part of her large bowel. A huge shock to Melissa who was only 42 and previously healthy and fit.

An email from Melissa popped into my inbox only 10 days after her operation, just after she read my book ‘The Bowel Cancer Recovery Toolkit’. This is rather unusual, as most people get in touch much later, but actually this is the best time to start and I was immediately really excited to help her as I knew she would benefit so much.

We started working together just 2 weeks post-surgery, via online video exercise sessions.

As an experienced yoga teacher Melissa already knew that she needed to move as part of her recovery, that she needed to rehabilitate and to strengthen her core muscles. But no matter how experienced you are, there’s something lovely about having someone else take your hand and guide you. And that’s what I could give Melissa. She could sit back and let me guide her and she didn’t have to think about it.

So those first post-surgery sessions involved super gentle rehab exercises. Focusing on correct breathing, learning to engage the deep abdominals and pelvic floor – pelvic tilts, knee drops and leg slides and other clinical Pilates movements. Almost immediately I could see a sense of relief and confidence, as she learned to execute the exercises perfectly (being a yoga teacher helps!) and learned how to move her body safely so soon after major surgery.

Clinical Pilates is different to yoga in the sense it focuses on ‘micro movements’ and isolated exercises before progressing to larger more flowing movements. I could see that Melissa really enjoyed learning this new way of moving and learning the differences between different exercise modalities.

She grew in confidence and strength so quickly and it was wonderful to see! I’ll never forget the look of surprise on her face when she did her first proper Pilates ‘roll down’ only 3 months post op.

We continued to do virtual 1:1 training session during her chemotherapy all on video link. Video training works amazingly well for clients with cancer – no exposure to any sort of virus (covid or otherwise), no travel and super easy to fit in. It made me wonder why I haven’t done more of it before now and it’s certainly changed how I’ll work with people moving forwards.

During her chemotherapy we started to introduce weight training (super important for chemotherapy patients) combined with clinical Pilates and Melissa felt strong enough to start running again. By the end of November, having just completed 4 rounds of chemotherapy, Melissa was safely doing intermediate-advanced level Pilates (including challenging abdominal exercises such as leg pull/planking, push ups and scissors) and weight training in our sessions.

I’ve been blown away by Melissa’s attitude. She’s had to cope with so much, but has made her health, exercise and body a priority. Investing both time and money in taking care of herself, knowing that it would help her recover and come out of it on the other side. Her attitude and recovery from surgery has been remarkable.

Here’s her story.

Melissa, you reached out to me for exercise advice at only 10 days post-surgery, which is quite unusual. Many people think they shouldn’t be doing any exercise at all at this stage or are even advised not to by their medical team. What prompted you to make contact with me?

Although I thought I was prepared for surgery and lack of mobility afterwards, I was shocked at how frail and vulnerable I felt post surgery, and how little confidence I had in my body. Despite having symptoms for about 18 months (during which time I had to fight to get diagnosed), it was really the first time I felt like I had cancer. Ironically, of course, the tumour had been removed by then.

A friend who had had a similar op 3 months before recommended your book to me. Reading it was like a lightbulb moment - firstly it gave me hope that I didn't have to spend 6 weeks doing nothing more than 'lifting a kettle' (standard post surgery recommendation) and secondly, it really inspired me that by getting moving again I could take back a bit of power in my illness and do something that evidence shows can help in long term recovery and prevention of recurrence.

The confidence in my body though was still an issue, even with the inspiration of your book. I knew that I needed some help and reassurance to build back my relationship with my body and reaching out to you was the first step.

You’re a yoga teacher and experienced movement specialist. What have you learned about Pilates and how would you describe the difference between yoga and Pilates? Particularly in the context of bowel surgery recovery and chemotherapy.

Pilates has been not only brilliant for my physical recovery but it has been a great learning experience. The precision and focus on micro movements and muscles has a different flavour to yoga. For me, there has been something really mindful about changing up familiar movement patterns which often become habitual through repetition and challenging your body and mind to do what might look, on the face of it, a similar movement (say, bridge) but actually requires quite a different set of muscular engagement, breathing and way of moving. In particular, the focus on the deep core muscles has allowed me to build up my strength and movement in a way that has felt really safe and supportive, and has probably meant I have a better sense of what core engagement means that I have developed in 20 years of yoga practice. I am definitely taking my new learning into my yoga practice and my clients.

Your teaching also really enabled me to flex through different levels and intensities of Pilates, which I could never have got in a general class environment. That meant that when I felt more fatigued from chemo, I could take it gently but still keep moving, but also allowed me to charge it up when I was feeling stronger.

People are scared to do abdominal exercises after surgery in case it causes damage or a hernia. What would you say to that? How can they overcome that fear? A lot of people think they shouldn’t do anything for 6 weeks after their surgery. You were doing core exercises at only 2 weeks post surgery. Tell us about that.

When I came to you, I was terrified of just being on my hands and my knees. Only a month before, I had been doing upwards of 30 reps of full body push ups. I remember only half jokingly worrying at you about becoming upzipped... I was also shocked by how quickly I had lost muscle mass. Working in a really controlled, intelligent way with you - building up my strength gently and carefully - combined with a gradual increase every day in the amount I was walking, meant that I was back to a modified yoga practice in 4 weeks and running (albeit carefully) in 6 weeks. But most importantly, I was learning to move in a really safe and supportive way that is sustainable long term.

The general advice about not doing anything for 6 weeks risks being counter productive - by then you have lost further muscle mass and fitness and potentially it takes much longer to build back fitness, and movement, especially if you are facing a course of chemotherapy. There is no doubt that a steady, intelligent recovery got me back in good shape for chemo, which helped massively with the side effects and - really importantly - my sense of self and mental health.

What have you benefited from the most. What has been the most powerful aspect of your rehab programme?

Learning how to engage and work with my deep core muscles and mindfully move from there. Tiny movements giving me access back to moving my whole body.

You’ve been through so much. Firstly a shock diagnosis. Then major open abdominal surgery during severe covid restrictions, and then chemotherapy. How has exercise and movement helped you during this challenging time?

It is no exaggeration to say that exercise and movement has been my lifeline. It has given me a sense of empowerment when I felt (and still feel sometimes) that control had otherwise been totally stripped from me. It has given me something hopeful to focus on, allowed me to build strength out of vulnerability and - something that is often sorely lacking during cancer treatment - it has allowed me to have fun.

How has your body changed physically after surgery and treatment and what has been the biggest challenge?

The obvious physical change in my body is an 8 inch scar running vertically down from my sternum to my pubic bone. I also have areas of tightness and restriction in other parts of my body (mainly my hips and mid back). The biggest challenge however has been mental. After diagnosis and surgery, I had completely lost confidence in my body. I felt that in getting cancer, it had let me down. So, it has been an emotional journey to love my body again, and appreciate all it can do - scars and all.

We’ve done a weekly 1:1 Pilates and strength session together. What else have you been doing? Tell us about your weekly schedule… and how has this changed from pre-diagnosis?

I restarted my yoga practice about four weeks after surgery, and I practice 4 or 5 times a week. It can just be ten minutes or an hour. It has been a real learning curve to adapt what was a very dynamic, strong practice into something much more compassionate towards my changed circumstances and body.

I try and run 2 or 3 times a week (although during my 'bad' chemo weeks, running wasn't right for me and I didn't) and have just managed 5K, which I'm really proud of. I walk every day, and have recently started practising chi gung.

Before diagnosis I was a reasonably regular runner although I hadn't been enjoying it as I was getting tired very easily. I know now this was the anaemia caused by my cancer impacting on my stamina. I weight trained at gym twice a week and practised yoga most days.

It would have been amazing to work together in person, but we have had to work on video due to pandemic restrictions.

How has this been for you? what would you say the pros and cons of video are? How have you found it?

Video has been brilliant - it has allowed me to access working with you when otherwise I wouldn't have been able to - both given the pandemic, but also because I am so immuno-supressed. It has also made exercising more efficient - no travel or faffing around before and after. I've been impressed at how well you can see me on the video and cue me to correct my posture or movement. Obviously, I'd love to work with you in person - and hopefully soon give you a hug to say thank you for all you've done for me!

People talk about how their relationship with exercise changes after illness or surgery. Do you think you can relate to that? and if so, how?

I've always enjoyed exercise (or since I hit about 20 - wasn't keen at all at school!), but now it has a different flavour. It could be key to keeping me alive and seeing my kids grow up. So I am willing to prioritise it in a way that I haven't been before.

Most of my learning post cancer diagnosis has been to slow down and work in more intelligent and compassionate ways, rather than constantly pushing my body to do more. So I include more meditation and meditative movement, and really listen to whether my body needs time to rest and recover. I am looking forward to getting back to heavy weights at the gym though!

If you could give 3 pieces of advice about exercise/recovery to someone else going through bowel cancer, what would they be?

• Start as early as you feel able but go gently - you need to build a new relationship with your changed body.

• Be kind to yourself - some days you just won't feel it, and you might need longer to recover.

• The more you move, the easier it is and the more you enjoy it, so try to find different ways to move throughout the day.

If you could go back and talk to yourself just at the time of your diagnosis and give yourself some advice or a pep talk, what would you say?

Hang on in there. Breathe. Don't google.

The challenge is as much mental as physical, but the physical will be key to getting your head in a decent place.

You'll dance, run and do planks again - sooner than you think. I promise.

Interviewed by Sarah Russell, Clinical Exercise Specialist and founder of The Ostomy Studio. With huge thanks to Melissa for sharing her story.

For information about training with Sarah Russell, 1:1 sessions online and Pilates classes go to www.theostomystudio.co.uk and www.sarah-russell.co.uk