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Old 08-06-05, 09:41 AM
PhillyDoc's Avatar
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Suggestions and comments requested on medical column on NBA from a huge Spurs fan.

Have permission to share concept from my site that I write for to see if this is along lines of what fans like - would like comments back on too much info or too little.



Regards all,

Peter Rumm, MD (PhillyDoc)

Medical Matters Revised - The "SportsDoc to the Fans" discusses NBA Player Injuries and Conditions
--------------------------------------------------------------------------------
By Peter Rumm, MD, MPH, FACPM
for HOOPSWORLD.com
Aug 6, 2005, 09:43





The "Sportsdoc to the Fans" Speaks up on Medical Matters of High Interest among NBA Players and Coaches:

Caveat/Background: The following column does not replace in any way personal medical advice from your practioner and should not be used as specific guidance on any persons own therapy, and also I will not knowingly release information not previously reported by press releases, the player, his team or his agent.

My background and training in medicine is broad and today I work as a public health/preventive medicine specialist at the Drexel School of Public Health as the Director of the Center on Public Health Readiness and Communication. I have also been a sports doctor at varous places including during a pediatric residency at Brooke Army Medical Center. We covered as a team of young doctors, a certain Cole High School, San Antonio, Texas - working primarily for the football team. This just happened to be the time when Shaquille O'Neal was there starring in a legendary high school career.

The following is an update on some current player injury or medical situations in the NBA from news sources and what I perceive then as a likely course of future action.

Fred Hoiberg, G, Minnesota Timberwolves.

Note: A strong assist to Editor Karl Schneider for providing me some key background facts on this great shooter's cardiovascular system related story!

Mr. Hoiberg had surgery for an aortic root dilitation - the same condition that was afflicting an Los Angeles Laker's NBA draft choice below (Rodney Turiaf ).

According to the AP on June 28th, The surgery was performed at the Mayo Clinic in Rochester by Dr. Hartzell Schaff, who corrected a bulge in the root where the artery meets the heart's aortic valve, according to a release from the team.

I agree with the AP and others that Hoiberg is a valuable veteran off the Timberwolves bench. Last season he averaged 5.8 points and led the NBA in 3-point accuracy, shooting a career-high 48.3 percent from behind the arc.

Hoiberg had also a pacemaker installed. As I am not privy to the details of the surgery, my guess is that Hoiberg had a fairly large repair and that the patch potentially affected part of a complex electrical pathway of the heart that controls the rate.

As several players are afficted by heart conditions, Yahoo's medical encyclopedia site does a pretty good job in my view of quickly explaining a complex system that controls one heart rate and in essence keeps us alive:

The (human) heart has four chambers. The two upper chambers are called atria and the two lower chambers are called ventricles.

Normally, the heartbeat starts in the right atrium in a group of special heart cells (called the sinus node). These cells act as a pacemaker for the heart. . .The heart's pacemaker sends out an electrical signal (impulse) that spreads throughout the heart along electrical pathways. These pathways transmit the signal from the upper to the lower chambers of the heart, which causes the heart muscle to contract. Regular, rhythmic electrical signals keep the heart pumping blood to the lungs and the body. This cycle of an electrical signal followed by a contraction is one heartbeat. A normal heart rate is between 60 and 100 beats per minute. Any disturbance along the electrical pathway can cause the heart to beat too fast, too slow, or irregularly (arrhythmias).

Note a good site for a diagram of this and a longer explanation is posted at:

http://health.yahoo.com/ency/healthwise/ps1158.


According to a SI.Com news story July 14, "the day after the pacemaker was installed, Hoiberg had a big setback. Feeling weak and nauseous and struggling to breathe properly, he collapsed and fell face down in his Twin Cities area home - cutting his chin on the floor . . . His wife, Carol, called 911 and he regained consciousness shortly before paramedics arrived. After checking into the hospital that night, doctors discovered an abnormal amount of fluid - about 1 liter, compared with the usual tablespoon - built up around his heart. That probably prevented blood from flowing freely to his head and prompted him to pass out."

Such complications from surgery while rare do occur and Mr. Hoiberg has access at the Mayo Clinic of some of the best regarded specialists in all specialties in the world and I am hopeful that he will continue to improve. Only he and his cardiologists will be able to make the final decision on the risk benefit of him playing in such a strenous game at least this year.

Years ago I wrote a residency paper on pacemakers and there have been cases of athletes competing with pacemakers and the technology has improved. I would be guardingly hopeful as well on his eventual return, again not privy to the exact day to day status.

Various news sources have hinted he would like to come back and Hoiberg said recently that "now I'm starting to feel a little bit better. And I'm sure as training camp approaches my competitive juices will start flowing a little bit, and I'll want to get back out there. But I'm going to have to take my time with this process."

As a doctor first in my professional life = I really like the following "right on" sentiments of his new coach and the management of the Wolves - very classy!

"We want him back as a basketball player first, but Lord forbid, if something happened to him he doesn't have to worry," coach Dwane Casey said and Vice president of basketball operations Kevin McHale has told Hoiberg he'll have a spot in the organization if he doesn't resume playing."(Source AP news, David Campbell, 7/14/05)


By the way, here is a nice synopsis on pacemakers:

A pacemaker is a device implanted into a patient's chest to send electrical signals to the heart, telling it when to contract (or beat). It is used to correct a form of abnormal heart rhythm (arrhythmia) in which the heart beats too slowly (bradycardia). . .Pacemakers are being combined with implantable defibrillators (ICDs) to detect and correct either a heart beat that is either abnormally fast or slow in the same patient. A biventricular pacemaker is a type of pacemaker being used in the treatment of heart failure. (http://heart.healthcentersonline.com/pacemaker/).

This bring us to two other players with ongoing heart situations.

Eddy Curry, C, Bulls

Mr. Curry is the most enigmatic of the players in the NBA facing heart situtions as by most reports he doing very well these days at least in the short term. The young 6'9", 285 lb giant of a man who was really developing as a player last year has had some sombering news related to a heart arrythmia condition that remains unresolved.

Recently, FoxSports (July 19) and others reported that the insurance carrier for the NBA, Trustmark, is not going to cover Curry, which may have been one of the reasons he did get an offer from the Atlanta Hawks in a restricted free agency year.

This news came as various sources had Curry back practicing after he underwent an examination in June by a renowned heart specialist and the Bulls repored "terrific news": The statement from general manager John Paxson on June 23rd did not give specifics or details, but said Dr. David Cannom's "positive report is terrific news for Eddy." Paxson did not return calls for comment from The Associated Press.

So what is going with Mr. Curry? Hear arrythmias can be of many kinds, can be interrmittant, and can even have genetic links. Curry has seen specialists at the Mayo Clinic and in Chicago and potentially other places so I believe he is getting good advice. The insurance decision may be a conservative business decision by the firm but is not unlike many other cariers refusing to write a pre-existing condition without some kind of disease free period and he is surely at some theoretical (albeit perhaps very small risk) depending on what his exact history is.

That being said, I expect Curry to play this year, perhaps after a monitored weight loss program and probably in more limited minutes as normally befits a potential star center who recently came into the league as a teenager.

I had wondered before about a pacemaker for him but I am sure his doctors would consider it if his condition came back or worseneed and was warranted it later. Note as well that there are specific indications and types of arrythmias that pacemakers are normally used for and like in the case of Hoiberg, having a pacemaker does not automatically ensure that one can play again.

Rodney Turiaf, F/C.

Mr. Turiaf was in my view a very astute rookie pick of the Los Angeles Lakers, even with his recent surgery - that as I note below I believe that in there is a decent probability that he will overcome it and play again unless ome new facts arise on his condition.

Mr. Turiaf is an otherwise physically gifted young man who had the misfortune of having like Mr. Hoiberg an aortic root dilatation and recently underwent late last month successful surgery to fix his dilatated aortic root. Fortuntetely, as I reported in an earlier story he did not have any need to have surgery on one of the four valves of the heart.

Of note, there was supposed to be a public update by the player yesterday according to a August 5th story in the Seattle Post Times and AP:

Los Angeles Lakers second-round draft pick Ronny Turiaf, who underwent open-heart surgery last month, canceled a news conference Friday because he did not feel well. Turiaf was chosen 37th in the NBA draft out of Gonzaga and had surgery July 26 to repair an enlarged aortic root that was discovered in a post-draft physical exam. Gonzaga sports information director Oliver Pierce released a statement 45 minutes before the scheduled news conference, saying "Ronny is not feeling up to it today" and would reschedule. "We will do our best — in conjunction with the Los Angles Lakers and Ronny's agent — to keep you informed of his progress," Pierce said. The 6-foot-9 power forward averaged 15.9 points and 9.5 rebounds during his senior season with the Bulldogs. He was the Lakers' second pick."

Note it is not unexpected to have mild setbacks after such a surgery (open heart) and this may be a completely un-related health issue.

With that in mind I will wait for more news before speculating on the short term prognosis but I do believe he has a strong chance of playing again. Watching games on television of the the Gonzaga games last year, this young man was an incredible physical specimen and seemingly very tough minded.

Willie Green, G, Philadelphia.

Willie Green probably has a broken heart from an emotional standpoint but physiologically that part is seemingly fine. The fast fleeted scoring threat of the Sixers suffereed a bad knee injury in a pick up game about a week before his contract that for some reason took about a week to get to surgery and definitive treatment (some knee injuries can not show severe symptoms early on and surely in a strong athlete the ability to endure pain may be higher).

Plus reports from the Philadelpia Inquirer and other other sources given by his agent having him walking around on the injury: According to one Inquirer story by one of their lead writers, Joe Juliano, Green's agent, Noah Croom, said doctors have told him they don't know yet how serious the injury is . . "All reports that we get is that he'll be back in due course. Even the most pessimistic diagnosis has him coming back in a matter of months, not a year. And he may be back sooner.

"Willie is a man of deep faith and he's confident he'll be back better," Croom said. "The doctors he has spoken to have indicated that there's no reason he shouldn't have a 100 percent recovery. Willie is optimistic like he always is."

The public severity of the injury is not fully known. According to writer Juliano (GM Billy) King described it as torn cartilage, but wouldn't speculate on whether the injury was bad enough to require full reconstructive surgery and knock Green out for the entire 2005-06 season. I will note that in general recovery times are quicker in athletes and motivated persons but that they risk reinjury by coming back too soon.

I was a physical therapy assistant and radiologic technologist before medical school and the advances in knee care are truly outstanding and I am sure he will see some very fine surgeons and therapists - the last specialty is just as important as the higher profile surgeon as there is an art and growing science on "how much to push the player" to get better to strengten the knee and other areas without re-injury

Here is a little review on the subject from a good source (www.orthopedics.about.com):

When people talk about a cartilage tear, they a talking about a meniscus tear. . . When people talk about arthritis and wear of cartilage, they are talking most often about the articular cartilage on the ends of the bone. It is not uncommon for the meniscus tear to occur along with injuries to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL)- these three problems occurring together are known as the "unhappy triad," which is seen in sports such as football when the player is hit on the outside of the knee.

The possibility of such a severe injury is there, but with him walking around and delaying the surgery, it sounds like potentially it may not be that severe of a situation; but we will need to keep you posted.

There are surely other stories out there on injuries (LOVE FANS suggestions on topics) but will get to them at a later date.

I will cover them again when I return from a public health related trip to Lithuania and England in about two weeks. Cheers!

Questions or comments? Send me an e-mail to [email protected]


Thanks for all input.

Last edited by PhillyDoc; 08-06-05 at 09:46 AM.
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Old 08-06-05, 09:50 AM
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Sorry to hear about Hoiberg's setback. But thanks for the insigt doc, an avowed "hypochondriac" I will probably start feeling every sympton you just stated. No, I'm just kidding, but thanks anyway, I wish you had been around in 2000 when Tim hurt his knee, but then you would have been in the same situation as the rest of us, because the Spurs released very little info about the extent and damage to his knee, other than the day to day thing after he was out a couple of weeks.
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Old 08-06-05, 01:51 PM
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I think the article is great and well written. It is very interesting and informative. However, you did ask for comments. So, my only real critique is that it parts of it may be a little too long winded and technical for the average sports fan. Fortunately for me, my wife is a Registered Nurse and much of what she talks about I have actually retained (actually I had to learn quite a bit on my own just to comprehend what she's talking about), so the technical parts were indeed interesting to me. But, I understand that in order to understand much of what you are writing about, you'll need to provide some background info. So perhaps maybe a little bit more of a "layman's" slant would be appreciated my some. The links to the websites with extra info is great though...isn't the internet great.
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Old 08-07-05, 04:23 AM
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Quote:
Originally Posted by SimTek
I think the article is great and well written. It is very interesting and informative. However, you did ask for comments. So, my only real critique is that it parts of it may be a little too long winded and technical for the average sports fan. Fortunately for me, my wife is a Registered Nurse and much of what she talks about I have actually retained (actually I had to learn quite a bit on my own just to comprehend what she's talking about), so the technical parts were indeed interesting to me. But, I understand that in order to understand much of what you are writing about, you'll need to provide some background info. So perhaps maybe a little bit more of a "layman's" slant would be appreciated my some. The links to the websites with extra info is great though...isn't the internet great.

Thanks working on that aspect - hard to decide how much to leave out, the population of basketball fans are so educated these days.

Plan to write on Devin Brown and his potential risk of recurrence sometime in future - anyone with an update on his condition from a local source?
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Old 08-07-05, 04:49 AM
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I'm always very interested in such articles that help us, people with very little knowledge on the subject, get a better picture of what's going on. Thanks and keep up the good work.

Quote:
Originally Posted by PhillyDoc
working on that aspect - hard to decide how much to leave out, the population of basketball fans are so educated these days.
Whenever a "technical" issue gives you a concrete and useful picture of the subject, it's relevant. I don't think you went too far with it.
Quote:
Originally Posted by PhillyDoc
Plan to write on Devin Brown and his potential risk of recurrence sometime in future
Great, i was wondering about it, so i'll read it for sure.
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