June 2020- 4 months after developing CECS

My first entry

I never learned to swim, and i’m drowning.

In honor of two years since developing Chronic Exertional Compartment Syndrome (CECS), I’ve decided to document my story, and shed some light on an otherwise relatively rare condition. I’ve been active since childhood, and while I never considered myself an athlete until I attended USMA, I was involved in numerous sports and activities throughout high school. More specifically, I loved to run. When life got hard during my teenage years, running became an escape. It wasn’t long until the runner’s high never left and moving was less a burden and more of a privilege, a gift. In hindsight, I am proud of the ways I honored the act of running, like a believer at a temple. Especially when I live in a reality where I may never be able to run again.

I enlisted in the United States Army when I was seventeen years old and in January of 2020, I left for basic training. I’d never felt stronger or faster in my life; I had just submitted my application to West Point, and I'd been training for years. I went in knowing basic training had nothing on me. And I was right, for the first few weeks at least. I was one of the fastest girls in my company, and I never fell out of a ruck. It was in my first month or so that I received my acceptance letter to USMAPS, it was the only time I cried my entire three months there. When I suddenly started experiencing intense pain in my lower legs, my first thought was, I can’t be recycled. I went from running two miles in twelve minutes to twenty-one minutes and afterwards I could always breathe, but never walk. I began to fear physical exercises and field training, not knowing if my legs could keep up. I slowly started hating myself. I knew I was injured; the pain never left, but I couldn’t help but feel weak. I started falling out of runs, struggling through rucks, and even basic foot marches. I fought for three long months against what would become my worst enemy, CECS, and I graduated.

When I returned home I told myself as long as I lay off for a few months I’d be ready for USMAPS, my injury would recede, I’d be remade. Of course, I was wrong, that isn’t how injuries work. When I reported to USMAPS in New York I was terrified, it was a fear I didn’t harbor even when I arrived at basic training, but CECS had given me the realest reason to be afraid. I tested positive for COVID-19 the first day on post and was quarantined for two weeks. Two more weeks to avoid my inevitable failure. Suddenly, those fourteen days were over, and I was up at 0500 for training. The first morning we did a five mile ruck, and I was overjoyed at how easy it felt. I experienced no pain, so my injury had healed, right? Wrong. The next morning we ran only three miles, but it was no easy task. I struggled all the way back up the hill; I can vividly remember the pain I felt. The way my legs felt like they’d explode if I took another step, the way I couldn’t pick my feet up because my muscles had stopped working, the way my anger caught in my throat. One of the cadre (the lesser cadet version of a drill-sergeant) ran beside me. Keep going, he urged, You’re a prior, I expect better of you.

I wanted to scream, or cry, or both at the same time. The way I kept saying I can’t was undoubtedly more disappointing to me than him. He couldn’t say to me what I hadn’t already said to myself.

During the school year, I was assigned to an ACFT development group during our daily athletics window. My school’s RTO (Regimental Tactical Officer) oversaw most of our training and would join us in our workouts. It didn’t take long for him to vocalize his own disappointment in my performance. My high energy and optimism was a direct contrast against the typical injured personnel profile. He assumed that because I could still laugh and smile during my day, that I did not feel pain, so I must be lazy. You don’t deserve to be here, he told me one day. I still haven’t gotten over it. I know society encourages women to take criticism and use that to fuel success but sometimes it just hurts, without helping. At this point I’d lived with my injury for six months, six months to hide the pain, to push through it, to not show weakness.

When I decided I couldn’t do this alone any longer, I visited my school's physical therapist. They were as lost as I felt, but I was given a rehabilitation program, side planks, foot exercises, lateral band walks, and numerous stretches. We found I could run at half my weight for 30 seconds on the anti-gravity treadmill before I felt pain. I felt hopeless. For five months, I visited her daily, doing all the exercises she gave me. A naval lieutenant who worked at the main academy who did dry needling met with me. My therapist thought that by releasing the pressure in my anterior muscles, the stress placed upon my shins would lessen and help me She was wrong, they were all wrong, and I realized something was utterly wrong with me when I white-knuckled the table and went head-to-head with unconsciousness. I had never felt more pain in my life. During those months, I visited our hospital on post, received X-rays, and visited the orthopedic surgical head, a colonel. Shin splints, that’s what I was told, over and over. Get better shoes, take these calcium pills, wear insoles, you’ll be better in a few months. My X-rays came back clean, my bones were untouched, but of course they never told me that. I didn’t find out until more than six months later.

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After winter break, I never went back to rehab, and one night I ran three miles without feeling that unbearable bursting pressure in my legs. For months, I believed there was a method to the madness, that all those seemingly pointless side-planks did indeed work; however, as I learned recently, CECS lays dormant with enough rest and flares up when training resumes. The school year where cadets focus on academics and lay the rucks and AGR’s to rest was good for my injury. I had hoped that I'd overcome CECS. In June of 2021, I reported to USMA for Beast, the academy's version of basic training for first-years. It wasn’t long until the pain came rushing back like an old friend, and I was devastated. The ache followed me everywhere, it was hard to sleep at night with the pain, and once again I couldn’t keep up with my peers. When I finally decided to go to therapy, the same lieutenant who’d stuck needles in my leg the year before, saw me. He was the one who showed me my x-rays, and the first to mention CECS. Only one other cadet at the academy suffered from what I did, he said. It’s taken almost a year but he can now run two miles, not pain free of course. But he can do what it takes to graduate. I cringed, understanding there was no way I'd run for passion again.

He did what he could to protect me at the time and prevented me from having to run or ruck unless it was a requirement to graduate. When I first told my cadre, they said to me Oh you’re one of those kids? I had a classmate who claimed the same thing. Because CECS was so uncommon, I was doubted daily, nobody understood my injury so every time I spoke they decided I was lying. Fighting a phantom of an illness, foreign to both me and my peers, birthed an unexplainable sense of insecurity. If you can’t run three miles without falling out, you guys shouldn’t be here. I don’t want you here, none of us do. That is what my company’s cadet CO said one morning after we’d completed our physical training; his face was red and flushed with anger. I felt stupid and useless. It didn’t matter that I used to have one of the highest physical fitness scores, or that I'd been in the Army longer than most of them had. It only mattered what I was going through then, at that very moment, which was a crippling injury.

I graduated from Beast, my “third” basic training. I knew I couldn’t keep scraping by and when it became time to commission, the Army wouldn’t wait for me. I had to prepare to be the platoon leader my future soldiers would require of me. Currently, I'm still a first-year, I'm expendable and West Point hasn’t invested all that much into me yet. I was reminded of that this school year when I began pursuing treatment. Earlier this year, it became painful to walk, my muscles felt explosive at every moment, every step. I needed help. The naval therapist I mentioned earlier had given two treatment choices: rehabilitation or a fasciotomy. He said he’d spoken to the surgical head, the colonel I'd talked to last year, and she’d claimed when I'd visited her she hadn’t thought my injury was shin splints. Despite her uncertainty, I was never approached for further testing. It didn’t matter whether I was diagnosed incorrectly because I was only one cadet, out of forty-five hundred. While I was angry at the time, I find myself rather relieved now. One week ago, I met with her again. You shouldn’t be here. If I had known about this, I would have never let you come to the academy. You took someone else's spot.

Her hostility surprised me, yet why would she show compassion to me, someone who had been dealing with a chronic muscular condition for years and struggled with it every single day. Then she gave me two choices, you can be med-boarded out of the Army now, or get the surgery and have a 70% of being med-boarded out after. I told her I’d think about it and cried the entire way back to my barracks.

I’ve been researching CECS on my own since I heard of it. I knew what the surgical procedure was, what the healing process looked like, and how unfortunate the condition was in the first place. I read an article on a 25-year-old special forces soldier who suffered from CECS, got the surgery, recovered in just three months, and deployed. The soldier allegedly experienced no symptoms following recovery, a rare chance, yet it happened. I thought to myself, why did I, a nineteen-year-old cadet who’d only gone through basic training, develop the same injury as a special forces soldier? CECS is said to develop due to intense over-training. Sure, I envisioned that 25-year-old surpassed what it meant to overtrain, but I?

All I'd done was run and lift up until I went to Ft. Leonard Wood where the most intense training I did was a timed-ruck up the hills of Missouri in an IOTV. It was sheer will that carried me through our final FTX where we rucked over 40 miles in a four day period. I can’t even remember what I felt like, only that I'd become someone who I no longer recognized in a mirror.

The Army embodies a mentality which encourages soldiers to take their pain and swallow it. Frankly, this is destructive and demands change. When you are made to break, becoming the country's defenders proves complicated. I have, in fact, not been driven to such a desperation as to dedicate the rest of my life to research compartment syndrome; that is frankly not my speciality. I am merely communicating the fact that I have experienced pain at the hands of this injury, and in this pain, I felt hauntingly alone. CECS is the embodiment of devastation with the power to shred your dreams and crush your desires. CECS is like dangling food in front of an animal, turning them feral with something just out of reach. So when and if CECS comes for you, and if it already has, remember to breathe. Curse the pain, spite the injury, but never hate your body. Treat it kindly, you are both suffering.

my second entry

Look Mom! I’m swimming.

It’s been seven months since the construction of my first entry on CECS. Seven months and I’ve still never been prouder of something I’ve put on paper. Seven months and I still haven’t gotten around to doing it again. After weeks of retyping paragraphs and struggling with finding the right words, I hope this is the time I finally get it right.

It is easier to be an angry writer than a satisfied one. Now, after two surgeries and months of rehabilitation, I am exactly that: satisfied. My first fasciotomy was February 2nd and although every doctor I talked to said it was okay to be nervous, I never was. I did not think about being sliced open for a procedure that is not always successful. I thought about how it would feel to run without pain, and to be a soldier again. At West Point, bilateral surgeries are performed once at a time, six weeks apart. That meant a full recovery would not actually begin until after my second surgery. While I initially thought I’d find the waiting to be difficult, in the scheme of things- six weeks meant nothing.

My first rehabilitation period, between the first and second fasciotomy, was the most difficult. There are certain protocols to be followed when recovering from such an operation; before surgery I researched them restlessly, never fully trusting West Point to properly nurture me. The truth is, I never looked at my rehabilitation folder once after surgery; I developed my own protocol. I had six weeks, two of those spent in a splint, to prepare my operated leg for full weight bearing, hopping, and constant walking. There was no point for me to follow the protocol, not when I was only preparing to get knocked down again. I trained twice a day, as hard as my body let me, doing every exercise until I got that sharp tearing feeling up the side of my leg. My limits broadened by the day, both my physical therapist and surgeon were pleasantly surprised by my rapid progression. My physical therapist told me once, if someone were to have tracked your progression from the outside, they’d have thought this operation is easy. It’s not. In a way she was right, it was easy and i’ll never have the chance to think anything different. I realized something during recovery, and it may sound like the worst advice I’ve ever given but CECS is not an injury you accommodate. I do not, and will not ever care what someone else tells you; CECS is not an injury you accommodate, in injury and recovery alike.

I’d like to attribute my healing to a measured sense of carelessness. I’ll admit I didn’t always wait for my body to catch up. After two years you’d think somewhere along the way I would’ve learned to listen but I didn’t and I'm partly thankful. My legs and I existed in opposition for so long. I acknowledge them as an independent bodily function with their own stream of consciousness and to me, my legs are not just an automated system but a half of my whole. It seems silly but I never wrote these entries to make total sense- I wrote them for you to find a helpful fraction of sense. If this isn’t one of those fractions, then I understand. I left my legs behind so many times over and I'd only stopped to wait up when they quit giving me a choice. It took me two years to stop demanding an impossible change, it took two years for me to sacrifice a part of myself for them. It seems obscure to speak of my injury as an estranged spouse but CECS was a stranger who shared my bed every night. The anger we reserved for each other was infinite. The last seven months were hard on me for many reasons, rehabilitation became what felt like the only thing I had control over. My legs made room for me, not the other way around. I cannot think of another way to describe it. I woke up everyday and made obscure demands, but they let me.

There's a more mild, medical explanation my surgeon gave to me. Immediately after coming out of the splint, encourage the fascia to adopt a sense of elasticity through motion. Not necessarily exercise, but motion. My surgeon explained it to me like this, if the fascia isn’t encouraged to expand properly following surgery, it will scar over in a similar position it previously held. Logically, if this were to happen, the anterior muscles previously entrapped by that stagnant fascia would continue to be. I listened to my surgeon, just not to my physical therapists. My own theory and successful application: exercise as hard and as soon as possible. You may be thinking, “Is that safe? This girl probably has no clue what she is talking about.” You’re right, I don’t. Once your sutures have been removed and the incision is successfully healed over, you can do anything your body allows. My father used to tell me: Don’t hurt yourself more. Don’t push too hard. Listen to your PT’s. Thank god I never learned how to listen to my father.

I used to ponder over that case of the 25-year-old special-forces soldier who deployed just three months post-operation. I realize something now, something that he and I probably had in common: A tendency to not listen, to push the body as far as it can go. Now, I think to myself, do I really think that man waited eight weeks until he began running again? The answer is no. No I don’t think he did. In fact, I’d guess he did somewhat of what I did. Roughly two weeks post surgery I was walking without my boot, As soon as I could hop, I ran. I spent every day since getting my splint removed on the shuttle system, seeing how much weight I could push without straining the incision. When my physical therapist said no impact, I found which agility drills I could endure and did every impact exercise that didn’t make me want to cry out in pain. She ignored my own ignorance and we both continued on with our days silently believing in each other- part of what allowed me to be able to run two miles three weeks post-operation with no symptoms.

I want to retouch on something I said earlier, a measured sense of carelessness. Measured is something that deserves emphasis. My first physical therapy session after getting my splint removed, I almost passed out. After a few hops on my leg and some agility ladders (under the guidance of a fresh tech) I lost my vision. It was a few more days until I tried anything more than biking and calf raises. Rehabilitation wasn’t without its difficulties, for awhile I had a section of my anterior compartment that swelled dramatically and every time I flexed my toe upwards, it felt like my muscles were being split apart with a hot knife. Although I was making exceptional progress, I could barely handle the reality of having to slow down. I was frustrated, and afraid. I lost my mind trying to distinguish whether my anterior compartment was sore or relapsing. A few days of spending more time aware of which way I shifted and stretched my compartments and I was back progressing forward.

My last surgery was on March 28th, Cadet Field Training started May 29th, almost exactly an eight week difference. I was not supposed to be cleared for CFT, in fact, I wasn’t. My PT and I never spoke on it but I showed up on May 29th knowing if I couldn’t complete the next five weeks of training, I’d have to leave West Point and the Army forever. To successfully complete all the events in CFT, I would have to be completely healed at the eight week milestone I started. It was a gamble, one that I was comfortable making and knew I had no choice but to. Going into CFT, I was terrified. I was terrified I’d get to my first ruck or run and my legs would light up with pain, that I'd have to begin out-processing on the spot. I passed every event without struggle and I felt just as I had when I reported to Basic Training, before CECS: ready and competent. Now, I run every day. I do sprints daily and when I go somewhere I’d rather run than walk, no matter the distance. Part of me feels like it’s something I owe to my body. After everything it went through, and for it to keep pushing, even in recovery- I will never be grateful enough.Though I don’t think I would have forgiven it if it hadn’t.

I didn’t expect to write a second entry around this injury. I thought my first would be my last, I didn’t think it’d be necessary. I also didn’t know if I expected to heal or relapse. Undergoing a successful surgery after being told so many times over it would fail, I owed it to every other person with CECS to share that. After my first surgery, it was only natural to let a mixture of ambition and impatience fuel my recovery. But for the body to rebound so successfully after not one, but two surgeries, was surprising- even to me, the person who woke up everyday and pushed it. I’ve read through my first entry countless times over, trying to perfect it for you all. I never expected it to mean so much to me, and maybe mean equally as much to one of you. So here I am, healed and no longer feeling like one of you all, but hopefully as someone who can guide you. Before, I was a bottle of unchanneled anger and pain. Now, I am calm aside from an almost feral edge of victorious ambition. This injury, and my recovery, taught me more about myself than I ever expected.

I think while writing these entries I’ve realized my greatest fear might be a doctor reading them. Doctors didn’t become doctors to get personal with- these entries are not catered for them. These entries are for me, the 18 year old girl who was nothing less than angry and terrified at having her life ripped away. For whoever finds themselves in my shoes, to some extent, so they don’t feel nearly as alone as I had. This last semester a classmate of mine approached me, asked about surgery, my recovery, and let me know a teammate of hers had just recently been diagnosed with CECS in one of her legs. My heart seemed to plummet in my chest and jump up my throat at once, I never thought I could fear for someone else so intensely. I remember how I felt after that initial diagnosis; thrilled to finally have answers, and then how I felt after discussing surgery for the first time, an infectious sort of disappointment. That made three cadets, that I knew of and including myself, who suffered from CECS. I was thankful it wasn’t bilateral, that in itself was a small victory. I prayed that this girl had what it takes to go head-to-head with CECS, especially in a place like West Point.

The realization that comes with knowing about her injury is the expectation of being able to shoulder the burden, to somehow transfer the injury onto myself so she doesn’t suffer the way that I did. I have fought many demons in my life, CECS is easily the worst. I wonder if it wouldn’t have been nearly as bad if I'd gotten treatment sooner than two years. If i’d been diagnosed promptly and put under the knife even sooner. I wonder if I’m one of the only people who feels so cheated, so scared of the possibility that I don't recover. The only one who went from competent to ridiculously incompetent in what seemed like overnight. The only one who feels so rattled after spending two years failing. I doubt it.

And if i’m not, I hope i’m not the only one who recovered. Who found that small sliver of hope and white-knuckled it until I could finally measure up again. Who took a nasty injury with a poor support system and persevered regardless.

2022 Feb 18- 1 wk post First fasciotomy

2022 Apr 8- 1 wk post Second fasciotomy