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August 16, 2010

Under The Knife

997

by Will Carroll

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Methylhexanamine. If you're like most people—including me just a few weeks ago—you have no idea what this substance is. It's now baseball's most abused performance enhancer. It's a powerful stimulant, described as a natural amphetamine, but legal. In the past months, eight minor-league players have been suspended in rapid succession for testing positive for methylhexanamine, a substance just added to baseball's banned list this year after WADA put the substance on its list. Please note the difference between banned and legal. "Banned" is a substance that is forbidden by a governing body, in this case MLB or WADA. "Legal" means it is not controlled by a government body. While methylhexanamine is banned in baseball and causing positive tests, it's also available at your local vitamin store or at hundreds of online retailers.

In fact, it is this very availability and popularity that has caused the problems for these minor leaguers. Bodybuilding.com is the largest Internet retailer of supplements (and owned by Liberty Media, which also owns the Atlanta Braves). On the front page of its site, Bodybuilding.com offers a product called USP Jack3d. They've nominated it for "supplement of the year," which gives you some idea how well it is selling. On the page for the product, you can see methylhexanamine listed as an ingredient, something that the maker of Jack3d doesn't doon the bottle. Instead, USPlabs lists it under a more technical name, 1,3-dimethylamylamine. This is key and used for another USPLabs product, OxyElite Pro, as well.

If you go to USPLabs' page for its product, you can page all the way down to see the list of ingredients. It lists 1,3-dimethylamylamine. It's unclear if this is also listed as a banned substance on baseball's list, but athletes are at ultimate jeopardy for anything they put in their body. USPLabs is relatively clear, if you dig enough, that Jack3d might cause issues. On this page, it admits that WADA and the NCAA have banned the substance, but throw people off by using two confusing concepts—the difference between banned and legal, and the concept of the false positive. Drug test opponents often point to false positives as a problem, but there's really no issue with this. A false positive is, by definition, a positive result in the absence of a substance. If I'm drinking tea, there should not be coffee in my stomach. Tests are sophisticated enough to do this in such a small number of cases as to consider it zero. The confusion comes when people call something else—a tainted supplement, a poorly performed collection, a problem in the testing procedure—a false positive. USPLabs is right in saying Jack3d wouldn't cause a false positive. It would cause a true positive!

It gets worse. USPLabs is hardly the only supplement maker using methylhexanamine in its products. It's legal and according to both studies and anecdotal evidence, it works. The problem is that USPLabs is run by a man named Jacob Geissler, who has been connected to a steroid shop known as DPharm. DPharm, now defunct, was known as one of the top designer steroid labs for a period of time. Its product was considered top notch in a world of shady suppliers. I'm certainly not one to say that people can't change, but the fact is that over and over, we've seen the line between supplements and steroids blurred. When J.C. Romero tested positive last season, it was because he had taken a supplement (6-OXO, since controlled by the FDA) created by Patrick Arnold, one of the chemists behind BALCO. This is a similar situation. In fact, Arnold appears to be the one who first used methlyhexamine in a product.

This goes beyond baseball. This substance—which is not regulated in any way and could be bought by children—is being investigated for its use as so-called "party pills" that have led to serious illnesses. If you think that a supplement shop owned by a giant, publicly traded company would be looking out for the health of its customers, you might want to consider the FDA-enforced recall and ongoing lawsuit involving Bodybuilding.com. If the lawsuit goes against Bodybuilding.com and the other defendants as alleged, they would be subject to damages in the millions for selling illegal anabolic steroids.

What this shows is how difficult an issue this is for both MLB and the players. No one is excused here. Players taking a supplement called "Jack3d" have to realize that they're treading on shaky ground. They have resources, both at the team and league levels, to make sure that supplements are clear of banned substances. But then again, are the teams and leagues, especially at the minor-league level, making these resources as known and available as they should? Are players given open and honest advice by athletics trainers and strength and conditioning coaches? Is there a subtle or not-so-subtle message being sent to players to get bigger, stronger, faster that's leading them down this path? How will baseball deal with what looks like an impending ban of caffeine by WADA, especially since methylhexamine is only on baseball's banned list because WADA placed it there last year? Red Bull and coffee might be next year's issue. Worst of all, why is an entity involved in the ownership of a team also selling substances that are banned by that very sport?

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Jacoby Ellsbury (fractured ribs, ERD TBD)
Go ahead. Call him soft. Ellsbury came back from his fractured ribs and proceeded to re-break them, it appears. If that isn't an indication that he might have come back early, pushing to return due to pressure from teammates and character assassinations in print, I don't know what is. I realize what I'm beating here, that not many are going to change their locked-in position about Ellsbury's issue. A CT scan showed problems in the same area that cost him most of the summer. Due to the re-recurrence, it's hard to expect any quick return. The bigger question is if Ellsbury is considered damaged goods now by the Red Sox organization. There's certainly frustration on how this has gone down, specifically the issues with the medical staff, but I notice Kevin Youkilis was pretty quick with a second opinion as well when he injured his thumb. I wonder if Mike Cameron questioned Youk's commitment to the team? Probably not. I'm not going to set an ERD just yet. I want to get a bit more information and there's really no rush with Ellsbury on the DL for at least the next 15 days. However, there is every expectation this is a season-ender.

Chase Utley (sprained thumb, ERD 8/18)
Dustin Pedroia (fractured foot, ERD 8/16)
Can an 0-for-3 day be good? For Utley, it can. He didn't strike out, putting all three balls in play. As I've said before, his ability to make fine motor adjustments are the last, best test for his thumb, so I'm looking for swings-and-misses. One observer said that Utley looked a bit out of sorts, not in that he was hurting, but just that he seemed frustrated with himself. Let's call that rust for now and continue to watch to see if there's any more sign that he's not adjusting or that the thumb isn't holding up well under the forces of the game. We should see Utley back this week as expected, but his results so far seem to have that return coming early in the week rather than later as I'd thought. As for Pedroia, he made it through a weekend of games. He looked rusty and there wasn't a play that challenged his defensive range. One observer thought he was playing under some sort of restraint, an order not to try something too taxing. Pedroia is a tough guy to rein in, but I think the fractured foot scared him enough that he's listening. It's impossible to say how this will affect him, if at all, but as long as he's reasonably healthy, he'll help the Red Sox.

Jeff Francis (strained shoulder, ERD 9/1)
Labrum problems have a way of recurring or worse, transferring. Francis was able to come back from his labrum surgery while many weren't sure he would, but by coming back, he doesn't escape the inherent riskiness of pitching with a shoulder that has changed dynamics. The fact is that a surgeon, no matter how skilled, can't perfectly recreate the shoulder. Things change in repairs even when they go perfectly. Because of this, the forces change and with 99 percent of pitchers, we have no idea how or why. The Rockies don't have any clue, beyond guesswork, hope, and probably a bit of prayer than Francis can stay healthy. He'll pass all the physical measurements, show the results, but he could snap at any time—or never. The soreness in the back of his shoulder is a tough one, but they seem to have caught it early and smartly shut him down. There's no timeline, but the Rockies do expect him back in September. Sources tell me that they're a bit unsure about how available he'll be, perhaps needing extra rest, so a return in September would allow them more roster flexibility. The Rockies are falling out of the National League West and wild-card races, but they would like to get a bit more of a look at Francis as they prepare for 2011 and hold a club option on his contract for next season.

Bobby Jenks (back spasms, ERD 8/17)
"Just spasms" is like being a "little pregnant." Sure, spasms come in different varieties and intensities, but they're a symptom, usually of a chronic condition. Jenks has been dealing with them over the course of a couple seasons and looking at him, it's little wonder. He's never been a small guy and he's getting bigger as time goes on. Jenks was unavailable over the weekend, but was getting treatment. Sources tell me that he made progress, but that "his leash is pretty short" and that if he's not available by tomorrow, he'll head to the DL. Jenks isn't likely to be free of these without getting a bit more serious about his conditioning or at least that part of a rehab regimen. Then again, the fact that he's been as productive as he has been as a White Sox is pretty amazing considering where he was when the Sox took him on as a project.

Gil Meche (strained shoulder, ERD 9/5)
It looks as if Meche is going to not only avoid surgery, but shift to the bullpen. There's still some question about his effectiveness, but sources think that Meche might end up in the 'pen in 2011, the last year of his deal with the Royals. Meche has shown that he can fight through injury, but the idea that relieving is easier just doesn't have much evidence to it. Relievers tend to throw harder, which changes the forces throughout the kinetic chain. As with Francis, the Royals don't know, because they haven't measured it. The Royals and their "four absolutes" don't have a better record at keeping pitchers healthy than anyone else. Some credit has to go to what they've done extracting value from Meche, and if he can be a positive in the bullpen, well, so be it. This ERD is a guess and it's going to be very fluid.

Kris Medlen (sprained elbow, ERD 10/4)
As expected, Medlen is done for the year and likely much of next season as well after it was determined he would need reconstructive elbow surgery. (I've been debating something. The Associated Press uses "reconstructive elbow surgery" rather than "Tommy John surgery." Both are technically correct, but is one more easily understood? In the day and age where you can look up any word with a click on Kindle or find nearly anything on Google, I have a hard time thinking I need to worry about complexity.) Medlen is expected to undergo the surgery soon and start the rehab. With Edinson Volquez returning so quickly, there's a bit of an expectation that everyone having it now will follow the same quick path. Quit it. Every elbow is different and the circumstances of Volquez's operation and rehab are pretty unique. Think 12 months for a return and 18 before we consider them "all the way back" as the standard, as it's been since Dr. Frank Jobe was working on Tommy John himself.

Justin Morneau (concussion, ERD TBD)
There's no new news on Morneau, but to save the inevitable WATGs, I'm putting it here. Fact is, any timeline on a concussion is just a guess and that's not me setting an ERD, but the medical professionals monitoring him on any given day. (Worse, imagine the hundreds of high school football players going to bed tonight with a headache they didn't tell the coach about.) I realize that when ESPN says "indefinitely," that sounds like "OMG done for the year!" It just means "we don't know, but not today." What the team is doing by pulling back timetables is saying, we'll do this the right way and keep pushing it back as necessary. If a watched pot never boils, a watched concussion just puts more pressure on a player who already wants to be back. There's no reason to think that Morneau is out for the season, but it's looking more like September.

Quick Cuts: I think Kevin Slowey's elbow is okay. Best moment for me was him handing over the ball to Ron Gardenhire. There was real respect there going both ways. ... For all those people who like to think they can look at people and see steroid use, look at Bill Hall. I remember when he came up and now? Different guy, but I'd be very willing to bet he's never used steroids. (I could be wrong, but I doubt it.). ... Derrek Lee hit two homers, then left with some back spasms. No word on severity, but he looked more uncomfortable than hurt. ... No truth to the rumor that Nelson Cruz hurt himself in the celebration of his massive Saturday home run. He is sore, but the Rangers lead allows them to give him a couple days off. They also shifted Rich Harden to the DL, perhaps ending his season and called up Brandon Boggs, who will cover for Cruz's absence and head back down when they need a pitcher. ... Kyle Lohse was back with almost no warning this week and didn't look great in his return start. There are going to be questions about the pace of his return. ... Great cause. ... Milton Bradley is heading to Cincinnati for surgery on his knee with Dr. Tim Kremchek. It's an exploratory procedure that could go many directions, so i have no idea on a timeline. Why Kremchek? He repaired Bradley's ACL after his freakish injury in 2007. ... Lance Berkman has a mild ankle sprain after stepping on the pitcher's foot at first. He might miss a couple days, depending on how it responds to treatment. The Yankees could use the open slot to rest some other field players anyway. ... I'm hearing that the Dbacks know that Brandon Webb is done for the season, but that Webb isn't ready to throw in the towel just yet. ... Homer Bailey's start coming off the DL looked good enough for the Reds to push Mike Leake out for a while. ... I've joined the amazing crew over at Press Coverage—we've been referred to as "the Expendables of blogging"—and my first article there will be up soon. It's well worth your time to check out the site. 

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