Posted by: mdegeorge | May 14, 2011

Weekly Diagnosis: May 13

The weekly diagnosis is back after a brief, work-induced hiatus that forced a misfire on the obvious—the verification that Dave Duerson suffered from the chronic traumatic encephalitis he feared when he took his own life. But this week has provided a fresh crop of stories, including Bartolo Colon angering conservatives, below-grade cranial protection and some really efficient HIPPA laws.

When seven days just isn’t enough

Major League Baseball’s concussion-friendly seven-day disabled list admitted its first occupant a couple weeks ago, with Milwaukee Brewers utility man Erick Almonte being put on the shelf after a stray toss from Craig Counsell in warm-ups April 26 gave him a Grade 1 concussion. Characteristic symptoms of that gradation of trauma generally abate in five to seven days.

But the team, according to manager Ron Roenicke, had someone monitor Almonte’s condition that night (he did spend several minutes unconscious on the ground), and the two-year veteran has no memory of the moments before being struck. Almonte continued to report symptoms, including dizziness and nausea, until he was transferred automatically, as is the design, to the 15-day DL. Only Tuesday was he cleared to resume physical activity, the first step before having to submit a “return to play” form to be activated to the active roster.

The first experiment with the new DL didn’t reveal its usefulness, per se. But it did allow the Brewers time to make a roster move on Almonte even before they knew a long-term stint was necessary.

He had what?

It was revealed Thursday that University of Minnesota coach Tubby Smith was declared free of prostate cancer. The surprising part? No one seemed to know he suffered from the disease.

Smith revealed, somewhat curiously, that he underwent surgery at the Mayo Clinic to remove a mass April 21, after the conclusion of a disappointing men’s basketball season for Smith and his Gophers. But Smith, whose one of the most outspoken advocates for Coaches vs. Cancer, also disclosed that he first saw signs of an elevated prostate-specific antigen (PSA), one of the substances tested for to determine presence of malignancy, at a routine physical the spring before.

It’s an interesting timeline that’s indicative of the different natures of this class of diseases. The remarkable thing is that information on Smith, one of the biggest names in college hoops even in his current relatively out-of-the-way outpost, remained under wraps for almost a year until he was deemed cancer-free. It’s great to see him get a clean bill of health, but it’s his publicist I’d most want to have in my rolodex.

A decidedly pro-choice choice of treatment

The resurgence of Bartolo Colon at age 37 has been nothing short of remarkable. Or in the eyes of some, controversial.

Colon didn’t throw a pitch in 2010 after a precipitous fall from grace. The 2005 American League Cy Young Award winner seemed to basically fall off the face of the baseball planet, his once lively right arm beset with frayed elbow ligaments and a burnt out rotator cuff. But the rotund righty sought out a revolutionary treatment that seems to be working wonders.

Thanks to Florida-based Joseph Purita, Colon was treated in his native Dominican Republic with stem cells derived from fat tissues (which he has plenty of) and bone marrow that were injected into the injured area. Aside from the obvious ethical implications of stem cell use (they clearly weren’t embryonic cells, but just saying “stem cell” seems to set off the ire of certain ideological groups), the legality of the treatment is also unclear.

The treatment is too new for Major League Baseball to officially take a stance on the matter, and at its usual glacial pace, that should persist for a few decades. But Purita is also a frequent prescriber of human growth hormone, a very illegal substance in the eyes of MLB. Purita firmly denies ever giving HGH to any of his several athlete patients, but the connection is a bit uneasy for some.

It’s hardly as gross as other last-ditch efforts, like Robin van Persie’s horse placenta treatments. But as long as there’s no HGH involved, it’s hard to argue with the results.

A Bronx mystery

The Yankees starting five seems a fertile group for the bizarre this week, with 40 percent of the rotation garnering mention.

The back half of that unusual duo is Phil Hughes. That starter-turned-reliever-turned-starter struggled to the tune of 16 earned runs allowed in 10 1/3 innings pitched over three outings this season. He was shut down in the last week of April with what the team rather nebulously termed “dead arm,” which loosely translates to “we don’t know what the hell is going on with this kid.”

The mystery ensues as to what is causing Hughes’ sluggish shoulder. Various regimens of rest and anti-inflammatory drugs have been suggested. The one positive to this maddening conundrum is that doctors know at least one thing it isn’t: thoracic outlet syndrome, a dangerous increase in pressure on the nerve endings and supporting blood vessels in the shoulder (explained here). The injury would require around a year’s lay-off and treatment with a rather unreliable history of effectiveness.

I’m obviously not privy to the day-to-day of the Yankees clubhouse, but I’m not willing to rule out extended contact with A.J. Burnett as a potential cause.

A two-in-five chance of disaster

The NFL has repeatedly talked a good game in its crusade against head injures. But a study released by researchers at Virginia Tech this week indicates things aren’t as advanced as the league would like.

The study, which tested the efficacy of 16 brand name helmet models, concluded that around 40 percent of the helmets worn by NFL players in 2010 received a rating of one out of five for ability to resist concussions.

The biggest culprit was Riddell’s VSR-4, which despite sounding like a model of robot from an Isaac Asimov novel, worn by 38 percent of pros. The VSR-4, along with a few other models that were worn by a minimal amount of players, scored a one, which provided basic protection against a skull fracture but not more advanced defense against concussions.

The good news is that Riddell, the league’s main helmet manufacturer with a 75 percent market share, ceased production of the VSR-4 in 2010. The better news is that a new generation of Riddell helmets, the Revolution series, rated a four or higher (including a five for the Riddell Speed).

The study makes a few things abundantly clear. First, Riddell has a great public relations department that basically turned the study into an ad for trading in old VSRs for the more pricey Revolutions. The study illustrates the need for control on the part of the league on its many vendors and the burden of having to extend their standards onto outside entities. And it shows that for all the potential rules changes and new health insurance and pension dispensations, there plenty of progress still to be made at a very basic level.

Weekly Diagnosis Video of the Week: Steven Threet

The once highly-prized recruit who started his career at Michigan before transferring to Arizona State is now a veteran of at least four known concussions that have forced him to hang up his pads. The interview, courtesy of the Concussion Blog, gives a glimpse of Threet’s struggle, replete with sunglasses he has to wear whenever he’s out in the bright Arizona sun to ward off extreme sensitivity to light. Despite the premature end to his playing career, Threet appears to have a decent idea of how to survive after football.

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