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 is Rob's story.
Rob – Colorectal Cancer
Rob is a commercial airline pilot and dad. He loves running, surfing and weight training. Diagnosed at the age of 38 with stage 3 bowel cancer in 2019, Rob had already had chemotherapy and radiotherapy before we met. The next stage of treatment was surgery and this is when Rob got in touch with me.
Rather unusually Rob contacted me BEFORE his surgery looking for advice about exercise and wanting to arrange some sessions for after his operation. We only spoke briefly, but I was able to reassure him and provide him with post-surgery exercises to start as soon as he could after his operation.
His surgery was fast tracked and he got his operation done just before the UK went into official lockdown in March 2020. Rob had open surgery where he had a sub-total colectomy and a temporary stoma formed.
I met with Rob (on video) around 10 days post-surgery and I remember thinking he had made a remarkable recovery. I remember watching him on video and he was moving with such ease, even just getting up and down off the floor.
We then did weekly 1:1 video sessions for about 6 weeks where I taught Rob a series of core rehab exercises based on clinical Pilates. I’m sure he thought were very tame at the time, but thankfully he stuck with it.
Being a pilot Rob has a methodical and analytical mind – and this really helped him understand his body and the rehabilitation process. He was prepared to listen, learn and adapt and he was a joy to work with. I was able to assess his form and technique on video and provide him with progressive exercises to work on each week. He progressed really quickly, probably due to the fact he had been so fit previously and was so dedicated to his rehab and home exercise. I suspect the fact his wife is an occupational therapist may have also helped, as she was able to support him and reassure him that he was doing the right thing.
After a few weeks, we moved to fortnightly sessions, each time introducing more challenging core exercises. Rob got stronger and stronger, got back to weight training and running and then one day around 3 months post-surgery I received a message and a photo of him surfing with a huge ‘smiley face’ emoji!
Rob then did something I’ve only ever had one client do before. He set up an appointment for me to chat online with his previous fitness trainer who wanted guidance on training him in the gym. This was a great session on video with his old trainer making notes about modifications to exercises and asking questions about Rob’s stoma and things to watch out for. His trainer was great and I felt reassured that Rob was in safe hands.
My philosophy is always to get my clients back to ‘normality’. No-one needs to do ‘stoma specific’ exercise forever or work with a cancer specialist trainer forever. My mission is to get people back to the things they did before. So they feel confident enough to exercise alone, in their usual exercise class or back to their sports and are able to modify and adapt things if they need to. I was thrilled that Rob was back to kettlebells, weight lifting, running and most importantly his beloved surfing. He knew how to modify exercises to prevent hernia, and was really confident exercising with his stoma. After everything he’d been through he was an absolute superstar.
But that’s not the end of the story.
We next spoke again when Rob was preparing for reversal of his ileostomy. He knew his pelvic floor would need to be in great shape and he had been told to work on it to improve his bowel function after his surgery. So we worked out a routine for him to work on not only his pelvic floor, but also intentional breathing exercises, glutes and deep core so that he would have the best outcome possible. I’m delighted that Rob feels he can just get in contact whenever he needs me.
Fingers crossed the reversal goes really well for him. At the time of writing, he is waiting for a date for surgery.
Here's what Rob had to say...
'Rob, I remember we first spoke the day BEFORE your bowel surgery, in fact I remember you having to dash off the call to take a call with your surgeon. We chatted only briefly at that stage. It’s rare for me to speak to clients before they have surgery. What prompted you to make contact with me at that point?'
Throughout my treatment I have tried to do everything that I can that might my treatment of better or me recover quicker, I feel that there is a huge amount you can do to influence how you feel after treatment and also if the results are not what I had hoped for at least I know I’ve done all I can.
'You were really fit before your diagnosis Rob and I’m not sure you had ever done Pilates before. I remember feeling worried that you’d think the rehab core exercises we were doing were a bit ‘easy’ and lame! And how did you find them at the beginning? And what have you learned about this phase of rehabilitation?'
Firstly at the time they didn’t feel easy, and I’ve found that, as I’ve progressed, the foundation that those exercises have given me have actually helped me to move with better form than I did before I think this is because I now have a far greater awareness of my core.
'People are often 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 10 days post surgery. Tell us about that'
I think it’s a question of doing the right exercises at the right time, building up slowly but consistently and working with someone who knows what they are doing, like you Sarah. I think some of the exercises we were doing at the start I would probably have skipped over before surgery but they helped lay a great foundation and awareness. I could very quickly feel what felt safe and what felt risky, and I am still using them today. Taking such small steps helped me make quick, recognisable progress and that inspired confidence not just in exercise but in doing everyday tasks. One of the most powerful things we discussed was picking up my 2 year old daughter who was desperate for cuddles with her daddy. You showed me a safe way to do it, and explained that six weeks was not some magical moment when all would be healed and I’d suddenly be able to do lots of things, the key was to slowly build up.
'What have you benefited from the most in our sessions? What has been the most powerful aspect of your rehab programme?'
I think the most powerful thing is that you have not just given me a series of exercises and movements, but helped me to understand how to train with a stoma and adapt things myself. I feel that you given me the tools to pursue whatever fitness goals I want to even if it’s not something you are familiar with.
'You’ve been through such a long journey with your cancer. Firstly a shock diagnosis at only the age of 38. A course of chemotherapy and radiotherapy and THEN surgery and a stoma during the covid pandemic followed by yet more chemotherapy. It’s been a long traumatic process. How has exercise and movement helped you during this challenging time?'
I’ve found that exercise and movement has made me feel better, but also given me a sense of having some influence over my situation. Cancer treatment can make you feel out of control, exercise and movement have allowed me to make a positive impact on how I feel during treatment and how quickly I can return to normal afterwards, which in turn have allowed me to feel like I am in control of at least some element of the journey.
'How has your body changed physically after surgery and treatment and what has been the biggest challenge?'
At first I lost quite a bit of weight but have stabilised to being about 5 kg less than I was before surgery and actually feel better at that weight. The stoma took some getting used to, but there is plenty of help and information out there. Things like surfing are much more achievable that I thought, they just take a little more thought and planning.
'In addition to our core rehab sessions, what else have you been doing? Tell us about your weekly schedule… and how has this changed from pre-diagnosis?'
Initially I slowly added a little bit of weight training with some advice from you, lots of walking and I used the couch to 5k app to get back into running. Then after we had that joint consult with my trainer I now train at his gym 3 or 4 times a week, although at the moment that is via zoom and often substitute core exercises that I’ve learnt from you or adapt things if myself and or my trainer feel they are more appropriate than what he has planned for the class. Pre diagnosis I had a tendency to dip in and out of different programs whereas now I feel far more comfortable with steady progress.
'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?'
I have two small children so only having to give up the time needed to train, not the travel to and from a session helped me and my wife. I think the fact that you were able to convey so effectively how movements should feel and give different cues if I didn’t quite get it helped to overcome any issues caused by the video sessions, despite having not actually met you in person yet I feel I have made a friend.
'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 think I’m less concerned with achieving a certain goal and how I perform in relation to other people. I am finding that I now just really value being able to move well and confidently. I’m more motivated to performing an exercise or movement well than how much weight I can lift, but the great by product of this is by moving better I’m able to achieve those things anyway. In terms of surfing it’s had a really positive influence, I now just enjoy getting out and surfing and I’m less concerned with how well I surf.
'If you could give 3 pieces of advice about exercise/recovery to someone else going through bowel cancer, what would they be?'
1) Get the right advice from someone who has specific experience with bowel cancer patients, at the very minimum I would recommend buying your book.
2) Try to find something active that you enjoy doing or would like to do, whether that is walking, running or in my case surfing. That way the prehab and rehab work is less of a chore, instead it is something that is helping you get back to or better at something you enjoy, that makes it easier when you maybe don’t feel motivated because of side effects or the general stress of life
3) Don’t be afraid, with the right guidance you can quickly become confident about how things should feel when your moving safely and recognise when things feel risky. Then as you progress you can be more adventurous because you will recognise that it feels risky a long time before it causes any problems.
'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?'
That as tough as it can be at times, you are still going to have wonderful moments, the key is to savour those.
Thank you to Rob for sharing his story. Rob is a client of Sarah Russell, Clinical Exercise Specialist, Pilates teacher and founder of The Ostomy Studio. www.theostomystudio.co.uk