Great Britain athlete Ollie Fox forced to take a back step after tough choices through illness
"I wonder in my mind whether I would take those steroids if I wasn’t running.”
Ollie Fox is searingly honest.
At a time when he should be looking forward to a promising athletics career with Great Britain, the 22-year-old student is instead facing up to leaving the sport he loves.
“I think I will be less likely to take steroids if I’m cycling and, on that basis, it suggests I might be taking steroids because of the running rather than because of the disease,” says the fifth-year medic.
“If the running is aggravating the Crohn’s then it’s the running that’s dictating the need for steroids which then brings a moral question into my mind – is it reasonable for me to take steroids truly on clinical grounds?”
Athletics was a passion for Fox from an early age.
He had started running in Year 5 at school, and by Year 9 was racing competitively.
As a member of Wells City Harriers AC, his aim was to race at the England Schools’ Cross-Country Championships, a feat achieved by winning a silver medal.
In the same year, 2015, he earned 14th place racing for the British junior team at the Great Edinburgh Cross-Country.
With each passing year, Fox was showcasing his talent on the biggest stages.
That led to representing the senior GB team at the SPAR European Cross-Country Championships last December, and then, in March this year, he raced at the IAAF World Cross-Country Championships, finishing 58th.
Further illustrating his ability was his performance for Achilles – the joint Cambridge and Oxford University athletics club – in their match against the might of US giants Harvard and Yale in June. He was the only track winner for the British team, in the 5,000m.
All of those senior accolades were achieved while managing the impact of Crohn’s disease, an illness that can be debilitating at times.
A warm, articulate and conscientious individual, it is easy to see why the situation weighed so heavily on Fox’s shoulders as he battled the illness, depression and ethical and moral dilemmas – and the will to win.
“I progressed quite well up to the senior cross-country ranks, that’s where a lot of the distance runners progress to Olympic standard after a few years,” he says.
“In an ideal world, I would have really liked to have done that. It was the long-term aim, and if you want to aim for something like the Olympics you have to be realistic about what you’re doing.”
Those plans did not take into account Crohn’s disease though.
It was in his first year at Robinson College that he started getting a lot of abdominal pain, lying on his bed with stomach cramps for hours after every run.
As the symptoms were slow to develop, Fox brushed it off at first, assuming that it was just a common pain that some people get after exercise.
When it became painful to eat, Fox decided it was time to see the doctor and, having been referred to a specialist, a colonoscopy revealed inflammation of the colon, and Crohn’s disease.
“At that point, all I was thinking about was ‘it’s good because there is a way to treat this pain that is stopping me running’,” explains Fox.
“When they did put me on treatment, initially, I was very well and could run loads. I never felt so good.
“But the nature of the disease is that it fluctuates so it got worse again and took another year to get properly under control.”
Having gone through clinical trials, he was given infliximab infusions at Addenbrooke’s Hospital and that had the desired effect as the running got better and better.
There was to be a downturn though, and as the Crohn’s got a bit out of control this year, allied with Fox’s determination to continue racing, he turned to a corticosteroid to control the pain and symptoms to compete.
Prednisone was a steroid used to enhance performance by some Tour de France riders.
To run while using steroids requires a Therapeutic Use Exemption (TUE), an issue that has caused much controversy in recent years.
Fox had the required documentation – letters from doctors and clinics, colonoscopy and histology reports – to confirm he had Crohn’s disease in order to get a TUE from the UK Anti-Doping body, but it clearly wrestled with his conscience.
“From an ethical or moral perspective you do think about it because you are taking a banned substance to let you perform,” he says.
“I think there is a distinction between taking it to control a disease to allow you to perform versus taking the drug to improve performance.
“Equally, you could argue that if I’m taking that drug it’s dramatically improving my performance because I’ve gone from a state of not being able to run at all to be able to run very well.”
It feels as if Fox is being particularly harsh on his own circumstances.
Was he using steroids to enhance his performance? No. Was it allowing him to perform? Yes.
However, in some ways, is it one and the same? Without the steroids would he be able to compete?
It is such a complex ethical issue that you can understand why such a diligent and educated person as Fox has found it difficult to find peace.
After all, at the heart of the matter is that prednisone is used to manage Crohn’s.
“What it comes down to is the subjective nature of treating patients,” he says.
“If I wasn’t running at all, there is a chance I wouldn’t have needed steroids, but the steroids I was taking were allowing me to continue a lifestyle that I wanted to live.
“I think, on that basis, it probably is reasonable.
“I’m getting pain when I run, but not when I’m not running. If I wasn’t running at all, I might not be getting those symptoms and therefore wouldn’t take steroids.”
There was a warning from doctors of the long-term side effects associated with taking the steroids to run, and it forced him to evaluate the situation.
“Back in March, I got quite depressed about the whole situation and so I spoke to the GP who helped me with antidepressants,” he explains.
“I think I’ve been able to look at it in the right perspective and think if I had to keep taking steroids to train and race, is that a reasonable thing to do?
“The reality is, in the long-term, it’s not sensible and will cause a lot of other health problems.”
Fox concedes that the decision to walk away from competing was an easy one to make – although it would have been a very different story a year ago.
While he will still run for pleasure and social reasons, the focus will now be on cycling.
The question is whether this will still not impact on his health? Fox believes not.
“I find when I’m on a bike, because all of the stomach area is totally still I can still push myself from a physiological perspective without getting the inhibitory pain that comes on with running,” he says.
“I have no idea why that is really. We thought the lack of oxygen to the gut was causing the pain, but because that doesn’t seem to happen on a bike the same way, it seems it’s not a lack of blood flow to the gut which suggests it must be an up and down thing.”
It is important to stress that it was not so much the Crohn’s that made running prohibitive for Fox, it was a bad combination with his will to win and desire to be the best.
“I could probably still run casually and just stop when it hurts, but I suspect I like to see how far I can go and when I can’t do that I would rather shift to something that I can,” he says.
“I think it’s where it was important to work out what I liked about athletics and how I could adapt that to reduce the impact Crohn’s has on my lifestyle.”
With such a grounded and level-headed approach to a situation that may have sunk others, Fox is still young enough to make a good fist of his second sporting life.