December 15, 2015 by Ana To Athlete

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

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.

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.

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.

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

October 16, 2014 by Ana To Athlete

Sesamoid Update – 1 year on

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

Hoorah for beating the odds – once again!

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

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

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

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

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

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

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

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

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

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

What I have learned about Sesamoid Stress/Fractures:

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

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

Happy Training

K xoxo

September 3, 2014 by Ana To Athlete

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.

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.

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.

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

K xoxoxo

January 6, 2014 by Ana To Athlete

The broken. A Survival Guide.

Part II:

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

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

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

What now?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

K xo

August 8, 2013 by Ana To Athlete

Sesamoid Fractures

Day 13 post-Op

“Your journey has moulded you for your greater good, and it was exactly what it needed to be. Don’t think that you’ve lost time. It took each and every situation you have encountered to bring you to the now. And now is right on time.”

So it will be two weeks tomorrow since my foot surgery, what a whirlwind of a fortnight. This is going to sound like stating the obvious but I just cannot wrap my head around how much it has taken out of me – I mean, I can do an Ironman and run 3 days later, but this surgery thing is in a whole different ball park! Even as a physio, I am constantly amazed at how exhausted I am and how little it takes to get fatigued or to swell up the foot…..but I am learning, often the hard way, and trying to be very patient with myself (doesn’t come easily!). I guess I figured that I was super fit going into the surgery and I had done so much “pre-hab” that I would just breeze through it – ah, close but no cigar! As promised, for the medical nerds out there I’ll go into the juicy details; if you’re not into it then feel free to let your eyes glaze over momentarily while you fast-forward past this section.

The fracture to the medial sesamoid happened 8 months ago; because of the difficulty in diagnosing this injury and because it was literally Christmas time there was a 2 week delay in getting the MRI results and a definitive diagnosis, then getting into a boot to offload the bone. Sesamoids are well known for being very difficult to treat and even with 8-12 weeks in a boot, your chances of it healing are statistically about 50%. This is mainly due to the location of the bone (under the forefoot so it gets your full body weight with every single step), and the poor blood flow to it – which is usually only one small artery for supplying all the nutrients needed for healing. Often when it fractures, you either break the artery or the swelling compresses it, further limiting the blood flow. I’m sure the delay in diagnosis would not have helped nor – I’m sure in retrospect – would me working 40 hours a week on my feet while in the boot; lesson learnt and I would never let a patient of mine do that. (Got to love the benefit of hindsight) So long story short, 4 months after this I had another MRI that showed no healing through the bone despite the mandatory time the boot, and I found myself sitting in the very swish office of a well-known sports surgeon in a big city far away from home.
He explained that we had a few options, and after a lengthy chat and a lot of questions from me, we both decided that the best shot I had at competing in Ironmans in the long term was to operate. He planned to do a bone graft from the hip and screw it into the sesamoid, but also do a dorsiflexion osteotomy of the 1st metatarsal at the same time, which would effectively offload the sesamoid and hopefully prevent me from having this problem again in the future.
So far so good, but here’s the kicker: it was fairly major surgery. Two hours under the knife, overnight stay in hospital, 10 days in a backslab, 6 weeks in a cast non-weight-bearing, then a further 6-8 weeks in a boot partial weight-bearing and a grand total of 9-12 months before I start a return-to-run program. Gulp. I asked him how long we could put off the surgery – I needed time to think! – and he gave me a couple of months. I needed every bit of that time to process how I was going to handle the situation (mentally and physically, not to mention the logistics of work etc) and to most importantly psychologically prepare myself so that I would be able to maintain good nutrition for healing and not revert to old habits throughout this challenging time.

Which brings us to the now, 13 days post-op.

The surgery itself did not go to plan in that when he got in there, the fractured bone literally “fell apart like an eggshell” and so he set about salvaging what he could of it. No bone graft was done but he re-attached the ligaments to the new smoothed out bone and the outcome should remain as favourable as if the bone graft was done. The osteotomy went well, and when the backslab came off it felt like unwrapping a present to see two relatively big but very neat incision scars and everything coming along well. Surgeon’s happy means I’m happy. He didn’t let me leave without a 15 minute lecture on training and not overdoing it, but then he does work exclusively with athletes so I am thinking I was not alone on the receiving end of that spiel! My next review is in 5 weeks to get an XRay done and hopefully we can remove the cast and get into a boot shortly after. I am allowed to do upper body weights and Pilates as long as I do not put my right foot on the ground, but nothing else. I will hopefully get back into swimming and deep water running, plus cycling in the boot on the turbo trainer, once the cast is removed.

The things I have handled well include preparing work and home so that I can still be keeping my mind occupied – that is, running the business from home and still overseeing my junior staff treating my patients etc. That has been huge for me, because without running AND my work I go mad. Take away running – and Physio becomes my main crutch, excuse the pun. So the surgeon was happy to work with me on that one, I was upfront from the beginning and he has been brilliant with setting clear guidelines. As of next week I will go back to the clinic and see selected patients during half-days so that will be even better – the worst thing you can do in this situation is have only yourself to focus on! I was also lucky to have my closest friends around me throughout the whole process, as well as my husband’s family who I am closer to than my own. They all knew in advance that I would be in need of lots of laughs, some sense of “normality” and zero sympathy (I am NOT a good patient! Business as usual….well, as much as possible!). Anyone in my life that I thought would not be able to abide by those guidelines I haven’t spent much time with (yet). I need to make sure I have a strong support network around me and it has been worth its weight in gold; I would do the same for any of my friends. (Don’t be afraid to tell people what you need – your true friends will actually feel more comfortable as they will likely be upset seeing you so busted up as well! This was a lesson in life that took me a long time to learn but that has been invaluable). And of course, there has been plenty of baking coming from my kitchen (therapy for me and a great “thank you” gesture for said friends). Equally as important as anything else has been making sure I eat great quality food, regularly, and getting enough sleep – not as easy as it sounds with zero appetite after all that my body has been through. Of course, this is hard for me when I can’t train as the two remain inextricably linked for me (ironically I am healthiest food-wise when I am in full Ironman training mode), but having prepared mentally for it beforehand was very important. I have no intentions of gaining any weight during the next few months, but by the same token now is not the time to be depriving my body of any vital nutrients – the success of this surgery depends on it. My long-term running depends on it. And that, my friends, is non-negotiable!!
What I have found most challenging has been pacing myself – I am so used to going 100 miles an hour every waking moment of the day; obviously being in plaster non-weight bearing slows you down but having to stop and REST every hour or two is a HUGE ask for this little duck! The other complications couldn’t have really been predicted – I have low blood pressure normally (110/70) and a low resting HR (55) which I put down to being fit and possibly a bit of after-effects from the ED; but my body really struggled with the anaesthetic – the night after my BP went down to 70/40 and things got a bit hairy for a while there. But all is well now, onwards and upwards, time to rebuild this body!

Anyone wanting more info about sesamoids and stress fractures can head to this brilliant site:
and of course I am happy to answer any questions on this tricky topic or with coping with injuries.
Happy training!
K xo

July 22, 2013 by Ana To Athlete

About Me

About me –

Anorexia and I shared space in my world (Ana hogged it 85% of the time…) between the age of 12 and 21. While the onset was pretty sudden at age 12, of course the interchange between “Anorexia Patient” and “Recovered” labels was not an overnight exchange – but I have put it as age 21 as that was the first time I honestly, truly decided for myself (and was not forced) that I wanted to recover. The actual road to recovery was a rocky one but I am happy to report that I have maintained a healthy weight for 5 years now. It’s part of my history, but I don’t allow it to define me. It is what it is. I would rather not have gone through it, but I do try to now focus on all of the lessons that I have learnt and am certainly hoping that some good will come from it via Ana to Athlete. I still refer to it as “Ana”, or the “Ana years”, for many reasons – not as an affectionate thing, more because “Anorexia” sounds so harsh and scary and brings back too many horrid memories. And I guess, because it’s a safer name, with softer connotations – it’s too easy to pigeonhole people with the more formal name when really, no two cases are ever the same and no two people are the same.

What I am these days, is a Physiotherapist, Exercise Physiologist and director of a successful sports physiotherapy clinic with my amazing husband, who is also a physio. I am a 5-time Ironman finisher (and counting), and my favourite thing in the whole world is running – I think my relationship with running is borderline unnatural. But running and I, we have been through A LOT (I started running at the age of 12, so, you know…..we have a bond that is unbreakable!). I have two dogs, love my job, adore traveling and use baking as my therapy (did you think that went away after recovery? Sorry!! Haha). After almost a decade of Ana, you get pretty good at baking, so as a result I now do wedding cakes as a side hobby to Physio when I am not in full Ironman training (random? Extremely. Overachiever much? Yep that sums me up). I also have a small addiction to roses and forster the “nanna” within by sporadically tending to my rose garden.

Life is magical and you are beautiful. Embrace it.

K xo