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.