Ignorance is not always bliss :-(

Some people will say "it's only running", but in fact, it is often actually so much more than that. Worse things can happen, but when a hobby and complications thereof can affect your physical and mental health in both the present and the future, it's a topic that should be addressed.

It might seem like I'm jumping on the recent bandwagon of personal stories, but I do think it's a good thing that more and more people are being open and honest with issues they face, and so if telling my story helps even one other person from going through the same thing, then it's worth recounting it.

Discovering the world through running!

I first started running 10 years ago, initially as a way of getting to know the local area, and meeting people/making friends when I moved here. I found that I loved it, being outdoors, the social side, getting fit etc and then coincidentally I found that I wasn't bad at it (well, distance running that is - "running" at school was all about short, fast stuff and I was {and still am} appalling at that). I've had my fair share of injuries over the years, such as tendonitis and plantar fasciitis, but these past 12 months have been a big different.

Hindsight is a great thing, but even so, I can't quite remember when I first noticed that there was a problem.

The marathon in Cyprus

At the beginning of the year, training had gone really well and I felt in great shape. In March, I travelled out to Cyprus to run a marathon with hopes of running in the low 2:40s, hopefully not far away from my PB. Unfortunately race was rather hotter than anyone had predicted, which affected all of the runners as we slowed down during the course of the event and many dropped out, so I was rather disappointed in my time.

I was then invited out to run the Kraków marathon at the end of April and despite being pushed over on the cobbles of the startline, I managed a much better time (despite rain, puddles and cold this time). A week later I ran an ultra.....by accident. I was going to accompany my parents when they ran the Wings for Life World Run in Poznán but they decided they'd rather I just ran my own pace and them theirs.....and I ran further than I thought I could despite having just done the marathon.

I'm not sure that's a happy face at the
 end of the Wings For Life World Run

I had a lump on my shin which swelled slightly when I ran, and I could feel a bit of pain in it with the first couple of miles of a run, but it then settled down and I was pain-free. I wasn't sure what was causing it so rested up for a couple of weeks after the trip to Poland and then went to see a physio. He looked with an ultrasound and couldn't see any periosteal reaction so reassured me that it was very unlikely to be a stress reaction/fracture and hence to return to running.

The World Trail Champs

The 100K in China

Fast forward to November and I'd run the World Trail Champs, 100K on concrete at altitude in China, and another marathon....but the lump was still there. I went to see my GP who also thought a stress fracture was unlikely due to the lack of pain and the presence of swelling which increased with exercise, but he agreed to refer me for an Xray and an Ultrasound (we thought that maybe there was a herniation of soft tissue through the fascia or something). He also signed my medical form and I headed off to Oman for a 6 day race across the desert....which was pain-free (well in my shin anyway...the infected blisters on my toes were another matter!!).

On returning from Oman, I had several voicemails letting me know that "surprisingly" the Xray had shown an anterior tibial stress fracture (the ultrasound was "normal").  I asked for a copy to be sent to Will, a friend in Carlisle who is an orthopaedic consultant with an interest in sports injuries and he nicely described it as "the black line of death". The problem was that you usually rest a stress fracture until it no longer hurts to walk/to do usual daily activities and then gradually return to running....but mine didn't hurt to do any of these, so Will suggested cutting back on my running and then rexraying in a month (the local xray department weren't very happy to do this, but luckily I have some useful medical friends).

Enjoying topping up my Vitamin D levels

Ice cream = extra calcium

I did cut back...right back for me...just the occasional 3-4mile easy run but a month later there was no change on xray so I cut back further (and hated it). I then headed over to see my relatives in Australia and although I initially did a few runs, I then stopped running and just walked, cycled and went to some non impact gym classes with my cousin (eg pilates). I hoped that a couple of months over there being in the sun (and so topping up my vitamin D levels) and eating ice cream (extra calcium) would mean I came back fully healed and raring to go.

Cycling in the Australian sun

I think that going to Australia was probably the best thing I could have done (even if the trip hadn't already been planned months beforehand) as it is at times like this that you really need the most support and often get the least - I'm not saying that people are "fairweather" friends and only keep in touch whilst you are actively running and racing (though clearly some are), but just that some are (usually unconsciously) a bit self-absorbed so don't think to ask how you're coping without doing one of the things that you love doing most (and that normally keeps you sane), whilst some are so used to bigging up their own niggles that they actually don't really understand/believe in an actual injury, no matter how serious it is.

On my return to the UK, my leg felt no different to me, and there was still a lump on my shin, but I "thought" it was smaller than it had been....but it's very hard to judge such a subjective thing so I went for a further xray. I was absolutely gutted to see no difference from the original films. I couldn't understand how I'd run on it for 6 months without any deterioration (but then again it didn't settle either), yet resting it for the most past of 6 months had not led to any healing (and I really had cut back.... from around 300 miles a month to about 8-10!!).

December (right) and March (left) - spot the difference...

I spoke to an endocrinologist with an interest in bone density and REDS (relative energy deficiency in sport) as this was the only thing I could come up with as a possible problem. I felt almost "angry" that my leg wasn't healing and frustrated that it had happened to me - I am not underweight, having a normal BMI, I love eating (and I really do love both ice cream and cheese) and don't restrict my diet at all, I do weight bearing exercise, and I take vitamin D supplements. The only things that count against me are that I have never liked milk so avoided it (except for no my cereal) through childhood, though I now add it to my scrambled eggs and porridge as well as having it on cereal, and that I have been amenorrhoeic for the last 6 years (and no cause has been found for this - normal hormones so not the early menopause I'd though, and a normal BMI).

She suggested blood tests - mainly normal except for a low white cell count (I would say that the WCC can become slightly suppressed with hard training...but I'm not exactly doing much of that now) and a low T3 (one of the thyroid hormones, though the rest are normal...which possibly suggest an energy availability issue) and a DEXA (bone density scan).

My FRAX score - risk of fracture

I had the DEXA scan last week and we could see that it showed osteopenia (the stage between normal bone density and osteoporosis), worse in the spine than the hip. I was devastated and sat and wept in the carpark before pulling myself together and returning to work. That might seem like an overreaction to some people.....but it's not "just running". Sure, it means that I doubt whether I'll ever be able to run at a high level again, but more worrying is the long term health impact. I have seen patients with osteopenia and osteoporosis who end up with minimal impact fractures and so have to avoid certain activities, and others in constant pain from multiple fractures, such as wedge fractures of their spines.

The NOGG guidance

I cannot thank my friends enough who came to my aid last week when I needed the support......hugs, messages, "care packages", meals, wine, chat and just company....you are all legends! As for me, at least I now know a bit more about what I am dealing with and so can try to work out where to go and what to do next......and hopefully this will not only benefit me, but also any patients, friends, colleagues and runners who have similar problems as my experience will enable me to advise them in a more knowledgeable way (eg since going through this I have discovered that giving hormones to those with premenopausal amenorrhoea is actually detrimental to their bone mineral density rather than beneficial as has been thought for years).......onwards and upwards......

NOT running the Krakow marathon....

I was invited to run the Krakow marathon in 2017 and, despite being knocked down at the start, acquitted myself fairly well by finishing in 4th place. I was invited back for the 17th edition this year and things couldn't have been more different. It would have been a totally different experience to (re)run the race, as the course had changed from a 2-lapper (with a very sharp downhill switchback to connect the 2 laps) to a single loop, and the 2018 weather (sunny and warm) was the complete opposite of 2017's cold rain!
 

The main reason why I got such a different view of the race this year was because I was still not running (this pesky leg of mine isn't making many friends). Despite this, the elite organiser still invited me out to Poland for the weekend, so I took my friend and GB teammate Sue Harrison along to run instead. The race was also applying to become a "Bronze Label" event with the IAAF so Hilary Walker was there assessing it on behalf of the IAAF. I have known Hilary for many years (as she also wears IAU and British Athletics hats) so it was also a chance to catch up with her and learn about how these events earn their accreditation.

The Elite photoshoot

Saturday was taken up with the usual duties of having photos taken, being presented to the general public on stage, and a "technical meeting" (where start details, antidoping, pacemaker times and bottle drops are discussed) but I decided not to go on a drive over the race route. Instead of this I pored over the course map and worked out that there were several places I could get to during the race to support without having to "run" between them in order to make it. 

I left Sue making up her drinks bottles after the technical meeting and headed to the Main Square in the Old Town for the sound and light show followed by the night 10K. It had sounded rather interesting last year, but I had been tucked up in the hotel resting my legs.....and the poor weather hadn't exactly been conducive to going along to watch.
 

"Running" the course

It was definitely worth attending this year....as they put on a great performance. Figures of runners moving along the course lit up the old buildings, and certain historical features were also portrayed in coloured lights. Then there were lasers, music and a lot of smoke (but a slight downside to standing up on the VIP platform was that some of the lasers shone directly into your eyes!).

The laser show

Everyone lined up for the 10K, and the starter fired a gun from right next to myself and Hilary. Hundreds of runners swarmed past just below us (it was rather reminiscent of the scene of the stampede in The Lion King) though I was rather surprised to see people wearing headphones in the race considering how loudly the music was blaring out of multiple speakers (in fact it was so loud that our platform was shaking and I had to stand on one leg to prevent feeling pain in my fracture site).

Catching up with friends at the 10K

Despite the time of the event (to be fair, it was run mainly in the city centre and so was relatively well lit) there were some speedy times recorded with the winning man coming home in just over 30minutes and the leading ladies under 36minutes. The time limit for the event was 90minutes which meant I had to negotiate runners when crossing the course on my way back to the hotel (I didn't want to get back late and keep Sue up before the marathon the next day), but at least they all seemed to be really enjoying themselves.

I confess it was very tempting to just lounge around in my bed while Sue went and raced, but I couldn't do that to her so I went down for a first breakfast with her, did my sunscreen application duties, made sure I knew how her camera worked and planned where I'd be to support her, and then had a second breakfast once all of the elite field had gone off on the official bus to the start and I had the dining room (and hence whole buffet) to myself.

With Sue pre-race

I'd worked out a quick route from the start to the 2k point that I could make while the runners did a big loop...and managed to be there well before the leaders came through. I started taking photos of the front men and then the ladies as they passed but didn't spot Sue. By the time the 3:15 and 3:30 pacers had gone past, I was starting to worry. I made sure that I could also see the runners coming back towards me at the 3K point, but didn't want to turn away from my first viewing position as Sue had told me that she would be starting slowly.......though I doubted it would have been so slow that she'd be this far back.

Supporting is obviously a tough job!!

Suddenly my phone rang, and my heart sank when I saw it was Sue calling me - her hamstring had gone within the first half mile and so she had been forced to stop and make her way back to the start - she was obviously very upset so I made my way back there as fast as I could (but not running). I was so upset for Sue as there was nothing she could have done about it, but she felt that she'd let people down. We got her some ice and a massage (or two)...and the massage therapists kindly offered to give my legs a rub as they had little to do until the rest of the elites finished.

We stayed around the race area to watch how it unfolded. Unlike the previous year, it was a nice warm sunny day, so although I made sure that Sue got treatment on her leg and didn't have to walk around much, I enjoyed wandering backwards and forwards across the square checking on her but also watching the big TV screen showing the runners at the sharp end of the field. I heard the race announcer talking about me and saying that he hadn't spotted me running this year, so I went and explained the situation to him. This seemed to earn me a media pass which meant that I could be right on the finish line when the leaders came in.

The leading ladies early on

It was quite exciting in the end as the Kenyan man who'd won the race in  2016 and 2017 was actually beaten by two Ethiopians this year...the first of whom missed the course record by a mere 7 seconds!! In the ladies' race, there had been a lead pack consisting of a Kenyan, an Ethiopian and a Moldovan (paced by the Moldovan Ukrainian husband). I didn't see "the move" but in the latter stages the Moldovan lady was running alone some distance ahead of the others, and took a fine victory by several minutes.

It was very difficult to be an impartial bystander rather than a medic at the end of the race, as I wanted to get the exhausted runners into the shade rather than having them sitting/standing in direct sunlight for photographs and interviews.....but it was important not to interfere, especially as Hilary was watching to see how the race organisers had prepared and how they reacted to developing situations, eg the 3rd placed lady's legs giving way when she finished necessitating her being carried back to the Elite tent, yet also needing to go to antidoping.

 

My new roles...

Although I really did wish that I had been able to run, I found it a very "educational" event. I hope that I was also useful to the organisers as I helped to make sure they understood the IAAF rules and protocols (as they were all written in English), eg what was required of an invited Elite field, and also learnt some of the issues facing a race organiser (who wanted to give advice to runners on course, eg to slow down in the early stages so they had more chance of running faster times overall, but was obviously not allowed as that would be "coaching them"), and some of the frustrations with interpretations of rules, eg that struggling runners do not realise that they can get assistance from someone outwith the race such as water without being DQ'd as long as that assistance does not constitute forward propulsion.

Hmmm.....maybe I could develop my skills in the race accreditation department...either that or athlete support/management.....

A cyclist's paradise

Mallorca

When my friend Mark initially invited me along to join his cycling trip to Mallorca, the hope was that my leg would be better, I'd have settled back into a routine of work since returning from Oz, and I'd be keen for a trip back to some sunshine to be able to start running regularly again. The three guys going were all keen cyclists, but it sounded like I would be able to split my time between going for a few runs, possibly hiring a bike to find new run locations, and spending some time chilling with the girls round the pool (ie the bar).

 

Enjoying post-dinner drinks together

Unfortunately, an xray on return from Australia showed no change in my stress fracture so I forbade myself any running at all. The guys were taking their precious bikes out with them, so I packed my helmet, pedals and shoes with the hope of hiring a bike and joining them for their "easy days"/"recovery rides". The complex we were staying in had a few outdoor pools (for the brave triathletes with their wetsuits), a small indoor one, and a gym (as well as a couple of restaurants, cafes and bars).

On my own cycle adventures...

Tracey and I couldn't resist the wine!

I knew that I wasn't a very good cyclist, so my aim was to get out and enjoy myself, and maybe alternate this with visiting the indoor pool, gym or spa. As it turned out, I ended up cycling every day that I had my bike (doing more mileage that week that I would normally do in a year)......and probably drinking almost as much wine as I did miles on the bike. I did discover that the 3-lane indoor pool was deep enough to aquajog in, but on each occasion that I ventured there, I was turfed out by German triathletes claiming that they'd booked sole use of it (I later found out that this wasn't the case as it wasn't possible to do so, but I wasn't brave enough to argue with them). I did however, make a few visits to the spa with its saunas, steam room (great for the manflu I developed midweek), infinity pool, massage jets and ?stony bottom to walk along (!!) - No, I didn't visit the nude area!!

Loving "chicking" some of the guys
 on the climbs

If you had a chance to look away from the
road and at the views they were amazing

The guys were great at looking after me and so I managed to ride with them on most days. I skipped their longest day and just enjoyed exploring the local area by myself before cycling along to the nearby village to join the girls for coffee. I'm not very good at cycling down hills as steep slopes, blind bends and sharp drop offs scare me, but I loved the ascents, especially on such smooth road surfaces. The guys would kindly wait for me at the bottom of the hills but I held my own going up - which was reassuring to me, as it meant that although I hadn't been running, I still had a decent cardiovascular base of fitness.

Having made it to the Cap
Formentor lighthouse

I loved every climb going out to the iconic lighthouse at Cap Formentor but panicked on every descent (even worse when you suddenly ended up in a long dark tunnel going downhill still wearing your sunglasses). They had 1 other day planned that sounded a little scary to me, so after a long climb up to Coll de Sabataia (and a cafe break), I peeled off to make my own way back down to Puerto Pollentia while they went on a side trip which had them descending round many 180 degree bends (I think 1 was about 360 degrees at they ended up cycling under the road they'd just been on).



The café at the summit of Coll de Sabataia

As I made my way down on my own, I passed hundreds of cyclists coming up the other way, but as luck would have it, the road stretched away from me without a soul to be seen just when I needed a helping hand. I had hit a pothole, which had made my chain jump rings, jam and then fall off. Although I felt rather smug to have fixed it all by myself, I was a bit surprised to be asked if I wanted to go to the toilet when I stopped for a celebratory piece of cake and coffee and the next cafe I found - it turned out that the waiter was trying to politely let me know that I'd smeared chain grease all over my face....a nice look!!!

After the best value coffee stop

A trip highlight for me was feeling like a "proper cyclist" following the guys over cobbles to a square in a local town (where we got 4 coffees for 5 euros), and i couldn't wipe the grin off my face.

At the top of Christmas Climb

On the final day, Mark and I actually "outcycled" the other two (well, to be fair they'd all cycled further than me the day before), as we headed up Christmas Climb for great views out over the bay we'd been staying in.



How could you not go back to somewhere that
has this view at breakfast time?

All in all, it was an amazing trip and I'd heartily recommend Mallorca for a cycling trip and it actually wouldn't have been that much fun if I'd been trying to run whilst there, as the only way to go from the resort, was out along the mainroad by the sea in either direction...not very inspiring, espeically as most of the other people running were all doing it in trisuits!! However, unless I can get over my fear of corners, descents and dropoffs, I'm never really going to be a cyclist...............