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

 

 

 

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

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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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.

sept 14 bb

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.

sept 14 ff

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

Exercise and Recovery

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

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

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

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

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

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

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

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

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

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

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

Food for thought anyway.

Happy training xo

Our Body Responds to the Messages We Give It

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

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

SAY WHAAAAATT??!!

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

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

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

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

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

Matching shoes and nails: check...

Matching shoes and nails: check…

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

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

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

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

I choose life!
Happy training.

K xo

When all else fails, Bake.

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

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

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

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

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

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

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

Death by Chocolate: Chocolate Mousse Layer Cake with Chocolate Ganache

Death by Chocolate: Chocolate Mousse Layer Cake with Chocolate Ganache

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

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

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

K xoxo

United Nations of Ana

“Be Careful what you wish for; it may just come true”.

Wining and dining in beautiful Queenstown....that wish came true!

Wining and dining in beautiful Queenstown….that wish came true!

I’ve noticed over the years, that when I really visualise and wish for something to happen, more often than not it has come about. As a student of science – two university science-based degrees, in fact – I do understand the absurdity of this statement. But on the flipside, as a Physiotherapist who largely works with athletes, I am also hesitant to brush off the power of the mind and the power of intention in making things happen. An advocate of “hippie medicine” I am not; but a believer in the human mind, very much so.

Just last week a colleague and I gave a presentation to a group of runners about the power of visualisation, in terms of goal setting and forming one’s identity. What athletes do really well, that “normal” people do not, is to clearly establish an image in their minds’ eye of what their goals are, what their body looks and functions like, and how they will perform on race day. They stick posters on their bedroom walls, photos in their wallets and cars, have firm self-affirmations and use frequent visualisation to enable them to see the future they want to create and to assist in their pursuit of excellence.

Let’s flip that equation. How often do you see someone who has been overweight and inactive for their entire adult life, go ahead and lose 20kg, along the way learning how to maintain that loss, only to turn around and put it back on? Often, the new lifestyle has been achieved, but the person has failed in their mind’s eye to identify this new person in the mirror, who is “healthy” weight and active. They don’t recognise themselves. So they go back to their place of comfort.

Sound familiar? Nowhere is this phenomenon more important than with ED patients trying to recover. We are the ultimate masters of visualisation and affirmation – Ana makes damn sure that the little birdy on our shoulder never shuts up, providing an incessant stream of buzz words and “motivations” to become the ultimate weight loss machine. Do we recognize ourselves when we get there? Hell yes, we have been dreaming day and night of reaching that mystical land and no person on the planet is going to take it away. Hello Ana!

Only that is not you. That is Ana you are seeing in the mirror. Somewhere in the process, Ana takes over and the real You becomes a mute little birdy on the other shoulder.

During the long and arduous process of recovery, it becomes so important to bring that birdy back to life, for if you cannot see You in the mirror along the road to health, the risk is that Ana will pull you back to the land of “comfort”.

Easy to say, hard to do. How does one find a new sense of self – particularly for someone like me, who lost that sense of self at around 12 and then had to try to find an adult identity at age 22? We use the same tools that we learnt so well during the Ana years. Flip that bitch on it’s head. When it comes to the power of the mind, no-one – elite athletes included – does it better than an Anorexia sufferer.

The first thing that I did was to find images of athletes who I thought were realistically about the same size frame as me (height and muscularity etc), and had beautiful, fit, lean, muscular and healthy bodies. The more they look like you (a healthy version of you….), the better. Then I wrote out quotes and powerful affirmations for me, as simple as “I am an athlete”, “I am strong”, “I am beautiful”. I needed to be healthy to finish my first Ironman, so I included photos of glowing Ironman finishers as well. I plastered these words and images all around my mirror and through my training diary, as a constant reminder of where I wanted to head. I was creating an image of my future life in my all-important mind’s eye. So that when I got there I would recognise the person staring back at me in the mirror. I knew what Ana looked like; I just had to work out what I looked like.

Over the next months and years, the photos and words got updated and I started to build “me”. And then a funny thing happened. I finished my first Ironman, and the finisher photos get sent out a few weeks later. I stuck one of them up on my wall, then took a step back.  It fit right in, amidst the photos I had put up there to visualise my future with.  I had to smile.

The magical glow of the Ironman Finish Shute - Cairns 2012

The magical glow of the Ironman Finish Shute – Cairns 2012

The transformation didn’t happen overnight, and I still don’t love what I see in the mirror. I still spend countless hours talking to my Psychologist about the division between what I see, and what others in my world see (I get very confused when people tell me I’m attractive, stunning, slim etc as I do not see any of those things – it’s a work in progress). But the most important thing is I do see me in the mirror. It’s familiar, and it’s a body that can achieve amazing things, and a mind that spends most of its days helping people with their health, and that is a beautiful thing.

I will never stop doing this process, as it has bode me well during my recovery years and so long as I am doing my life’s dance on this epic planet, I will never stop trying to achieve amazing things. In the future the images will change as my life evolves, and I can’t wait to see how the rest of my life unfolds.

Bring it on.

K xo

“When I stand before God at the end of my life, I would hope that I would not have a single bit of talent left, and could say, ‘I used everything you gave me’.”

– Erma Bombeck

Multiple Choice Questionnaire

Multiple Choice:

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

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

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

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

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

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

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

Two days. You can do it.

K xo

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

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