Remote/FODMAPS/injury and still No mountains: By Emma Kraft:
Alice Springs Masters Games, 10km, Simpsons Gap
(picture: Justin Kennedy)
So yes here is another Blog on Runners Tribe about a distance runner with a running injury. Surprise Surprise; is this DeJaVu? However, this is a little different as I literally had to board a plane, take a minimum 3 days off from work and travel 2000km for a Doctor's appointment. I don't want to 'blame' where I live on my injury, but honestly, I think living in Alice Springs has cost me my running career and goals for 2015. I do want to point out that I have had some amazing support and expertise on my side in Alice Springs, but I needed more and further follow-up.
Its hard to say when it all started…. Im guessing after the World Mountain Running Championships in Italy last year where I had my 'Hypo' (Hypoglycaemia) and conked out on the side of the Italian Alps, it still doesn't make sense as I didn't fall suddenly or feel like I did any acute damage to my back/hip/hamy origin. But 12months on; I don't even know what part of my body is playing up? Is it my back? My hamstring or Nervous system? And what the hell is going on with these Hypos? Why do they keep coming on and why do I feel bloated after I eat an apple!!!???
Pictures from 2014 World Mountain Running Championships in Italy, after a Hypo, and then walking to the finish line. After this race, I have never been quite right since
(Picture by Giuliano Del Moretto)
Here's a more in depth account of this event.
So after my mystery Hypo I had in Italy I'm guessing in October last year when I returned from my trip (Italy) and competed in the Alice Springs Masters Games, I was relatively unfit from travelling but still managed to run a 10km, 5km XC and my 1st ever Mile. Maybe I shouldn't have participated in these Games, but I felt I had the expectations of the town to run and of course try and win. After that I was running with pain down my left leg, and pushing my body to run fast, in which it hadn't done for a month or so. I was aiming for Zatopek but I just wasn't getting the training in that I needed to so I knew I had to pull the pin on that, have a rest from running and then go from there. It was also getting really Hot here in Alice, so I didn't mind having a bit of a break to get things right. Who would have thought 12months later I am still trying to get 'things' right.
Alice Springs has One Sports Doctor (Doctor A) who visits from Darwin once every 6 weeks, which is a long time between visits. They came just before Xmas in which I have already had 3 weeks off running, hoping for him to say "have another 3-6 weeks off and then start running, you will be fine". Either way, I was already 3 weeks into a rest period and was heading down South (Victor Harbor and Goulburn) for Xmas. I didn't even know if I should pack my running gear for this trip or not. I ended up getting a MRI scan on my lower back, 1 week later a CT Scan. The CT Scan showed a pretty messed up lower vertebra around my facet joint. I just want to say that luckily The Alice Springs Hospital had a MRI/CT Scan machine installed about 12months ago, otherwise, I would have had to fly to Darwin or Adelaide just for a scan.
My back on a CT scan….check out the last disc….
I had to wait 4 weeks for my physio (Physio A) to come back from holiday before I got some new exercises for my Clinical Pilates routine, which I had been doing twice a week for about 3 years. I was also doing floor/mat Pilates 1-2 x week, and from a few appointments and 'advice' I heard that I shouldn't be doing this and that and this and that as it not good for my back, so in the end I was so confused and wasn't even sure if I should even be doing these Pilates classes, as am I doing more damage to my back? Or not? Should I run? Or should I rest? I knew I needed to strengthen it but I didn't want to make it worse. I was also so used to my weekly routine, work, training, Pilates, so now I actually had some time and I did not know what to do with myself!
I had another appointment with the Doctor A here in Alice Springs in which I ended trying a Cortisone injection to my lower back…. It felt good for about 3 days but then it wore off pretty quick. As the Cortisone didn't work I then went back to Doctor A 6 weeks after this when he was back in Alice Springs, he then referred me to a Pain Specialist in Melbourne. I was already heading down to Melbourne (Stawell) over Easter, so I pushed to get into the specialist during this time, as I was already down there on an airfare. I was successful and had Radiofrequency Neurotomy booked with Doctor B.
I ended up joining a gym in which I thought I could 'maintain' my running fitness and my motivation. I did some water running classes, loved Spin and the Elliptical machine. Again the 'Gym' hype wore off as its just not the same and I never thought I would be one of those people who pay for a gym memberships and 'don't use it'…. Yep that was me and I was so ashamed!
I had been working with a local Endocrinologist ever since my first Hypo back in 2011 and of course I was in contact with her after Italy. We did some more tests and the next plan was, when I have a 'Hypo' don't eat anything and go to the Emergency Department and get the following test done (while depleted). I put the tests I needed to get done in my phone. One day I went for a run and fortunately had a 'Hypo' while out running. I ended up walking home in which I normally do and did a BGL test and then got my Fiancé Brad to drive me to ED and here we had a wonderful 'date night' lol. Test were done, got home at 11pm and went to work the next day.
Just chilling in Alice Springs ED
Test results come back clear, so it was suggested that I should go see a Sport Dietician while I was down in Melbourne. Considering I have a nutrition degree I kind of rolled my eyes thinking it would be a waste of time. As I was going to be down in Melbourne I thought I may as well 'see if I can get in'. This may have been one of my best decisions I have ever had.
Melbourne: Before I underwent Radiofrequency Neurotomy (RFN) with Doctor B, I thought about getting more advice or fresh eyes on the origin as I was in Melbourne, with access to some great Doctors and Specialist. In my appointment with the Sports Dr (Doctor C), we did a few other tests and ordered another MRI scan in which they picked up on a Hamstring issue (Tendonitis). So is it my back? Or is it my Hamy? Or do I have both and is one a secondary injury. I was very confused and I was booked in 2 days later to get this Procedure done on my back! What do I do? Get it done? Not get it done? Wait for more pain and fly back down to Melbourne like I'm made of money? I did what any desperate injured remote based athlete would do and decided to get it done. (Radiofrequency Neurotomy (RFN), which basically burns-off the nerve endings (pain receptors) so I don't get pain running down my leg, can last up to 12months).
While I was there I ended up seeing a Physio B to get the latest run down from the Sports Doctor B so we were all on the same page and I could take back my exercises back to Alice Springs and work with Physio A.
I had a Sports Dietitian appointment at Olympic Park who was fantastic and we got on to something!!!! We discovered there are a few things wrong with me (haha), and agreed to go on a Gluten free FODMAPS diet.
(FODMAPS stands for: Fermentable, Oligosaccharides (eg. Fructans and Galacto-oligosaccharides (GOS)),Disaccharides (eg. Lactose), Monosaccharide's (eg. excess Fructose) and Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt). Please refer to http://shepherdworks.com.au/disease-information/lo... for more information or contact a Dietician)
This was hopefully going to sort out the issues I have resulting in 1) 'Hypo's' and also 2) 'Bloating' which symptoms I have had for over 3years, and just became immune to it and thought it was normal to feel full after eating an apple. If anyone has ever been on FODMAPS diet, you pretty much can't eat anything! We discovered most of the food I was eating on a daily basis wasn't FODMAPS friendly. This included foods/ingredients such as garlic, onion, mushroom, milo, apples, dried fruit, stone fruit, watermelon, honey and even the 'Extra Gum' I was chewing had to go! Then on top of this, I couldn't eat anything with Gluten (which is pretty much everything, lol), I was already on soy milk (lactose free), however I could only use certain brands as some were high in Fructans (FODMAPS). I kept in constant contact with my Dietician over the last 4 months, including keeping a very precise daily food diary with all bowel movements, just to get to the 'bottom' of this. I then cut out all dairy and soy-based products, so you can see how exciting my life was, I could barely run, I was injured and I could barely eat any foods.
I was just getting back into running and still aiming for the Australia Team for the World Mountain Running Championship, yep… very ambitious I know. Anyways it was a very upsetting day when I found out I didn't make the Team for obvious reasons. I cried. I was very upset and sad and took a while to get over. I am well aware I am not fit enough to be in the Australian team and the other Women in the team are amazing runners and deserve to be there, but I just felt so sad, empty and frustrated. What made it really hit home, was my fiancé Brad went to the trials and made the team, so I couldn't escape from the World Mountain Running Championships, as now I was going over no matter what but not as a competitor but as a Spectator. Of course I am extremely happy and proud for Brad as he is an amazing runner and has worked so hard for this but it just hurt. And then the team announcement gets out and you have to face the crowd and come to terms with the reality that you are going to be at the World Champs as a bench warmer and you won't be able to do what you love. Least if I wasn't supporting another Athlete in their journey, I could ignore Mountain running or running in general….. but unfortunately I had to face it.
I decided to turn this negative into a positive and apply for the Australian Team Assistant Managers Position in which I was fortunate enough to get, working in a team. This is different to the team role I wanted to play, but I am very fortunate to pass my experiences on as once a competing athlete to these new Mountain running Representatives. I am very excited to say that this year we have a Junior women team (we haven't had one since the last 2 years) so I am looking forward to mentoring them and working with them on race day.
I had to think of something else to do to take control of my injury. I hadn't had any follow up from Doctor A who referred me down to Melbourne for RFN, so how could I even get another referral or advice on what to do? I spoke to my Adelaide based coach (Adam Didyk) and did what any desperate frustrated athlete would do and jump on a plane and go see another Doctor (Doctor D) and Physio C but in Adelaide this time. I was just so frustrated and I knew it was too late to make the team (I was a reserve so you never know) but I couldn't just sit here and wait for..... I don't even know what I'm waiting for…answers, a miracle? Do I rest, run, run every 2nd day, strengthen what, stretch this, or take that. I was still working with my Dietician and I mentioned I was going to Adelaide, and suggested taking FODMAPS to the next level which was a Hydrogen Breath Test through Gastrolab. Again none of this was available in the NT. This was going to help me with possible allergies of lactose, fructose, glucose, mannitol, sucrose or sorbitol, as the FODMAPS free diet (elimination diet) wasn't really working for me (was killing me!). However, you can only do one Breath Test at a time and you have to start with the baseline test (Lactulose) which took 3 hours and it's just the start….. to be continued….Doctor D was very good and got me a referral for another injection in my Back in which I'm not even sure is available in Alice Springs. I got this done while in Adelaide the day after my Dr D appointment with them squeezing me in which I'm thankful for. We have ruled out the hammy injury. He also orders a couple of blood test in which I got this competed during my 3hour breath test at Pathology.
I drove myself into Adelaide city for this injection, I needed to park the car close as I wasn't even sure if I would be able to walk back to the car, let alone drive! Whoops!! Of course I said 'I had someone to drive me home', in which I didn't as I was in Adelaide on my own. So similar to what I have done before, 4 x locals in the lower back, and then 4 more needles. Luckily I was ok and I could walk relatively well which was good.
While I was in Adelaide, I decided to get back in contact with the Pain Specialist (Doctor B) from Melbourne. I felt on a whole the RFN procedure had worked, but it was like just one nerve or so was missed. So I got into contact with them, booked another appointment and flew down to Melbourne literally for a needle.
With consultation from my dietician after my baseline breath test results, I ordered 4 x Breath Test home kits in which I had to carry out at home, for 3 hours, in a fasted state, no exercise before the test and you weren't even allowed to clean your teeth (the toothpaste contained one of the FODMAPS ingredients)! This was a challenge in itself just trying to find a 3 hour window where I could complete not just 1 but 4 tests. I was exercising in the morning most of the weekends which only left me the option of during the week where I start work at 8am and of course wanting to clean my teeth before walking through the door. I basically had to blow in a bag every 30 minutes.
Undergoing one of my Breath test (Team Ricky in the background!)
I set aside 1 week to get the entire tests done, as you could only do ONE/per day and have a day rest in-between. Most mornings I set my alarm at 6am and started the test, blowing into a bag every 30mins while 'snoozing' with my alarm. As this test took 3 hours, I would then go in to work at 8am, continuing the test, to finish at 9am, then have breakfast and then finally clean my teeth. Luckily I wasn't sharing an office at the time J. Got them all completed and sent off. Results are back and it is now clear that I have intolerance to sorbitol and mannitol….. Finally an answer for my Hypo's and my bloating!!!
I was lucky enough to manage a couple of local runs here in Alice which included the Alice Springs Running Festival and Run Larapinta Stage race. Although despite all my bad luck so far, there was still more to come! I went into each race with a) a head cold and b) and strained SI joint in my back from lifting something. With multiply appointments to the Physiotherapy I made it to the start line …. Just! And basically had to wing-it!
Namatjira Stage 1 of Run Larapinta, fortunate enough to make it to the start line
(Picture NT Events Photography; Chloe Geraghty)
If someone told me I was going to have 12months off running, I would have done things differently. I would have taken up another hobby such as coaching or been on a running committee. This year has taught me a lot of things and I had to adjust to my new lifestyle. Going from 15hours/week training to 5hours/week was a huge lifestyle change. I went from running every morning before work and getting up before the sun, to even wondering if I was going to run today. I went from people asking me 'how my running was going' to telling me that I was looking 'well' which we all know is CODE for looking fat, lol. I also struggled mentally with trying to find the real Emma and not the runner Emma as in this town that is what I am associated with. I felt I wasn't anything special without my running.
When I got invited to talk to kids at schools or sports, I questioned myself if I deserve to be there. I felt guilty when I spoke to my sponsors for being injured and feeling I had let them down. I was so frustrated trying to explain my injury (as I don't even understand it) or 'why I am not running' at this event to the running community. I went from planning races all over Australia to booking Doctor Appointments all over Australia. What happens if that was my last run? No one tells you when your last run is going to be. Run each run like it's your last!
I would also like to thank my on-going Sponsors and Supporter especially Alice Springs Physiotherapy & Sports Injury Clinic, Coleman Printing, Eastside Pilates, NT Government, Athletics NT, Alice Springs Running and Walking Club and Eyecare Plus. Thank you to Runners Tribe for this opportunity and I wish the Australian Mountain Running team all the best in Wales!