What's wrong with Phil Hughes ??

Hello Everyone,

So the last two days I've been stuck at home, unable to move more than just a few feet from the toilet, seeing as everything on the inside of me would much rather be out. I'm not sure I can recall a time in my life I've ever vomited so much. I know ya'll really wanted to know that, but it has given me some time and I was watching MLB network this morning when a conversation about Phil Hughes came up that I found interesting. They mentioned that Phil would be going in for an MRI to rule out a circulatory cause of his recent loss in his velocity.

Of course, my nerdy brain thought more into it. And as much as I don't like talking about the Yankees I think he is someone worth writing about.

If you don't know, Hughes is a right handed starting pitcher for the New York Yankees. He was drafted in the first round out of high school in 2004 and made it up to the majors by 2007. He is well known for his nasty 1-7 curveball and has a 4 seam fastball that averages around 93 mph but can get up to 95-96 mph. Last year, his first full season as a regular starter, he went 18-8 with a 4.19 ERA.

During spring training this year, scouts began noticing a drop in his velocity. A drop in velocity is almost always the first sign of injury in a pitcher. Pain can also accompany a drop in velocity, however most pitchers are experiencing some sort of pain at any given time (they throw a ball overhead at over 90 mph) so it may be difficult for them to differentiate a new pain. Hughes continued to pitch into the start of the season where he went 0-1 with a 13.94 ERA in only 10 1/3 innings with a fastball that was only averaging 89 mph. Hughes problem? He complains that after just a few pitches his arm feels fatigued.

"The first few felt all right, and then there was nothing there," Hughes said. "It's sort of the feeling you get after 110, 115 pitches -- I normally should feel that way. It's way too soon."

So yes something was wrong. Placed on the DL with "shoulder inflammation" Hughes was put on a strength and conditioning program. No MRI performed. According to Joe Girardi (yankees manager )

"Usually, if a guy says he has pain, you go for an MRI," Yankees manager Joe Girardi said. "He just said he felt like it was dead and there wasn't a lot coming out. We figured that maybe he needed to be built up. We put him on a program, and now that the program didn't seem to work, we go get an MRI. He still says he's not experiencing pain."

There is this diagnosis in the baseball world called "dead arm." The idea behind dead arm is that right after the ball is released (like in the picture) , when your elbow is

nearly fully extended and the forearm is pronated there is a distraction force on th

e shoulder joint itself. There are ligaments and muscles in the posterior shoulder whose job are to apply a compressive force to oppose the distraction. However over time, these structures can become faulty and pitchers can have pain, loss of velocity of loss of control. These types of forces can also cause a tear in the labrum called a SLAP tear. Players at greatest risk for these types of injuries usually have a significant loss of internal rotation at their shoulder joint; deficits that should be picked up by pre season physicals.

Now Phil may or may not have a SLAP tear, only the MRI can really determine that. I would not be surprised if he did. There are other things that could cause his symptoms however. When a player complains merely of loss of velocity with no pain like Hughes is, I'm thinking a nerve injury (maybe axillary) could be a possibility or a circulatory issue that could be as simple as his brachial artery getting impinged somewhere.

Either way I just wanted to write about this because I think its an important lesson. Guys like Phil Hughes don't just lose 4 mph on their fastball at the start of the season because they need to get stronger. A drop in velocity like that should be a red flag that something else is going on. Can't wait to find out what it is.

Have a good day everyone,

Go Giants,

Katy

Staying Positive

Hey Ya'll,

So I was watching srubs the other night and I thought this was funny....

Carla "So what are you guys going to do now that residency is over?"

Doug " Oh I'm still a resident. First resident in the history of the hospital to be here a third year!"

Carla "thats a bad thing doug"

Doug "I'm trying to stay positive."

Me too Doug. Me too.

So us residents are in the middle of our clinical testing right now. Pretty much that means we have a tester from a different facility come in and follow us around with our patients. Its a little nerve racking. Not to mention my mentor and bosses have mentioned to me several times to "not let me down." Hahaha. I know they are joking. I think.

Last week my testing didn't quite go as planned. Half my patients didn't show up. And the testers can only test you on what they see, so I'm getting a little anxious because they only saw me treat two patients. Can I help it if all my patients get better and don't have to come back?

Hopefully I survive.

Here is how I keep my sanity..... chatting with Nationals 2B Matt Antonelli about oblique strains.

http://www.youtube.com/watch?v=jEtG0_k-Z3c

Have a good week everybody,

Katy

The Joys of being a new grad

Hello Everyone,

If you know me at all, you know how little confidence I have in who I am as a therapist.

But something happened today that made me laugh.

I went to the waiting room this morning, called my first patient of the morning back. It was a new patient, but this elderly grandma jumped right up when I called her name and looked very enthusiastic to get started. Once I sat her down to do an eval, she began talking about another therapist at the clinic that had been treating her neck (even though I had a referral from the doctor for back pain). She was the kind of sweet grandma that liked to talk about everything, and pretty soon I realized it was going to be difficult to get the information I needed. It took me several tries but I finally got her to talk a little bit about her back. As she started talking about it I began realizing it didn't match the information I had been given in the chart....like at all.

"tell me a little bit about the pain in your back...."

"my back? oh its fine. feels like .... well not too bad."

hmmm....thats weird because in the chart it said she was complaining of 8/10 pain with severe bilateral numbness and tingling.

"How about the numbness in your legs?"

"its not too bad."

ummm...okay......

"How would you rate your pain?"

"pretty good I think."

ok. something is wrong.

"what is your last name?"

Patient answer...... not the name on my chart.

Uh oh.

So sweet little grandma wasn't a new patient at all. She must have been so excited about getting her neck worked on that day that she didn't realize when I called out a name, that it wasn't her name. And she didn't realize that I wasn't her therapist either.

Now its been a good 15 minutes,I have to go back to the lobby, and call out the name again.

When I finally find the right patient I ask her,

"did you hear me call your name before?"

"yes i did. but i thought that lady had the same name."

so thats how my morning began.

needless to say the rest of the therapists thought it was pretty amusing.

some day I'll laugh too.

Hope you are all well,

Katy

New Year, New Adventures

Hello to all my faithful followers!

"In the silence You are speaking, in the stillness you are moving, in the Chaos You are still here, here with me."

Well a lot has changed since my days of running around in Arizona.

Within the last month I passed my board exams, graduated (yup its true, ya'll have to call me "Dr" now), moved out to west LA, and started my residency and a brand new job.

New town, new job, new life.

Needless to say life has been a tid-bit nuts for me lately, but its all very exciting. I thought I could continue to document my adventures throughout this year to see what God does and the challenges that lie ahead. After 2 weeks as a resident, I've already been met with struggles and challenges that have pushed me to question who I am as a therapist, and who I would like to be.

I am not going to lie, I thought it was going to be quite an adjustment going from working with professional baseball players to working for Kaiser in South Bay. However, it hasn't been too much of a change. No matter where I am, or the people I'm working with, my job allows me to help better feel better and get back to their lives.

Today I taught an 85 year old woman with a spinal fracture how to cough without getting excruciating pain. She was incredibly grateful and I'll I did was show her one little thing. Then I got to hang out with a sweet little 7 year old who was in a car accident with his father (who is a surgeon) and made an experience that was so scary for this little boy turn into a fun afternoon (ya thats right, I can be fun.) Then I had a 35 year old marathoner that was so grateful for my ability to give her some real answers to why she can't run beyond 6 miles without getting pain.

My life is a total new adventure. Every patient I see is new to me. There is no routine, there is no "been there, done that." I am a raw, unpolished, new grad with a tremendous amount of enthusiasm and motivation to really be the best therapist I can for these patients, while trying to glorify God in all that I do.

The Adventure begins.

The Next Step

Hey Everyone,

Since I finished my internship with the Padres, a few things in my life have changed so I wanted to share that with all of you.

Currently I'm still out in AZ, spending most of my time studying for my national board exam and preparing a presentation for the first year students about my time out here and the things that I learned. Its hard to summarize just how much I learned this summer, and I feel like only now that Ive had some time off can I really absorbed everything. No matter where I end up, or what I end up doing, this summer, and the players I worked with, will forever be a part of the kind of therapist I become. These players probably helped me more than I ever helped them. By gaining their trust and respect, I can walk away from this with confidence in who I am as a therapist, and the obstacles I can overcome to fulfill my dream.

In other news, I got into the orthopedic post professional residency that I applied and interviewed for in Long Beach. This is a good thing. I was very on the fence about this whole program, and I felt like the only reasons I was doing it was due to pressure from professors and classmates. It was a player that knocked some sense in to me. While struggling with whether or not to apply I was weighing my options with this player. He asked me, "Will it be good for your career?"

I answered "Yes."

"Will it make you better."

"Without a doubt. But I'm just not sure I want to be in school another year. And I don't want to live in socal anymore."

To which he responded, "Do you think I want to be in the minors? Look around, you think any of these guys want to be here? Hurt...in the minors....in AZ? No. But you do what you have to do to get where you want to be."

He was so right. And I knew at that moment that I really should be doing this program, and that this is where God wants me to be; Its my minor leagues. It will make me a certified specialist in orthopedics and will ultimately not only benefit me and my career but more importantly the people I treat. The acceptance letter was addressed to Dr. House; I thought that was pretty cool. It is a paid residency with mentorship hours from a specialist, and then I will be attending courses on the weekends. So yes, a little more school. Can you believe it? It starts in Jan and I'll hopefully be living somewhere in redondo beach but that is yet to be determined.

Since I've had a little free time I also have been doing a lot of reading, and as per a sugestion am currently reading a book by Josh Hamilton (OF for the Texas Rangers) called Beyond Belief. He was the first overall right out of high school pic back in 99. Plagued with injury his first three years he resorted to drugs, and through that experience found salvation in Christ. I haven't finished it, but for me it was such good insight into the minds of some of these players and what

injuries can do to their mind when there is an endless amount of expectations from teams and fans and a tremendous amount of money invested in them....

"The pressure I felt came from me; I've always expected more of myself than others have. So what was wrong? Why didn't my life feel as good on the inside as it looked from the outside? To me, the problem was incredibly simple: my back hurt, and nobody knew why. Ever since the accident I couldn't shake the stabbing pain I felt whenever I changed directions quickly or attempted to make an explosive movement. I could sense the doubts from the team about my back, and I began to wonder too. The pain was there, it was real, but nobody could find anything wrong with me. Doubt started to work its way into my mind too. Was I imagining it? Did I really want to play baseball?"

I read this paragraph a few times. These are some of the things these guys deal with everyday. In fact, a Broncos running back just killed himself after struggling for a long time with a knee injury. It makes me want to do everything I can to dig deeper, to find out why players are hurt, and to never give up on them. Its a good book, I look forward to finishing it. Just thought I would share....

So thats what I've been doing lately. Got a chance to go the Padre/Giant game thanks to the padres. It was quite entertaining picking up the tickets....they were in the player willcall for the padres but of course I was wearing giants gear; I had multiple people confused...it was awesome. Go giants!

In His Hands,

Katy

The Gift

Hello Everyone,

Well the summer is coming closer to an end, which also means so is baseball, and my dream internship. I'll probably write one more blog after this to share about my last week here, but for now I wanted to tell you all a quick story and a gift that was given to me.

I mentioned previously the frustration of not getting to go play catch with some of my guys. Well that changed about a week ago, when I started to play catch with a starting pitcher that had a SLAP repair (google it..). The rehab is pretty extensive for this type of surgery, so when he started throwing again, he could only throw 45 to 60 feet, which even I can do. So over the last week I've been going outside in the 110 degree weather to play catch with him. As excited as I was to do this, I didn't really think about it fully.

You see, when these boys play "catch" they are still putting more heat on it than anything I've ever caught before. Also, here I am trying to catch a professional pitcher with my 20 dollar kmart special youth glove, which was not exactly designed for this. Not a good idea. I was really trying to not be a big baby, but with every catch my index finger was getting quite a zing, and I played it off like no big deal, but it hurt like the dickens!! I came in from playing catch the other day and another player asked me how catch was going. I told him I was doing fine except that I couldn't feel my left index finger. He asked me what kind of glove I had and when I showed him he said, "ya thats what I thought." He walked away and came back 2 minutes later with a brand new glove that he handed to me and said, "here. Its yours."

A brand new, professional pitchers glove. Not only is it brand new, but it has this guys name stiched into the side. I was speechless. He shook it off like no big deal, reminding me that he gets that stuff for free, but to me, it was a huge deal. Its got to be one of the coolest things anybody has ever given to me. He told me he'd been thinking about giving it to me as soon as I started going out there to throw because he knew I wasn't just getting balls lobbed to me, and even though the guy isn't throwing a 95 mph fb at my face, he still puts heat on it without even trying.

So now I'm learning how to break in a new glove. Its pretty sweet. All the guys are showing m how to bend it, and beat it, and rub stuff all over it. I feel like a little kid, I have that thing with me everywhere I go. The pitcher that gave it to me made me promise to use it, and not to put it in a box and save it. I promised. Its something I know I'll have the rest of my life, and no matter where I end up, its going to be a reminder of my summer under the lights of the stadium.

People can sometimes do something and never know what it means to someone else.

Enjoy your day wherever you are. If you are somewhere where its less than 70 degrees....please wear a sweatshirt for me :) Oh how I miss that!

Katy

The Change Up

"You gotta be a man to play baseball for a living, but you gotta have a lot of little boy in you, too."

Haha, I read that quote by Roy Campanella the other day in a nerdy baseball book and I found it quite fitting for this blog entry.

I felt like it was time to share some of the lighter moments from the last week with you guys. This way, when my mom steals internet from the hotel on her route to check her facebook and read my blog, she won't start crying and decide to read it to every person that passes by :) Love you mama.....

Anyways, on to the good stuff.

First of all, I didn't get voted class klutz Harbor High 2002 for nothing! The other day, I was in the exercise room with about three of my favorite players. The room is adjacent to the training room where probably another 10 players were hanging out as well as the other PTs and ATCs. The rooms are only separated by windows by the way. So the three players are all doing their own thing, and I'm specifically working with one guy but we are all kind of chatting. I go to sit down in a high back desk chair (that I learned seconds later was BROKEN), and as I lean back I find myself instantly on the floor, flat on my back with my legs over my head! I'm not talking about a small little fall....I sat in this chair, leaned back, and CRASHED. And let me tell you, it did not go unnoticed. A roar errupted from the three players in the room, which I really was ok with. Its when I looked up and realized the crowded training room through the windows was also watching, that my face suddenly flushed red and I quickly tried to pick my self up off the floor. But there was no recovery. The damage was done, and I had to stand and accept the joyous laughter it brought the boys for the rest of the day.

I found out that before I got there, the boys all looked me up on facebook to see if I was hot...I hope I didn't let them down. Haha. One of them also was going to walk in butt naked on my first day. I'm glad that one didn't happen....

I get teased a lot obviously because I'm the only girl and its fun to mess with me. I get it. There is a player that gets teased a lot because he has a seriously ugly mullet and its fun to mess with him too. This means the two of us try and stick together because we both get picked on. The other day in the training room someone said something to me and he came to give me a high five to let me know we were in it together, but when I go for the high five he drops his hand below mine and shouts "change up." Everyone got a kick out of it, and its become quite the game in the training room to see if you can get people to fall for it. Its fun. Try it....go now!

I also got to take some swings off the tee today in the batting cages. I'm not going to lie, I was pretty nervous that I wasn't even going to hit the darn thing with it sitting right there in front of me. I played one year of softball when I was like 10 years old. I didn't really like it because I couldn't put my elbow into anybody's chest like I could in soccer, and after taking one fly ball in the face I was over it. And I don't think I've ever hit a ball with a wood bat....ever. So I step up and I'm thinking "just don't miss the freaking ball..." but I didn't want to take a baby swing either. So I put everything I had into that swing, happy gilmore style, and I smacked the heck out of that ball. Now we were in the indoor batting cage, so you can't really tell what the ball does, but in my mind it was a double into the gap.

I learned the hard way that baseball managers don't like to be called coach. I'll just leave it at that.

Lastly, the player I've talked about in previous blog entries that I was struggling so much with trying to figure out how to help, was sent home. He got an injection that has him immobilized for 6 weeks, so they just sent him home because he was unable to do anything for the next six weeks. Before he left though, him and another player took Dom and I to dinner as a thank you. And I'm not talking In-n-out. It might have been one of the most expensive dinners I've had in a very long time. But he wanted to thank us, and it meant a lot to me. He also left me with this ball on his way out. It says, "to Dr. House, thanks for everything!" Its going up in my clinic some day :)

Never has this job been harder than it was this weekend because I had to watch the padre/giant games while wearing a padre shirt and couldn't cheer for the giants at all (seriously they threatened to fine me if I did.) However, the funny thing is most the guys cheer against the padres. In their mind, if the padres keep winning, it decreases their chances of getting called up. Haha, it made me laugh. One said, "I always root against them. Until I'm up. Then I'll want to win"

Its been a fun week.

You stay classy San Diego,

Katy