On Thursday, the 6th of June 2024, after more than 10-months of struggling with debilitating nerve symptoms down my left side running into my leg and foot, and living with chronic lower-back pain, I was finally able to get help and undergo a back operation.
In this post, I explain in detail how I got to this point, explain the details of the procedure that was done, as well as why getting surgery was the only option left for me…
YOU NEVER KNOW WHO YOU ARE GOING TO IMPACT
Shortly after publishing my previous two blog posts in March, I went to visit my best friend in Cape Town. We took a walk on the Sea Point promenade before going for breakfast.
It was hard to enjoy the view with all the runners passing me. I felt broken, both physically and mentally.
‘What is wrong with me?!’, I thought.
‘Why can’t I run like all these people? How did I go from winning the national marathon title at the Durban International Marathon only a year ago to this… being so weak that I can’t even walk without being overwhelmed by the pins and needles running down my leg into my left foot?’
Suddenly, a stranger touched my shoulder.
“You don’t know me, but I just wanted to say thank you. Thank you for the blogs you just posted and sharing your journey with the world. It meant so much to me.”
This blew my mind. In that moment, her words meant the world to me, because, at that point, I no longer felt worthy of sharing my journey. Who cares anyway? Who would want to read my story? That small gesture changed my perspective.
I am not the only one suffering. Every time I share my journey, I receive feedback from people resonating with certain parts, sharing their own injury or chronic health struggles with me.
I think that is powerful!
Currently, it is not a very happy story, but maybe, if I choose to keep fighting despite obstacles thrown my way, someone else out there will choose to do the same!
RUNNING THE ULTRA-MARATHON OF LIFE
For as long as I can remember, life has never been easy, and that is okay. An easy life is not necessarily a meaningful life, and in many ways my story has shaped me into the person I am today.
I am also not here to complain – I know there are others who have it far worse than me.
However, it has been a rocky road ever since I turned 11, with steep climbs and plenty of detours along the way. They say, the struggle makes you stronger, but sometimes I ask myself, ‘How much stronger do I need to be?’.
I have not run an ultramarathon yet, but, when I make my debut, I will be prepared, because the last few years of my life have felt like an ultramarathon without a finish line. When you think the end is in sight, a few more turns climb over the horizon. It becomes hard to pace yourself if you don’t know how far you need to go.
Since the pandemic, I have gone through several major health and injury setbacks, as well as some personal things that have truly been some of the most difficult challenges I ever had to face.
2020 amounted to a blur of marathon race cancellations, as much of the running world can attest. My running was blooming towards the start of 2021, but I got no chance to put a time on the board in a real race. I broke all my personal bests, and even a couple of South African records, in training. It was all meaningless, though, since none of it was done in an official race. The disappointment peaked when I was selected for the 2021 South African Olympic Marathon Squad, but was unable to seal the deal by running the Olympic qualifying standard in an official race.
In the middle of 2021 my health started deteriorating. I struggled to manage my symptoms in my everyday life, and even more during training. I kept passing out during my runs due to dehydration, and eventually was diagnosed with diabetes insipidus during September of that year. This is a direct result of my hypopituitarism and my body’s inability to produce adequate ADH to maintain an optimal fluid balance. Antidiuretic hormone (ADH) is a chemical produced in the brain that causes the kidneys to release less water, decreasing the amount of urine produced.
Life with celiac disease has always been challenging, but I have learned to live with it and plan ahead. I can’t help thinking, though, how much easier it would have been if I could pick anything off a menu when I go out with friends or family, not having to travel everywhere with my tupperware. I am not picky – I would have loved to eat normal bread, pasta, or pizza without having to check every label for gluten contamination. I sympathize with anyone who has food allergies, because it really sucks.
However, learning to manage diabetes insipidus ended up being an even bigger challenge. It is embarrassing and influences nearly every aspect of my life.
I hate having to ask where the toilet is everywhere I go; waking up multiple times a night; going for blood tests every month to ensure my electrolyte balance stays within the normal range; interrupting a meaningful conversation, because I need to find the nearest restroom; always having cold hands and feet due to the diabetes neuropathy (poor blood circulation).
I despise everything about this illness and, in 2022, it nearly killed me.
My medication dose was too high, which caused a severe electrolyte imbalance. Speaking plainly, my urine output was less, but more concentrated, so I was still losing all the key minerals needed to maintain and build strong bones. (Sorry for the dirty details!)
A whole year out of competition, four MRI scans, two ultrasounds, a CT scan, the first stress fracture of my career (followed by three others), and a seizure later, we finally figured it out. The doctors promptly adjusted the dose. Things quickly turned around thereafter. My blood sodium levels and electrolytes were back in balance. I was able to resume running and returned to harder training in December.
If you want to read about this experience: THE MISSING PUZZLE PIECE
2023 started strong for me, and it felt like things were finally turning around. Alas, it ended up being one of the most challenging years of my life, both physically and mentally.
HOLDING ON TOO TIGHT
When I was a junior athlete, I had this tendency to clench my fists really tightly when I ran. At the time, my first running coach noticed this and gave me a form tip:
'Imagine you are holding a small bird in your hand. You don’t want to squeeze too tightly.'
Recently, I've thought a lot about this concept as it relates to life.
It could be...
Your biggest goals or dreams, your greatest passion, an opportunity of a lifetime, a career-defining decision, or even a person you really like...
There is such a fine line between holding on to something so tightly that you break it OR loosening your grip to the extent that it slips away.
Everything worth pursuing comes with the possibility of failure and humiliation.
However, often the greater the risk, the greater the reward as well.
It is all about finding the right balance...
Don’t squash the little bird.
But, don’t let it fly away either…
That bird was my Olympic dream.
I was so careful, but it got away all the same.
My opportunity to go to the 2024 Olympic Games in Paris had slipped away. The qualifying window closed at the end of April. At that point, I couldn’t even cross train without debilitating nerve symptoms down my left leg and foot.
There was no way I was going back to Durban to defend my title as the South African Marathon Champion.
I had to let go and, for the first time in my life, I have serious doubts about whether I am ever going to make a comeback.
I have heard ‘you will never run again’ MANY times, but doubt only becomes dangerous when you start to believe it. Up until this point, I still believed that I was good enough to become one of South Africa’s top female marathoners.
I no longer know if this goal is possible.
I thought I was doing everything I could to fix the problem. I worked with a biokineticist, thinking hard work in the gym would correct the imbalance. In fact, the strength work and plyometric training may have actually made my symptoms worse.
I have seen multiple chiros and physios, had weekly dry needling sessions, and sports massages. I have done hours upon hours of rehab and strength exercises in the gym. I seeked out the guidance of a sports doctor and exercise physiologist. I have now seen several orthopedic back surgeons. I had 3 MRI scans. I have undergone 4 epidural injections to try to calm down the inflamed nerve and ease the pain.
Nothing helped.
Read my two previous blog posts if you want more context on what went wrong in 2023 and how I got to this point where I am right now.
KEEP LOOKING
At the end of 2023, I saw the first orthopaedic spinal surgeon, Dr. Attie Botha, at Busamed Private Hospital. He looked at my MRI and said I had three options:
Rest and hope it heals with time.
A spinal disc fusion, where they would insert 3 screws between the L5 and S1 in my lumbar spine to repair the annular tear.
An epidural injection to try calm down the inflammation and reduce the nerve irritation and pain.
I chose the third option, since I thought it gave me the best shot of still making a comeback. I wanted to defend my national title at the Durban International Marathon in April, thereby qualifying for the Paris Games in 2024. It ended up being the wrong choice, since the epidural only bought temporary relief. A few weeks later, my symptoms were as bad as before.
I had two more epidural injections two months apart before seeking out a second opinion. On the 10th of April, I saw a new specialist – a neurosurgeon in Stellenbosch. I felt like I had exhausted my other options. Perhaps surgery was my only path to relief.
Unfortunately, she was unwilling to operate, citing my osteoporosis and Diabetes Insipidus as too high of a risk.
I was left with no answers and a simple: “Keep looking…”
So, that is exactly what I did.
On the 5th of May, I flew to Johannesburg to see a doctor at Spine Africa Medical Centre, who specializes in non-invasive surgical options.They wanted to see me in person before evaluating my case. They were highly recommended to me by a man who works closely alongside Bruce Fordyce. I was optimistic that these people would understand the mindset of an athlete longing to compete again. I was desperate for help.
It ended up being a horrible - and very expensive - experience! I was instructed to arrive 1 hour prior to my 1 o'clock appointment.
At 1:30 PM, I was called to record my height and weight, and to make a payment.
At 1:45 PM, I had to go for an X-ray.
At 2:30 PM, I saw the general physician.
He jotted down my medical history and told me to wait for the spinal surgeon. He came in at 2:55 PM, briefly examined me and (just like the previous surgeon) made it clear that he was unwilling to operate on me after looking at my long list of medications and knowing the severity of my medical conditions. The risk was simply too big.
I was mind-blown.
I had flown all the way, spent all that money on tickets, only to top it off with R3000 for the consultation. And for what?
ENDURE
Sometimes, when we are in the thick of things, we think they can’t get any worse, but, as crazy as it seems, I would rather be back in 2022 than deal with this injury. At least bones, with adequate rest and nutrition, typically heal within six to 12 weeks.
However, this injury has no timeline, and the future of my running career hangs in the balance.
No amount of rehab, strength training, nutritional interventions, or treatments are going to help it heal faster. I can't cross train on the ElliptiGo like I did in 2022, since it also aggravated my symptoms, even worse than running. In fact, even hiking feels too uncomfortable.
The only thing I can do without any symptoms is swimming. And I really don’t like swimming – my body hates the cold water. The doctor explained that swimming takes the pressure off the disk in my spine. A lot of people find water therapy to be beneficial for the rehabilitation of injuries. I have never swam competitively, nor have I had any swimming lessons, but doing so daily helps keep my dream alive.
At the time of writing, the nerve symptoms have progressed to a point where it impacts every aspect of my life. I feel constant pain and discomfort in my back and down my left leg.
I can't sit or stand for longer than 10-20 minutes. It wakes me up at night. I can’t walk without compensating and heavily favoring my right side. I am taking extreme (category 5) pain medication three times per day just to keep working.
I don’t know how much longer I can endure this pain. It feels like I am running a race at an unsustainable pace.
They say annular tears can take quite a long time to heal on their own – 18 months to two years. Some tears never heal. There is no guarantee that the symptoms won’t return or that there won’t develop another tear, because it will always be a weak spot.
Like I explained in my previous blog posts, this is an old injury stemming from a car accident I endured in America, in 2015. During my build-up towards the Berlin Marathon last year, I developed an annulus fibrosus tear in the disc that got hurt during that accident. The discs in the rest of my spine looks perfectly normal, but the disc between L5 and S1 is basically just deteriorating.
THE ONLY OPTION LEFT
I requested a DEXA scan from my doctor to show that my bone density has increased over the past few years. I knew the medication and near-religious daily resistance training must have made a difference. I also applied my sport nutrition knowledge and used supplements that have been proven to help improve bone density, like vitamin D, calcium, whey protein, creatine, and collagen.
I went back to Dr. Attie Botha, and asked if he would be willing to perform the operation. Once he saw my bone density had increased by over 20% in only one and a half years since my last scan, he agreed to help me. In fact, my bone density has increased so much that I no longer have osteoporosis in my hips or spine!
I also booked an appointment with my endocrinologist to ask him if he would guide the surgeon through the correct protocols. An electrolyte or fluid imbalance occuring during the operation could be life threatening for someone with diabetes insipidus.
Then, on the 6th of June, I received a spinal fusion between the lumbar discs L5 and S1, which basically involves putting in three screws in my back.
I have become dependent upon those around me for basic things. I can’t drive, and doing simple house chores is hard.
At this stage, I just want quality of life back.
THE RECOVERY ROAD AHEAD
Dr. Attie emphasized that I need to manage my expectations and that I should not go into this operation with the hope of running professionally again. If I do, that is a bonus. Right now, the main priority should be to get relief from my symptoms and be able to live again.
However, I have, AND WILL NOT, give up yet. I know it will require a lot of patience – I need to wait six months before attempting to run again – but I will make a comeback.
Even if it takes me a lot longer to eventually achieve my goals and dreams, I know when I do they will be so much more meaningful because of what I overcame to get there.
Recently, I have also seen one of my best friends go through back-to-back labrum surgeries in less than one year. Seeing how he navigated this challenging journey with so much persistence, patience, and determination to return to what he loves was very inspiring to me. Observing the disciplined and dedicated approach he took to his recovery timeline and rehab gives me the courage to do the same.
I also love running too much to just let it go. I am so passionate about the sport, I can’t simply step away and move on with my life.
Plus, I have come too far and endured too much to give up now.
So, I am going to keep going…
I hope this post inspires you to do the same!
Thank you for taking the time to read this blog and supporting me along my journey.
I would also like to give a shoutout to all my amazing athletes who are part of Annie’s Athletes. They have all been so supportive and caring throughout this whole journey.
A special thank you to those closest to me who stood by me through this very challenging year and were there to pick me up when I was at my lowest. (There is no need to name them all here, because they know exactly who they are!!) 🤍
It is so powerful to have people in your life who have the ability to make you laugh and smile in the midst of your pain.
Subscribe to the blog to follow along with my recovery and comeback back to the road.
~ Written by Annie Bothma, edited by Francois Bothma
