This too shall pass

I've been known to be a bit of a drama queen. Everything comes falling down and I know I like to have a whinge. Yet when something quite significant happened to me to really alter my perspective, I really found out who I am & how I deal with things.

So the bottom line is that I was diagnosed with malignant papillary thyroid carcinoma (cancer) at the end of June. The big C.

I have copped the brunt of (negative) public opinion on triathlon forums this year. I have spent the past 2 years questioning a decline in performance in both training and racing. I have had constant injuries that never fully healed. I have been told by a coach that all my problems were psychological and in my head & battled with my weight when being extremely rigid with my diet. Papillary thyroid cancer is a slow growing cancer. At diagnosis I had a 2cm primary tumour in my thyroid, a second 2cm mass in my neck on the opposite side, extensive lymph node involvement, parathyroid involvement, multiple cystic masses- two being 6cm in size. My doctors tell me that this cancer has been in my body for years. For the past few years my body has not only been under constant stress of training, an international race schedule and balancing part to full time work as a physiotherapist, but also battling cancer.

I am not writing this to evoke a pity party. These are the cards I had been dealt and I get to choose how to play them. I have no doubt that this will change who I am and how I see the world but that doesn't have to be in a negative way. I am so bloody lucky this was found when it was. I’ve had hormonal imbalances for 7 years- amenorrhea thought to be due to the high volume/ intensity of training I do to compete in my beloved sport of triathlon. In March I mentioned to my GP that my amenorrhea continued. She was concerned that it had been an issue for far too long- ran bloods to check both my hormone and thyroid levels. The hormones were low and the thyroid was normal. With a lot of persuasion required my GP referred me to see another endocrinologist locally. Unfortunately they work publically which meant I had to wait until the end of May before an appointment came up. On the physical examination the doctor noted a thyroid nodule in the right lower lobe & I was referred to have this investigated by ultrasound.

95% of thyroid nodules turn out to be nothing so I stuffed around a little. Booked the ultrasound about 2 weeks after my appointment and went in for it on the 18^th of June thinking it was overkill. The sonographer took an extensive scan of my neck and finished up by telling me; “There’s a lot going on in your neck. You can’t tell exactly what on ultrasound but more investigation might be needed.” Thankfully I got in to see my GP the next day. When I got there we read the report together: The nodule requires further investigation with contrast CT & fine needle aspiration (FNA) as it is suggestive of neoplasm….. Cancer….F**k…. Which is exactly what my doc said.

Over the following days I had a nuclear scan (which showed a cold nodule- still not good), then a contrast CT which coincidentally fell on my 29^th birthday. On Tuesday I went back to QDI (Queensland diagnostic imaging) for the FNA. When I got there they had found a second mass on the CT on the left side of my neck extrinsic to the thyroid which was suspicious so they biopsied both. On the 27^th of June I went back to my GP to get the results. That morning I had been up at 5am to swim 5km with my squad, then went for an hour run/ walk (as I was recovering from a pelvic/leg injury), all this before my 9am appointment. I heard the pathologist on the other end of the phone give my GP the results from the biopsy, “papillary carcinoma”….. I had done my extensive research on all possible outcomes…. This was not the outcome I was expecting or the one I wanted… Cancer… I had cancer….Me…. But it’s the good one to have…. >95% five year survival rate… and surely not being sick means we've caught it early….. didn't we????  Surgery is a certainty…. This was everything that ran through my mind in the first 5 seconds. I went back for a chest CT to check for secondaries (which eventually came back clear) and then I took myself off to work. I told only a few people that day as I felt as though it wasn't really happening to me. It took me a really long time to come to grips with the phase ‘I have cancer’.

Of course there was the ever so fresh memory of my wonderful friend Katie who passed away on her 28^th birthday in 2011 after a short battle with cervical cancer. I remember when and where I was when she told me she had been diagnosed and when I found out she had passed. She had not won her battle but for me this was a war I would win.

Me & Katie on my 25th birthday

Of course I went on overdrive on researching treatment, surgery, risks, complications, mortality and from this developed a long list of questions for my surgeon. I shied away from those that were over the top with pity and emotion and wanted to offer me advice on a thing they hadn't been through themselves. Special mention here to Paige for being an awesome source of information and encouragement through the initial stages of diagnosis and lead up to surgery. I became intolerant of other people's reactions- why are they crying when was holding my shit together. I didn't need those types of people around me to assist me to beat it. Why did people say sorry- I kept telling them they didn't cause this so what's there to be sorry about? I needed to surround myself with people that showed support and strength, treated me no differently to how they normally did and resisted the urge to smother me.

When the first thing the surgeon said to me was ‘your tumours are quite large and one is occluding your internal jugular vein’ the reality of it all started to set in. We talked about the possibility of multiple incisions as a lot of lymph node clearance would be required, parathyroid involvement, removal and re-implantation if she was able to salvage any, which would probably require some calcium supplementation until it started to work again. We talked of the extent to which the cancer had spread- into multiple levels of lymph nodes in my neck, throat and into my chest & then the possibility of it having invaded other structures such as nerve or blood vessels. This was possibly the point at which the enormity of the situation crashed down on me like a brick wall. And then came the post-op complications; permanent voice changes or possible loss, potential for bilateral laryngeal nerve damage resulting in a permanent tracheostomy (breathing tube in the neck) or brachial plexus damage (nerves that supply your upper limb). Triathlon wasn't even on the mind, but brachial plexus damage was a huge concern for me as I need my arms and hands to work to be a physio. Of course with any surgery is also the mention of death. This was serious. Cancer is cancer and even when it’s the good one there is always the risk with surgery or cancer that something can go wrong. Dad’s only question was ‘when?’ “Tuesday” said the surgeon. To me that wasn't soon enough- another entire week- I wasn't quite sure I could mentally wait that long. The sooner the better as it would have less chance to grow and spread.

But life went on and I needed some normality. The next morning swam with Bec (my training partner). For a blissful hour I forgot all that I was facing. I went to work where I had to pull myself together for a busy day of work whilst trying to process all that had happened and all that was going to. I gradually got around to telling friends as it was something that would soon be public knowledge on the small Sunshine Coast and triathlon world.

And then it was surgery day. I was admitted at 11am, showered and waited and waited. A quick visit from the anaesthetist and surgeon and around 2pm I was taken to the operating theatre. At this stage I was now packing shit. I was no longer nervous, just plain scared. I was wheeled into the theatre and transferred onto the operating table and the last thing I remember is the surgeon walking over. Then I was awake asking if they had started yet- “it’s over” said the nurse in recovery. Great I can talk!!!! No trachey. Do I sound normal?? YES!! Can I move my hands- YES!!!! Brachial plexus intact. The surgery had extended to 7 hours- not 4 as first expected and I was feeling every second of it. I spent the first sleepless night in intensive care. All I could think about was the nausea and the impending threats of vomiting with a neck wound. Drainage tubes were hanging out of both sides of my neck and it hurt to move my head, so I didn't  The first night, as expected, was horrendous. There was pain everywhere- the front of my neck at the incision, the back of my neck from having my head in full extension for 7 hours, my throat was raw, my gut was nauseous and my right heel had a pressure area. And to think 24 hours beforehand I felt fine. I knew that this had to be done but when you feel ok sometimes the logic doesn't add up.

The next day I was moved to the ward and my surgeon visited to give a quick rundown on the surgery: d been a lot more extensive than first thought. The nodule disease was right down into the chest cavity to the nodes just above my heart. The surgeon managed to salvage one parathyroid gland and reimplanted it into my sternocleidomastoid muscle (in my neck) but it probably won’t work for a while (until it regains blood supply) so I'd have to take calcium supplements until that happened. The surgeon was confident, however, that she had got it all. I was supposed to stay 2 nights but a combination of uncontrollable nausea and a declining calcium level saw me stay for 5.

Another scare a week later after a high thyroglobulin level came back that there was still macroscopic (large) cancer remaining meant a full body scan which thankfully came back clear. I met with my oncologist in Brisbane to organise radio-active iodine treatment for October. This should be a one (or two) off treatment where I ingest a capsule that should kill off any remaining microscopic cancer cells. And then essentially I should be CURED!

I am slowly returning to my normal life. I have of course rushed this process. Having the first 10 days out of hospital at my parent place 90km north of the sunny coast kept me under some control. Since coming back home to Mooloolaba I have worked myself up to a bit of swimming and biking but the fatigue levels are high and I get breathless very quickly so my physical limits are low. I am still having dramas with calcium levels and the thyroxine levels will take time to get right. I will go back to part time work next week. The emotional side of it is the biggest roller coaster. Some days I feel fantastic as though nothing has happened and the next the cracks appear. One of my biggest personal faults is my inability to ask for help. I have been inundated with messages, calls, visits, flowers, cards, emails and texts from all around the world which continues to pull on my heart strings. I am not yet ‘in the clear’ but will be making that fact well known when I get that call.

Jodie, Me & Meg 2010 (I was a red-head!)

To my parents; this wouldn't have even happened without you- I owe you my life twice over now! My mother has been beyond incredible. Words cannot express what she has done for me. She’s my best friend and I don’t know if I would have been as stoic throughout this ordeal if she wasn’t by me taking the majority of the stress of the situation. 

Me & Mum at a wedding in April

To my brother Mark, he is a doctor in Townsville and although a long way away, was the one person that managed to ease my nerves and anxiety in the lead up to the operation. We haven’t been close the past few years but something like this is what you need to put the past behind you and realise that family is the most important thing in life and it is imperative to repair these relationships. A huge apology to my folks to them for having to cancel their overseas holiday as my timing couldn’t have been worse. 

Me & Mark (2009)

Meg, Jodie, Ilana, Vanessa, Lisa, Adam & Sophie, Ben & Nat, Mick, Bec, Kirsten, Nat & Ray, Bel, Matt, Steve, Col & Pieter- thank-you for treating me no different to how you normally do yet giving me the strength, confidence, support, friendship and love that I have needed the past 5 weeks.

Kirsten's wedding- 12 days before diagnosis

And so triathlon? We will see. Health is currently the number one priority. Things are all on hold at present: my coach (who’s been an incredible friend though this), my pro licence, my goals and dreams. Now knowing something quite significant has potentially been holding me back I am very keen to see what I can do again. My fantastic sponsors; Mizuno, Cannondale, Enervit, Orca, OSHE and Ryders eyewear have all been very understanding and supportive during these circumstances and I look forward to giving you all a superb comeback story.

3 weeks post-op- back to drinking coffee at Mooloolaba with Ilana

And with the most simple and eloquent mantra (thanks Brett!) said to me 5 weeks ago; “This too shall pass” I sign off.

Rachie xo

My recovery spot

Apologies for it sounding like a big fat one.....

So I'm not going to make this a big excuse as to why I'm not happy with my performance in Noumea. 5th place is where my body is at right now so disappointment cannot factor into how I am reacting to the outcome of my first race since February (which was a pretty disappointing day at Huski long course where I walked away seething with anger but now isn't the time or place to vent!). Lining up for a MRI only days before heading to Noumea wasn't a good boost to the confidence leading into this race. I was happy to get through this race, cross the finish line in one piece and still be able to walk afterwoods.

The truth of the matter is I haven't run without pain for 2years- this started off with a inferior pubic rami stress fracture (pelvis). To be able to run at all I have become quite dependent on a sacroiliac joint belt to hold my pelvic joints stable & rather too many anti- inflammatories. Certain bike position adjustments over the past 15 months have also been culprit to aggravating this and leading to an irritating sciatic nerve issue. Not to mention numerous hours/ week spent flexed over on a TT bike. I am at the end of my tether with my body as the training I have been doing hasn't been reflected in my race performances. This is a huge roadblock in my path- I can't seem to get past it and therefore I can't seem to move forward- if anything, it continues to push me backwards.

As a Physio I'm quite aware of what's going on. I'm not going to go into extensive details as to the physical impairments I am facing. I am a hypocrite as I don't listen to my Physio when he suggests that I have a break from aggravating activities (ie. riding & running) to allow my body to heal. Having done extensive periods in the gym focusing on core stability and glut activation with minimal change to discomfort I have really questioned a lot of what I know proffessionally as a Physiotherapist or am throwing myself into one of those who fails conservative management of SIJ stabilisation.

So unfortunately this sounds exactly what I was hoping it not to sound like- a big fat excuse. I actually don't have any excuses. I am the one choosing to line up on the start line when I know deep down I'm not physically 100% & therefore am learning to lower my expectations of how I am going to perform. I am only a fraction of the athlete that I have been in years before.

The other side of this is a huge apology to my sponsors. My racing has been light on as I am not quite sure as to how my body would hold up racing as much as I have in the past or in the longer distances where my passion for racing triathlon lies.

 

It's an apology to my ever supportive coach, Matt, who has taken me on in a bit of a state to begin with. Constant modification and support from him has helped me be able to continue to be able to train and race- mainly with the restrictions he has placed upon me as I am a stickler for overtraining and pushing through 'damaging' pain.

So where to from here? I already had numerous specialist appointments booked prior to the weekend but wait lists meant that I had to wait until this week to start the process. And the MRI results-well I didn't want to know until after my race (& still don't!).

As for the race- I had a strong swim in a choppy, shortened condition, average bike where I lost time I shouldn't have and a run that was to the best of my body's current ability. The thing that hurt the most about this race was the blisters!!!! It's been 12months since i ran without socks and boy am I paying for it now!

Thankyou to Cannondale, Mizuno, Ryder's eyewear, Orca, Enervit, OSHE, Allezsport & Cyclezone Mooloolaba.

Rachie xo

Auckland 70.3 Asian- Pacific Championships

I started this blog this morning and still haven’t finished it- it reads boring- I swam I biked I ran- I finished Auckland 70.3 in 13^th position which was a less than desirable outcome but let’s not dwell. So we’ll say- yes I have thankfully returned to racing and that hopefully I’ve got my shocker out of the way for the year! Positive notes were that the swim and the bike are definitely heading in the right direction…. The run let me down but wallowing is just time out of training to improve it! I wasn’t expecting something spectacular, especially when I chose to line up against one of the strongest 70.3 fields outside of the 70.3 world champs! I needed however to get back into the game. I am a racer- I love to race (sometimes too much!) and I need to remind myself why I flog myself day in and day out in training- cause nothing beats the feeling of racing!

There have been a lot of changes in my triathlon life and life in general. I had started training under Matt Koorey in November. This has definitely been a good decision, even if the weekend didn’t reflect it, it’s beside the point. At present we are trying to build fitness and what I feel is attempting to undo some of the damage that has been sustained over the previous 12months, this in itself will continue to be a work in progress. Miracles don’t happen in triathlon in 8 weeks! And in retrospect those past 8 weeks have been quite unsettled and haven’t been ideal in leading up to a championships race.

Personally I hung out in Ballina/ Lennox until the 2^nd week of December for a few reasons. Firstly my wonderful roomies that I lived with for the year got hitched on the first weekend of December. Potentially the best wedding I’ve ever been too and after having watched the two of them prepare for the big day the whole year, wild horses couldn’t have stopped me being part of it. A few days later I packed up my life into the back of the Festiva and headed north back ‘home’ to the sunshine coast.

Me and the stunning bride Amy

Ben the groom and I

Mr & Mrs Rippo! (& me!) 

The second reason I waited was due to the work side of things- I finished up with the boys at PhysioPlus in Lismore/ Ballina- a huge thankyou to Tony and Emile for having me and being very tolerant of my ‘triathlon’ lifestyle which saw me take off for 6 weeks mid-year and being quite pedantic that work hours fitted with training (not vice-versa!). Thankfully with a little pleading my awesome boss back up here at Warana Sportscare begrudgingly took me back into the clinic ;-) I have worked with Adam on and off since 2008- he’s seen me move from age-grouper to full time working pro- to full time pro- back to semi pro! I couldn’t have a more understanding and supportive boss. He was also kind enough to allow me to house sit whilst he and his family took off to Europe for 3 weeks which gave me time to find somewhere to live. So I’m now in my 4^th home in the past 18months- a lovely unit on the top of Buderim with spectacular views of Kawana and the sunshine coast….. That however means hills hills and more hills!

So the lead up probably wasn’t ideal now that I’m back to being ‘semi-pro’ as work was quite busy and I was pushing the limits to get the training done/ work finished/ pack and think about what I had to do the weekend coming. I was up at 4am Friday to get to fly to Auckland. Travel was a breeze with the flight, catching my transfer to my hotel, the hotel itself being an absolute bargain in the heart of Auckland and my bike travelling unscathed. A massive shout out to my great mate Ben Marshall (Performance Bicycle Tuning) who is probably one of the best bicycle mechanics going around. I first met Ben at the Port of Tauranga half in early 2011. Since then every time I’m in NZ Ben goes out of his way to make sure my stead is race ready. This time I received VIP treatment with Ben showing up at my hotel on Friday evening to spend an hour and a half making sure my Cannondale ‘Mint’ Slice was running good and proper! Thanks a tonne Ben!

So putting that one in the training bank and moving on. Next month I will head back to Huski to do the long course triathlon. Easily the nicest race I did last year in the world! The elite energy guys do a fantastic job at organising this event and to anyone considering stepping up to long course in 2014 this would be the best one to start with!

Thank-you again to my wonderful sponsors; Cannondale (CSG), Mizuno, Enervit, Ryders eyewear, OSHE, Orca, Allez sport Mooloolaba & Cyclezone Mooloolaba- your ongoing support and sponsorship is appreciated.

Rachie xox