Friday, June 3, 2011

Training clients with cancer - by Sara-Clare Lajeunesse

Sara-Clare Lajeunesse isn't a person who does things half way. When Lisa became her client, she tackled her training plan with veracity and passion and most of all, professionalism for providing Lisa with exactly what she needed given she had just been diagnosed with cancer. This is an article Sara-Clare wrote for Agatsu Magazine. I am so moved by this article and hope you will pass it along to anyone in cancer treatment to inspire them to find their Warrior Within.

Training clients with cancer

When I first met Lisa, neither of us could have truly understood the journey that lay ahead. I have worked with several clients dealing with serious life threatening issues, such as permanently implanted heart defibrillator and another client who only has one artificial heart value working. But never have I had the chance to meet and work with someone pre surgery or illness.
Lisa walked into Urbanfitt, a boutique gym in the west end of Toronto, one day as she had heard that we “take the broken clients no other gyms wants to deal with”.
-Lisa 47
-June 2010 diagnosed with Invasive Ductile Carcinoma (advanced in left breast)
-Tumor was 6.5 cm and cancer had spread to lymph nodes.

We sat and chatted a little and then I had the pleasure of assessing this amazingly vivacious, full spirited and head strong lady. We were able to get through two training sessions together, before her treatment started. In them we worked on mobility, strength, and connection in everyday movements. We also discussed our game plan.
-The Come Back

First two training sessions
I could see that she had good body awareness, decent core strength and a pretty good understanding of her foundational ‘everyday’ movements (squats, pushing and pulling etc...) She lacked strength in the upper body and posterior chain.
She was also big into spinning and yoga, 2-3 days a week. We had a great base to start with.

Next came the surgeries and treatments
-Chemotherapy was started right away. Her doctors needed to get the tumor under control before they could even hope to operate.
-She was giving a PICC (Peripherally Inserted Central Catheter) basically a long piece of tubing that is inserted into the vein on her arm and extends into her heart. That is where they would inject her with chemo treatments every three weeks (July 2010)

Once the tumor was under control she underwent the following surgeries:
-Double Mastectomy
-Removal of 12 Lymph nodes
-Ovariectomy (removal of ovaries)
After this she continued on with the rest of her chemo treatments.

Training during treatment
We had set out our goals for this part of the journey early on. Preserve and maintain body, mind and spirit. These sessions were wrought with complications.
3 days after her first chemo treatment and dealing with a little fatigue, things seemed to be going well. Being very head strong she went to a spinning class and felt great for a few days afterwards. Until the side effects that she had been warned about seem to hit her overnight.
She went from a stubborn take no guff from this cancer warrior to a quiet shell of the lady I had once met. She could no longer even squat onto a base and simple movement patterns like alternating sideways stepping faltered from day to day.

Complications and side effects during her treatment
-The PICC ended up giving her a blood clot.
-Extreme fatigue
-Extreme Joint and Muscle pain
-GI Track complications, and major loss of appetite
-Shortness of breath
-Early menopause, therefore battling through shortness of breath and hot flashes during sessions
-Loss of bone and muscle density (osteopenia)
-Immune system at zero due to chemo
-Peripheral Neuropathy (Peripheral nerves carry information to and from the brain. They also carry signals to and from the spinal cord to the rest of the body.
Peripheral neuropathy means these nerves don't work properly. Peripheral neuropathy may be damage to a single nerve. It may be damage to a nerve group. It may also affect nerves in the whole body)
-Loss of Proprioception and Basic Motor Skills (It is the sense that indicates whether the body is moving with the required effort, as well as where the various parts of the body are located in relation to each other)
-Mental and Emotional discouragement

Training for preservation changed from day to day. There were days she would call and want to cancel but I talked her into coming. If she was able to get to the studio, we should work. Unless she was at the hospital there were no excuses. Letting her give into the temptation of staying home and sitting with what the cancer had left her would defeat her mentally. It is so important that a trainer understand when and how to encourage their client to work in these dark times. The emotional aspect of training and being in control of even the littlest of things, gave her a sense of control and hope for the next days battle to come. If she could get through today then tomorrow is one step closer. Mind over Matter, Warrior Within.
We did what we could, even if it meant I was moving her body for her.

On GOOD DAYS some training consisted of
-Re-learning basic motor skills such as squatting onto a base
-Balance drills like standing on one foot. The floor was challenging enough at this point, never mind trying to perform a walking lunge, she would lose her balance.
-Posterior Chain Work
-Connection in moving her body from one position to another.

Good day Workout Sample
-Joint Mobility with simple arm and leg swings and circles
-Figure eights with broom handle
-Box Squats
-Roll downs
-Inchworms or Bird Dogs
-One foot balance drills (with varied step ups a la Poliquin, we later worked up to throwing a ball back and fourth on uneven surfaces like wobble board)
-Rows with bands and Posterior Chain work like tree hugging and proud chest pose (only once PICC was removed)
-Isometric holds like Dead Bug or One leg out holds (Mosquitoes) for Core Engagement work.

On BAD DAYS some training consisted of
These days were sometimes so bad that a simple roll down or box squat confused her CNS and her would get very dizzy and fall over.

Example of Bad Day Workout
-Short walks up and down the stairs focusing on proper overall engagement.
-Rehab exercises of walking her fingers up and down the wall and extending her arms fully to open areas where she had had the surgery.
-Posterior Chain work lying down doing T, Y and W shapes with her arms while getting her the retract into my hand.
-Flexibility work on hips and shoulders with PNF (proprioceptive neuromuscular facilitation)
-Me moving her body using myofascial release (it is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion.

Once her treatment was over, her energy started to stabilize a little more and we were able to work a little longer in our sessions. We had to now build her back up from scratch. The preservation exercises had given us a good base with which to start.
Most important in this next phase was to gain muscle and bone density as well as cardiovascular endurance. The chemo had really stripped her of these essentials.
So we started small with an 10lbs Kettlebell, while still incorporating other joint mobility body weight training, rehab exercises and myofascial release.
The main reason I choose to use Kettlebells was because it offered her a low-impact way to build up bone, muscle and joint density. Also it challenged her coordination skills immensely and gave her the mental rush she had been missing from her spinning classes.

Some samples of her workouts as she progressed are:

Day 1
5-10 mins walking incline warm-up
Tea Cups (major focus on mobility in surgery areas)
Inchworms and Walking Lunges 3 times across room
Windmills 2x5
Circuit of 10 reps 2-3 Rounds of:
Seated Rows
Leg Raises
Box Squats with KB overhead
Fire Hydrants

Day 2
Joint Mobility with PVC pipe shoulder openers (focus on opening fascial chains around surgery area)
Scorpions hip openers
Uneven Ball Tosses and Circus Lunges for balance 3x10 at each end of room after crossing with lunges
Wall Ball 3x10 with plank holds for 5 breaths
Circuit of: 3-4 Rounds
5 KB Dead lifts
5 Side Plank holds each side using stability ball at first (10 sec each)
5 Push Ups
5 Band Hacking each side
5 One Leg Kb Rows

Day 3
Joint Mobility with Kb to open shoulders (Halos and Bent Over Circle drawing)
Single Leg Hip Circling
Bear Crawls (forward and backwards)
Walk Squats and Hands Together, Feet Together Squats

KB Circuit 3min rounds x3 (30 sec each exercise)
-Two Hand Swing
-High Pulls (Right/Left)
-Two Hand Swing
-Push Press
-Alt Backwards Lunges holding kb bottoms up
*Adding in around the body passes with and with and without stalls as active rest when she felt she was fading.

I am glad to say that to date Lisa and I are still working together, but less often as she is back at work as the amazing photographer that she is. She has purchased kbs for her home gym and keeps up with the prescribed routines I have given her while on the road. Recently she gave me a signed copy of her latest book. In it she thanked me for all the work we had done together and for how good she feels today.
I feel the opposite. I can’t thank her enough for walking into my gym and allowing me to learn and grow so much as a trainer and athlete.
There are days when I am training, I hear someone complain that the exercise is “too hard” or “I don’t like this one. Can we do something else.” Even days where I am in the middle of a grueling workout (Agatsu Level 2 cert, to name one) and I feel like I have nothing left or am getting frustrated with a new movement and want to swear and quite. But I think about her, and how hard it was for her to re-learn all those basic movements we take for granted in our everyday lives. We once spent a whole hour on re-learning how sit, stand up and then walk up stairs properly so she wouldn’t have pain in her joints. I sometimes think that if I was her I would have lost my mind with frustration, but she never once gave up when I gave her a task during a session.
She truly inspires me to push beyond what I think I’m capable of mentally and physically.

1 comment:

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