Pregnancy, Dual-Athlete Households and Ironmums

Yesterday marked a new low point in my Pregnancy: throwing up in the middle of the foodcourt of a very busy shopping centre. Yup, that happened. No warning and obviously no time to run to the bathroom. The running commentary in my head was quite comical, from the “Oh God this is actually happening” moment through to “thank God I actually look pregnant now, not just like some super prolific Bulimic…” (LOL). At 7 months, you’d think one would have stopped throwing up, but apparently this little bubba is a strong one on the hormonal front and having a laugh causing mum lots of embarrassment!

Top 6 female finishers at Ironman Western Australia, 2014...plus Wynne

Top 6 female finishers at Ironman Western Australia, 2014…plus Wynne

In other news this week, my new hero Beth Gerdes – Professional Ironman athlete and baby-mumma to 6 month old Wynne – whipped around the Busselton Ironman course in a PB time of 9 hours and change, clocking one of the fastest marathons of the day in under 3 hours….all while dad Luke McKenzie (also a Pro Ironman athlete) and Wynne cheered her on. I’m not going to launch into the politics of Feminism, but I will say that as a member of a dual-athlete household where I am actually the better Ironman athlete of the two of us, this made my heart swell.

I get so sick of people assuming when we go away to Ironman races that I must be the “wife” that goes to dutifully cheer on my husband. And let’s not forget that he doesn’t get out of it scott-free either – the heckling from his mates when I beat him down the finish chute of an Ironman is ridiculous. But I’m lucky enough to have a husband who is both manly enough to not let that phase him, and who is also super proud of my athletic achievements and happy to defend me – like he says, if I’m in front of him then it means I’m having a great day and that makes him happy (he’s beaten me a few times too, but on the current score card I win…..and the last one I beat him on, I had a broken foot for the marathon, so he’s not living that down for a while….!).

Anyway back to Beth and her superhuman effort. I’m not advocating that the mere mortals among us who balance a day job with training loads shoot for the goal of an Ironman PB 6 months post-partum, but this is her career and it’s her “normal”, and I am hugely proud that her partner Luke is so publicly supportive of her getting her career back on track after Wynne’s arrival. They’re not the only example in the Ironman or distance running world either – thank goodness over the last 5 years we are finally starting to see a host of female professional athletes supported by their partners returning to full time sport, with happy healthy little bubbas to cheer them on. I have been a one-woman study nerd in following their blogs through pregnancy and beyond, and have used a lot of their guidance in deciding how much exercise I am happy safely doing throughout my pregnancy, and also in setting a realistic race goal post-partum for myself (which includes an Ironman one year post-baby arrival, not 6 months – I have a business to run and as it’s my first child, and Ironman is a great love but not my source of income, I want to prioritise enjoying my time with the baby and not to feel rushed with the training). If you are interested in more from these amazing ladies, my favourites include of course Beth’s blog (California Training), and the blogs of Clara Peterson, Lauren Fleshman, and Steph Rothstein (the latter two come complete with photos of what REALLY happens to your body after baby….fascinating stuff!).

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As for my plans on returning to racing after the baby arrives, I’m finding that once again, reactions of those around me tend to reflect their own insecurities about things. My closest friends and family think it’s great and are super supportive; others are surprised and like to add a snide remark about “focusing on the baby” or “oh well, just see how you go with that” – with an added glint in their eye like they’re really trying to say ‘good luck finding the time/getting your body back to that level/you’re about to lose your whole identity because you’re becoming a “Mum”…..Of course my life is going to change, and I’m so excited about the next chapter with a new person front and centre and the added challenges that come with that. But I also want to set an example for my son or daughter that I am still an amazing, strong, independent woman and an athlete, as well as being a great Mum. Not to mention the travel experiences and awesome family atmosphere at triathlons in this country that our new addition will get to be a part of – seriously unreal!

The stunning Botanical Gardens in Queenstown, NZ.

The stunning Botanical Gardens in Queenstown, NZ.

On a deeper (ED) level, having a big Ironman race looming one year post-partum is also a protective thing for me. It’s long enough that I won’t feel rushed at all with preparation, but not too long in that it might interfere with when we try to fall pregnant with a sibling for this little one. But the biggest factor is it helps me to stay on track with eating and training once the baby is out, which is the “danger zone” of pregnancy for those of us who have had an ED from a relapse perspective. Even though I have maintained a healthy weight for 5 or so years now, I have still found the pregnancy body changes quite confronting, and have fears about the post-partum period. It’s hard to ignore the statistics on relapse rates. But I do know me, and I know that I have beaten the stats to recover after a decade of Ana; I also know how to pull my head out of a relapse phase in the earlier stages and in my case, it’s by focusing on running or triathlon (and in this case, producing breastmilk too) – which means being healthy, not skinny.

When I have a big race goal, I am focussed on being 100% healthy and strong – no nutrition short-cuts, and the focus is off weight and onto performance, which has in the past worked perfectly for me because the better you eat, the better you perform and the happier you are. I fear that if I don’t plan any big races, the focus will too easily slip back to losing all the baby weight or worse, the number on the scale….and it’s a slippery slope from there. On the flipside, I also feel as though if 100% of my focus is on the baby, then I will fall into the trap of having to be the ‘perfect’ Mum, and that’s a dangerous game to play as well – from a postnatal depression point of view.

The weekly baking for work - well fed Physios are happy Physios!

The weekly baking for work – well fed Physios are happy Physios!

As always, balance is key….. with a side of preparation, and communication: these are things that I have spent many, many hours discussing with my psychologist, husband and to a lesser extent, dietician, in the hope that I can be as prepared as possible and to minimise the overwhelmed and isolated feelings that can come with motherhood. With less than 12 weeks of baby-growing to go, I’m feeling very ready for this next exciting stage of our lives!

Happy Training xo

What I’ve learnt from being Injured (and it’s not what you think)

Mountain biking in New Zealand about 6 months post-op. Probably wishing I was mountain running instead, but not a bad option B….!

We rarely come away from life’s challenges having learnt nothing. How we propel in the aftermath of major setbacks can be the major shapeshifter in our lives, and indeed in who we become as people thereafter.

I am finally at the point where I’m fairly comfortably through the trauma of what we shall call the “Everest” of my injury history. If I were to sketch a visual of my colourful history, it would look like a scattered flow of 13 stress fractures, starting at age 12 in relatively non-important locations and then escalating into some more heavy terrain as my eating disorder and distance running career progressed, finally reaching the peak at doing an Ironman with a stress fracture in my foot at age 29 and subsequently ending up needing major reconstructive foot surgery and a total of over 12 months off running. I can confidently say that that will be my peak, as I have finally, definitively, learnt how to respect my body. Which brings me to the 2 (yes, only two, but they’re BIG ones) things that this last 18 months has taught me:

1) Respect your body – you only have one (Yep That Old Chestnut)

Love it or hate it, your body is the only one you’re going to get. Sure, a surgeon can plate and drill you back together, but ultimately the bones and healing capacity that you have is still dependent on just that one body; you don’t get a new one just because you treated the old one like a rental car.

During the worst of an eating disorder it’s near impossible to comprehend or love your body, such a minefield is your brain at the time. And certainly, it’s something that I have really struggled with well into recovery – which is going on over 5 years now. It’s funny how it sometimes takes something so huge as threatening my ability to run and race – the loves of my life – to really “get it”. I guess in the aftermath of your eating disorder, those early months and years are spent just trying to survive the new life that you’re supposed to embrace – the daily climb of having to face food and weight gain, doctors, dieticians, psychologists….it’s all so much to cope with at the time. It’s often only years later that you can look back with some perspective and truly see what your body went through, and indeed how blessed you are to now still be standing here. Able to run. Able to love, and laugh. Able to grow a baby from scratch. It’s truly remarkable, what the body can come back from.

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Eventually the trauma ends, the memories get softer and we get back into our routines….and then along comes a “choice point” in life. I had one of those a fortnight ago. After having a good few months of pain-free and enjoyable running, I started feeling an all-too-familiar pain in the butt….well, my right sacrum (tailbone) to be technical about it. I’ve had two stress fractures there in the past, so I know what it feels like. The fact that I’ve had two, indicates I failed to learn from the first one, as with most of my injuries up to this point. However this time was different: I was able to use my “logical” (Physio) brain, take a step back and assess the pros and cons of continuing to run on this. For the first time ever, I was able to take a week off running, knowing that it was the best thing for me because I want to be able to run not only after the baby arrives in a few months, but also when I’m 60, or 70 years old. And my poor sacrum has already been beaten up enough. So even though I hated having a week off running now, in the long term, it was the best thing for me. And sure enough – my efforts were rewarded: I was able to go back to my 5km run yesterday morning with minimal butt pain. Seems so trivial, but such a huge step for me – in all my years of life, I’ve never yet been able to not just keep “pushing through”. I am finally confident that going forwards with training and racing, I will be capable of making the right decisions, rather than living in fear of what I know I can do to myself. The thought of training and racing injury-free seriously excites me. I have a plan, devised together with my “moral compass” aka my husband, on how I will approach training and racing coming back from this surgery and after the baby arrives in March. I know I have posted some awesome results in the past being tired, injured and generally unbalanced, so I am itching to see what the future brings. Bring on the post-baby running and Ironmans!

Hamilton Island - hiking up that hill at 7 months pregnant was totally worth this view!

Hamilton Island – hiking up that hill at 7 months pregnant was totally worth this view!

2) Enjoy the mundane routine of life – it is truly a blessing.

This is the big one. The surprise I got out of going through this surgery and the months of healing and rehab after was how much we take for granted the routines of our lives. Never before have I appreciated so much the simple acts of being able to walk, sleep, work, drive, cook dinner, do the washing up, hang out clothes washing, water the garden, and not to mention walking my dogs in the sunshine – that’s like ecstasy! The “daily routines” that I used to think got in my way of being…well…busy/productive/important/useful, I now see with a completely different light. Being in plaster and unable to do much of anything independently gives you a fair amount of time to think about these matters. The thing is, what we fail to realise while we get tied up in our own “busy-ness” and in seeming important all the time, is that the majority of our lives are, in fact, made up of us doing the daily routines. They are life. And if we can truly learn to appreciate how blessed we are to be able to have the health and the homes to do those ‘chores’ every day, then the daily grind suddenly becomes more magical.

As a pleasant secondary offshoot to this, this new appreciation for the simple things in life has translated into being able to be still, and just be with “me”, for the first time in my life. A big factor in eating disorders is that inability to relax and enjoy the quieter moments in life – for so long, I was fearful of weekends or holidays, and always had to plan every moment. I’m still not great at it, but I am much, much better. And it’s just so lovely to be able to take a big sigh of relief and know that everything will be OK with the world if I am just still for a little while.

Every experience in life – good or bad – can be a blessing in disguise if we can learn from our experiences. Sometimes this takes time, so be forgiving and gentle on yourself, especially in those early stages of recovery. You are a champion just for embracing the fight of a lifetime and let me promise you, it will all be worth it in time. Life truly can be a beautiful thing.

K xoxo

Even looking at this photo is hard....early days post-op.  Never again!

Even looking at this photo is hard….early days post-op. Never again!

Sesamoid Update – 1 year on

oct c 2014

“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….!!).

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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.

Oct E

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

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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!

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!

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.

tattoo and white rose

K xoxo

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.

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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.

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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.

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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

The Broken: A Survival Guide Part III

Right now, I am at the point where my foot is essentially 95% healed, and I’m ramping my running back up.

Cue music: “Highway to the Danger Zone”……

You see, this is the magical moment where the bones are healed enough to need adequate loading in order to reach full strength and function. This means running every other day (yippee!!), but crucially it also means having the discipline to not overdo it. And to listen to my body. And put my pride and perfectionism to the side.

This is, in many ways, the hardest part. It’s the part where I have to test my growth over the past 9 months. Have I really become more patient? Stronger? Less perfectionistic? More realistic? Hell, will my body even remember how to run, let alone with decent pace or technique?! And then the toxic seeds of doubt creep in: what will my fellow runners think of me now? What if I’m not good enough? What if I never get back to where I was before I broke my foot? Will I ever beat my husband in an Ironman again?

Of course, it’s highly likely I will come back stronger than before, will continue to kick my husband’s butt in many an Ironman to come, will have learnt a boatload about myself and my body and most importantly, learnt how to train more efficiently and with less risk (cue Britney Spears: Stronger. Yep, I went there). This is my “logical voice” talking. But we all know, that illogical voice is the one that dominates when we have been out of the loop for some time.

Hiking in NZ with my better half

Hiking in NZ with my better half

Two weeks ago, I readied myself to go to running squad for the first time in over a year. It’s a super friendly bunch of runners who I have trained with throughout all my Ironmans in the last 5 years. Saturday mornings are usually a sociable 8-12km group run, with coffee afterwards. There is a front pack, of which I’m usually a member, and then there’s everything back to a 5km jog/walk group. In all, we have about 50 people turn up, so it’s not like I would be lonely.

Only I chickened out. Why? Because according to my return to run program from my Ortho, I still have to walk 2 minutes for every 8 minutes of running. And, I knew I wouldn’t be able to stop and have the discipline to walk when everyone else was still running. And my pride didn’t want the slower runners to catch up (there I said it. I may be the world’s most competitive person). A week later and I decided to try again. I took off at decent pace with a largish pack, and I did manage to stop and walk when I was supposed to. It was harder than getting through an airport on crutches, I’ll tell you that much. My heart and soul just wanted to keep on running!!

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Whether you are getting back into training after an injury or after an eating disorder (or both), the hardest part is often sticking to the plan. I know from coaching beginner run groups that the three aspects of training that “normal” people struggle with most are 1) motivation; 2) fitness; and 3) being able to mentally push themselves. This is not the case for athletes or those of us with the ED birdy on our shoulder. These are some strategies that have helped me over the last couple of months:

1) Front and Centre: How Far You’ve Come (and how quickly it could go wrong). Its human nature to compare yourself to others, and even moreso for uber-competitive athletes like myself. There’s a bunch of people you used to be faster than lapping you around the park. But that’s OK, because they don’t have a metal plate in their reconstructed foot. They haven’t walked every step of that hard road to recovery. When the temptation to push yourself overwhelms you, it’s important to remember how broken you were and how quickly you could return there (ie another stress fracture or overuse injury). Sometimes fear can be a very good motivator! Write it on your hand, stick a photo in your wallet – whatever it takes, a not-so-subtle reminder is key.

2) Plan Ahead: The Insecurity Factor. As a flip side to point 1, remember that we are all humans and we do all have our own story and our own journey. When that little evil voice starts sprouting doubts in your mind, squash the insecurity by fighting back with basic logic. Those runners know what you’ve been through, know what kind of an athlete you are, and really couldn’t care less that you are running slower than you used to. They’re more than likely impressed by your motivation and determination, not judging you for your pace. They’re likely happy just to see you back at squad. Or they may not have even noticed that you’re not as fit as you were (you’d be surprised how remarkably un-observative “normal” people can be, really….you’d be shocked….not everyone can recite what the whole table ate at lunchtime and what times they ran on the track for the last 4 years….that’s a very unique trait!).

3) No Negotiations. Even if you feel like Paula Radcliffe today. Any changes to the plan MUST be pre-approved by your Physio/sports doc ahead of time. As with any rehab program, you have days where you just float like a butterfly….and days you feel like an elephant. Just enjoy the fact that you feel great, cherish every step, and know that if you stick to the plan, it’ll be that much sooner before you get to have another great training session. If that fails, revert to point 1.

4) Focus on how Amazing Your Achievements Are. And celebrate them. Who cares if your old training buddies smashed out 10km in sub-40min pace? YOU just did 36 minutes of quality running, and you had the discipline to stop and walk, and your technique was great, and you are coming back from major foot surgery, and you get to be outdoors in the fresh air running…you get the picture. Gratitude is the best emotion on the planet. Use it to your advantage. Write it in your training diary. You’re doing awesome. Repeat.

5) Enlist a Training Buddy who is on board. Does not have to be of the human breed. If you are going to squad, suss out who is about your pace at the moment or perhaps also coming back from injury. Or grab a friend who is willing to do walk breaks with you. My favourites for this are my husband and my dogs, the three of them are always whinging that I run too fast normally so they are happy for the walk breaks – much happier than I am!

6) Nutrition: ensure that you are adjusting your eating plan for the increased exercise load. You need to be eating for training, recovery AND healing – the triple threat. Bones have a lag time of about 3-4 weeks with increased load, so when increasing run kilometres it is best to have a training week that is about 50% of your normal current load for that week, to let your bones catch up and get stronger. Push over that and you may find another stress fracture. So if you are up to running say 40km a week, on the fourth week, stick to 20km and you can add some walking or cross training. It’s an annoying but foolproof investment, and any running coach on the planet worth their salt will stick to this plan for injury prevention. You’ll actually come out the other side feeling fitter, as your body will have “absorbed” your training up to that point and feel fresh again. Bonus!

7) Get a Hero or Two. Professional Triathlete Jesse Thomas actually broke his foot during Wildflower triathlon 2013 and subsequently had surgery about a month before I did the exact same thing. He has blogged about his rehab, the highs and lows, and I have found it hugely helpful following his progress along the way. His wife Lauren Fleshman is also a great role model and her blogs are highly entertaining for any athlete who has faced injury or childbirth and beyond. As a side note – be wary of Ironman athletes claiming to be recovered from their eating disorders. There are a lot of them around who hide behind “Ironman/triathlon” as their excuse to continue with disordered eating patterns. Chrissie Wellington’s book “A Life Without Limits” is probably one of the worst so don’t go there if you are still recovering. Same goes for any running or ultraendurance bio if you are recovering from a running injury – it’s like motivation on steroids to go do something really stupid!

I hope that helps! The journey back to health can be a long and lonely one, especially once you get towards the end and on the surface everything looks fine. Stay strong and remember how far you have come. Most importantly, reward your body for the amazing job it has done by nourishing it and letting it bloom into its full potential. It will serve you very well if you treat it right.

Happy Training xo

From Rehab to Racing

8 weeks post-foot surgery, happy to be out of plaster and trying to stay positive...

8 weeks post-foot surgery, happy to be out of plaster and trying to stay positive…

I flew today.

Well, it felt like it. 6km run at good pace with minimal foot discomfort, able to find my rhythm for the first time since July 2013. Excited much?! I was smiling from ear to ear for the rest of the day!

It’s been a huge challenge, a very long 9 months, and the biggest mountain I’ve had to climb in my post-ED life. But I can finally see the light at the end of the tunnel. Today I entered two 5km fun runs, and an Olympic Distance Triathlon which I will do as a team (as my surgeon is not giving me the green light to run 10km at race pace just yet!).

Still a long road to another Ironman finish line but every day is a step forwards

Still a long road to another Ironman finish line but every day is a step forwards

So what have I learned along the way? Patience. Something I never had a lot of before. I’ve learned how to apply my discipline to my rehab like nobody’s business. That applied effort has allowed me to return to running 2 months ahead of the schedule my surgeon set out for me post-op. In fact, when my psychologist was warning me about the danger zone I am currently in (given my raging exercise addiction, it was a fair concern!) – I reassured him “don’t worry. I am treating my rehab program just like I once did Ana – I am aiming to be the “perfect” patient, which includes following the program to a tee, eating every nutritious food I can get my hands on, and doing every recovery strategy that is validated in the research – compression, ice, physio, you name it.” I’m not sure he 100% approved of my approach but was nonetheless impressed by my creativity and my insight into my personality characteristics (well, they weren’t going to go away just because my foot got cut in half and I couldn’t run for a while, let’s face it. May as well make use of them).

Full steam ahead: back on the bike and loving the training!

Full steam ahead: back on the bike and loving the training!

So, as my coach would tell me, it’s “onwards and upwards”. Every day is another opportunity to “practice perfection” – every stroke on the bike, arm turnover in the pool, step on the run, and weight in the gym, all tiny building blocks that will one day form the strongest Ironman body I’ve had yet. Every new day is another chance to be thankful for my health and my happiness. To breathe in the fresh air and feel alive.

I don’t believe in luck, but I do believe in Karma. And I am grateful for the chance to rebuild my body and to live life to the fullest.

Happy training everyone!

K xoxo