NEWARK, Del. -- Elena Delle Donne is used to the physical toll. The University of Delaware's 6-foot-5 All-American is familiar with all that comes with being better and bigger than anyone else on the basketball court -- the clutching and grabbing, the elbows and forearms that find their way into the small of her back but go uncalled.
Watching Delle Donne with the ball in the post or as she drives the lane is as close as basketball comes to what cameras capture of the underwater mayhem that makes Olympic water polo must-see television every four years. She went to the free throw line nearly eight times per game last season; she could have gone at least that many times each half.
It's part of the deal, and when your team goes 31-2, spends a good part of the season ranked in the top 10, wins a conference title and gets visits from the vice president, the bumps and bruises aren't so bad.
But the defensive dark arts aren't all that will take a toll on Delle Donne's body in her final college season. There is one more twist for her to navigate.
With the start of the regular season just a week away, Delle Donne told espnW she is experiencing a recurrence of symptoms of Lyme disease, the same illness that forced her out of the lineup for 12 games during the 2010-11 season.
Although she experienced sporadic symptoms last season and remained on medication for the disease, she was for the most part healthy as a junior. The results were otherworldly, one of the greatest statistical seasons on record. She averaged 28.1 points and 10.3 rebounds per game while shooting 52 percent from the field, 41 percent from the 3-point line and 89 percent from the free throw line, turning over the ball fewer than two times per game.
But when full practices began several weeks ago, Delle Donne felt the return of familiar symptoms, which can include extreme fatigue, migraine-like headaches and anything from mild to debilitating pain in muscles and joints (hold your arms out in front of you for a few seconds; now imagine not having the strength to keep them there).
"After last season, I thought I was kind of clearing it and thought it was going to be over with," Delle Donne said. "I even started going off medicines in the summer because I was doing so well. And then for it to flare up for my senior year -- it's disappointing, but I'm not going to let it stop me from playing. I'm going to be out on the court if I can."
She said if the opener against Sam Houston State had been this Friday, instead of a week away, she would have been in uniform and on the court for the preseason WNIT game.
"I don't feel great, and I don't always look great," Delle Donne said, "but I'd play."
She is taking a new round of medication in consultation with the specialist she has seen for two years. She is practicing; Delaware coach Tina Martin finds Delle Donne before practice each day, and sometimes again during practice, and asks a simple question: good day or bad day? They go from there.
There will be a litany of small challenges to overcome -- things like keeping on enough weight to withstand the punishment she takes on the court. But unlike two years ago, when she cautioned that she wasn't sure if 100 percent was a realistic option after she returned, she is hopeful it is now.
"I'm optimistic that at some point in the season I will be," Delle Donne said. "Right now, I'm not at all. But I've played at not 100 percent for a lot of games before, and it's something I'm used to. It's something I'm willing to deal with."
Delle Donne originally contracted the bacterial disease known to be spread by bites from infected blacklegged ticks in 2008, during the summer in which she returned home from the University of Connecticut. Antibiotics were prescribed, but because they hurt her throat, Delle Donne said she stopped taking them a week earlier than directed, something she believes allowed the disease to linger dormant within her.
When symptoms reappeared in 2010, they were more severe than anything she had experienced two years before, at times leaving her physically unable to get out of bed. She played the first eight games that season while feeling the full effects of fatigue and pain, but in tears after a game at Penn State, a contest in which she scored 25 points on 9-of-23 shooting in 37 minutes, she told her parents she couldn't take it any longer.
But two years had passed, and Lyme disease wasn't on the radar in explaining her misery. In the weeks that followed, the search for answers led down some rather dark paths.
At one point, Delle Donne's father, Ernie, said a doctor told him that his best guess was either Amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease, or a brain tumor. These weren't just basketball-threatening maladies.
"I was scared, really scared," Elena Delle Donne said. "My family, obviously it was great being with my family at that point in time because they were taking care of me the best they could, but they were also there for me mentally, where I was like, 'I could be dying.' That's what I felt like; I felt like I was dying. No doctors knew what it was."
Six weeks later, the recurrence of Lyme diagnosed, she was back on the court, scoring 28 points in her return. Neither she nor the program seemingly ever looked back.
The Blue Hens drew fewer than a thousand fans to the Bob Carpenter Center for all but two home games during the season before Delle Donne decided to return to basketball. The school has already sold more than 2,000 season tickets for the upcoming campaign and expects to be close to a capacity of around 5,000 most nights. The team is ranked No. 11 in the AP preseason poll and returns most of its core.
All of that is just fine with Delle Donne, the competitor within her craving the challenge, just as she takes the physical punishment from opponents, rarely says a word and keeps piling up points. But the flip side of the phenomenon that is Delaware women's basketball is the specter of disappointing a community if she is unable to meet her own standards, a dilemma that could tempt her to push her body too far.
"It's a really difficult thing to not let people down," Delle Donne said. "No one even knows about [the disease] that much. They thought I had it, and then they thought I got better and it was gone. And especially after last season, I was fine through most of the season, had a couple of flare-ups, but no one knew about it.
"It's a difficult thing to handle when people think you're going to be on top of your game, 100 percent, and you know with the illness you just can't be."
Speaking one night after somehow procuring a Gumby costume that fit her frame in order to partake in Halloween celebrations, and before heading home to cram for an exam the following day, Delle Donne still seems, to her great satisfaction, to be just another college student. Basketball is only one part of that.
But someone who once ran from college basketball begins her final season doing everything she can to stay on the court. The toll is one she's willing to pay.