A research workout in Paisley – Nicola Dames meets Susan Moug

It’s not as would be expected from the usual patient-meets-surgeon – it’s usually the hospital beat booming in the background. But this time it’s keep-fit music, and it’s Vanilla Blush CEO Nicola Dames meets renowned Colorectal Surgeon, Susan Moug.

Although Susan recently appeared live on the BBC, this time the beads of sweat are nothing to do with the bright lights of the television studio – this time a gym workout is the culprit.

The fitness fanatic Colorectal Surgeon specialist from the Royal Alexandra Hospital, Paisley, was discussing live on BBC whether a country like Scotland – which has a higher rate of bowel cancer than most other countries in the western world – should change the appropriate testing age from 50 to 35?

Susan pointed out that Bowel Cancer is the third most common form of cancer in Scotland, with around 4,000 people in the country diagnosed every single year.

But for Susan she has a deep professional and personal appreciation of her rise to success, which she says was also down to “good mentors”.

She claims she was lucky, saying that as “the evolution of Laparoscopic colorectal surgery came in as I was a registrar”.

And it’s obvious this is personal, as she relishes the professional pride that comes with “helping patients with colorectal cancer get better.”

Always grounding her professional experience in reality, she states that “incontinence is a sub-specialty term but it really pops up in all aspects of bowel surgery – fistula, cancer, IBD, previous childbirths, post surgical problems. It’s something we all see.”

But it is not a simple clinical approach Susan adopts, she knows the human is important: “if it’s incontinence that’s the main issue, you have to start by reassuring the patient that it is very common and they are not alone. There is not an instant cure but there are lots of options to work through with them.

I like it because it’s a real opportunity to work with the patient to see what their needs are. It’s not a clear-cut field which is why it’s interesting for me.”

And it’s not just the physical but the psychological, which also excites Dr Moug. She is driven by three projects, the Plato Project, her investigation into magnetic micro bubbles and rectal cancer, and the hugely successful ELF study.

The Plato Project, which “is the next step on from the Published Edinburgh Delphi work. Here we found that the personality of the individual surgeon influences decisions making in rectal cancer surgery. This may seem logical but it has never been shown before.

“Plato is the next step to confirming these findings by looking at colorectal surgeons across the world (using social media) and we have steering groups members on board from Australia, Canada, USA and Europe. And patient reps too!”

From the psychological, things switch to the physical: “Another piece of work is on optimising rectal cancer staging. We are working with scientists from Edinburgh, Glasgow and Sweden to see if magnetic micro bubbles can help target and define lymph nodes in rectal cancer.

If the findings are promising then treatments could be placed inside the bubbles, like chemotherapy, to treat these lymph nodes”

Elf is an emergency general surgical audit where we have assessed frailty in all older adults undergoing emergency surgery. Death rates are high in this group where little research has been performed. With publication imminent we hope that frailty scoring is the first step to improving patient outcomes.”

One other area of research interest is in prehabilitation. She says: “We don’t do this well, especially in relation to weight and nutrition. In the benign setting, we usually send patients away to achieve a target safe weight by themselves. I suspect this rarely works. In the cancer setting, we do not have time to reduce weight significantly and work has shown that we don’t really address this afterwards either.”

“Your own health habits provide insight into different approaches that can help guide your patients. In addition, if you don’t have this conversation with your patient who is going to? As surgeons I feel we have a responsibility to look at the big public health issues – low activity, bad diet, obesity – that are only going to cause future problems. You wouldn’t dream of not addressing smoking so why not the other lifestyle factors?

“That lifestyle changes start at time of any diagnosis in the NHS. They need to be addressed at first point of contact then lead into programmes to help and motivate patients. We are starting this in RAH where a lifestyle clinic will run alongside colorectal clinics. Patients will be seen there and an individualised programme developed according to their needs and diagnosis. This will be pre-op and post-operative to ensure the message is clear.”

Susan always makes clear to each person – otherwise known as each patient – that “you can do anything in your life with a stoma.”

But she is blunt with her simple steps to success: “Day one – time to move out of bed!”

Susan emphasises that physical “has to work alongside psychological. Clearly physical activity can help some mental health issues so they are not disparate entities.”

But as the conversation drifts into every medical corner possible, a sudden turn of chat arises unexpectedly. There is still one pressing personal touch which is discovered and that is there is still a dream in Susan, one in which she pictures herself in a different life, a different role. Every so often, asked what she would have become if she had not grown into a medical expert, she answers without a breath:“An artist.”

And suddenly – with the medical world dramatically forgotten – it’s a conversation from Cezanne to Raphael and anything in between.

And with the quieter thought of the artistic world – and with it many questions for a future interview left unanswered – its time to leave the sweat-house gym. With the heartbeats working overtime and the voices now inaudible with exhaustion, it’s time to call it a day.

After a final word from the author, Nicola Dames:

“In simple terms, I just had to meet and interview – in a real life situation! – Susan. I first had the pleasure of hearing Susan talk at the Cancer Information day held in the New Queen Elizabeth Hospital two years ago. I was inspired immediately by her wit and how she presented to a large group of men and women living with/battling Cancer

I waited until everyone was gone, to corner her and get a chat in! Since then, I’ve had the great pleasure of getting more involved with research with Susan and her colleagues, so it was only a matter of time before I could get a proper interview in, to allow others a peek of who is behind Susan Moug.”

Thank you Susan for you being you!