- Annie Bothma
- May 11
- 13 min read
Updated: May 18
It has been nearly two years since I last got myself to put pen to paper and write, or rather type, a blog post.
Needless to say, a lot has happened.
I certainly did not shy away from sharing the struggle; that is not why I stopped sharing my story. I was too busy fighting. That is what the past two years have been: one hell of a fight.
I thought my back surgery was hard, but what followed in the aftermath turned out to be an even greater challenge…
DISCLAIMER: I am not giving medical or injury advice in this blog post. I am simply sharing my personal experience. Every person’s body, journey, medical situation, and recovery process will be different.
SEEING RED
In case you have not read my previous post, Just Keep Going, here is a quick recap of what happened. On 6 June 2024, after more than ten months of chronic lower-back pain and debilitating nerve symptoms, I underwent L5-S1 spinal fusion surgery. Dr. Attie Botha, together with Dr. Swanepoel, operated from the front to reach the damaged disc, create space between L5 and S1, and stabilize the structure with three screws. I knew the risks were high. I knew my life could change after that operation, either for better or for worse. But by the time surgery arrived, I was desperate for relief.
I was barely holding on. There was no more thriving. I was just surviving and going through the motions.
When I woke up in ICU and heard that the surgery had been successful, it felt like winning a marathon.
But the recovery was not simple.
The first days after surgery were painful and overwhelming, and unfortunately, my hospital experience was not what it should have been. Less than 24 hours after the procedure, while I was still in ICU, one of the staff nurses instructed me to get out of bed and go shower. I had been told that I should not move until I had been transferred out of ICU and seen by the physiotherapist, so I was confused, scared, and in a lot of pain. At that stage, I had only just come through major spinal surgery. I was still connected to medical equipment, heavily affected by the procedure, and completely dependent on proper post-operative care.
When I got home, I woke up bleeding on Monday morning. By Wednesday, I was back in hospital in the emergency room. I was losing so much blood that they thought I might be experiencing organ failure.
Looking back, we will never know with certainty whether that moment contributed to the complications that followed, but it became part of the fear and uncertainty that surrounded my recovery.
For the first six weeks, I was not allowed to bend, lift, drive, or sit for more than short periods. My world became very small. At a time when I had imagined chasing races, titles, and Olympic dreams, I was learning how to stand, walk, and trust my spine again.
One month after surgery, I was cleared to return to the pool. For a brief moment, it felt like the first sign that I might start rebuilding. But that hope did not last long. Only a few days later, I tried to swim in an extremely cold pool in the middle of winter. My body could not cope. I developed hypothermia and collapsed, nearly falling into the arms of one of the gym staff members.
After that, I stopped cross-training completely. For the next six months, there was no structured training, no pool sessions, no bike sessions, and no significant athletic return. My days consisted only of walking, rehabilitation, and trying to manage each day.
During those same six months, I was seeing red as I continued bleeding on a daily basis. I faced pain, infection, medical investigations, blood tests, urine tests, ultrasound scans, antibiotics, medication changes, and the emotional burden of watching the life I had worked so hard to build slip further away.
It was not a clean comeback story. It was blood, sweat, and tears in the most literal sense.
SALT STAINS
By December 2024, something finally began to shift. The bleeding and recurrent infections resolved after my appointment with my endocrinologist, and I slowly started running again. For the first time in more than a year, my quality of life felt like it was returning, and I was able to start training again.
My business was growing, and I was preparing for a demanding entrance exam for an advanced master’s program, a pre-PhD pathway I had worked hard to be considered for. In January 2025, I passed the seven-day exam with distinction and was accepted into the program. It felt as if life was finally opening again.
But that comeback was short-lived.
The program turned out to be far more demanding than my body could handle while running my business, training again, and managing a complex chronic illness. I became chronically sleep-deprived, overstressed, and severely under-recovered. I lost weight, my immune system weakened, and my hormone levels declined significantly. It was simply too much stress for my medical condition to withstand.
At the same time, managing my Central Diabetes Insipidus became increasingly difficult. A medication change led to my new generic medication being dosed too high. On 7 March 2025, blood tests showed that my sodium had dropped to 128 mmol/L. Normal sodium levels are considered to be between 136 and 145 mmol/L. Below 135 mmol/L is classified as hyponatremia, meaning diluted blood plasma sodium.
Three days later, I experienced my first major hyponatremic episode. I nearly lost consciousness, became confused, developed a pounding headache, and felt my body start to shut down. What followed marked the beginning of a month-long battle with chronic hyponatremia and severe immune suppression.
At the end of March, I contracted both a bacterial and viral infection. On Monday, 31 March 2025, my sodium had dropped to 123 mmol/L in the morning and later fell below 120 mmol/L. I blacked out in the car on the way to the emergency room.
For a moment, everything became still, and all that was left was darkness.
My mother urgently contacted the doctor, who realised how serious the situation had become and arranged for my immediate transfer to ICU. I remained in ICU from 31 March to 2 April, receiving carefully controlled sodium correction, antibiotics, close monitoring, and frequent blood tests. The dual infection, chronic hyponatremia, hormonal suppression, and fluid-electrolyte instability created a perfect storm that nearly cost me my life.
I was discharged on 3 April, but the crisis was not over. Two days later, an at-home IV drip was administered in an attempt to help me recover. Instead, it triggered another severe deterioration. Within hours, I began losing extreme volumes of fluid. Over the next four days, I passed approximately 26 litres of urine, not including gastrointestinal losses, sweat, or respiration.
The basin crystallised with salt. My body was dumping sodium faster than I could replenish it. This became the most severe hyponatremia episode I had ever experienced. I had headaches, severe cramps, weakness, memory lapses, delayed processing, blurred vision, irregular blood pressure, elevated heart rate, heart palpitations, sleep disruption, another loss of consciousness, and complete physical shutdown.
Later in April, I was admitted to ICU again, this time at Milnerton Mediclinic. On 17 April, after severe symptoms, urine losses between 4 and more than 8 litres per day, loose bowel movements, and another low sodium reading of 129 mmol/L, my doctor admitted me directly to ICU for urgent monitoring.
At first, the plan gave us hope. There was structure. There was monitoring. There was a protocol. But over the long weekend, my care was transferred, and the original plan was not continued in the same way. My sodium dropped again, my symptoms worsened, and my family no longer felt safe with the care I was receiving. A critical sodium reading of 119 mmol/L was recorded on Saturday night, and my mom feared that she was going to lose me.
I do not recall much of the episode. I just remember pain. I remember wanting the suffering to stop. I wished they could just put off all the beeping machines around me and give me an out.
The doctor on staff kept increasing the rate of the hypertonic sodium IV drip, alongside another normal IV drip. My body responded by dumping more and more sodium through my urine. By Sunday afternoon, another blood test showed that my sodium had dropped yet again to 120 mmol/L. We no longer had trust in the medical system, and I signed a discharge against medical advice form to take me home. I was lying in bed in ICU with my heart rate over 100, and with each blood test, my sodium levels were dropping further and further.
That night, my condition deteriorated further. I was nauseous, cognitively disoriented, in extreme abdominal pain, and experiencing cramping and full-body contractions. I eventually passed out from exhaustion and excruciating pain.
For a long time after that admission, I did not feel like myself. I could not work. I could not read. I could not listen to music or podcasts. My brain felt foggy and shut down. Any noise became magnified.
I have not had a day since where I do not battle with chronic headaches; only the severity of the headache changes.
After fighting so hard to come back from back surgery, I had been forced into a different battle altogether: learning how to stay alive in a body where the margin for error had become terrifyingly small. Managing my medical condition had become a full-time job.
Every day, I have to manage my body to stay alive. Each morning, I begin by lying down and measuring my HRV, resting heart rate, and respiration. Then I sit up and take my blood pressure and resting heart rate again. I take a USG reading to see how concentrated or dilute my urine is. Then I check my weight and calculate the percentage change from the day before to estimate fluid loss. I measure every millilitre of fluid I drink and track my sodium intake to help keep my blood plasma sodium within the normal range.
I still have to do all of this monitoring every single day. Tracking has helped me manage it better, but it has also taught me how little control I really have. This disease is relentless.
The winter months that followed were brutal. My life revolved around symptoms, medication, urine output, sodium, blood pressure, and blood tests. In one month alone, I had 36 blood tests. There were days when visiting PathCare felt like part of my daily routine, not because I was preparing for performance, but because we were trying to keep me alive.
A WARMER PLACE
Then, one morning, while sitting at PathCare, I received an email from the International Olympic Committee. I had been awarded a grant I had applied for at the start of the Paris Olympic cycle. At the time I applied, the grant was meant to support my Olympic dream. By the time I received it, I was barely holding myself together. That grant became something else. It became a lifeline.
My parents were scared. They had watched me nearly lose my life more than once and feared the cold Western Cape winter would push my body further backwards. We used the grant money to move somewhere warmer and stayed in an Airbnb in Ballito, KwaZulu-Natal, for three months.
Ballito gave me back quality of life.
The warmer climate helped, but more than anything, the people helped. For the first time, I became part of a real running community through Dolphin Coast Striders. After years of fighting so many battles alone, I found myself surrounded by people who saw me not only as an athlete trying to come back, but also valued me as a person and appreciated my expertise as a sports nutritionist with a master’s degree.
The return to running was humbling. At the beginning, my long runs were over a minute per kilometer slower than normal, my mileage was far lower than before, and I could not sustain what is now my marathon pace for even sixty seconds at a time. Even walking upstairs left me out of breath.
I still had more bad days than good days, ongoing symptoms, and a lot of setbacks, but slowly, something started to shift. The progress was small and very inconsistent, but it was progress. My body, which had felt so broken for so long, began to respond again, and there were flickers of hope.
BETTING ON MYSELF AGAIN
It was only in December that things really started to click for the first time. I entered a small local 10 km race shortly before the start, instead of my Tuesday workout, with no pressure and no certainty of what my body would give me. I ended up breaking the course record.
That race reminded me that the athlete inside me was still there.
Soon after, I entered the 2026 Durban International Marathon. It was a quiet decision, but a significant one.
I was betting on myself again.
On my birthday, during a week with high mileage, I accomplished my longest run to date: a 50km. It was one of the most unforgettable runs I've experienced, with my brother and dad cycling alongside me. We talked, and the time passed quickly. We covered most of the Winelands Marathon course, adding a few extra laps in our neighborhood to complete the 3-hour and 15-minute run. This run gave me the confidence that even if my speed was not where it use to be prior to surgery, my endurance capacity was still there.
The build-up was not perfect. Comebacks never are. They are messy, but when you learn to embrace the process, you often look back on the journey with much more appreciation and satisfaction.
I approached each run without judgement. “Let’s just see what my body gives me today” became my mantra. I built my comeback on grit and gratitude. I get to do this. I was no longer lying in a hospital bed—any run was better than no run.
I had to rebuild my fitness, endurance, strength, running form, posture, and confidence around a spine that had been surgically repaired and a chronic illness that still demanded daily attention. I raced myself back into shape through frequent small local races, treating them as workouts without proper tapers. I focused less on times and more on becoming race fit again.
On 15 March, we swapped my weekend long run for the hilly Tygerberg 30 km. In previous marathon builds, I would often run a 25–30 km tempo at goal marathon pace, but with the elevation, a full week of training in my legs, and no proper taper, the goal this time was different: run at marathon effort and get the right training stimulus. Around 5 km into the race, I took a hard fall. I do not have complete feeling in my toes and feet, and when my Diabetes Insipidus symptoms and neuropathy are worse, I can lose touch with the ground. I hit the pavement hard, but jumped straight back up and still ran a 3:25/km split. Adrenaline, grit, and determination are a powerful combination.
I ended up clocking 1:48:57, winning the Battle of the Sexes according to the World Athletics points table, and breaking the course record of 1:57:54, previously held by Monica Drögemöller, former SA 30 km record holder, multiple Two Oceans Marathon champion, and current Cape Peninsula Marathon course record holder. All in all, my first 30 km race was a great experience, and it gave me confidence that my form was returning.
After not being selected for the WPA marathon team in February, I submitted an appeal asking the board to reconsider. I was the WPA marathon record holder and the first WPA female athlete to win a national marathon title. However, the board declined, stating that I had not run a marathon in the previous eight months and that they did not believe I would be ready by May to represent the province at the national championships.
At the start of 2026, I joined Dolphin Coast Striders Running Club. The Dolphins are more than a club; they are a community. When I was at my lowest at the end of 2025, they welcomed me onto the road and made me feel like I belonged again. I am proud to represent them and feel thankful to be part of a running club that values me for more than my performances.
At the end of March 2026, I returned to Ballito, where I am now based for more than half of the year. A few days later, I lined up for the Durban City Marathon in wet and windy conditions. It was my first marathon in over three years. It was not a perfect race at all, in fact, it was chaos. There was no lead bike for the women’s race, hardly any water stations, and I ended up running half a kilometer extra. Still, I kept pushing, crossed the line first female, 6th overall, winning in a new course record of 2:33:35.
After everything it had taken to get back to that start line, the result meant more than another race win. It was proof that I was ready to compete in the marathon again. Following that performance, I was fortunate enough to be selected by KZNA to represent them at the South African Marathon Championships at the Durban International Marathon.
THE BLACKBOARD
In 2021, this was written on my chalkboard:
I am capable.
I am strong.
I am a soldier.
I am a marathoner.
2:27:42.
That was the goal. That was the time I was chasing. That was the dream I was trying to make real. My target average pace was 3:30/km, which would bring me to a 2:27:42 marathon.
At the time, I had just won the Sanlam Cape Town Marathon in 2020 and had been included in the Olympic squad for the Tokyo Games. The Olympic qualifying standard was 2:29:30.
But after one race postponement, cancellation, and setback after another, I never got the opportunity to seal the deal. When the qualification window closed in May 2021, my hourglass had run out.
And then life kept happening.
In 2022, I spent the entire year out after being diagnosed with diabetes insipidus. Medication complications meant my body was losing the minerals needed for strong bone integrity, leading to four bone stress injuries.
In 2023, I fought back and won the Durban International Marathon, claiming the South African marathon title in the process. I was set to run in the elite field at the Berlin Marathon and chase the Paris Olympic qualifying standard.
But that dream was interrupted too.
In 2024, while the Paris Olympic marathon was happening, I was sitting in the sauna, staring at the swimming pool, recovering from back surgery.
In 2025, I spent much of the year in and out of hospitals, undergoing repeated blood tests, and fighting for my life in ICU.
The chalkboard has long been erased. The original timeline disappeared. The dream had to be redefined over and over again.
But the goal never fully left me.
TEARS OF JOY
On 3 May 2026, I returned to the Durban International Marathon.
Three years earlier, Durban had been the place where I won my first South African marathon title. This time, I returned as a different athlete and a different person.
I had been broken down, chewed up and spit out by life. I had back surgery, thought through chronic illness, ICU admissions, months of blood tests, infections, neurological symptoms, fear, weakness, and uncertainty.
I had been forced to rebuild from a place that felt lower than rock bottom.
I finished second overall and ran 2:27:45, claiming the South African marathon title for the second time. In doing so, I became the ninth-fastest South African woman ever over the marathon distance and one of only ten South African women to break the 2:30 barrier.
But that result means more to me than a time.
It represents every hospital bed, every blood test, every painful step after surgery, every winter morning, every night where my parents feared they were losing me, and every moment I wondered whether my body would ever allow me to run again, let alone race a marathon at an elite level.
If someone had told the Annie lying in ICU, or the Annie lying in a hospital bed after back surgery, that she would one day return to Durban and run 2:27:45 to win another South African marathon title, I do not think she would have believed it.
I never lost hope.
I never stopped fighting.
I never gave up.
I hope my story encourages you not to abandon your goals, and to choose to rise again after every setback and failure, even when you reach rock bottom. Choose to continue fighting, even when all hope appears to be gone.
~ Annie
