The Space Between

“When we ski the trees, the trick is to focus on the spaces between, not the trees themselves.  The lines we choose are defined by our fears and our confidences, and when these are out of balance, when our fears outnumber our confidences, we lose the ability to find the spaces between the trees.  We lose our rhythm.  This goes for life, too.

My wife has anorexia.  She’s struggled with this all her life, but recently – to keep the analogy rolling – she smacked into the trees.  She’s struggling to find the spaces between.  As her partner, I’ve struggled to keep her moving through the forest.  At times, I’ve guided her into trees too dense for her to navigate.  What appears to me as an open glade of old-growth aspen, to her is a tangled mess of icy deadfall.

But I must keep my partner from becoming lost completely.  I’m responsible for her safety, and she for mine.  I can point out the spaces, but I can’t expect her to ski them as I would.

Rhythm, when skiing the trees, is as important as finding the spaces between.  The two are interlinked; one cannot exist without the other.  At speed, it’s easy to decide which way to go, which space to pass by and which to pass through.  With each turn is another decision in a rhythm that repeats itself over and over again; turn after turn, flowing from space to space.  I struggle mightily to find good lines these days.  Skiing much too slowly to find any rhythm, I’m forced to stop short – to hunt for a new space in woods that only seem to grow more dense.

Skiing the trees, there are no guarantees, no timelines: only expectations.  It’s not certain; I only expect my partner and I will find our rhythm again, and we’ll flow from space to space as easily as we once did. Momentum is everything.  We’ll gain momentum, and though it doesn’t always lead to the spaces between, stopping leaves us no choice but to stare at the trees”.

  • James Foukes, Backcountry Magazine

 

 

 

Can you laugh about it now?

Then she pulled at my stitches one by one and looked at my insides clicking her tongue, and said ‘this will all have to come undone’  And doesn’t that sound familiar? Doesn’t that hit too close to home? Doesn’t that make you shiver: the way things could’ve gone?

And doesn’t it feel peculiar, when everyone wants a little more?  And so that I do remember, to never go that far, could you leave me with a scar”

– Missy Higgins, Scar

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So this last week I did something very mature, facing up to some things from my past and not burying my head in the sand about them. I was in an accident when I was at university, which basically involved me stepping out right in front of a bus in the middle of the Brisbane CBD…. I don’t actually remember from about 20mins before the accident to the whole two weeks I was in hospital. I had multiple fractures (skull, jaw, ribs, shoulderblade), torn hip labrum and some pretty gnarly road rash from hitting the bitumen. Everything healed, and life moved on….but now that I’m getting older I am finding that I’m having to face up to some of the consequences of that accident, likely confounded by my long-running relationship with Ana during that time which would have affected how well my bones and body healed.

My husband – who doubles as my physio (friends with benefits haha) – has been at me for some time now to get follow up scans done on my neck and left hip just to see how they are looking and whether we need to be concerned in the long run, since I am determined to be doing Ironmans or at least running until I skid full throttle into the grave at some point, hopefully a ripe old age. My neck still bothers me and the hip catches a lot, but neither of them stop me from doing anything right now.

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Cutest little bum you ever did see

So I went and visited the sports doctor who managed my foot injury a couple of years back, and he organised the scans; today I went back to discuss the results. We work with him a lot on a professional level as well – I consider him more of a friend than a doctor and I feel like I can talk openly to him about my past. My little mini (my 9 month old son) was with me, charming everyone left right and centre. We were making small talk about who he looks like and somehow got onto talking about genetic traits….and how one side of my family is full of eating disorders and mental health problems. Then we got on to talking about the actual accident, how it happened and the forces involved so that we could discuss the pathology together. I joked “so yeah, I stepped out in front of a bus. And no, before you ask, I wasn’t drunk or suicidal….but I probably hadn’t eaten for a week so I may as well have been!” then laughed it off, because that’s what I do.

And then he asked “can you joke about it now?”.

“What – the bus accident or the anorexia?!”.

“No, the eating disorder”.

I paused. “That’s a very serious question!”, I said again attempting to laugh it off.

He waited for a serious answer.

I thought about it.

“Well, I guess you have to laugh about it, right? Or else you cry about it. It’s one or the other. Why do you ask?”.

He replied that in his experience most people never get to a point where they feel ok talking about it. I still don’t feel comfortable with it, that’s for sure. But I do know that while that part of my life is now safely fairly hidden (since we moved from Brisbane 7 years ago I strategically don’t tell anyone…it’s nice that people here don’t know that part of my life and gives me a sense of freedom from their judgement about my body), it’s also important that there are a few people who I can turn to when I’m struggling. Dr C is one of those people. Two close girlfriends; my coach; and my husband are the others. And I guess when push comes to shove, I don’t really know that laughing about it is a healthy response.

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Preparing for my Ironman comeback one year post pregnancy, two years post foot surgery.

There’s nothing funny about anorexia.  It destroyed my mind, my body; took away my childhood and leaves me with a very deep pit of anger that bubbles only millimetres away from the surface (it does not take much scratching to delve there). And yet here I am, living an amazing life, at a “healthy” weight, and considered “recovered” (whatever that means).

But the scars remain and I can tell you that the voice of Ana never goes away…even after all this time I could flick a switch and go back there in a heartbeat. I don’t want to, because I have so much more to lose these days – my husband and son deserve so much more from me and I want to be fully present to experience all the happiness they give me on a daily basis. I don’t want to allow Ana to steal my ability to be present in those moments and replace that with anxiety about the next meal, the next opportunity to burn calories, or the number on the scale.

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BUT. And there has to be a But. I don’t know what other way to cope and to move forwards than to be able to face each day, give it my best, and be able to vent by joking about Ana to my “inner circle”; precious people who I know go way beyond judging me on my body weight or my scarred past. I still have to talk about the heavy shit (for one of a better description) with my psychologist on a fairly regular basis, which inevitably results in tears, slow progress and home truths…so I guess for me this is a way of processing all that went on and attempting to repackage it in a way that is more palatable. I have other friends from treatment who I’m still in touch with, and more still from around the world who I have connected with since recovering. Many of them never talk about their ED pasts except to fellow sufferers. Some go above and beyond to hide their history from everyone, denying anything. More still are what I would consider “partially recovered”, masquerading behind a healthier BMI but almost as neurotic as they ever were about their food and exercise consumption. A rare few are strong enough to cope with recovery by flipping it on its head and going fully public about it in the hope to help others who are struggling too. I don’t feel like I am bulletproof enough to do that; there still needs to be that barrier of anonymity there for me when going about my daily life not as a “Recovered Anorexic” but just as me, who used to have an ED but doesn’t any more. Especially with my job as a health professional. And still…when I see patient of mine, friends or even strangers walking down the street so obviously going through the hell of an ED, every cell of my body wants to run straight to them, hug them and take away all the pain. But I know I’m not the right person to do it, and I would not be strong enough to resist the pull myself.

 

So on goes life.

 

I’m not sure what the correct answer is but for now, “Yes, I Can Laugh About It”. I can also cry about it. Revert back to it for hours, days or weeks at a time. Flirt with the line in the sand between “recovered” and “disordered eating patterns”. And especially, I can be pissed off about it, mainly for the family issues that still exist and trigger me off so easily (case in point: during a 5 day stay with my parents recently I managed to lose an impressive 4kg…and I wasn’t even trying). I can be ashamed of it. I can be in denial about it. I can wish it never happened.

 

But above all, I have to be stronger than it, and to rise above it, and to ultimately think that it has made me who and what I am today. And for that, I have to be thankful and at peace.

 

Onwards and Upwards,

K xo

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Weight Loss During Pregnancy

So it’s safe to say that pregnancy hasn’t been anything like what I expected it to be. I’m not going to harp on about the gory details of severe morning sickness that lasts for 40 weeks because it’s very rare and most people will never experience the ‘joy’ of it, at least for that length of time. What I will focus on, is how amazing the human body is. And how little control you have over this whole amazing journey of creating a human from scratch.

The Dude or Dudette's room, finally ready to go.

The Dude or Dudette’s room, finally ready to go.

In the first trimester, I lost weight. No surprises there, I was vomiting so much I was hospitalised. In the second trimester, my body really came into its own: I gained weight like a trooper, with an aim to eat as much nutritious food as I could get down and keep down, and my baby grew like a little champion. In the third trimester, the vomiting and nausea returned with a vengeance and I have been losing weight again. Remarkably, the baby continues to gain weight – proof that the human body is simply incredible in just “knowing” what to do throughout this whole process. It’s now officially “baby month” as the baby is due to arrive any day now….something which is extremely exciting and equally frustrating for a control freak like me!

WHEN is “D-Day?” Such a simple little question. Thoughts race through my head about when it could be, where I will be (hopefully not at work taking a Pilates class!), what it will be like. I can handle the excitement of not knowing the sex of our little bubba, but not knowing when it will arrive is a huge challenge for me. I feel like I’m in the final days of preparation for an Ironman, only I don’t know which day I’m actually going to have to pull it all together to perform….

Control freak aside, I know I will cope with whatever labour throws at me when the time does come; know after everything I’ve been through that I am strong enough for that. I can’t wait to become a “mother”, and to meet this little person who’s shared the toughest 9 months of my life with me.

Birthday Cake: despite my nausea, I couldn't break my annual tradition of making myself a cake and eating some of it.  It wasn't much, but that's a win!

Birthday Cake: despite my nausea, I couldn’t break my annual tradition of making myself a cake and eating some of it. It wasn’t much, but that’s a win!

What scares me is the presence of Ana, ever there perched on my shoulder and nattering away its useless voice. Every time you get weighed at the Obstetrician’s office. And you’ve lost weight. Or gained weight. Every time you think about life after pregnancy – returning to racing, eating (normally, without vomiting…), running. Breastfeeding. Every time you see your body in its ever-changing state (why aren’t there any stretch marks there? Is that even possible?!). And of course, all the unknowns about how you and your body will be afterward. I put a lot of the uncertainty down to being so sick for so long, which invariably makes you dread eating food but forcing yourself to do it anyway. In some ways, it’s like being in recovery all over again. And then when you LOSE weight despite all the effort to keep some nutrition down, it’s like an extra factor messing with your head.

I am all too aware that statistically, the postpartum period is a high risk one for ED relapse. And that those of us who have had ED’s are also at higher risk of postpartum depression and anxiety. I’m concerned that I hear the little voices of Ana already planning “when the baby is out we’ll….[insert damaging behaviour here]”. I guess I somehow thought that by being all-absorbed with the love for the little person inside of me, there would be no room left for those thoughts. I was wrong.

I feel like pregnancy does make you strong enough to fight those thoughts and do everything in your ability to nurture the child within; my question is, what happens to that force once you are no longer carrying the baby inside of your body?

My hope is that the strength will carry over. Ultimately, that little person, whether inside of me or out in the big wide world, is relying on me and only me to be its whole world – at least for the start of its life. It’s still me who has to feed it, love it, care for it. And I can’t do the best possible job of that if Ana is taking up any significant real estate in my head. I also like to tell myself that after everything I have been through in the past few years, if major relapse was going to happen, it would have happened already: if major foot surgery, 18 months away from my beloved running, and 3 miscarriages doesn’t push you over the edge I think you can stand tall and be proud of where you have gotten in your recovery.

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I’m choosing to focus on my “strategies” and all the positive things to come, rather than the fear of relapse and Ana returning. Those strategies include having races pencilled in, so that I can feel like “myself” again in the not too distant future (it has been the longest time since I have raced an Ironman, fit and healthy, and I cannot wait to do it as a ‘Mum’ with my husband and baby cheering me on). And focusing on new friendships: up until this point in my life, I feel like I have friends who knew me as anorexic, then when we moved here 5 years ago, I formed a heap of new friendships with a clean slate – mostly triathlon-related friendships, and those people have no idea about how much of my life Ana took up. And I like it that way. But I have been missing spending time with a lot of those people with the reduced training that comes with surgery then pregnancy. I am excited to meet yet another bunch of friends through mother’s groups etc, and to start the next chapter in my life. I’m excited to blend that with my return to racing and hopefully have the best of both worlds: new mum, and Ironman comeback Queen. I’m blessed enough to have had a number of amazing women pave the way before me (see previous post on elite athletes and motherhood) and show me that not only can it be done, but you can actually come back even stronger.

Bring on 2015: New baby, new (stronger) body, and a long-awaited return to Ironman!

Happy Training,

K xoxo

My gluten-free Iced Vovos...presentation was a fail but I am assured they tasted amazing!

My gluten-free Iced Vovos…presentation was a fail but I am assured they tasted amazing!

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.

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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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FUNCTION OVER FORM. ALWAYS.

You never quite realise how much you take your mental cues from the physical body – that is, until you try to recover from an eating disorder. Or get pregnant. That glimpse of flat abs, outline of a six-pack, the toned and lean legs, tanned and glowing skin from hours in the sunshine; these things you take for granted at the time, but are all a daily reminder that you are fit, healthy and an athlete. Recovered.

Being so recovered, I thought of myself as being “above” all of that. Above needing physical clues – indeed, I didn’t even realise how much I relied on them until they went away. You do all this work on the mind during recovery, establishing yourself as a whole person being so much more meaningful than a weight on the scales or a dress size. But what I didn’t realise is that in my successful quest for recovery, I had replaced many of the anorexic cues with athlete cues – arguably, much more healthy for me, but nonetheless a crutch of sorts for self-esteem and self-worth.

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This was a deliberate strategy to a large extent on the behalf of both my psychologist and my dietician: as being particularly resistant to treatment after 10+ years of anorexia, it was eventually discovered that I work best when we replace the focus of weight with the focus of athletic performance. Function over form. As I’ve discussed in previous posts, a key component to the success of this strategy was in allowing me to continue with my athletic and University endeavours during this treatment process. My incentive was as simple as this: If I don’t fuel my body correctly, I cannot perform athletically to my potential nor academically. And for me, my self-esteem and self-worth became more hinged over time on my identity as an athlete and a smart, successful woman. I fuelled my body and mind and discovered, in doing so, that my potential was far greater than I had ever dreamed of. I found my niche in Ironman and my passion in physiotherapy and succeeded in recovery life. Together we created visions of where I wanted to be – career-wise and athletically – and honed in on what I required of my body and mind in order to achieve these goals. Ana did not fit in with those dreams. Fuelling my body for hard training sessions, recovering well for my mind to work, and achieving some sort of balance in the way of sleep and relaxation were all imperative to the puzzle working.

I realise this strategy may not work and indeed may not be necessary for some ED sufferers. It worked for me primarily because physiologically I was, while underweight, stable enough to be allowed to keep exercising, albeit at a reduced load to my previous program. I was also at a key age: old enough to be independent and choosing to be in recovery; but also still studying at University and therefore able to easily manipulate where I wished my career pathway to go from here. You could call it “lucky”; I prefer to think it was my time – I had been in several treatment programs at younger ages and none had worked. So successful was the strategy that even now, when I’m having particularly challenging Ana thoughts that last more than a few days, I am able to trace it back to either work or training not going well for me. Focus has gone away from the things I’m most passionate about and my go-to backup is Ana. It happens subconsciously, only now I am so much better at recognising it and addressing it. Function over form. Recalibrate your life, sort it out….there we go.

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The reason all of this is on my mind is that with the last 8 weeks of hell (being pregnant with the worse morning sickness ever) – there has been little training, time in the sun, intake of nutritious food, all-important sleep; even work has gone largely out the window (it’s difficult to treat patients when spontaneously vomiting). You’re growing a baby – possibly the ultimate function! – but you are so sick that it’s hard to comprehend this, and it’s also such a new identity: baby-grower. Person-manufacturer. Mum. So, day by day the Ana thoughts creep back and to make matters worse, all those lovely physical cues you didn’t even know you loved so much start slipping away – the stomach and boobs rounded, the skin grey and pale, dark circles under the eyes, muscle tone going….

But alas the solution lies in the past. Let’s get the focus back to my newest function: growing an awesome human. And yes, let’s remember that the morning sickness does not last forever. It is not Ana returning, just a transient loss of all the things that make me, me. Now that I am starting to get back outdoors, get into work, swimming and running, baking, and eating wonderful food again, sure enough the happiness grows too day by day. It might take me a while to get used to this new addition to my identity (“baby-grower”), but in time, it will come. It took a long time to see myself as an athlete, I can’t expect to click my fingers and have this happen overnight.

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Chin up, stay strong, and remember that those thoughts aren’t you…..you, my friend, are far more beautiful than that.

K xoxoxo