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September 14, 2011

Collateral Damage

Lots on Clots

by Corey Dawkins and Ben Lindbergh

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Bobby Jenks, BOS (Pulmonary embolism) [AGL: TBD (TBD DL), ATD: TBD (TBD DL) (Explanation)
Most injuries or medical conditions that arise in baseball can’t be classified as “life-threatening.” Jenks was recently diagnosed with a pulmonary embolism (PE), a life-threatening medical condition where one of the arteries of the lungs gets blocked suddenly, usually by a blood clot. PE is not something to be taken lightly; up to one-third of people suffering from PE will die if left untreated. However, with early recognition and prompt treatment the risk of death decreases significantly.

In most cases, PEs result from blood clots breaking free from a deep vein thrombosis (DVT), a condition where blood clot(s) form in deep veins of the body, usually in the calf. The clots are not a rock-hard, crystal-like substance but rather a sticky pliable collection of platelets and an insoluble protein called fibrin that resembles threads. Once the clot breaks free, it can wind its way through different veins before finally getting stuck in any blood vessel. Multiple clots and multiple arteries are usually involved, making it difficult for the body to circulate oxygen. The lung tissue with compromised blood supply will eventually die from the lack of oxygen. Additionally, the clots may break free again and travel to other tissues, causing further damage.

As with many things in the human body, PE can manifest itself through a multitude of different symptoms. Factors that affect the symptoms include the size of the clot, the involved blood vessel, and the amount of lung tissue affected. The most common symptoms include shortness of breath, chest pain, or a cough that may or may not produce bloody sputum. Other symptoms like wheezing, irregular heartbeat, weak pulse, lightheadedness, or clammy skin may also present themselves.

In order to diagnose PE, multiple tests may need to be ordered. The initial standard test is a chest x-ray to rule out things other than PE that can present with similar symptoms. Another test called a ventilation-perfusion (V/Q) scan studies airflow and blood flow in the lungs. In this test, a small amount of radioactive material is inhaled, and then another small amount of radioactive material is injected into the bloodstream. Specialized CT scans can also be used.

The most accurate method to diagnose a PE is to undergo a pulmonary angiogram. A small flexible tube is inserted into one of the large veins of the body, most often in the groin. The tube is then threaded up through the heart until it reaches the pulmonary arteries. Dye is then injected into this tube and into the pulmonary arteries themselves. As the dye travels through the pulmonary arteries, x-rays are taken and can pinpoint where the blockage(s) is. This procedure comes with possible complications, including a temporary change to the heart’s rhythm and kidney damage.

The good news for Jenks is that it was a small embolism, and treatment was started immediately. He was placed on the right medication and will have to take it easy for the time being. The doctors found the PE while performing tests for his back troubles, although the two are unlikely to be related. Jenks should be able to return to the mound in 2012, but he is certainly done for all of 2011.

Corey Brown, WAS (Staph infection in knee) [AGL: 4 (69 DL), ATD: -.013 (-.058 DL)]
Staph infections are another affliction that shouldn't be taken lightly. Staph bacteria are commonly found on the skin and in the nasal passages but normally only lead to minor localized skin infections. Some infections don't stay localized to the skin and can travel into the bloodstream, joints, bones, lungs or heart, all of which can turn deadly.

One type of staph infection that is becoming more of an issue in athletics is methicillin-resistant Staphylococcus aureus (MRSA). MRSA is a strain of staph that has become resistant to antibiotics and often begins with something as simple as a little boil. Newer antibiotics are being created to treat MRSA, but there are rare times where antibiotics are not needed at all. In general, athletes who suffer from non-resistant staph infections or MRSA infections recover well after a drug or therapy regimen. Brown has been restricted from traveling while stabilizing the infection but should still be able to return before the end of the year.

Chris Valaika, CIN (Right knee – ACL) [AGL: 13 (76 DL), ATD: TBD (-.031 DL)] *
Valaika will miss the remainder of the season after tearing the ACL in his right knee on Sunday against the Rockies. He will likely have surgery sometime next week to reconstruct the ligament as well as evaluate any possible meniscal or articular cartilage injuries. While in years past the ACL was reconstructed almost immediately, experience has shown that it's best to wait for normal motion and strength to return and for swelling to subside. By regaining the motion lost from the injury, athletes enjoy a lower rate of complications after the surgery, and often better functional outcomes. The rehabilitation is a lengthy one, but Valaike should be ready for the start of next season.

*The 13 games missed represent three cases where the injury happened at the end of the year and the players in question were not placed on the disabled list as a result. The 76 games missed also does not represent all of the games truly lost to the injury, since some players did not return in the same season.

Logan Morrison, FLO (Right knee tendinitis and contusion) [AGL: 1 (44 DL), ATD: +.01 (-.095 DL)]
Morrison was diagnosed with chronic patellar tendinitis and a contusion to the patella itself after fouling a ball off his knee over the weekend. According to Morrison, the doctor took the swelling out, likely meaning an aspiration of the joint. Chronic patellar tendinitis very rarely swells up, and certainly not to the extent that it would need to be drained. The foul ball may have produced enough swelling that it was staying in his joint and causing him pain and limited range of motion.

In cases with this amount of trauma and swelling, there is some concern for cartilage injury to the back of the kneecap from the compressive force of the foul ball, which could also lead to swelling inside the knee. If the swelling was from a cartilage injury and needed to be drained, there is a good chance that he’ll need surgery over the offseason to clean up the joint. Morrison will take a couple of days off before trying to get back into the lineup but may not make it through the rest of the year.

Flesh Wounds: R.A. Dickey won't need surgery to repair the partially torn plantar fascia in his right foot...Jason Isringhausen had to undergo another injection in his back to deal with the numbness in his right leg. It appears that his herniated disc is not cooperating with conservative treatment... Todd Helton's back is flaring up again... Chris Stewart strained his ankle Friday and has yet to get back into a game. There has been no update as to how many days he will miss... Jon Rauch was placed on the disabled list with torn cartilage in his right knee and is likely headed for surgery in the next few weeks... Hiroki Kuroda's neck started to stiffen up on him again in his last outing. He has a known bulging disc in his neck dating back to at least 2009, when he missed the first round of the playoffs. He's day-to-day for the time being... Shin-Soo Choo is getting close to being activated from the disabled list after recovering from a strained oblique... Matt Holliday was removed from the game last night with a right hand/wrist injury. Holliday thinks that it is a “ligament or tendon” problem, but we will see what the test results show us today… Jose Reyes still feels tightness in his hamstring and is not going 100 percent all the time as a result... Troy Tulowitzki's left hip is bothering him again, and he needed to be removed from the game last night. With his pain going on for this long, it's becoming more likely that the cause of the pain is something other than some simple inflammation... Jason Michaels fractured one of the metacarpal bones in his left hand and will need surgery within the next week or two.

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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