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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The Broken: A Survival Guide Part III

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

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

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

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

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

Hiking in NZ with my better half

Hiking in NZ with my better half

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

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

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

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

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

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

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

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

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

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

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

Happy Training xo

From Rehab to Racing

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

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

I flew today.

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

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

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

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

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

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

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

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

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

Happy training everyone!

K xoxo

Racing Weight

So yesterday I had a revelation. It’s only been, hhmmm, 18 years coming.

I was looking through some race results from a recent track meet and they had accompanying photos. One photo in particular really set me off – I felt a deep pang of ?yearning? to suddenly stop eating and to run a really long way. To look like that. ASAP.

I won't put the triggering photo up for obvious reasons.  Instead, here's a bunch of awesome, fit healthy chicks at the New Balance Games.

I won’t put the triggering photo up for obvious reasons. Instead, here’s a bunch of awesome, fit healthy chicks at the New Balance Games.

Ever since I started restricting calories at age 12, I have always been very easily triggered by certain people – for me, mainly athletes of the very lean, tanned, blonde and hot description. I most definitely have a “type”. For the longest time it was Anna Kournikova. I remember as a 12 year old looking up her height (same as mine – I was tall at 12. Incidentally, I never grew after that….amazing what starvation can do to the human skeleton) and weight. That was ground zero. Only, once I got to her weight, of course the ED/Ana was in full flight and I couldn’t stop there. I may have had the long blonde hair, the sports trophies, the tan….but I didn’t look like Anna Kournikova, because, well….she looks healthy. She glows. I had some grey death staring out my eyes to match the grey shades under them, and a bony back to boot.

Anna Kournikova in full flight.

Anna Kournikova in full flight.

Over the years the role models have evolved, and as I’ve talked about in previous posts, I now tend to look up to healthier athletes as a matter of requirement. I am simply too easily set off by the former. And of course a swap to a sport that suits my genetic make-up to a tee has helped as well: as a distance runner, being lean and super light was always an uphill battle, whereas I build the endurance and strength needed for long course triathlon almost by mistake, it happens so easily.

Anyway back to the point. To give you some context, my body at the moment is not at racing fitness and after being “Ironman fit” for the preceding 3 years straight, that’s a hard thing to get used to. I was as fit as I’ve ever been going into my foot surgery in July last year. But 3 months in a cast and non-weight bearing on crutches, when all I could do was core and upper body gym work and then after that, swimming….well for someone who builds muscle easily, I suddenly developed upper body muscles. Throw into the mix a couple of pregnancies then miscarriages in that period and well, needless to say, my body has changed. So I’m in the prime target zone of being affected by such triggers and constantly fighting the urge to overexercise and undereat, when in reality my body needs to be loved in every way in order to repair right now.

Only yesterday, for the first time ever, a shocking thing happened. I’m not even sure it was my brain producing the thought process, so foreign was that thought process. I suspect perhaps my psychologist or dietician found a way of tapping into my brain waves and altering them. For when I saw the picture, I yearned to starve and go run 35km. But then the next thought that followed was astounding: “yeah, if you want to be skinny-fat and unhealthy. If you want to get back to that level of fitness, you know what you need to do. You need to commit to training hard, and eating. A lot. Of really high quality food.” Sigh. Wait – whoah!! What just happened?!!!! Was that my head talking?

New, healthier role models: Caroline Steffen aka "Xena", 2nd fastest female Ironman athlete in the world.  Machine.

New, healthier role models: Caroline Steffen aka “Xena”, 2nd fastest female Ironman athlete in the world. Machine.

After deep consideration, I’m fairly certain it was me. I’m impressed. And when I analyse it, it’s true – the only times in my life I have been super race-fit, lean, healthy and glowing (and incidentally injury-free) have been when I’ve been able to train well and at a high intensity, and when I’ve been able to eat a lot of food to support that. For many of the other times, I may have been clocking in at my desired “racing weight” – for distance running, not triathlon – but I was far from glowing, and the fake tan and smiles were barely hiding a very frail skeleton with 10+ stress fractures in their short history.

As we all know a little too well, it’s far easier for us to undereat and overexercise. It’s comfy, predictable, safe, not scary. Eating like an athlete is frightening, uncomfortable, requires planning, and a lot of mental strength – and not just for a day, but for months. But when all is said and done, it’s always more rewarding doing something challenging than sticking to the same well-worn path. I don’t want to be a skinny-fat distance runner anymore; I will stand proud as an athlete. Glowing, too.

Bring it.

xoxo

My hand-made Easter chocolates for the family.  Happy Easter everyone! xoxo

My hand-made Easter chocolates for the family. Happy Easter everyone! xoxo

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?

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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.

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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.

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

K xo

Here comes The Fighter

Only a man who knows what it’s like to be defeated can reach down to the bottom of his soul and come up with the extra ounce of power it takes to win when the match is even”. – Muhammad Ali

Today, I commiserate celebrate the half-way point of my foot rehab journey. 4.5 months since the surgery, 4.5 months until I can run again.

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Never before have I yearned for running, the first and longest love of my life, so fiercely. When I was running competitively at university, I had a beautiful old man of a coach who was in his 70’s (and still running…) and had been coaching distance runners for most of his life. After thrashing ourselves and giving 100% of what our hearts had to give at any given session, we would warm down and joke and laugh amongst the group. When all was said and done, he would look at me with those wise wrinkled eyes and say “I have never met someone who loves running like you do”. In my youthful naivety, I used to laugh at him. But right now, if you asked me to choose between running and my husband – my two grand loves – well I’d have to think about it! I’m joking sort of.

Early days....

Early days….

And yet, never in my life have I found it so hard to keep the “athlete mindset”. Not as in, screw training why bother. As in, screw rehab I want to go run, PRONTO. I want to get back to racing weight fitness, PRONTO. Hell, I want to race, and feel the best pain in the world. Not rehab pain. Not idle resting pain. Or surgery pain. Just the deep, all-encompassing fantastic pain of racing. I want that. And my heart yearns so extremely deeply for it, I feel a black hole that can’t be patched back up.

And God knows all too well that I am not patient. Ironic given all those years of being a patient. I suspect this may be God’s way of testing me….so that I learn patience. And so that I learn the most valuable lesson of my life to date: I am an Athlete. I am no longer Anorexic. Or an Athlete with an Eating Disorder. Facing the surgery, all those months ago, I remember with clarity driving home from the surgeon’s office crying, desperately hoping, but desperately fearful that I could not do this. I could not do this, without Ana. This was going to be the hardest test of my “recovered” life.

And in these last weeks that have passed, I cry again – because I know I am there. Throw vulnerability to the wind, I’m fighting the good fight.

There you are. I finally found you.

K xo

2013-09-05 med ball 1

Sesamoid Fractures

D10 Post Op Review
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