American Society of Plastic Surgeons
For Medical Professionals

A soldier wins the hardest battle with an invisible enemy

Sam Schaefer found the perfect position with the Air Force in combat control.

"I was immediately like, 'Yes, this is me,'" said Schaefer. "This is where I should be. This makes me the best version of myself."

Yet, a long fight with an invisible enemy – chronic pain – would lead him to a new profession. It was an injury to his foot sustained during a training exercise that began the battle.

"In my infinite wisdom, I was like, 'I'm here to go,'" said Schaefer. "Got up and finished the run, and that was my last moment out of pain for nine years."

That injury ended his military career two and half years later. Schaefer was shuffled between doctors and specialists for nine years to try and figure out how to get relief.

"I tried to shake it off and just assume that it was going to get better," said Schaefer.

Battling the pain through his twenties

Yet, the chronic pain continued despite his active lifestyle doing CrossFit and coaching at a gym. Then, in his twenties, he needed a cane. It affected not only his workouts but also his relationships.

"You don't want to be very social when you're in constant pain," said Schaefer. "Why would I want to go spend a bunch of money to go be miserable somewhere? You don't go on trips. You don't go on vacations. That's an age range where you're hanging out with your friends at bars. I wasn't doing that, so I didn't have friends to hang out with... I'm in pain. I'm not sleeping. Everything is just spiraling out of control. I hadn't even gotten a handle on how depressed I was."

Soon, the cane wasn't enough. Schaefer was using a crutch by 28.

"I don't know how much worse this can get," said Schaefer. "Like, I truly can't fathom this."

Schaefer fought the pain for years, but he decided to fight for a solution and a relationship when a woman with an accent came into his gym one day.

"She was an au pair from Brazil working for a military family," said Schaefer. "They had just moved to Scott's Air Force Base (in Illinois) and decided to try our gym out. She eventually made it clear she wanted to date. That was the first person that was like, 'I'm okay that you're not okay. I'm willing to work with this.' That really helped me limp to the finish line, if you will."

Finding a doctor who could help his pain

That woman eventually became his wife, and he knew he needed to be the best version of himself for her. That meant taking what some considered a radical step to get rid of his chronic pain – amputation. Schaefer was 29.

"There's a lot of reasons to go for that," said Schaefer. "I was out of options. It was the last punch to throw. I was going to throw it. I wasn't like I'm afraid of this. I'm afraid of what happens if I don't."

Schaefer was referred to John Felder, MD, a plastic and reconstructive surgeon and Washington University Limb Preservation Program co-director. Felder confirmed he had complex regional pain syndrome (CRPS), a condition that involves excess and prolonged pain and inflammation following an injury.

"I understand that whenever you have an invisible illness like that or an invisible issue, people treat you really poorly because they can't understand it," said Schaefer.

Truthfully, many other doctors didn't recognize the illness.

"I lost my entire twenties," said Schaefer. "By the time Dr. Felder did his thing, I had lost a third of my life. My memory is shot from those years, partly because of pain, for lack of sleep, all these things. I actually have very few memories, and almost none of them are positive because of those negative things. They cut deep enough to stick. Dr. Felder just listened. He's like, 'What's going on? How are you doing? Obviously, things aren't great if you are looking for amputation.'"

Felder's first interest was in trying to save Schaefer's leg, if possible, by reconstructing the foot.

"But, you know, not everybody with a problem with their foot or leg is going to do well from reconstruction," said Felder. "Sometimes things are so damaged that they'll have a more functional result with amputation, and choosing what's going to give people the best function is the biggest part of my job."

Amputation to alleviate the pain

Schaefer and Felder eventually decided together that a below-the-knee amputation would be the best option.

"He really had come to terms with this and come to grips with the impact it had on his life," said Felder. "He had considered what it would mean to have an amputation. He had decided and it was obvious after I made him go see other specialists that he was firm in his decision."

Yet, Felder designed a nerve transfer technique to allow Schaefer to continue his active lifestyle.

"He was a dedicated athlete," said Felder. "He was training in the military when this happened. He somehow, even though he could barely put weight on his leg, even though he was in constant pain, he was still doing these intensive workouts, CrossFit and being a CrossFit coach."

There was no guarantee the amputation would give Schafer the pain-free life he desperately sought. Yet, Felder believed by carefully reconstructing Schaefer's nerves during the amputation there was a chance he would live an active life without pain.

"That gives the nerves somewhere to go and something to do so they don't keep trying to reform new nerves and cause pain," said Felder.

"I just woke up really groggy and out of pain for the first time in my life," said Schaefer after the surgery.

The amputation was a success, and the chronic pain he suffered for a decade was finally gone.

"It means I'm down a leg, but I get a life," said Schaefer. "Nothing has been worse because of my amputation. Everything, it's just been better... Doctors have to stop seeing amputation as a loss and start seeing it as a solution. That it can be a solution instead of fighting."

Becoming an inspiration for others

Now, Schaefer fights to motivate other people as a coach.

"I don't care if you are 55 years old with rough knees and never really done much to take care of yourself or you're 25 and you just need some direction," said Schaefer. "I have failed at my job if I have not contributed to you being a better human and a better version of yourself."

His experience working around his injury taught him there are many different options and ways to help people get fit.

"It's on you," said Schaefer. "It's on you to do what you need to do to live the life you want to live. It's hard work, but in the end, you get to decide your life. You can choose to make conscious decisions and push forward."

Schaefer, a lifelong hockey fan, recently added the sport to his physical pursuits. He plays with a prosthesis. He now fights for the puck on the ice rather than fighting his chronic pain.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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