What happened next: Annie Bothma
Posted on 3 June 2021
A series of misdiagnoses saw Annie Bothma suffer from a range of debilitating symptoms, until, at age 19, she was correctly diagnosed at Mediclinic Milnerton with hypopituitarism. Now able to manage her condition, she is thriving as a long-distance runner with eyes on this year’s Summer Olympics
We tend to think of Olympic athletes as superheroes. Usually they’re bigger, faster, stronger than us, possessing physical strength that normal people can only dream of.
Distance runner Annie Bothma, who is aiming to qualify for the Marathon event at this year’s Tokyo Olympics, is certainly a superhero – but not in the way you’d expect.
She’s a 25-year-old woman living, at least in medical terms, in a schoolgirl’s body.
Bothma has a rare condition called hypopituitarism. Her pituitary gland – a bean-sized gland situated at the base of her brain – doesn’t produce the right hormones, which means her bones don’t grow and her metabolism doesn’t function as it should.
ONSET OF SYMPTOMS
The symptoms first started when Bothma was 11. At the time, nobody knew what was wrong – least of all Annie herself. “I was having physical pain – like cramping, diarrhoea and nausea – related to my digestive system,” she says, “but I experienced even more emotional pain. It felt like my peers were moving forward, while I was standing still.”
At 12 she was the short girl in class. At 14 she was the very short girl. By the time she reached 16, and her classmates were developing physically while she still had the body of a Grade 4 child, she felt like a social outcast.
“I was small and skinny,” she says. “I was bullied, mocked and rejected by my friends and classmates. Even my family no longer treated me like before. I felt alone, and started struggling with my mental health for the first time as well.” It didn’t help that her siblings and cousins are relatively tall. “I stand out from the rest of my family,” she says.
At age 17 Bothma was diagnosed – incorrectly, it turns out – with coeliac disease, a serious autoimmune condition in which foods containing gluten, such as bread, cake, pies, and so on, cause damage to the small intestine. “It was very hard to go completely gluten-free, as it is a part of so many common food groups,” she says. “But since I’d already been struggling for so long” – by now her condition had defined her entire time in high school – “I’d already started to eliminate certain foods that gave me more discomfort. I went to dietitians to try to figure out if I had intolerances to certain food groups. I was desperate to try anything that would relieve my symptoms, anything that would make a difference.”
By the time she reached matric, Bothma had – as she puts it – no quality of life. “Every day was a struggle,” she says. “Eventually I left school and finished Grade 12 from home, only going in for exams and tests, as I couldn’t sit through more than a period without needing to go to the bathroom. I battled with diarrhoea and a lot of physical discomfort.”
Mentally, she was fighting depression and feelings of isolation. “I could no longer handle the consistent judgment and bullying from my peers,” she says. “I had no true friends.”
Finally, at age 19, Bothma found the answer she’d been searching for over eight long years when Dr Carsten Weinreich, an endocrinologist at Mediclinic Milnerton, diagnosed her with hypopituitarism. “Annie was referred to me by a colleague, basically for stomach problems and osteoporosis,” he says. “She had stress fractures because of her weak bone density, and as part of that work we saw that she had two or three clinical symptoms as well as a rather suggestive history.”
“Dr Weinreich saved my life,” Bothma says. “He was the first doctor we went to see who considered the whole picture. He didn’t just see a small, skinny girl and immediately stereotype me as having as some sort of eating disorder. “He did tests that had never been done before, and came to the conclusion that my body wasn’t producing the key hormones – such as growth hormone, oestrogen and follicle stimulating hormone (FSH) – that I needed for normal growth, physical development, muscle mass and weight gain.”
Speaking to her, it’s clear that throughout those long high-school years, with her constant stomach aches and her deeply painful embarrassment about her body, all she wanted was to know what was wrong with her.
“For Annie, the biggest thing was knowing the ‘why?’,” says Dr Weinreich. “Why did she have the symptoms she has? Why were these things happening to her? She’d been mislabelled as having an eating disorder and a psychiatric condition, when the real issue was actually hormonal. “She’d been dealing with a lot of stigmatisation because of how she looks, and without a correct diagnosis she couldn’t even tell people what the real cause of it was.”
Yet, as Dr Weinreich points out, the Bothma family struggled to convince their medical insurers to cover her treatment. “She’s had an uphill battle,” he says. “Because hers is not a prescribed minimum benefit (PMB) condition, it’s tough to get medical aids to understand that although she’s in her mid-20s, her skeleton is that of a teenager. They say they only give growth hormone to children, but her body is still that of a child, with potential to grow.”
After a year of treatment, Bothma finally started to see changes in her weight and height. Around age 20, she had the kind of growth spurt you’d expect to see in a young teenager, going from 1.54m to 1.65 metres tall.
“Annie’s is a lifelong condition,” says Dr Weinreich. “We know what it is, but we can’t magically make it disappear. We can manage some of it, but certain things will never come right. For example, while her bone density has improved it’s never going to be normal, and because she trains and exercises so much we’ve been struggling to get her to put on weight.”
Ah, yes. Training and exercise. Bothma does a lot of that, having developed a rare talent for distance running. At high school she won the Helderberg Harriers Running Club’s Junior Runner of the Year three years in a row. She also won the Grand Prix Spar Series for Juniors twice, was named Western Cape Junior Sportswoman of the Year, earned Western Province colours for road running, cross country and track and field, and – year after year – clocked the fastest times for a junior girl in South Africa over 10km, 15km and 21.1km.
Initially, she wasn’t just running. She was running away. “I started running as a way to escape my problems and the pain I was experiencing, both physically and emotionally,” she says. “But running taught me to persevere through the challenging times with my health, and it gave me a reason to keep fighting no matter what. Running was the thing that made me feel strong and capable when I was small, skinny and weak.”
In 2019, at age 23, Bothma ran her first marathon, in the SA Marathon Championships. She was the first South African female to finish, achieving 10th place with a time of 2:41:44, the sixth-fastest debut marathon ever run by a South African woman.
She had previously represented SA at the Junior Cross Country Championships in Poland, and again at the Senior Cross Country Championships in China, at just 19 years old.
“Representing the country gave my life meaning and purpose,” Bothma says. “It showed me I’m capable of more than people said, or what I thought I’d be able to achieve with my health conditions. I love the feeling of pushing my limits and breaking through barriers I used to think were impossible.”
After eight years of enduring misdiagnosis, pain and depression, the marathon metaphors write themselves. Bothma is the first to tell you that her health troubles were the perfect training ground for endurance sport.
“I’ve experienced so much physical pain that being able to choose my pain when it comes to running is actually a privilege. I get to choose how hard I’m willing to suffer, and how much pain I’m going to push through to achieve my goals.”
But as she has learnt, you can’t choose everything that happens to you. Her running achievements soon caught the attention of American colleges, and at age 20 she was offered several scholarships – an opportunity she says she’d have been foolish to let slip.
“The transition was difficult,” she admits. “Living in the States is a lot different to South Africa, especially because I didn’t know anyone there before I flew over.” She started studying kinesiology at Idaho’s Boise State University before transferring to South Carolina’s Coastal Carolina University, where she studied exercise science. “I also completed my Master’s in personal training through the International Sports Sciences Association on the side and worked as a personal trainer at the university.”
But fate struck again, early in her stay in the US. She’d been in Idaho for barely a month when, while cycling home from training, she was hit by what Americans call a pick-up and she – still wet off the boat – only knew as “a big black bakkie”.
The accident left her with serious injuries – exacerbated, of course, by her naturally weak bone density. She was unable to train for extended periods, leaving her with a frustrating, stop-start battle for race fitness.
In South Carolina, she was involved in a second car accident when a vehicle T-boned her, sending her car rolling and leaving her with whiplash and concussion. The psychological impact was even greater. “That was the final hit that made me leave the US,” she says.
Born with a rare condition that trapped her in a pre-teen body, afflicted with an inaccurate diagnosis and social stigma throughout high school, stung by unhelpful medical aid, injured in two motor-vehicle accidents (the second of which totalled her new car and left her in a dollar-shaped financial hole)… Just don’t ask Annie Bothma if she feels unlucky.
“I don’t believe in luck,” she shrugs. “The second accident ended up being instrumental in shaping my perspective on strength and conditioning, as I’ve been actively working on improving my strength, mobility and flexibility to become a stronger and more resilient athlete.”
Bothma has now been running consistently – “Two years straight,” she says – without any major injuries or setbacks. “I’ve had some health-related struggles that forced time off, as well as planned rest days to allow my body to recover from hard training, but I’m extremely grateful that I’ve not had to take one single day off because of pain related to an injury. I try to listen to my body, and have learnt what works for me. I back off or adjust my training before anything turns into something!”
Her diagnosis and the positive results of treatment have dramatically changed Bothma’s outlook on life. After years of being stuck in a painful, confusing present, she can finally look forward to a promising future.
She’s now working towards representing South Africa in the Marathon event at this year’s delayed Tokyo Olympics. At the elite race version of last October’s Cape Town Virtual Marathon, she ran loops around on a measured course and clocked an official time of 2:33:35. She then spent time at a training camp in Kenya aiming to hit the International Olympic Committee’s qualifying standard.
When we spoke to Annie recently, she was in a high-altitude camp in Kapsait under the tutelage of former marathon runner Erick Kimaiyo – also coach to current women’s world-record holder Brigid Kosgei. “His belief in me has given me new confidence in what is possible,” she says. “After a few weeks’ training, Coach said to me: ‘You are a soldier.’ That stuck with me. I’ve been through a lot, and I still struggle with low blood pressure, cold hands and feet, dizziness and headaches. “But I hold on to what Coach told me. I am a soldier. Regardless of what I may face, I know how to fight. I know how to not give up.”