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July 20, 2011

Collateral Damage

Heat Wave

by Corey Dawkins and Ben Lindbergh

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Roy Halladay, PHI (Heat exhaustion) [AGL: TBD, ATD: TBD]
Heat exhaustion can happen in any weather or sport, not just during summer football two-a-days. Cases have been documented with air temperatures in the 50s. Sweating allows us to cool off our bodies, but doing so excessively comes at a price. By losing fluids, we become progressively more dehydrated, until we can no longer sweat and the thermoregulatory system begins to shut down, depriving us of the ability to cool down our bodies. Once we lose this ability, we are at risk of developing heat illnesses, sometimes a deadly consequence. Heat cramps, heat exhaustion, and heat stroke are all included under the umbrella of “heat illness,” but they are not required to follow that progression.

Heat cramps in the legs, arms, and torso are caused by a combination of salt and fluid depletion and intramuscular fatigue. They’re also an affliction that many do not associate with heat illness. Treatment of heat cramps is straightforward and include cessation of activity while replenishing fluids/electrolytes, usually all that is needed.

Heat exhaustion is more severe than heat cramps, but not as severe as heat stroke. Core temperatures—either measured rectally or by an RF-tagged pill that is swallowed pre-exercise—climb to approximately 104 degrees Fahrenheit, and heavy sweating occurs. Clammy skin, headache, weakness, nausea, vomiting, and light-headedness can all be present, though not guaranteed.

A player who comes down with heat exhaustion needs to be moved into a cooler shaded area, and cool fluids should be administered. Fans, ice bags, and ice towels are applied in an attempt to cool the body, for IV fluid replenishment is a possibility depending on the fluid levels lost.

The most severe heat illness is heat stroke, in which the thermoregulatory system shuts down and quickly causes a medical emergency. Sweating ceases, causing the skin to become dry and flushed, while core temperature climbs above 104 degrees Fahrenheit. Mental confusion is common, such as difficulty remembering facts about oneself, as well as deficits in general cognitive function. The pulse elevates as the body tries any way possible to get blood closer to the skin and cool down.

Eventually, seizures, coma, and/or death can occur. The body must be cooled down either through water immersion tubs, ice, or body-cooling units to decrease the likelihood of permanent damage or death. A thorough examination still needs to be performed once the core temperature has been stabilized in order to determine if any internal organs have been damaged from the effects of the hyperthermic episode.

Heat cramps and heat stroke have fairly obvious deleterious effects, but often heat exhaustion is a silent factor contributing to ineffectiveness during play. It can produce decreased visual acuity, reaction time, and muscle power output, not to mention mental fatigue. Every aspect of baseball is touched by these factors, and players require all of them to work together flawlessly.

Halladay was taking all the necessary steps to try to prevent heat illness during his last start. He was consistently taking fluids between each inning and was removed once it was apparent that that would not be enough. Players can return from milder cases of heat cramps and heat exhaustion after a few days, which is where Halladay stands in the grand scheme of things.

Ramiro Pena, NYA (Appendectomy) [AGL: 25, ATD: +.024]
Joba Chamberlain, NYA (Appendectomy)
Sergio Mitre, NYA (Right shoulder inflammation)
[AGL: 38, ATD: -.034]
Yankees players are dropping like flies these days. Pena had to undergo an emergency appendectomy early Monday morning and was placed on the disabled list shortly thereafter. We've seen with others that appendectomies don't always require a lengthy DL stay, but Pena will be on the shelf for at least the next two weeks. Chamberlain's appendectomy is not going to affect his return from Tommy John surgery.

Mitre was placed on the disabled list with right shoulder inflammation, and according to the AGL figure above, he will be there for approximately one month. Mitre hasn’t been effective since his return to the Yankees a couple weeks ago, and he has also been battling an illness over the last few days. Mitre has suffered from repeated bouts of shoulder inflammation in the past, which raises our eyebrows concerning the possibility of something else going on.

Miguel Tejada, SFG (Lower abdominal strain) [AGL: 8 (26DL), ATD: +.001(-.037DL)]=
Tejada left Monday's game with a lower abdominal strain and was subsequently placed on the disabled list Tuesday afternoon following an MRI. Lower abdominal strains, as is true of most core strains, can be difficult to heal fully because they are constantly used in almost every motion. Tejada reportedly did not want to go on the disabled list, which is not surprising given his earlier consecutive games streak. He should not miss an extended amount of time and should likely return in a few weeks.

Flesh Wounds: Brian Roberts suffered from a migraine headache that was not associated with his concussion. Luckily, he doesn't need to start back at square one once again... Jason Heyward will likely return today after missing the last few days with a left foot contusion... Travis Buck has been diagnosed with a head contusion after a beaning from Francisco Liriano... Scott Sizemore has also been diagnosed with a contusion after he was hit by a pitch near his jaw/neck on a bunt attempt... Julio Borbon did have surgery on his ankle to repair the ligament damage. It's going to be about six to eight weeks before he can begin baseball activities... Juan Cruz was placed on the disabled list with a strained right groin... Chipper Jones was running close to 90 percent on Monday and tolerated it well. He seems to be progressing very quickly, as we expected... Aubrey Huff is day-to-day with tightness in his lower back... Chris Coghlan has suffered a setback in his recovery from a sore left knee. No word on how much it set him back... Nothing seems to be working in the Dodgers’ attempts to solve Casey Blake's neck pain. He was given another cortisone injection… Lastly, and not surprisingly, Justin Duchscherer is facing another surgery following the recommendation of Dr. Thomas Byrd, a leader in hip arthroscopy.

Corey Dawkins is an author of Baseball Prospectus. 
Click here to see Corey's other articles. You can contact Corey by clicking here
Ben Lindbergh is an author of Baseball Prospectus. 
Click here to see Ben's other articles. You can contact Ben by clicking here

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