Pitching Relief

Two articles caught my eye recently, dealing with Red SOx pitcers and the physicians and psychologists keeping them on the field.

In today's Boston Globe, there's a discussion with noted sports psychologist Harvey Dorfman, on why he thinks Matt Clement will successfully return to the mound after being beaned in the head by a line drive:
"A lot of it has to do with where you've been hit, believe it or not," said Dorfman, who has worked with the Athletics and Marlins and is now on the staff of sports agent Scott Boras.

"I was watching on TV when Matt was hit and the first thing I said to myself was, 'I think he'll be all right, it was on the side of the head.'

"Look, you can't predict the future. How people respond is up to them individually. But what I mean when I say it was better that he was hit on the side of the head is that it allows a guy the idea that essentially, he got out off the way. Of course, that's almost absurd in a sense, but he was turning out of the way of the ball. When you're hit flush in the face, that's a different story."

Interesting, that a split-second response, barely effective, might save him from debilitating fear down the road. I would have thought the severity of the injury (in this case, luckily, minor) would play a larger role.

Also, from a few weeks ago, the LA Times had good report of Dr. Bill Morgan's dismissal from the Red Sox last fall (if you can stomach some of the sportswriter's overwrought style). The best part of the piece was the physician's perspective in watching Game 6:
While others were writing off the season, however, Morgan was having a brainstorm. Instead of fixing Schilling's ankle, he wondered, what if it were somehow possible to temporarily freeze its malfunction? What if the dislocated tendon could be held fast to the bone, just to keep the thing from flicking back and forth?

An intriguing idea. Just one small problem. It had never been done before. In the annals of medicine, in the annals of ankles, the procedure Morgan proposed was unprecedented, the surgical equivalent of coming back from 0-3. "I've never thought of doing it myself, nor have I ever read of someone else doing it," says Dr. Robert Leach, professor of orthopedics at Boston University Medical School and former team doctor for the Boston Celtics.

Morgan ran his idea by Schilling and found the pitcher willing. Nervous but willing. "I walked in the training room," Schilling recalls, "and Doc looked at me and said, 'Let me throw this at you.' It was a last gasp. We'd exhausted all our options. It was either this or I didn't pitch. I'd resigned myself to the fact that I was done."

Once Schilling—and Sox officials—agreed to the procedure, Morgan decided he'd better practice first. He needed to make sure the procedure was even feasible, that the tissue around a human ankle bone was soft enough to be penetrated by sutures. With time running out on the season, Morgan performed a dry run on a dead body.

The practice surgery worked. Sort of. There was no way to really test it because there was no way to send the dead guy out to face the Yankees. Then, turning from corpse to ace, in a remote training room far below Fenway Park, Morgan knitted Schilling's ankle with five or six deep O-shaped stitches.

Schilling's teammates, meanwhile, partly inspired by the specter of their comrade laid out on a makeshift operating table, managed two wins against the Yankees, staying alive until Schilling could take the ball again.

October 19, 2004. Game 6. Cameras zoomed in on Schilling's ankle and millions of Americans saw the sock slowly turn red, as Schilling's face turned white. "I was scared to death," Schilling says. Tentatively, perilously, he stood propped on his Morgan-repaired joint, peering at New York's batters over the webbing of his glove.

Fans everywhere held their breath. Morgan, watching on a TV in the clubhouse, held his breath, too. Some bleeding was normal, he knew, but what he looked for, what he dreaded, was blood on the sock that appeared "frank," or dark red, which would mean the sutures had torn.

Everyone in the Sox organization had a lot at stake that night, but Morgan and Schilling were risking the most. They both knew that if Schilling's tendon ruptured, if infection set in, if any number of things went wrong, Schilling could fall to the ground like a man shot with a deer rifle. More, he might never heal properly. He might date the end of his brilliant career from that night, that game, that unprecedented procedure.

A great look behind the events of that week. But some details are missing from the larger picture: though he touched upon Morgan's drinking, the the writer should have informed readers about Morgan's driving record. More importantly, the reporter neglected to mention the Red Sox management's principle of non-sentimentality. Hell, they traded the high-energy Cabrera and even Dave Roberts, who stole second base and began the greatest turnaround in sports history. Both these guys became fast fan favorites, performed above and beyond expectations, and certainly didn't cost much.

Breaking News

I like to browse the headlines on ScienceDaily, looking for stuff to read or blog about. I don't know if it's my mood or a particularly obvious set of headlines, but this Friday's edition gave my inner snark some material to work with:

Do Free Drug Samples Influence Residents' Prescribing Decisions?
I think it depends on how fastidiously the residents take the drugs.

Nuclear Weapons Continue to Pose a Serious Health Risk to Europe
I actually thought this was lazy headline-writing -- that it was really an article about storage leaks or background radiation. But no, the report is about nuclear weapon detonation being a health risk. Because, you know, they're weapons.

Delirium Associated with Premature Death
But what a way to go!

Knee Pain Often Linked To Pain Elsewhere In The Body
This was particularly true of patients who had been run over, or had fallen from great heights.

Top Ten Reasons Blogborygmi's Been Quiet

10. This new city I'm living in has more things to do
9. Furniture shopping can expand to fill all my free time if I let it
8. I've been writing on Medgadget (and using the royal "we" has left me without a sense of identity)
7. I have two posts about moving, two on orientation, and one post about my first shift that still need some polishing
6. Making new friends, keeping the old
5. The PGY-2's are 'teaching' me poker
4. It's really humid
3. I find myself reading more medical journals, instead of surfing medlogs
2. Interns don't seem to talk a lot

And the number one reason I haven't posted here in a while:

1. The networks stopped calling me, what's the point anymore?

Inside the Beltway

Last year I blogged about Nathan's Hot Dog eating contest. This year, I gave some thought to attending this spectacle of competitive eating (these plans were laid to rest the night before, when I enganged in the spectacle of competitive drinking).

Anyway, it doesn't look like I missed too much. The same guy, Takeru Kobayashi, won again (though last year, he was frequently called by his nickname, "the Tsunami." Not so much, this year).

Also unchanged: the dearth of scientific inquiry into this ... sport. I mean, it's been over twenty years since competitive race-walking was examined in detail -- is that any more of a sport than competitive eating? Which activity is of more relevance to the obese American taxpayer?

All I can really find on the matter is this press release from the International Federation of Competitive Eating:

The November 2003 Popular Science addresses the tendency for thinner, in-shape gurgitators to beat heavier eaters in competition. Many intuitively believe that a larger individual has more room to hold food, but this is not the case. The magazine states that the size of the stomach at rest is inconsequential and that the ability for the stomach to expand is all that matters.

This is the conclusion reached by former world champion hot dog eater Edward Krachie in his 1998 scholarly journal article, "CAN ABDOMINAL FAT ACT AS A RESTRICTIVE AGENT ON STOMACH EXPANSION? An Exploration of the Impact of Adipose Tissue on Competitive Eating." In his article, Krachie goes a step further and proves that the stomach of a heavier eater is prevented from expanding by a "belt of fat."

The IFOCE and Edward Krachie submitted his piece to numerous academic journals including the New England Journal of Medicine. Sadly, all journals rejected his piece.

Sadly, Popular Science doesn't really conclude the 'belt of fat' theory is correct. The reporter just asserts it, and goes on to talk about satiety signaling. The entire piece is not much longer than the IFOCE press release.

I think there's plenty of room for more ... data. Granted, I have an appetite for this stuff, but I think it's worthy of extra helping from the scientific community. Because the few morsels of information we have now are hard to digest (as are these puns. I'm sorry.)

Krachie and company are arguing, essentially, that a belly of fat is more compressive than skin and muscle are distensible. I'm not convinced. I wouldn't be surprised if the thin eating champs were born with weak pyloric sphincters, or exhibit higher capacity for smooth muscle relaxation. But until we start doing some barium swallows and endoscopies on these people, we're just guessing.

Sooner or later, the reward money for these contests will prompt some competitors to fund their own clandestine research. And it would be a shame if these athletes were smeared with allegations of shady practices. Let's keep the research open and freely available -- let science have a seat at the table.

Escaped from the Madhouse

A conversation fragment from the incoming resident orientation (I used proper names in reality):

Me: "So, you did your medical internship at Hospital X? Maybe you know Madhouse Madman?"
2nd-Year Resident: "Oh, yeah. He's great. Actually, he told me to look out for you, that you'd be here. He said you two met online."
Me: "Uh, well, I wouldn't put it that way, really. I mean, I heard of him through his website..."
PGY-2: "You've never met him in person?"
Me: "No. I don't even know what he looks like. But I've seen pictures of his new daughter, though. And he just got back from this trip to Israel, it sounded nice."

PGY-2 pauses to wonder how I know these disparate pieces about a man I've never seen.

Me: "He leads a very public ... private life."


Tim Gee of Medical Connectivity is hosting Grand Rounds this week:
Grand Rounds always impresses me with the diversity, richness and good writing that comes from folks in the many areas in health care, and today is no different.

Well said. As a medical connectologist, Gee is an interesting and underreported player in the health care industry. Stop by his site, learn about what he does, and check out the latest from the medical blogosphere.

Next week's host is Shrinkette.