October 16, 2014 by Ana To Athlete

Sesamoid Update – 1 year on

“At some point you need to stop making a comeback and start running towards who you are meant to be next” – Lauren Fleshman #womanup

Hoorah for beating the odds – once again!

Sesamoid fractures have a pretty serious reputation for not going well. There is little evidence-based research available for treating practitioners on best standard of care, and even when that has managed to be achieved, they tend to be slow to heal and long to recover from.

Being a Physiotherapist and knowing all of this information, I was shaking in my boots a little at what I was staring down the barrel of just over a year ago now. Compound that fear with the knowledge of what I had done to my foot (doing an Ironman on a stress fracture is not something I will ever do again…), along with my history of poor-ish bone density thanks to a decade of Anorexia, and I was pretty much crawling with my tail between my knees into that surgeon’s office and pleading with him to save my life. Ok, dramatic…but running IS my life, my first love, my sanity and makes my soul happy. So NOT running again was simply not an option.

I am happy to say that even with the odds seriously stacked against you, with a great medical team and some serious dedication to a long and conservative rehabilitation process one can come out the other side flying. Once I got to the point where surgery was the only option left – 8 months of conservative treatment already tried and failed – I had to make a choice. I had to put my big-girl panties on and suck up the situation; there was zero time for feeling sorry for myself and about 24 hours a day to dedicate to doing an awesome job of this rehab process. As discussed in previous posts this included everything from sleep to nutrition to Physio – and most importantly, a great medical team: a brilliant sports physician who understands my passion for running as well as my medical history; the best foot and ankle surgeon in Australia; and a sexy Physiotherapist (OK that was my husband so I may be biased….but it probably helped the treatment come along….!!).

Which brings me to the now. My surgeon was clear and stern with me from the start that it would be a 9-month rehab process before running would even begin, and 12 months before my foot would be adapted to what we had done to it: bone grafting the sesamoid plus breaking, elevating and plating the 1st metatarsal (dorsiflexion osteotomy) to take load off the sesamoid underneath it. 8 weeks in plaster non-weight-bearing was followed by another 8 weeks partial weight-bearing in a boot; then a very gradual increase in walking and loading the area. When I was in plaster I was doing a lot of Pilates, strength work and all-importantly, resting and eating well. My arms got pretty buff at this point – crutches plus strength work= guns!! As soon as I was out of plaster I was into the pool. Initially not allowed to deep water run, but I was allowed to swim if I used a pull-bouy and didn’t push off the wall with my right foot. This made me feel about 100% more human just being back in the sun and in the water again, even if it was limited. Towards the end of that 8 weeks in the boot, I was able to start deep water running and freestlye swimming (kicking). Then came the fun part.

The “real” rehab began once I was walking more and out of the boot. My right calf muscle was over 3cm smaller than my left at this point…I had a lot of work to do. Not to mention adapting to my new biomechanics – the first time I stood on my right foot, I felt like I had a marble under my 2nd metatarsal! Now a lot more of my weight would go through that bone rather than the 1st metatarsal/sesamoid complex, and so I had to go slow to allow the bone to adapt – it’s common at this stage to get stress fractures in the 2nd metatarsal if rehab is too aggressive, due to the increased load. I was allowed to start cycling (using carbon-soled bike shoes so the toe doesn’t bend) at this stage.

Due to my job being so physical – Physios are pretty much on their feet for 8+ hours a day – it would be another month or two before I could introduce any extra walking outside of work, which was frustrating. This was (mentally) probably the hardest part – not being ‘disabled’ any more, but feeling like you’re not actually working towards running either. My patience paid off and once I was able to walk for exercise, things moved quickly – at 7 months post-op, I was walking 30mins every other day with minimal swelling and less than 2/10 pain (ie. Acceptable pain levels given the surgery I had)….which meant I was allowed to jump on an Alter G treadmill and start running, 2 months ahead of schedule!

My surgeon was very strict with the Alter G protocol to follow. I started with 50% body weight for 20mins at just 10km/hr. This felt easy as my fitness was pretty good by now from the swim/bike/deep water running routine; that was a key part of this stage going so well. Over the next month I built the AlterG sessions up to 40 mins at 70% body weight including intervals, allowing me to build some speed and rhythm in. I had the luxury of having my husband and Physio accompany me and give me feedback on biomechanics and technique – it was like getting used to running on someone else’s foot! It felt very strange. I will be forever grateful to my sports physician for making access to an Alter G so available to me; not everyone has the luxury or the joy of this.

At 8 months I was given the green light to start my road running return program, which was also very conservative…it started with 30 minutes walking with 8 x 1 minute run throughout. But I was the happiest person on the planet! I kept up the Alter G sessions for a few more weeks just for my sanity more than anything else – it was still a novelty and better than drugs being able to push myself again (from a cardiovascular perspective), plus the fitness boost it gave me was invaluable and transferred beautifully onto road running.

I was slowly building week by week and up to running 5-10km, 3-4 times a week when we got pregnant this time around….and so I have maintained that level of running over the last 5 months, and will continue to for as long as I can into the pregnancy (I’m now 5 months along and 4kg up). Ironically, the extra relaxin hormone boost from the pregnancy has allowed me to get my full flexibility back in the foot post-op and so running feels better than ever! This could have taken a year or more to achieve without relaxin. I can honestly say now that I don’t even think about my foot anymore – it feels “normal”, strong and functional.

Of course, I am missing racing immensely – between the surgery and pregnancy, it’s been almost 2 years since I’ve raced an Ironman and I cannot wait to get back to it. I am hoping to do an Ironman about 10-12 months after the baby arrives; it would be nice to go back to Busselton where it all went down in the first place and get some unfinished business out of the way!

What I have learned about Sesamoid Stress/Fractures:

– Get a health care team on board that KNOWS WHAT THEY’RE DOING. Search for someone who has experience with treating sesamoids; if your GP/Sports Doc/Physio/Podiatrist does not, then call around until you find a team that does. Don’t be afraid to ask upfront.
– Use an MRI for diagnosis and follow-up progress scans. XRays are not sensitive enough and bone scans are not specific enough. The cost is worth it to know what you are dealing with.
– You need to be aggressive – from day dot. These are typically not super painful injures (well nowhere near a femur or sacral stress fracture – of which I’ve had both – hence being able to finish an Ironman on it without realising), and so they can be deceiving. But you need to take them very seriously, as hard as this can be early on,
– From the moment of diagnosis you should be in a boot; either partial-weight bearing or full weight-bearing if pain allows – needs to be <2/10 pain at all times.
– Use contrast bathing or ice/heat protocols – 20mins of each, 1-3 times a day, to flush swelling and increase blood nutrients to the area.
– Give it TIME. Prepare to be in the boot for 8-16 weeks. Yikes! I know….but trust me, this option is much better than having to go through surgery. Sesamoids have poor blood flow and don’t heal well, but if you treat them like gold from the start you will give it your best shot at healing conservatively.
– Statistically, following the above protocol, 50% of sesamoids will heal and 50% will not (at 12-16 weeks). It depends where the break is, what the blood flow is like, and how well you rest it during this time.
– If you are a serious athlete, love your sport, or have a job that requires you to be on your feet, think about getting a referral to a very experienced foot surgeon early in the process. They typically take a couple of months to get into, and it doesn’t mean that you will have to have surgery – but if it’s a slow healing fracture, they will give you an all-important educated opinion on your time frames, options and prognosis. You can always cancel the appointment if you’re going well, but it’s hard to get an urgent appointment if and when you do need it so plan ahead!
– If you do need to go ahead with surgery, ask the surgeon how many sesamoid stress fractures they have treated and how they have gone. You want the most experienced surgeon with good long-term outcomes ie. Return to full sport pain-free.
– Avoid removing the bone at all costs. Unless it is completely shattered, a good surgeon should be able to either bone graft, pin or shave off part of the bone to salvage it. A foot without one or both sesamoids is, biomechanically-speaking, a disaster zone for arthritis and injuries and is not very conducive with a future running career!
– Further, if you do need the surgery, plan it well and be prepared for a long haul. Be ready mentally and physically to put in the hard yards from a rehab perspective (exercises, pain and swelling management, and lots of rest…), but even more so be ready to be patient from a psychological perspective. There is no point going through major surgery only to rush it on the other side.
– Be rest assured that with a good surgeon, and an even better rehab protocol (think slow-and-steady), you CAN and WILL return to your old athletic self. It’s possible you may even come back stronger after all the time spent with rehab and core strength work, and in my case, biomechanically improved because he fixed the 1st metatarsal angle at the same time, decreasing my chances of getting the injury again.

Currently sesamoid injuries are highly misunderstood by the medical profession and usually by athletes as well, but over the next decade I believe there will be huge improvements in understanding and treatment from medical professionals. In the meantime, those of us who have walked this path beforehand can hopefully shed some light, advice and much-needed hope that there is indeed light at the end of the tunnel!

Happy Training

K xoxo

July 30, 2014 by Ana To Athlete

Pregnancy and Eating Disorders

How do you rattle a Type-A control freak with a history of Anorexia and a love of exercise? Shower her with morning sickness and extreme fatigue, and watch her world unravel….

Challenging would be an understatement for the last couple of months of my life. My previously well-controlled little cocoon that I know as my life, with routine, structure, and an all-important sense of controlling what is happening to my body, has been dismantled for the best possible reason. But the fact that there is a little person growing inside me only manages to give me glimpses of fleeting happiness amidst the 24-7 nausea, vomiting, and extreme fatigue. I know that this will improve once the sickness eases, and I cannot wait to feel as though I’m floating on clouds with happiness about our little human growing day by day in my belly (and, well, just to be able to eat something – anything – without vomiting would be great too!).

Coffee won’t be happening any time soon!

Throughout the challenge of the last couple of months it has taken all of my strength to maintain some semblance of a healthy lifestyle and body in which to house my little person. This surprised me. I am well into recovery and haven’t had a relapse for quite some time. And aside from anything else, my Psychologist has always been adamant that the best cure for an eating disorder is to get pregnant. I did question him about this one time, to which he elaborated that we of the selfless kind tend to be able to eat for someone else but rarely for ourselves. And also that suddenly we have no control over what our body is doing and so there tends to be some relief in the fact that there’s not a lot we can actually do about that for once. Then I questioned him further about after the baby comes out – when relapse rates hit a spike – and well turns out that’s another story, but we won’t go into that right now…. I do know that it took me a good 5 years after recovery to truly believe that I was ready to start a family. Of course, the fear of the weight and body changes scared me. But it was actually a much deeper fear that stopped me from wanting children: I was petrified that if I had a daughter or son, they would have Anorexia one day too. And that was something my heart just couldn’t cope with. It took a very long time of sorting through that with my psychologist before I felt more confident that I could do everything in my power to prevent that from happening: the genes I pass on I can’t change, but the environment of the child I most certainly can. And will.

I guess the hardest part for me currently is that I am acutely aware of trying to maintain the healthiest possible food intake and exercise program, and keep stress levels low, laugh a lot – all the things a little human needs to grow happily. But when every smell – from perfume to food to drinks – bothers you and every meal and snack is a massive psychological and physical event to get through, well it’s like being thrown back into the recovery ward. To make matters worse, despite my best efforts to eat enough I am losing weight, and this plays on my mind as well. I desperately want to be healthy, and yet there’s this voice that is happy about not getting “too fat, too soon”. I know I will put the weight back on and then some, and I know that losing weight in the first trimester is common when you have severe morning sickness, and I also know that the baby is happy as Larry inside despite how I’m feeling out here in the Real World. But it still bothers and confuses me and I really didn’t expect to have so many mixed emotions around this magical event.

My best management strategies have involved getting plenty of sleep, because everything seems so much more distressing when you are tired. And incidentally, so is Morning sickness (aka 24/7 sickness). I have also found it helpful to try to do some form of exercise every day. This has been a big one for me….my goal after my foot surgery was always to be able to comfortably run 5-8km when I finally got pregnant. Catch 22: my fitness is at that level, and so is my foot, but it’s managing the nausea and tiredness that’s been the hard part. Being flexible is not easy for me, but I’ve had to learn to pick my battles and get outside for a little run/walk when I feel the least nauseous. It’s good for the baby and it’s good for my head (much better than sitting on the couch moping about how I feel). I can’t swim or bike right now, because of the body positions making me more likely to be sick, so gym work and running it is. And I have to be OK with that. I can’t control everything. And that is extremely hard to say as an Ironman athlete and former Anorexic.

My heart goes out to anyone with a history of Bulimia, I can only begin to imagine how difficult the initial stages of pregnancy must be with the challenges of extreme hunger, accompanied by frequent vomiting. I have only ever been a restrictive anorexic and I am certainly finding it a monumental challenge. Not being able to keep up my normal training routine is hard enough – I love my early morning sunrises over the pool, my bike sessions with our squad or my husband, our local Roadrunners every Saturday. I miss the physical but also the mental aspects of that. And racing….I really miss racing too.

Tragedy….I haven’t even been able to handle the smell of baking!

I follow a few Ironman athletes on social media who have recently become new Mums. Two of them “accidentally” did an Ironman or two while pregnant, without realising. I regularly think of this while I’m battling through my 5km run at a very slow pace, fighting waves of nausea, and feel like I just completed an Ironman marathon – How did they not know??!!! I am baffled. But you have to laugh and realise that in the end, every body, and mind, is so different.

For now, I am focusing on daily survival as best I can. “Lucky” for me, I have had experience with battling food and weight and so I have an army of strategies to help me through this tough patch. I am looking forward to the magic as well as the challenges to come. I’ve had a lot of time to think about coping with a changing, growing belly; how to be healthy afterwards (ie not relapse); and all the amazing things that come with this process. But as I’ve just discovered, I’m sure nothing will be as it seems on the surface – so bring on the next challenge….it’s going to be an exciting 9 months and beyond.

K xoxo

May 8, 2014 by Ana To Athlete

Exercise and Recovery

I’m going to be a little controversial with this post. I’m going to suggest that for a large majority of ED sufferers, recovery would be best done while they maintain their work or school, and for athletes, their training.

Before everyone gets riled up about it, I am not talking about those so severely undernourished that they are at risk of dropping dead from a massive heart attack at any minute, or those with suicidal tendencies….clearly an inpatient program would be best for these patients (at that stage in their recovery, even if those programs for the most part keep people alive but do not really assist in long term recovery and have notoriously high relapse rates….but that’s a post for another day). I am talking about the majority of ED sufferers who are under their individual ideal weight (note I did not say “under BMI 18” – how ridiculous, what about the person with a bigger frame who is still starving but able to maintain a BMI of 21? Are they “less sick”? of course not), are still participating in work or school, and particularly those who are athletes and see that as a part of their identity. I’m talking about the people who are functioning in society, but are significantly affected day to day by their eating disorder – maybe with the accompanying depression, lack of energy and concentration, fatigue, social isolation and the other joyous side effects.

Here’s why. Think about this: What is the biggest challenge in recovery? I would argue that one of the hardest parts about recovery is learning to lose the “ED” identity and to learn who you really are as a person. Only once that has occurred can one begin to truly move on with their lives and to want to nourish their mind and body. Only then do they have a sense of self to take care of – a reason to recover, if you will. For recovering for someone else, or to get out of Inpatient care, or for the sake of a “goal weight”, will never do it. That typically leads quickly back to a relapse and the cycle that entails.

Inpatient care, while necessary to sustain a life on the edge, takes away all the other factors in the patient’s life that will be the foundation of their true identity as they return to health: their job, their hobbies, their social network, and for athletes, their training and usually tightknit support crew – coaches and fellow athletes. Not only does it take those things away, it actually forces the patient to focus 100% of their time and energy on the eating disorder. Their days are spent focusing on food, psychology, analysis, resting, scales, and usually the added bonus of in-house competition between patients on who is the “most sick”. Statistically, success rates aren’t good – the weight is temporarily gained, yes; but in the long term, recovery rates can be as low as 20% for patients who have had an ED for an extended time period. The statistics have not improved even after a few decades of treatment in this way. Why not?

At some point, the patient needs to learn how to function in society in a healthy way, and for this to happen there needs to be a reason for the patient to want to get better. Want being the key word here. When an athlete-patient is allowed to keep training, albeit at a reduced load, there is an all-important reason for them to put in all the hard yards day to day that go with recovering from an eating disorder. There can be clear goals and rewards: you gain X weight, you get to train X amount. You eat X foods, you get to attend X training sessions. If you don’t, you can attend but you have to sit out and watch. Sure, it’s harder to gain weight while still training. But guess what? Eating like an athlete is hard, full stop. Years on I still find it a challenge day to day. When you train hard, you have to work even harder on fuelling your “machine” (body), and the sooner a patient gets used to that process the sooner they can master it. Secondly, gaining the weight as muscle, bone density and fat via increased food and some continuation of training is much healthier and less traumatic for the patient than gaining fat alone on a resting protocol. Lastly but most importantly, there are three overwhelming psychological benefits to this approach:

1) the motivation-reward system is clear and immediate;

2) the social interaction with teammates and coaches is maintained, which is so important;

3) the patient is nurtured through the process of minimising their ED identity and replacing that empty space with their “healthy athlete identity”. {You can replace “athlete” and “training” with anything else relevant – student and school, physio and work, etc.}

The key to this process is to have a fantastic support team who can facilitate this transition. For me, it was a brilliant Sports Dietician (it was her idea to allow me to keep training – every other rehab program I had entered forced me to rest and spiral into depression), a brilliant Psychologist who specialises in treating athletes with eating disorders, a Coach who was on board with the plan, and a flexible workplace (I was still studying at University but my part-time job as a research assistant allowed me to set my own work hours, so I could go in when my energy levels were highest – early in the morning). For the most part, my dietician set out my goals for the week and my rewards – when and if I could train etc. All the while she communicated with my psychologist, who from the get-go has focussed on establishing my identity as an athlete. As he reminded me recently, I have always done best when we focus on what my body can do (as an athlete), not how it looks. All body fat % and weight measures were taken away from me, and replaced by more relevant measures like time trials and power outputs. And the only way I can get stronger, fitter, faster, and keep up with my teammates? To eat. Simple as that. I know when I skimp, I fall behind, and as a competitive person, that is motivation enough to nourish my body.

The best part is that the system WORKS. And it’s not just a bandaid fix – it works in the long term. To this day, years on from the start of my “recovery”, I still have a crappy day at work, feel “fat” as my go-to coping mechanism, and then know that if I go and do a solid training session, by the time I walk back through that door at the end I am going to be happy with my body and what it can do for me. Nothing to do with how it looks or what it weighs. Simply what it can do. And that’s pretty cool. Add in the extra bonuses of a good training session – fresh air, endorphins, improved fitness, mental clarity, relaxation – and it’s a win-win situation.

I make it sound easy and like the obvious solution, which for me, it was (obvious, not easy!). Nothing else had worked over the decade beforehand. And certainly this system wouldn’t work for everyone either, but for athletes, I would argue that it is the best way to structure treatment. Realistically, there needs to be a change in the way we treat eating disorders in Australia as the current inpatient systems are not working in terms of long-term outcomes and relapse rates. There is no easy answer.

Food for thought anyway.

Happy training xo

April 14, 2014 by Ana To Athlete

Our Body Responds to the Messages We Give It

I have a friend in Brisbane who has just taken up Ironmans, which I am over the moon about. At first glance, she has all the right ingredients to make a solid long course athlete: she’s tall, muscular, mentally pretty tough and she has the support of her family – her husband also does Ironman triathlons. And boy does she like to train.

Before her first Ironman she was understandably nervous, and wanted to skype with me to pick my brains about a few things; I was more than happy to help out. I had a lot of fellow Ironman athletes take me under their wing when I first started out, and along with my coach I felt extremely well prepared going into my first race and subsequently had a great time. I was excited to be able to do the same for her, and so I wrote down some key nutrition, pacing and training concepts that work well for me (mainly female-specific things).
So you can understand my shock when no more than 5 minutes into said skype date, she blurts out “well of course I’m only doing Ironman to keep my weight under control – for the same reason you and every other girl does it!” she laughed. I was not laughing. I was actually trying not to choke on my espresso.

SAY WHAAAAATT??!!

Firstly, let me get this off my chest. Ironman is sacred. It is a place where you go to search the depths of your soul, to find out what you’re really made of in a way that daily life just doesn’t allow for. It is a celebration of the human body and mind, of the incredible things it can achieve. It is a magical place with a finish line that feels better than ecstasy. And when all is said and done – the months of discipline, the long, long rides with fellow athletes who become friends, the many memories made, the body chiselled and honed, the mind strengthened and the self-confidence firmly built one brick at a time – you become part of the “Ironman Family”. And THAT is what Ironman is about. Nothing short of a celebration of life in all its glory. Amen to that.

My second thought was “oh boy you are going to crash and burn in a big way, you’re doing it for all the wrong reasons”. (I didn’t say that out loud….). I do Ironman to celebrate my recovery, and to be around a couple of thousand people who don’t make excuses about why they can’t do things, they find a way to do things and be happy and loving and I am addicted to the joy and self-confidence that Ironman has brought to my life. I now respect my body for what it can do, NOT what it looks like or what the number on the scale is. It’s not an exaggeration to say that it has saved my life, by taking me away from Ana and onto richer pastures. I can’t believe how amazing this body now is, and also feel ~~mortified~~ sorry for the things I have done to it in the past.

The third thought – and this is where the scientific nerd within kicked in – was “you’re not going to lose weight by doing what you’re doing, if that is your goal….”. She refused to take any nutrition other than water during any training sessions, scared that it would make her gain weight. Then she would try to restrict her calories during the day as well, to try to cut more corners. (Subsequently I am sure) she hated long rides because….well….she probably felt like crap, running on empty! Not surprisingly, she had a few niggles that she couldn’t settle and she wasn’t able to push the training up to the next level.

And sure enough, after her first Ironman, she didn’t enjoy the experience. She was too focused on trying to keep her weight under control, and stressing about not training in the couple of weeks after the race.
Here’s the thing. This may come as a revelation to non-athletes and to Anorexics, but our body responds to the messages we give it. If you starve yourself, it learns that food is scarce out there in the world and it better slow down its metabolism and store fat for the long cold winter (we still have the same DNA as our hunter-gatherer ancestors, remember). It learns that it better prioritise only the essential life-giving functions, like breathing and brain activity – so those niggles don’t heal and the muscles don’t repair from the hours of training. Minimal training adaptations occur, so you don’t really get fitter either, you just keep breaking down. Not to mention hating the training because, well, you never really feel good! In the short-term or if you get extreme about the starvation yes, you will lose weight (hello eating disorders). But eventually that weight loss slows down. And I can tell you from personal experience that after 10 years of it, your metabolism becomes very smart and very thrifty. I could go days on minimal food and not lose any weight. My body just knew it had to conserve to keep me alive.

On the flip side, if you train hard, and fuel your body, it will get the message that you want it to become fitter and stronger, and that since there is plenty of food around, it’s therefore safe to make those adaptations. You’ll lose fat, and gain bone density and muscle. Your mental health, sleep and mood will improve. You will have more energy through the day. And on race day, you will perform well and likely also enjoy yourself and the experience (which is the whole point, right?!).

Matching shoes and nails: check…

And then the best part of all is the famous post-ironman “afterburn” phase, which lasts between 1-4 weeks depending on your metabolism and fitness and genetics. This is where you pretty much eat whatever you like, do minimal exercise, and lo and behold – you get leaner. It’s hilarious. Your body is working so hard to repair everything, and it’s still zooming from the 12-hour race, that if you feed it with A LOT of food, you will then set it up beautifully for the next phase of training and racing (or just life in general if you so choose). BUT if, like my friend, you decide to hardly eat anything at all after the race, you will actually halt that process and force your metabolism to really, really slow down. Your body is madly trying to repair and recoup, and if you don’t nourish it now, you will set it up for an ever slower metabolism and, unfortunately, you will likely actually lose muscle and gain fat. Which is what happened to my friend. And so the cycle continues, as she has signed up for the next race in order to “control her (now higher) weight”…..

I know it’s hard to get your head around the fact that eating more could result in losing weight. It certainly took me a long time to believe it. I tried it as a one-woman experiment and took all my measures weekly. Sure enough, over the course of 6-8 weeks I got leaner, stronger and my performance and recovery were better than ever (read: I was kicking my husband’s butt in training). The key is to keep the food as nutritious as possible, and to eat most when your body needs it most – before, during and after training. It still feels odd for me to do that, but it’s worth the mental discomfort in order to now feel like an athlete.

As a final disclaimer, I’m not saying that there aren’t people in Ironman who have eating disorders and abuse the system, and I’ve talked about this in previous posts. But they aren’t the ones succeeding in the long term. They’re the ones you see at one race, who look super fit and fast, but who end up walking the marathon because they have no fuel or endurance. They are the ones who, after 1 or if they’re lucky 2 years in the sport, you never see again. Or the ones who are one big chain of injuries one after the other – they never line up on race day 100% healthy. And they certainly aren’t the ones with the sparkle in their eyes, who will still be doing it when they’re 60 years old. Now those guys are the real superstars!

We all have one body in this life, and we all have a choice. We can nourish it and let it flourish to its true potential, or we can cut corners and watch it struggle.

I choose life!
Happy training.

K xo

March 10, 2014 by Ana To Athlete

When all else fails, Bake.

Hormones rule the World…ok I get it, I GET IT!

It’s been a pretty stressful last few months, which largely stems from the fact that I am once again faced with the ever-challenging issue of learning to trust my body.

After having a miscarriage 4 months ago, my body has decided that it’s going to do its own thing, regardless of whatever I am choosing to do. Despite zero change in my food or exercise, I have been battling an influx of hormones presumably stemming from the miscarriage. My previously flat stomach is now decidedly curved and my breasts have gone from a small B cup to a large C cup. Initially I thought that this would level off over time, but it seems they are here to stay – at least for the time being.

Tiffany’s-inspired Chocolate Cupcakes. I dare you not to feel uplifted!

It’s brought all those recovery memories flooding back. The overwhelming feeling that you are drowning in a sea of change and you don’t know when the wave is going to stop pummelling your body against the floor of the ocean. It’s also a bitter pill to swallow: that I would not only lose my baby, but that I would lose control over my body as well. My doctor reassures me that it’s a good thing, that my body is trying to set itself up to become pregnant again (which is what I want more than the world). My psychologist says that I should focus on the positives, like having amazing breasts – my husband has certainly had less trouble than me focussing on this one – and that this will not last forever. But for me, it’s all been downright confusing. Just when you think you truly know your body, know what it likes, know where its set point is, have come to accept a certain size as being healthy for your frame….it all gets thrown to the wayside. I can almost hear God laughing.

Once again it has reminded me that hormones do, in fact, control the world. Or at least our sleep, mood, emotions, fat deposition, curves, weight, fatigue and ultimately, fertility…. So what to do? The only thing I know how to do: make sure I am taking the best possible care of my body and mind and trust that it will settle into itself, wherever it is supposed to be. Which means, for me, cutting out caffeine and alcohol, eating A LOT of fruit, vegetables, good quality protein, nuts, seeds, good fats, and of course steering clear of gluten (I have Coeliac disease, as an aside, which does put me at a higher risk of miscarriage along with a history of Anorexia. Oh the joys.). It also means focussing on nourishing my body with activity that brings me joy and relaxation, namely running, dance, Pilates, group rides and swim sessions with my husband. Not because I have to do a set session or hit a predetermined interval; simply because my body can and it makes me happy. That is an important distinction. It means getting at least 8 hours of good quality sleep a night, and actively trying to relax during the day – deep breaths at work, 5 minutes of meditation when I get the chance, and laughing a lot. And of course, when all else fails, it means baking – the cheapest and best therapy of all.

Death by Chocolate: Chocolate Mousse Layer Cake with Chocolate Ganache

I’m not sure that I will ever be able to accept that I cannot control what is happening with my body. Ultimately, your body will change at various stages during your life, and there is very little that you can do to stop that – short of being unhealthy and falling back into eating disorders patterns, or conversely, saying “stuff it” and allowing yourself to become significantly overweight, which is not healthy either. It is well established in the research that your body has a “set point” – a range of about 5 kg, that it will defend at all odds. So just like in recovery, when you have to trust that you won’t keep gaining and gaining indefinitely; I too have to now trust that if I nourish my body and treat it well it will do what it needs to do to create the optimal environment for baby-making and health. I can’t change what that shape ends up looking like on me, but I can change how I react to it. I am faced with a choice – to reject the change and stick to everything I have known up to this point, or to embrace that I do not have control of what is happening and to learn to love my body, no matter what form it presents in. After all, I am still the same person inside.

It’s going to be a challenge, but I’m pretty good at overcoming those.
Keep on keeping on fighting the Good Fight. This one is going to be tough.

“When doubt seeps in, you got two roads, you can take either road. You can go to the left or you can go to the right and believe me, they’ll tell you failure is not an option. That is ridiculous. Failure is always an option. Failure is the most readily available option at all times, but it’s a choice. You can choose to fail or you can choose to succeed.” – Chael Sonnen

K xoxo

February 13, 2014 by Ana To Athlete

Insecurities

“Step out the front door like a ghost into the fog
Where no one notices the contrast of white on white

And in between the moon and you, angels get a better view
Of the crumbling difference between wrong and right

Well, I walk in the air between the rain
Through myself and back again
Where? I don’t know”

– Round Here, Counting Crows

Please read the following scenarios and choose the most correct answer:

1) You are an elite female triathlete with the following stats to your name: two sub-9hour Ironman finishes, <12% body fat and arguably one of the fittest bodies on the planet. When asked your weight in an interview, would you:

a. Tell the truth – your body is a weapon, your job, and a beautiful machine and you are proud of it!
b. Take off 5kgs from the true amount; you think you are ‘heavy’ with the muscle on your frame and your height.
c. Refuse to answer.

2) You are an athlete who has had an eating disorder in the past, you are now recovered but do not know your weight. You haven’t been able to run for 6 months due to injury, but have the chance to run on an Alter G treadmill that your sports doctor has arranged. In order to use it, you and your doctor will find out your weight. Do you:

a. Get on it – to hell with my weight I am desperate to run!
b. Agree to use it as long as you don’t need to find out the weight, then proceed to have a meltdown about it anyway, fearing that your doctor will think you’re the most obese athlete on the planet;
c. Gracefully decline. You are desperate to run, but the trauma of going through being weighed is just too much.

What would you do?

WA Ironman 2009

Impossible scenarios like this face us day in, day out, when we have the tracks of a previous ED in our scar tissue. We may be doing well for the majority of life’s intricacies, but there will always be situations like the above that will either get our blood boiling, or mentally challenge us more than is desirable (I don’t think it’s considered “normal” to have a panic attack at the thought of someone else knowing your weight….).
The first scenario makes me so furious that it sends me searching for my soapbox – in fact, I did send a huge ranting email to my good friend and doctor about the exact situation. I have been in the fortunate scenario to be on a squad alongside professional Ironman athletes for the last few years, and some of the best female triathletes on the planet to that end. Our head coach boasted more sub-9hour females on his squad than any other coach worldwide. It has been incredibly insightful and for the most part beneficial for me to be able to access their wealth of experience and knowledge and to apply that to my own racing and training.

But it doesn’t come without some serious eye-opening of the bad kind. Over the years, as you get more “well”, your triggers become so much more obvious. Racing has always been one of my biggest triggers – lining up on the start line in little more than some loud flimsy lycra is one thing; having that then photographed and marketed back to you in the eschewing weeks is truly disconcerting. No-one looks good in lycra, just putting it out there. The males who don’t have eating disorders love the race photos because they look so buff and muscly; the females – ED or otherwise – hate the photos for the same reason. I continue to race because for the most part it heals my soul. I’m good at it, and so it builds my self-esteem and creates an identity other than “anorexic”; in short, the risk-reward ratio is in the right place for me.

What I have learnt, however, is that disordered eating is rife among these professional women. They are not immune to the pressures; in fact, they feel it more than most.

Which disgusts me. Here you have 5 of the fastest, fittest, most incredible female athletes on the planet, all with bodies which would make any human proud. Their bodies are their livelihood, and to that end are serving them very well. Their self-confidence should be oozing; success is practically their middle name. And yet, they feel the need to lie about their weights, ashamed by the number on the scale.

What does that mean for the rest of us?

What message does that send?

Fast forward to scenario II, where I get this amazing opportunity to start my return to run training 3 months ahead of schedule following my foot surgery, thanks to the Alter G treadmill purchased my sports doc…..and yet I baulk. Frozen. Panic sets in. I know it means being weighed, and for someone who has just had 6 months off normal training, that is paralyzing.

But why should it be? I weigh 5kg more than the average of those 5 elite females put together – their real weight, not the one they put down on our team bio page. I am healthy, lean, fit and carry as much muscle as a good Ironman athlete should. Yes, I’m a few kgs up from my race weight, but that is OK too – because I am not race-fit right now. My body is as it should be right now, and I would like to be able to “own” that.

In the end, I guess you could call me a hypocrite. It upsets me that those women feel the need to lie about their weights, and it saddens me that that will send a very wrong message to young impressionable athletes coming through. It’s as if we are expected to achieve the impossible: to have muscle and minimal fat, and good bone density, and yet to weigh in at featherweight. Consider who is setting these expectations, and whether it is a sad modern extension of the female bullying epidemic, insisting we be perfect and able to do-it-all and yet so ruthlessly judging one another for how we all look/dress/work/live/parent…..the list goes on. I can tell you that my doctor, who is a male, didn’t give two hoots about my weight. And you rarely hear males bitching about their fellow mates, judging how they live their lives. Food for thought.

My plea is for female athletes to start “owning” their beautiful bodies. Be proud that you weigh a little more than your unfit ~~skinny~~ counterparts because you actually have muscle tone. Be proud of what your body can do, and how far it has come. For those of us who have climbed from the dark depths of an eating disorder, also be kind and forgiving – for your body has been through so much more than you will ever know, and every day it wakes ready to heal a little more and to help you to keep fighting the good fight.

Never forget that. Own what you are, and be proud. Starting a revolution starts with one tiny step, and you just never know who you’re inspiring by how you live your life.

K xoxo

January 6, 2014 by Ana To Athlete

The broken. A Survival Guide.

Part II:

So you’re fractured – body and brain. You want to scream at the world and pull your hair out and cry, simultaneously. I get it.

In the previous post I introduced the concept that perhaps it is essentially the mind that causes stress fractures in the large majority of athletes, moreso than just the body failing, as modern medicine would have us believe. Specifically, the sheer force of power that is that voice in your head that will not allow the body to stop, even when presented with increasing physical pain. We are a smart bunch; it’s not like we don’t know that something’s wrong and it’s getting worse. It’s just that stopping is infinitely harder than pushing through a little physical pain. Hell, sometimes the physical pain feels good – euphoric even – like you are fighting the beast in a different way. And yes, the pain of a stress fracture is “little” in comparison to running 35km after not eating much for a few days….there’s levels of relativity and most of you here have an abnormal sense of ‘perspective’ when it comes to matters of human suffering. I wish it wasn’t so, I really do.

Sometimes the beast wins, and you find yourself in the doctor’s or physio’s office with a full-blown stress fracture or major overuse injury, which essentially you did to yourself. Yet another kick in the guts. Facing down the barrel of 6-12 weeks off your beloved sport, you feel the red rush of hot panic bubbling up from the fracture site and seeping into your heart. Staring at the image of a clear break on a clear scan, suddenly the pain feels so much worse.

What now?

There are hundreds of well researched and accessible texts on gold standard treatment protocols for stress fractures, ranging from stopping running right through to the extreme of surgery, depending on the site and severity of your injury. But there are very few resources written on coping with the emotional and psychological backlash of injuries, much less if you also have an eating disorder or disordered eating and you are now faced with the removal of one crutch – running (emotional) and the replacement by another crutch (literal).

1) Take time to digest the news and go through the stages of grieving, so that you can recognise what you are dealing with. If possible, have a close friend or loved one with you to help with the support and to remember information. The average patient only retains 30% of what is said to them during a medical consultation. Even better – write it down. The doc won’t mind.

2) Embrace the “Athlete Mindset”. The fact that you are in this situation means that you are dedicated enough to your pursuit of excellence that you are already in the top minority of athletes. BUT….you need to learn when that line is approaching and how to not cross it in the future. Allow yourself to recognise your best traits (discipline, commitment, passion), but also to define what you would like to work on in the future (the strategies in part I – prevention; listening to your body; allowing yourself to rest and letting go of some of that perfectionism….). Your “training” now is recovery. That is no.1.

3) Get some Sun. It’ll help with the bone healing thanks to its Vitamin-D inducing properties. It will also assist with depression, appetite and most importantly it will get you outside into the fresh air.

4) Ensure Social Contacts. It’s more important now than ever to make sure that you stay involved somehow – whether that be with group catch-ups after training, going to training or dance class and assisting the coach or teacher, keeping up with dance or running magazines. While it seems counterintuitive, this can actually help you to keep the “athlete mindset” and to help with staying on track in order to achieve bigger goals in the future.

5) Create a different outlet. Use your emotions as a guide. Do what makes you feel good; steer away from things or people that make you feel more down or frustrated. Be aware of being pulled towards bad habits – they can be strong and start sneakily. Tune into your emotional radar early when it’s slightly easier to resist.

6) Develop a nutrition plan. And stick to it. Most notably:

a. Avoid regular and diet sodas due to the bone-leeching phosphoric acid contained in these liquids.

b. Reduce caffeine intake, ideally to less than 2 cups a day. Caffeine also leeches the skeleton of calcium, critical when the bones are in healing mode.

c. Avoid alcohol, which can induce a pro-inflammatory environment and affect absorption of important nutrients in your food. Aside from this, it is a depressant so probably not helpful on the brain given the current situation.

d. Maximise sleep, as this is where your largest surge of growth hormone occurs – crucial for healing and mental health as well. Talk to your doctor about this if you are struggling, which is common when you are used to expending so much energy on a daily basis.

e. Most challenging of all….keep the focus on nourishing the body with high quality foods, now is not the time to diet or restrict food groups. Keep in mind that healing takes up a huge amount of energy. Accredited Sports Dieticians are very experienced in this field thanks to the high injury rate in elite athletes – and yes, you can totally book an appointment and request a meal plan to maintain your current weight while injured, whatever that weight may be. Even if they suspect you have a phobia of certain foods or a controlling personality, they will respect that and all information shared is legally confidential.

7) Most importantly, give yourself permission to rest and heal. If you cannot give it to yourself, ask your health professional – whether it be your dietician, psychologist, physio, doctor or even a friend or loved one. The most weighted words you can hear are “you are not allowed to exercise with this”. You have permission, to just heal. That is your number 1 job. There will be plenty of time once you’re back on your feet to concentrate on training; for now, the more you rest, the faster you will heal.

Of course, it all sounds so practical and easy when it’s neatly typed out on a page. It won’t be – it’s going to be hard, much harder than the physical pain of the initial injury or the discipline of full training. But if there’s one thing that’s certain, it’s that with no plan at all, things will likely slip downhill fast on the sliperyslope to ED-land. You will have a much harder fight on your hands in the mental department during your down time, but it is worth fighting for and you will come through the other side a stronger, better, more passionate athlete. In my younger (Ana) darker days I had a tibia stress fracture which I couldn’t (mentally) stop running on, eventually I ended up in a cast. When the repeat XRays were done at 8 weeks there was zero evidence of healing, mainly because I had been stressing and severely restricting food during that time and had consequently lost a significant amount of weight. Yes, that can happen. Don’t muck around with it – the psychological setback is so much worse the longer it goes on.

Stay strong, fight the good fight, and learn from your experience so that you can come out fighting.

K xo

December 23, 2013 by Ana To Athlete

Multiple Choice Questionnaire

Multiple Choice:

Please read the scenario and choose the most correct answer from the list below.

You randomly wake with your head in a fog, suddenly your work pants feel two sizes too small and you feel approximately 6 months pregnant with a food baby. You:

a) Acknowledge that yesterday your clothes fitted fine, and that it is likely just fluid retention or a case of flash insecurity and you refuse to panic;
b) Decide to take the “logical” objective approach, taking your measures to compare to yesterday and determine that it is, in fact, a large exaggeration from your mind’s eye;
c) Throw your entire wardrobe on the floor and begin to throw a tantrum, hating the world;
d) Think “fuck this, I’m not eating (indefinitely)” and feel the calmness warmly ooze over you knowing that you are going to be just fine…..
e) All of the above, in any given order.

I’m going to propose another option, option (f): The Two Day Rule. Given that the majority of us out there will indeed pick option (e), probably several times over, and put oneself at the risk of the relapse-merry-go-round, we need a set strategy for days like this (good tune, Van Morrison).

Give yourself two more days. 48 more precious hours. You’re not having to be so strong that you’re defiantly pushing Ana to the curb, you’re just gently turning your back on her for a couple of days. You only need to be strong for two days. All you have to do, is just keep on keeping on…..give the body nourishment, just like you did yesterday. Baby steps (meal-snack-meal-snack-meal-sleep repeat x 2). One foot in front of the other. Don’t go and punish yourself with a 3 hour training session. Head up, face the world. As a random side note, I find it helpful on days like this where your self-confidence is about the size of an ant, to utilise the self-affirmation “fuck you, world!”…..for no reason in particular except that it gives me the strength to leave the house, face other humans and pretend to be normal….and sometimes provides for some humorous self-talk while walking down the street. Fake it till you make it, or something like that.

Then on day 2, you can reassess. Chances are, your soul has gathered that ounce more strength to fight; your body gained that much needed fuel to cradle to mind through the dark room and out into the glorious sunlight. You’ve probably managed a few moments of clarity, sane thought, objective reasoning, realistic assessment…..hopefully all of the above.

And it becomes much easier to flick Ana back to the dark room where she belongs. Don’t let the Wrecking Ball win; fight the good fight.

Two days. You can do it.

K xo

....note to self: when faced with a bar full of Moet, do not drink yourself into oblivion, tempting as it may be.....

….note to self: when faced with a bar full of Moet, do not drink yourself into oblivious, tempting as it may be…..

December 13, 2013 by Ana To Athlete

The Importance of Nothingness

“Normal is an illusion. What is normal for the spider is chaos for the fly.”

The Importance of Nothingness:

The ability to sit still with oneself in a non-anxious state
And truly be present in the Immediate Moment.

A ~~heartbreakingly~~ very difficult ability to learn, for us…

And yet perhaps the ultimate Yardstick to one’s true sense of Mental Health.

Can You be content in the company of You?

K xo

December 8, 2013 by Ana To Athlete

Here comes The Fighter

“Only a man who knows what it’s like to be defeated can reach down to the bottom of his soul and come up with the extra ounce of power it takes to win when the match is even”. – Muhammad Ali

Today, I ~~commiserate~~ celebrate the half-way point of my foot rehab journey. 4.5 months since the surgery, 4.5 months until I can run again.

Never before have I yearned for running, the first and longest love of my life, so fiercely. When I was running competitively at university, I had a beautiful old man of a coach who was in his 70’s (and still running…) and had been coaching distance runners for most of his life. After thrashing ourselves and giving 100% of what our hearts had to give at any given session, we would warm down and joke and laugh amongst the group. When all was said and done, he would look at me with those wise wrinkled eyes and say “I have never met someone who loves running like you do”. In my youthful naivety, I used to laugh at him. But right now, if you asked me to choose between running and my husband – my two grand loves – well I’d have to think about it! I’m joking ~~sort of~~.

Early days….

And yet, never in my life have I found it so hard to keep the “athlete mindset”. Not as in, screw training why bother. As in, screw rehab I want to go run, PRONTO. I want to get back to racing ~~weight~~ fitness, PRONTO. Hell, I want to race, and feel the best pain in the world. Not rehab pain. Not idle resting pain. Or surgery pain. Just the deep, all-encompassing fantastic pain of racing. I want that. And my heart yearns so extremely deeply for it, I feel a black hole that can’t be patched back up.

And God knows all too well that I am not patient. Ironic given all those years of being a patient. I suspect this may be God’s way of testing me….so that I learn patience. And so that I learn the most valuable lesson of my life to date: I am an Athlete. I am no longer Anorexic. Or an Athlete with an Eating Disorder. Facing the surgery, all those months ago, I remember with clarity driving home from the surgeon’s office crying, desperately hoping, but desperately fearful that I could not do this. I could not do this, without Ana. This was going to be the hardest test of my “recovered” life.

And in these last weeks that have passed, I cry again – because I know I am there. Throw vulnerability to the wind, I’m fighting the good fight.

There you are. I finally found you.

K xo