Jan 29, 2015Courtney Evans, Tufts University
In December of 2004, Courtney Evans should have felt like she was on top of the world. The top blocker and server on the Tufts University volleyball team, the junior middle hitter led the Jumbos to a 28-6 record and second place in the New England Small College Athletic Conference. Despite that success, she felt nothing like a fine-tuned athlete.
Instead, Evans was exhausted and experiencing extreme abdominal pain. She had also noticed a loss of appetite and energy—although she didn’t tell her teammates or coaches.
Somewhat concerned, but not overly-worried, Evans described the symptoms to her father, Douglas Evans, MD, Surgical Oncology Chief at The University of Texas M.D. Anderson Cancer Center. Initially, Dr. Evans thought his daughter was simply lactose intolerant and recommended a dairy-free diet.
When the pain and exhaustion remained, Dr. Evans quizzed a number of the hospital’s gastrointestinal experts, who believed the symptoms were consistent with a bacterial infection and prescribed an antibiotic. The antibiotic alleviated some of Evans’s symptoms, but it wasn’t enough. So at the conclusion of the season, she went to Massachusetts General Hospital for testing.
A colonoscopy revealed Evans’s symptoms had a cause: She was in the early stages of Crohn’s Disease, a rare, chronic, episodic illness affecting the gastrointestinal tract that afflicts more than 500,000 people in the United States. Doctors put Evans on Imuran, an immunosuppressant, and she returned to campus. But her energy continued to wane and her appetite plummeted. Evans struggled to get through her final exams, and returned home to Houston for winter break simply exhausted.
The cause of Crohn’s Disease is unknown and there is currently no medical or surgical cure. An inflammatory bowel disease, Crohn’s causes blockages in the intestines, resulting in chronic diarrhea, abdominal pain, fever, and weight loss. The pain can be intense, with symptoms dominating a patient’s everyday activities. For Evans, who would lose 30 pounds in the two months following her diagnosis, the disease caused episodes of extreme abdominal pain and diarrhea that had her sprinting to the bathroom every 45 minutes.
When Evans told Head Volleyball Coach Cora Thompson, CSCS, about the diagnosis, Thompson was naturally concerned. And when she received a phone call from her star hitter over winter break warning her that the symptoms had worsened and Evans had lost a significant amount of weight, Thompson grew more worried. At five-feet-11-inches tall and 165 pounds, Evans was a lean, lanky athlete for whom bodyweight was already at a premium.
However, that phone call could not prepare Thompson for what appeared before her eyes when Evans walked into her office at the start of the spring semester. “My heart dropped as soon as I saw her, and I became extremely concerned,” says Thompson. “Her muscles were completely gone—her arms were so thin. She was so weak and gaunt. It was very, very scary. She didn’t have 20 pounds to lose to begin with!”
Upon her return, Evans had some tough decisions to make. First, a planned trip to study abroad was cancelled, and Evans signed up for only three courses—the minimum to be considered a full-time student at Tufts. Thompson helped make arrangements for Evans to move to a dorm on campus where she could be more closely monitored.
“My parents didn’t want me to go back to school at all, but there was no way I was giving up my senior season,” says Evans, who had been voted co-captain for the upcoming year. “At first, I basically went to class, then straight home to sleep. I was anemic and had zero energy.”
Evans’s health continued to decline and by January she had lost another 10 pounds, bringing her down to about 135. “I couldn’t keep anything in my body and I didn’t have an appetite,” says Evans. “I didn’t want to eat because it only made me more sick.”
But Evans did not want to hand in her uniform or kneepads either. So, Thompson and Athletic Trainer Patricia Cordeiro, ATC, met with Evans and figured out a strategy to get her back on the court. “We put some very basic plans in place, and vowed to keep everybody on the same page,” says Cordeiro. “We wrote out a timetable for her that said, ‘By this point you need to see this specialist, and by this point you need to do this,’ and so forth.”
Evans says creating a formal plan was a big help in her recovery. “That’s something I really needed because I’m a go-with-the-flow type of person and wouldn’t have done it on my own,” she says. “Everyone was motivating me throughout the process. Pat was very diligent about keeping me in the moment. She was accommodating and completely supportive. She never said, ‘This is going to be a really hard road, you better get ready.’ It was always, ‘Here’s what we’re going to do, let’s get started.'”
Thompson also spent a lot of time on the phone with Evans’s parents, working with them to find the best specialists. Early in the semester, she drove Evans to see a nutritionist in Boston. “Because there is no known cure, a patient’s best method of managing Crohn’s Disease is through medication and improved nutrition,” says Thompson. “Some of the nutritionist’s ideas were a little funky and hard for Courtney to get used to at first, but they helped a lot. For instance, the nutritionist told her she needed more flax seed in her diet. Courtney had to go out to a health food store and buy flax seed and be conscious about adding it to her morning yogurt. Those kind of details were a big change for her.”
Thompson, who also serves as a strength coach at Tufts, tried to find out all she could about what her player was battling. “In addition to researching on the Internet, I talked to our athletic trainers and anybody else who might know anything about Crohn’s,” she says. “But to me, getting her in the hands of the right doctors and helping to expedite the recovery process was more important than becoming an expert on the disease myself. I saw my job as finding the resources she needed and working with her parents and the specialists.
“I wanted to make sure Courtney knew I was there for her,” Thompson adds. “I also wanted her to feel structured and to feel like part of the team—not like she was out there floating around amongst the masses. And most importantly, I wanted to make sure she knew we weren’t giving up on her.”
Though she realized her coach was squarely in her corner, Evans still experienced bouts of depression that spring and decided to get help from a sports psychologist employed by the university. “A lot of times I felt depressed about not being able to do what I used to do, and I didn’t want to burden my friends by talking about it all the time,” says Evans. “So I started seeing the sports psychologist once a week. We not only talked about my illness, but also about dealing with the responsibilities of being a captain the next season. It was really helpful to think ahead about that kind of stuff—it helped me keep my mind focused on getting back to where I was before.”
In March, Evans, who was anemic, started getting IV infusions of iron, which were easier for her to take than oral iron supplements. And slowly, she noticed her energy levels rising. At that point, even though she still experienced symptoms of Crohn’s, Evans began working with a Tufts personal trainer for 45 minutes a day, three times a week.
“We wanted to prescribe exercises that kept her comfortable, and we found that stretching was the thing,” says Cordeiro. “She did lots of static stretching with long, prolonged movements that lasted for 30 to 120 seconds. She started each session by working on her priority areas—whatever was tightest. And it really seemed to improve some of her symptoms.”
By the end of April she began some basic strength training using very light weights. Because the goal was to increase Evans’s body weight, the program was designed to limit her cardio conditioning. “We started doing really basic circuit training on machines,” says Cordeiro. “Eventually, she progressed to lower-body exercises like squats and leg presses using light weight. By then the team was doing their team lifting and she worked out at the same time. It was a good way to keep her connected with her teammates and focused on her goal.”
By the end of the spring semester, Evans had put on more than 10 pounds and was starting to feel a little better about her chances of returning to the court for the 2005 season. But she wasn’t even close to feeling like her old self. So that summer, Evans’s doctors put her on a new IV medication called Remicade. The results were startling. “After two infusions, I felt 100-percent better. After the third infusion, I felt completely normal again,” says Evans. “It took away my symptoms completely. It has been a miracle drug for me.”
Spending the summer in Cape Cod, Mass., Evans hired a personal trainer and attacked her workouts with newfound energy and vigor. Intense lifting three times a week packed pounds on Evans’s frame while hardening and tightening her muscles. “That summer I set a personal best in the squat and restored my vertical jump to what it was before I got sick,” she says. “It was a lot of hard work, but I regained everything I had lost during the spring semester.”
When Evans returned to Tufts for volleyball preseason practice in August, Thompson was again blown away by what walked through her office door. “When I first saw Courtney, she flexed and said, ‘Look! Muscles!'” says Thompson. “She was lean and strong and her body mass index had improved over what it was before the Crohn’s. Then I sat back and watched her play a couple pickup games—that’s when I realized she was back to her old form.”
And that form carried her team to another level. The Jumbos won a school-record 29 games and advanced to the regional finals in the NCAA Division III championships. During that magical season, Evans played in every match, earning first team all conference honors.
Despite exhausting her collegiate eligibility, Evans was not ready to stop competing. Two weeks after the team’s final game, Evans told Thompson that she wanted to start training for the Boston Marathon. “We were coming off a grueling season and to have her say that was mind boggling,” says Thompson. “She trained all winter long, was eating a ton, and feeling great. It was amazing considering a year earlier she couldn’t even get off the couch.
“The whole experience of rehabbing from Crohn’s Disease taught her a lot about nutrition and what her body could handle,” Thompson adds. “And throughout her marathon training she kept asking Pat and I, who have both run marathons, for advice.”
That spring, Evans completed the 26-mile race in less than six hours. She was escorted to the finish by Thompson, who met Evans at the 17-mile mark, and seven of her teammates, who joined in with four miles to go. “The girls were wearing T-shirts that read, ‘Court Support’ on the back and chanting her name and getting the crowd into it—I’m getting a little choked up just talking about it,” says Thompson. “Granted, they were silent after about a mile as they tried to keep up with Courtney.
“It’s so inspirational to think that she started that 15-month ordeal flat on her back and ended it by crossing the finish line of the Boston Marathon,” Thompson continues. “And in the middle, to have the best season in school history—I really couldn’t have scripted a better story.”
Evans is currently a teacher and Head J.V. Volleyball Coach at Episcopal High School in Houston. She says the lessons she learned last season have helped shape her coaching philosophy. “The whole never-give-up mentality is the basis of my coaching style,” says Evans. “I never hang my head on the bench and I’m always encouraging our players—no matter how dire the circumstances seem. Cora taught me that if I don’t give up on the girls, they won’t give up on themselves.”
Though she still receives Remicade transfusions every two months, Evans says she has the disease well under control and feels healthy and strong. Ultimately, she says having Crohn’s Disease has taught her a lot about herself. “I always thought I was mentally tough, but I learned exactly how tough I am,” says Evans. “It would have been really easy to let my situation get the best of me, especially at the beginning of that spring semester. I got sad, but I never let it get out of hand and a lot of credit for that goes to my support system: Cora, Pat, my personal trainer Dan, and my friends and parents.
“Also, I learned to never say no to somebody who was trying to help me,” she adds. “As a very independent person, it would have been natural for me to say, ‘Thanks, but I can do this on my own.’ If I had done that I don’t think I would have been able to get well as quickly as I did. It helped so much to have other people beside me saying, ‘You’re going to be fine, we have a plan.’ Having people do all those little things really added up.”
PROFILE: Courtney Evans
- Injury: Crohn’s Disease
- Rehab notables: Lost and regained 30 pounds of muscle in eight months.
- Result: Returned to starting middle hitter position in 2005 and led the Jumbos to the most wins in Tufts volleyball history. Also completed the 2006 Boston Marathon.
- Quote from Coach: “It’s so inspirational to think that she started that 15-month ordeal flat on her back and ended it by crossing the finish line for the Boston Marathon. And in the middle, to have the best season in school history—I really couldn’t have scripted a better story.”