Pregnancy and Eating Disorders: Part 2

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Growing a human being from scratch is a unique experience. It becomes even more unique for those of us who have been through an eating disorder. No matter what stage of illness or recovery you are in, there are individual nutritional, physiological, and psychological challenges that you will experience that all the well-meaning ‘practical’ pregnancy books and blogs in the world will not be able to help you with, or that other pregnant women could ever understand.

Currently I’m 6 months into my pregnancy and have been living these mini-battles and celebrations like a rollercoaster ride that still has 4 months to go (because yes, pregnancy is actually 10 months or 40 weeks, not 9 months!) . As the weeks go on and my body changes, the challenges get bigger but so too do the rewards – feeling your little person doing kung-foo fighting in your belly is one of the coolest feelings on the planet, and something I’ve come to focus on when everything else is becoming overwhelming.

I am hoping that like all things in life, it will get easier with time and experience – I want to have 3 children in the long-term scheme of things so I have to find a way to cope with everything during pregnancy in order to be OK with going back into the battle field! Easily the hardest part from an ED perspective has been the nausea, vomiting and constant hunger, which I’ve discussed in previous posts. But wait – there’s more – oh so many more things that may blindside you along the way on this journey of life creation….

Keep calm and stress less...hiking in Milford Sound, NZ

Keep calm and stress less…hiking in Milford Sound, NZ

Getting “weighed in” at the doctor’s office

Everyone is different with their recovery but I know a lot of you do not know your weight once you start down the recovery journey, and I am the same. I have had to find out maybe 5 times over the years I’ve been in recovery (they weigh you in before and after an Ironman to check for dehydration post-race, and also before surgery for the anaesthetist ie before my foot surgery). It doesn’t get less traumatic with time and distance from Ana. I just think it’s one of those things that despite your newfound health, identity and logical reasoning, it just tips you over the edge every time. The good news is that most other things get exponentially easier with time – like eating out and getting dressed in the mornings, but in my experience that number on the scale seems to be like a ticking time bomb.

Which brings us to the Obstetricians office where I get weighed and my blood pressure checked each and every time I see her. I even get competitive about the blood pressure reading – because I know how low mine is when I’m “race-fit” and I love that sense of numbers reflecting my health. See – it’s an issue! So I had to do the hard strategy that you learn soon enough into your recovery – to ask not to know the weight as you take that monumental step onto the scales. Which feels ridiculous when you are a grown woman, and a health professional at that, and look to be a healthy weight. You instantly feel the judgement of the weigher cloud the room (imagined or otherwise) and then usually end up blurting out something about having an eating disorder in the past and then by that point you just want to shrink into the palm of your own hand and disappear.

But here’s the thing. As horrible as that moment seems to you, I guarantee you the doctor or nurse weighing you is not judging you like you think they are. They, of all people, understand eating disorders and even if they don’t, this moment is just one of thousands during their very busy day and they won’t think twice about it after you leave the room. And they will never turn around and tell you the weight despite your request; they are more professional than that.

You, on the other hand, need protection. So it’s a matter of having that conversation to not know the weight, or finding out and then winding up in a spiral of destruction for the next few days/weeks/months……Five minutes of awkwardness vs a month of self-criticism? I’ll take the five minutes, thanks. And THAT conversation does get a little easier, even if the weight thing never does.

Knowing how Much Weight to Gain….and not freaking out about it.

Here’s the thing. This becomes a two-pronged issue as soon as you get pregnant: The things you can control, and the things you can’t. A lot of us have come from a lifetime of rigid eating and exercise patterns, even through to recovery, and control is a big issue for us – indeed often the initial cause for triggering an eating disorder.

So firstly, the part you can control during pregnancy is what you eat, how you exercise, and your stress levels. None of these things will affect the actual growth of your baby much – babies develop even in horrific environments at times and most come out around the same weight and health status – however these factors do greatly affect you, and how you feel during pregnancy. Your health and happiness, shall we say. So work with your dietician or read up on optimal pregnancy nutrition and where you can, try to eat well and adequately so that you as well as your baby can thrive and hopefully enjoy the experience.

The part that you cannot control is how your body grows. Where you carry your belly (high/low/front/spread etc), how big your boobs get, how much morning sickness you get, how much weight you gain, and where you gain it. If you are eating well, exercising sensibly and keeping stress under control, the rest is up to your body. You will likely gain between 9-15kg and it won’t necessarily be in a nice steady increment – sometimes the baby (and you) will grow a lot in a month, other times not so much. This has been a challenge for me, sometimes it feels like I’m watching an alien take over my body. But it has helped extraordinarily knowing that hey, I am doing everything that is within my control to be healthy, so the rest is up to Mother Nature. It’s important to note also that very little of that total amount is fat gain – most of it is baby, water weight, placenta, breast tissue and the like. I have found it helpful to look up the average breakdown of weight gain with respect to these things to keep the feelings of “fatness” in perspective!

And a final word….don’t buy into all the online bullshit popping up with “All Belly Pregnancies” and the like which seem to promote gaining absolutely the minimal weight and getting back to pre-pregnancy weight within 2.5 seconds of giving birth. It’s unrealistic and a ticking time bomb for eating disorder sufferers….it’s best to just not go there!

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Coping with comments from the world at large and worse….people touching you

So apparently once you fall pregnant, everyone in the world becomes an expert in pregnancy, childbirth and breastfeeding. They want you to know how knowledgeable they are, which they express by shoving it down your throat with a good dose of judgement on the size of your bump (and sometimes boobs and butt…) and possibly a feel of your belly. Yup, not joking. I will preface this with the fact that I have always hated people touching my stomach, even my husband doesn’t go there when I’m lean and fit and sporting a washboard down there. So to say that I feel self-conscious about the ever-growing beach ball in my mid-section, and people launching their hands at it when you least expect it is an understatement! And as for the birthing and breastfeeding horror stories, well everyone seems to have gone through World War III giving birth to their brood, wearing their drama like a badge of honour. Makes you wonder how humans did it for all those centuries without the intervention of medical specialists and fancy hospitals, right? Right….

We are just animals after all, and we must remember that pregnancy and childbirth are one of the most normal, natural things that females can go through. The baby knows what it’s doing; the body knows what it’s doing…..you and your overactive, impressionable brain are just along for the ride. And you can make that ride calm and magical, embracing what nature does best, or you can listen to the horror stories and spend 10 months stressing about what will or probably won’t go wrong during childbirth. The way I see it is that we are blessed to have the fancy hospitals and specialists available on the small chance that something does go wrong. But I’ll be happy to go through the experience knowing that my body knows what it’s doing, even if it’s new to my mind….and that it’s a great day if I don’t have to see my Obstetrician during the birth because it means that all is well (midwives, on the other hand – the more the merrier!).

As for the comments on size…the only consensus I have on this is that 100% of the time, the people telling me “gee you’re huge!” or my personal favourite “wow you’re really looking pregnant now” are not….well….pictures of health. They are the ones who are a little on the tubby side and clearly insecure about their own weight. My friends who I train with or who are healthy weight tell me how awesome I’m looking. It all comes down to the common denominator once pointed out to me by a very smart psychologist: people talk about themselves. So when someone is bitching about so-and-so’s choices in life or commenting on your weight, just smile and think to yourself “wow you must have an insecurity about that within yourself”. Think about it. It can be a very informative experience! And maybe next time you catch yourself about to say something judgemental about another….stop and think – is this my issue or theirs?

Much more to come on the intricacies of growing a baby within one’s post-ED body, but for now this baby-mumma needs to get to work.

Happy training,
K xo

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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