Advil can ruin your liver in as little as a year with overuse.

And kidneys. NSAIDs are a huge no-no for most kidney patients as are quite a number of OTC medications like antihistamines.

About a year ago we had a little discussion in the office about the NFL, I think it was about that strike/lockout... and I remember that the consensus was that if anyone truly cared about the well-being of the players, they would ban the administration of in game painkillers

if you'be been hit/hurt during a game and you can't continue without a shot of something, you should not be playing, period.

Does this mean I should not be popping 3-4 advil a day to help the hangover from excessive intake of alcohol?

I'm guessing your doctorate is not a medical one, dr. scott? If that is your real name....

3-4 Advil a day is OK. 3-4 Advil at a time, for days, not OK.

Just to be clear, your position is that aspirin is also a performance-enhancing drug?

To the extent that helps performance or that many people believe it does, yes. So is caffeine.

Does this mean I should not be popping 3-4 advil a day to help the hangover from excessive intake of alcohol?

I'm not sure how facetious this is. But no, no one should be taking 3-4 advil a day. Especially not if they're heavy drinkers.

Dr. Google suggests there's no real risk to occasional advil use to treat occasional hangovers.

Toradol may be a perfectly safe drug when used in proper moderation but who believes that teams are actually exercising proper moderation in its use?

'Teams' aren't using it at all. Players are. Even if the teams are encouraging their use to get more value out of their player contracts, a crackdown on that would simply lead to lots of contracts with playing time incentives and then the players wouldn't need any encouragement to take them.

Players take these measures because they want to. Now maybe that's often a poor decision by them and they haven't factored in everything involved, but then that's the situation that needs to be addressed. Cracking down on every pharmaceutical known to man in professional sports leads to nowhere good for the sport.

Maybe instead of banning PEDs we should ban the root of the problem: self interest. I suspect we'd have the same amount of success in achieving what we wanted to.

We saw how self-interest in terms of injury recovery worked for $InjuredRedSoxOutfielder (was that Ellsbury, or someone else -- I'm blanking on the name).

In another recent thread I mentioned the Lawrence Taylor subplot in "Any Given Sunday": The new team doctor played by Matthew Modine doesn't want to give him another cortisone shot just to get him on the field because it might lead to more serious problems, but the issue barely registers for the senior doctor. This has been going on for a long time and I agree that it's a big problem.

Toradol sounds like something you would give to injured bullfighters.

i'm not sure if this has been brought up somewhere else on the site, but papelbon was listed as an honorable mention on jonah keri's worst contracts in baseball list, along with the following entry:

Let's start with the usual arguments against paying big bucks for closers. They have a limited impact on the game, throwing one-third or even one-quarter as many innings as top starters; they have a high attrition rate, whether due to injuries, diminished performance, or both; and good closers usually come from humble beginnings and can thus be had cheap. Eric Gagne was an amateur free agent and a failed starter before he became an elite closer, while Fernando Rodney looked washed up before the Rays signed him for next to nothing and turned him into the 2012 version of Mariano Rivera. Still, with Rivera's season-ending injury last season, Papelbon owns the longest uninterrupted track record of health and success for any closer in baseball, with a seven-year run that includes a 2.32 ERA, a best-in-baseball 2.52 FIP, and a strikeout-to-walk rate of about 5-to-1. If you're a team with money to spend, and you've got a dominant relief pitcher in your sights, giving him a lucrative long-term deal isn't the end of the world.

So what's the problem with the three years and $39 million left on Papelbon's contract (four years, $52 million assuming he hits some very reachable performance markers and sees his 2016 salary vest)? It's the rigid way that managers use closers, with Charlie Manuel one of the game's worst offenders. Whether due to fear of being second-guessed, fear of using pitchers in anything but the most predictable circumstances, or simple inertia, closers get used far more often in easy-to-manage, up-two, bases-empty, ninth-inning situations than they do in tie games with runners on and the game actually on the line. Crashburn Alley ran an excellent post documenting the times Manuel could have and should have used Papelbon in high-leverage situations, only to see the manager save his closer for a save situation and have the Phillies go on to lose instead. This happened seven times. Publication date of that post? June 10.

Until the Phillies start using him in situations where he's actually needed, rather than almost exclusively in spots that nearly any pitcher with a pulse can handle successfully 85–90 percent of the time, Papelbon will remain the $200,000 Aston Martin that never leaves the garage. The reason Papelbon merits only honorable mention is because someone, somewhere, might use him properly if the Phillies ever traded him. In a way, this is more of a tragic waste of resources than an untradeable contract.

i'd just like to point out the obvious flaw with that line of thinking, which is that the phillies didn't have anyone else to put in the games. for the first 2/3 of the last season, the bullpen was in shambles and if they tried to use papelbon every time there was a high-leverage situation late in games, he'd have had to come in from the bullpen 2 or 3 or 4 or 5 times per game because everyone else who was out there was a ####### gascan.

there are strong arguments for using your best reliever in the highest leverage situations, but in the case of papelbon last year, it would have been whack-a-mole because those high-leverage situations were created by the fact that noone else in the bullpen could throw a clean inning.

'd just like to point out the obvious flaw with that line of thinking, which is that the phillies didn't have anyone else to put in the games. for the first 2/3 of the last season, the bullpen was in shambles and if they tried to use papelbon every time there was a high-leverage situation late in games, he'd have had to come in from the bullpen 2 or 3 or 4 or 5 times per game because everyone else who was out there was a ####### gascan.

Cmon, Papelbon had plenty of appearances in non-save situations last year, a lot of them in games with 4+ run leads. But Manuel was unwilling to use him in tie games on the road even when available, and last year they happened to lose a bunch of these games with inferior pitchers on the mound while Papelbon rotted on the bench solely because of the save statistic.

E.G. The Phillies head into the bottom of the 9th in Toronto on June 16th in a tie game. Papelbon hasn't pitched since the 13th and is available, but instead Scwimer comes in to pitch the 9th, and then Savery starts the 10th before losing the game. On the following day, Papelbon pitches the bottom of the 8th in a game in which the Phillies are down 6-2.

These types of sequences happened several times last year.

Agree very much with #62. Sure, using Papelbon for a tie game or 1-run deficit a few games in a row might have kept him out of a desired "save situation" later in the the week, but more often than not it led to him having to "get his work in" in a 5-run blowout.

Manual's usage of Papelbon absolutely lowers his value.

To challenge the argument that it's one of the worst deals, however, the Phils are precisely the kind of team that can get away with this usage given that they have three starters who can go 8 or 9.

'Teams' aren't using it at all. Players are. Even if the teams are encouraging their use to get more value out of their player contracts, a crackdown on that would simply lead to lots of contracts with playing time incentives and then the players wouldn't need any encouragement to take them.

Players take these measures because they want to. Now maybe that's often a poor decision by them and they haven't factored in everything involved, but then that's the situation that needs to be addressed. Cracking down on every pharmaceutical known to man in professional sports leads to nowhere good for the sport.

If a drug isn't over the counter, how is it proper terminology to say that "players take these measures"? Doctors are supposed to be there to keep patients healthy, not keep them available.

As long as we're allowed to revisit and revise our current blithe opinion into an ironclad moral denunciation later on, it's all good.

To challenge the argument that it's one of the worst deals, however,

Not only that, but not too long ago at OTM, we *generally* came to conclusion that the Sox would have been better off (money and wins) keeping Papelbon. It would have taken a crystal ball to see that and all...but still...

edit: And as for the 'If he were used properly' argument. I absolutely believe that some players cannot handle being used outside the role they've been told they will have. You have to weigh the immediate benefits vs. problems down the line.

Doctors are supposed to be there to keep patients healthy, not keep them available.

Ehhh...doctors are there to help their patients live a certain lifestyle, within fairly broad (some broader than others) safety thresholds.

The issues here are

1. Papelbon claims he was not informed of the side effects so could not make an informed decision. Also, he would not have known to stay away from other OTC NASID’s which could exacerbate the side effecs.

2. The other issue, more important, is the use is not in accordance with the manufacturers or FDA guidelines to use short term only for acute pain. Buchholz was getting an injection every 5 days to treat chronic pain typical among pitchers, Papelbon also seemed to use it quite frequently. The safety of such usage is not known since it has never been studied.

3. The other issue is given it’s effectiveness to kill pain, if using it to play through an injury can cause more serious injuries. Pain is a message sent to the brain that a body part needs rest and is injured. Ignoring that can worsen an injury.

In light of the Red Sox issues with players returning from injury too early and then getting reinjured (Pedroia, Ellsbury, Papi, Daisuke, Hill, etc) one wonders if Toradol is contributing to this.

4. Since the side effects are so serious that some players/teams may avoid using it, it gives a clear competitive advantage to those willing to put their bodies at risk, and younger players may feel compelled to use it though they otherwise would not. This is exactly what happened with steroids. There may be players for example on the Phillies who are injecting themselves with Toradol despite FDA requirements it be administered only by a Doctor (like steroids).

In some countries, the tablets have been banned and you can only get the injection at hospital due to the serious side effects which dwarf OTC NASID's.

'Teams' aren't using it at all. Players are. Even if the teams are encouraging their use to get more value out of their player contracts, a crackdown on that would simply lead to lots of contracts with playing time incentives and then the players wouldn't need any encouragement to take them.

I have to agree with SBB on this. Strong painkillers and anti-inflammatories of this sort are not available over the counter. Their use requires a doctor's prescription and often a specialist's administration. The doctors work for the team. The teams, then, are the ones using the drugs.

I am pretty surprised they don't give you a secured remote access device (i.e., "a laptop"). It might be that I've worked for software-driven companies, but I've only worked at one place in the last 10 years that didn't hand me a laptop with remote access (of some kind) when I walked in the door.

To be clear, I have a laptop that I can bring home with me. I can also log into the network from my home PC. But I don't have the ability to print from either device except on a network printer in the office.

this is one reason I still keep my blackberry. I negotiate contracts, and if on the road (or even golfing), the Blackberry is still the most dependable device to read/edit/compare two docs. (w/ tracking changes) contracts when the use of a laptop isn't practical at a particular moment in time. Plus it is still 'corporate approved'

I have found Blackberries are great for typing emails and little else. Trying to read at a document on a Blackberry is usually a complete waste of time for me unless it is a very short document.

edit: And as for the 'If he were used properly' argument. I absolutely believe that some players cannot handle being used outside the role they've been told they will have. You have to weigh the immediate benefits vs. problems down the line.

But do you think Papelbon (or any closer) considers pitching in tie games in the 9th at home as a different role than pitching in tie games in the 9th on the road?

####, I've been taking twelve Advil a day for fifteen years or so. I get ulcers every year or two but my liver is in excellent shape. I thought acetaminophen was only OTC painkiller that caused serious liver problems, but a Google tells me that you're right and that Advil does it, too. Surprised none of my doctors have ever mentioned that.

(I get migraines. Sometimes the doctors give me Toradol, but it hardly does a thing. They hate prescribing good painkillers because this country has ###### up priorities and the government would rather people be in pain than take life-PEDs to manage it.)

I'm guessing your doctorate is not a medical one, dr. scott? If that is your real name....

I've been called that before, but the Dr. came with the degree, not the birth certificate, the scott did... That being said, Im not a medical Dr, nor do i play one on TV.

Yes, I was being somewhat facetious, but I thought it was an important thing to point out, as I know its a fairly common hangover "remedy", and in my youth I was a bit to free with it in those situations. They dont teach you about that in laser physics classes though.

Isn't Toradol controversial because it ends in -ol?

As is alcohol, which was apparently a Performance Enhancing Drug both on and off the field when you hear all the stories about Babe Ruth and Mickey Mantle.

Asked a doctor... Toradol, despite the scary sounding name, is really nothing more than IV ibuprofen. If that is a "ped", then everything is a ped.

Taken in large does like Buchholz supposedly did, it is a PED (Performance Eliminating Drug).

[72] My wife got migraines, but only sporadically. They went away when she was diagnosed with celiac disease, and started eating completely gluten-free. The same happened with a colleague's wife, whose migraines were more debilitating. You may have explored 1000 different migraine treatment/prevention avenues, but I figured those were anecdotes worh sharing.

But do you think Papelbon (or any closer) considers pitching in tie games in the 9th at home as a different role than pitching in tie games in the 9th on the road?

Maybe. It's not a save situation, and some pinheads might start carping about with "Why is he using me now?? 3/4ths of the managers in the league wouldn't do this, so they must be onto something."

I know *we* say things like..."The first thing I would tell my bullpen is, 'your role is to get people out, deal with it.'"...but it's just not that simple. Unfortunatly.

Gluten is apparently the devil, but I love it so.

(I get migraines. Sometimes the doctors give me Toradol, but it hardly does a thing. They hate prescribing good painkillers because this country has ###### up priorities and the government would rather people be in pain than take life-PEDs to manage it.)

Will they really not give you some decent meds? That is ###### up. If you're in pain, you're in pain. I take 1 alleve, and 1 aspirin a day. I have some old meloxicam my physician gave me via the phone, that i use if I'm really sore, but I can't really tell if it works....

smileyy - Thanks for sharing. I was gluten-free for several months last year but it didn't seem to do much good. I'm preparing to try another complete dietary overhaul soon and will give it another go. I've heard similar stories from many other people, as well, so it's definitely a solution that's working for a decent percentage of migraineurs. Glad it worked for your wife.

To - orado - ol
Helps me catch the ball
Summer, Spring, and Fall
So I'll gain the Hall

Isn't Toradol controversial because it ends in -ol?

Yes. That's why I won't allow my children to attend school.

Gluten is apparently the devil, but I love it so.

An extremely small percentage of people have actual celiac disease, which causes severe gastrointestinal problems when you eat gluten.

A lot of people have been diagnosed with a "gluten allergy", which has nothing to do with celiac disease, and I am skeptical relates to much of anything. Cutting gluten out of your diet can be useful because gluten is found in lots of simple starches, which are generally not good for you, but gluten itself is not actually bad for you if you don't have celiac disease. (Or, maybe, a well-founded gluten allergy.)

EDIT: Apparently there is some evidence of a celiac-migraine link, though a lot of the sources aren't exactly peer-reviewed.

Maybe. It's not a save situation, and some pinheads might start carping about with "Why is he using me now?? 3/4ths of the managers in the league wouldn't do this, so they must be onto something."

But Manuel doesn't care about the carping when using a closer in tie games at home.

Dale Sams - They're happy to prescribe whatever their favorite preventative medication is (these vary from neurologist to neurologist), but they absolutely hate to give out any kind of "rescue medication" because most of those options cause rebound headaches. (As do acetaminophen and the other NSAIDs, incidentally.) So if the preventative pills don't work - and I haven't found one that works for me - you're doomed.

The rebound headache thing is some justification for why they don't like to give out the good painkillers. But having to completely give up on a day every time a minor headache becomes a moderate one because the only way to stop it from becoming a major one is to hide out in a darkened room with an ice pack...I'd be much more functional under the influence of narcotics. And my doctors realize this, but still won't help.

Jick: Have you tried Zolmitriptan? My ex had good results with it, & no rebound headaches.

'Spos - I have, in nasal spray form. ($30 a pop since my preexisting condition kept me from getting health insurance. That ought to change this year, finally.) Though triptans have a fairly high batting average compared to most other migraine medications, they've never worked for me. That's the problem for a lot of people - if triptans don't work, there's nothing left with a high success rate.

I'm ballparking based on what one doctor told me several years ago, so the figures are probably off, but triptans help in maybe 80% of cases, and every other drug family is a coin flip at best. If you're in that 20%, you'll be searching for a while.

To bring the thread back somewhat, doesn't Papelbon get migraines, too?

doesn't Papelbon get migraines, too?

Google seems to concur.

Never knew the % of Migraine sufferers who couldn't use triptans was so high. Learn something every day.

And my doctors realize this, but still won't help.

I'm assuming you've had an MRI? If you have actual holes in your brain to show them, I'd like to hope that would help getting them to sign off on it.

Uncle Walt's quick guide to "performance enhancement"

X_t is your level of performance at time t
X_t+1 is your level of performance at time t+1
A is a treatment active at some point t to t+1 inclusive (this does not rule out administration prior to time t)
Y is the difference between X_t+1 and X_t

X_t+1 = X_t + Y

If Y>0 then A is performance enhancing (or the correlation is spurious).

Simple no?

The debate then is over whether A is "acceptable." Sometimes that is decided based on widespread usage -- e.g. eyeglasses. Aspirin would fall into this category as would caffeine (one of the first things they tried to ban actually). Sometimes that is decided based on whether it would be, well, obvious -- i.e. working with a batting coach presumably enhances performance but practicing one's craft is obviously something we want professionals to do. It would seem logical to also include legality -- if it's illegal it would seem to by definition be unacceptable ... but baseball tolerated greenie usage for decades. Sometimes acceptability is defined based on how large Y is ... or more generally how large Y is believed to be in the absence of any real evidence.

But really acceptability is determined by the same screwed up human process we decide whether much of anything is acceptable -- i.e. irrationally. One minute polygamy is the thing to do, next thing it's a sin, then next thing folks are studying whether primates are wired to be polygamous.

As to "serious" painkillers and/or anti-inflammatories -- they are in reasnably widespread usage but they have a huge impact on performance (taking the field or not, returning from injury sooner or not) and, to the extent they are overused, the legality and/or widespreadedness issues come into play.

I certainly don't object to the safe use of an anti-inflammatory to speed healing. But then, if they are safe and effective, I don't have any objection to the use of roids or HGH to speed healing.

But to the extent painkillers/anti-inflammatories are used heavily to keep a player on the field when it would be better for the player's health to rest ... well, that's morally the same as roids adding HRs to McGwire's total (if that's what they did).

The easiest bright line to draw is that the use of controlled substances to enhance athletic performance is unacceptable. But that's not the line that we've drawn (although that's pretty much where the Olympics tried to start, even including non-controlled stuff like caffeine).

A Google suggests it might actually be 40% or more for whom triptans don't quite do the job. More than I'd thought, too.

I'm assuming you've had an MRI? If you have actual holes in your brain to show them, I'd like to hope that would help getting them to sign off on it.

I have, but the MRIs were to rule out other conditions, as they don't show evidence of migraine. My first MRI came while I was in the middle of a headache, actually, and they told me beforehand that it wouldn't manifest itself on the readout. (This is my recollection, anyway, I was ten or eleven at the time.) Anyway, the doctors have no argument about the migraine diagnosis - it's come from probably half a dozen neurologists. They just argue about how to treat them, and they only rarely come up with ideas that will let me keep normal hours and maintain steady attendance at class or work.

Part of what I would like - not ideally, but practically - is an equivalent of the athlete's cortisone shot. I've just about given up hope on fixing the underlying problem, at least until I get decent health insurance again, but I want something to cloud the pain so I'm not constantly on the DL, so to speak. In that respect, I can almost understand why they're reluctant. But I also have a lot of sympathy for the athletes who just want to be on the field.

And as for the 'If he were used properly' argument. I absolutely believe that some players cannot handle being used outside the role they

I'm pretty sure Papplesmear is going to go out and take the ball whenever asked. The Phillies overpaid to get him, and he wants to continue to be overpaid.

But more importantly he wants to win, and seeing game after game blown while he's rested and available cant sit that great with him. The "closer" role no longer matters once you get paid, he can't really worry too much about his next deal 4 years away now.

And it's Manuel's job not just to put players in the best role for the team, but to motivate them to want to do that role. I have a hard time believing that if Manuel had sat Pap down and found the right way to say "this team doesn't need a closer, it needs a fireman, and you are the only guy who can do it and singlehandedly turn around our season", that Pap wouldn't have ran out to the mound breathing fire whenever Manuel brought him in early.

Part of what I would like - not ideally, but practically - is an equivalent of the athlete's cortisone shot.

I was prescribed Maxalt for my migraines a couple of years ago, and that has made a huge difference. The only side effect is that they leave me somewhat sleepy, but the migraines make me sleepy as well.

But really acceptability is determined by the same screwed up human process we decide whether much of anything is acceptable -- i.e. irrationally. One minute polygamy is the thing to do, next thing it's a sin, then next thing folks are studying whether primates are wired to be polygamous

Being wired for it doesn't make it right.

It just makes it oh so dirty hot.

Once again, sacrificing your body for sport is the essence of it.