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Saturday, February 16, 2013

Edes: Boston Red Sox medical staff divided team

There’s stuff in here about the injectable advil brouhaha, but the real story here is the dysfunction and incompetence.

Allegations that a former Boston Red Sox athletic trainer was illicitly injecting players with the legal pain-killer Toradol appear to be just the latest indicator of what one team source described as “open warfare” between various factions of the team’s previous medical staff.

The friction that existed for years between former medical director Dr. Thomas Gill and trainer Mike Reinold spilled over into the clubhouse, multiple sources told ESPNBoston.com. Reinold was originally hired as athletic trainer but was given expanded authority until his dismissal after last season. Players took sides not only on Toradol, but other issues.

Outfielder Jacoby Ellsbury in 2010 publicly challenged Gill over what he contended was a botched diagnosis of his fractured ribs, while former Red Sox pitcher Jonathan Papelbon said he informed then-general manager Theo Epstein and then-manager Terry Francona he would no longer allow Reinold to work on him.

“My thing is that [Reinold] thought he knew everything about everything,” Papelbon said. “You couldn’t tell him anything. I don’t know of any players who thought he was a good trainer.”

And there’s more!  You thought this was just about a few players?  Nope.

The rift in the medical staff also divided the front office, according to multiple sources. Principal owner John W. Henry championed Gill, who as his personal orthopedist twice operated on Henry’s shoulder. Henry is also a trustee at Massachusetts General Hospital, where Gill is on staff. The baseball operations staff, meanwhile, backed Reinold. At one point, Epstein fired Gill and tried to transfer his duties to team internist Dr. Larry Ronan and Reinold, but was immediately overruled by Henry.

But the situation became so “toxic” between not only Gill and Reinold but with other members of the medical staff, a source said, that Henry did not stand in the way when Gill was not retained as medical director after the 2011 season. That followed a meeting in which Gill, according to multiple sources, demanded that Reinold be fired.

“I’d rather not characterize it, except to say there was a discussion about it and a mutual resolution was achieved,” Red Sox CEO Larry Lucchino said Thursday about that meeting.

The team also fired Scott Waugh—whom a source said had been at odds with Reinold—as physical therapist, Greg Barajas as assistant trainer, and David Page as strength and conditioning coach after the 2011 season. Reinold was also given a reduced title, named to replace Waugh as physical therapist, although former manager Bobby Valentine would complain privately last summer that Reinold exerted undue influence over when injured players could return to the field.

Matt Clement of Alexandria Posted: February 16, 2013 at 09:07 AM | 53 comment(s) Login to Bookmark
  Tags: crazy clown town, red sox

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   1. Matt Clement of Alexandria Posted: February 16, 2013 at 09:16 AM (#4370621)
Gordon Edes has really been killing it on the clowntown beat. I think something like 90% of our actual knowledge about what went wrong in the Red Sox front office and clubhouse has come from Edes' reporting.
   2. mboling Posted: February 16, 2013 at 10:39 AM (#4370632)
If it is not illegal and not banned, why is it a story in the first place?
   3. Dale Sams Posted: February 16, 2013 at 10:40 AM (#4370634)
Chicken Pox and Beriberi? It's early. That's all I got.
   4. Jose Can Still Seabiscuit Posted: February 16, 2013 at 11:20 AM (#4370639)
If it is not illegal and not banned, why is it a story in the first place?


Fair point. I think the bigger issue is that it's clear that in the last 3-4 years (at least) the players, management and medical staff have been at odds. Given the way injuries have decimated this team (2010 particularly) I think that's something that needs to change.
   5. with Glavinesque control and Madduxian poise Posted: February 16, 2013 at 11:58 AM (#4370656)
@2: The activities causing concussions in football were neither illegal nor banned, but there's still been a justified uproar over them. The use of Toradol as it was sometimes described in the Boston Red Sox club house is almost certainly a bad idea for the players; it's not a drug that should be used consistently over a long period of time.
Pretty much any use of aspirin is legal, but it will still screw your liver all the way up if you take a bunch.
   6. Avoid running at all times.-S. Paige Posted: February 16, 2013 at 12:05 PM (#4370661)
Pretty much any use of aspirin is legal, but it will still screw your liver all the way up if you take a bunch.


Add to that the rampant use of Budweiser and some of the Socks were going to be jaundiced before their primes!
   7. Swedish Chef Posted: February 16, 2013 at 12:11 PM (#4370662)
Doctor 1: "Leeches!"
Doctor 2: "Mercury!"
Doctor 3: "Trepanning!"
   8. Matt Clement of Alexandria Posted: February 16, 2013 at 12:31 PM (#4370669)
it's not a drug that should be used consistently over a long period of time.
As far as I know, there is no more reason to be concerned about long-term Toradol use than long-term Tylenol or Advil use. There is much more reason to be concerned about long-term corticosteroid use (which has been going on for a long time in sports) than long-term NSAID use.
   9. Matt Clement of Alexandria Posted: February 16, 2013 at 12:32 PM (#4370670)
Doctor 1: "Leeches!"
Doctor 2: "Mercury!"
Doctor 3: "Trepanning!"
This is funny.

It is worth noting that even if all three doctors offer non-crazy treatments, having players bounce between them based on personal preference and organizational infighting is a great way to provide massively sub-standard care.
   10. snapper (history's 42nd greatest monster) Posted: February 16, 2013 at 01:13 PM (#4370694)
If it is not illegal and not banned, why is it a story in the first place?

Because an incompetent treatment may have been treating players in an inappropriate fashion, disguising injuries, and causing more serious injuries down the line?

If I go to the Dr. and say I have a headache, and he gives me a shot of morphine, that's not illegal. But it's still bad medicine.
   11. Matt Clement of Alexandria Posted: February 16, 2013 at 01:17 PM (#4370700)
Yes, but there's no evidence that Toradol was being used in a way that was any more inappropriate than the use/overuse of other NSAIDs and of corticosteroids that has been going on in training rooms for decades.

If people want to clean up the use of pain medications and anti-inflammatories in sports, I'm all for that. But there has been nothing reported about Toradol use that is any different from how many extremely similar drugs have been used for a long time. I'd be a lot more concerned about corticosteroid overuse than Toradol.
   12. DFA Posted: February 16, 2013 at 01:20 PM (#4370701)
This has to be good for ratings!
   13. TerpNats Posted: February 16, 2013 at 01:51 PM (#4370710)
If there's one MLB market where you would expect the team to have top-flight medical care, it would be Boston. To have something like this happen there is absurd.
   14. snapper (history's 42nd greatest monster) Posted: February 16, 2013 at 01:51 PM (#4370711)
Yes, but there's no evidence that Toradol was being used in a way that was any more inappropriate than the use/overuse of other NSAIDs and of corticosteroids that has been going on in training rooms for decades.

I think the fact that there was dissension between players and among the medical staff on the way the trainer was using it is evidence that something wasn't kosher.
   15. Matt Clement of Alexandria Posted: February 16, 2013 at 01:56 PM (#4370712)
None of the reported dissension is related to Toradol.
   16. Chip Posted: February 16, 2013 at 01:59 PM (#4370713)
I think the fact that there was dissension between players and among the medical staff on the way the trainer was using it is evidence that something wasn't kosher.


Its evidence that there were power struggles over control of care, not evidence that there was something particularly non-kosher about the application of Toradol with the Red Sox, at least as compared to other pro teams.
   17. rfloh Posted: February 16, 2013 at 03:47 PM (#4370754)
"As far as I know, there is no more reason to be concerned about long-term Toradol use than long-term Tylenol or Advil use. There is much more reason to be concerned about long-term corticosteroid use (which has been going on for a long time in sports) than long-term NSAID use."

1. There are health concerns, eg liver disease, about long term high dosage NSAID use. With aspirin, those health concerns are balanced out by aspirin's potential benefits viz cardiovascular health, and also potentially (some types of) cancer.

2. Even putting aside concerns about health, there are also concerns from a sports performance standpoint. In the short term, obviously painkillers allow you to play / train through pain. But, in the long(er) term, painkillers (ie Cox2 inhibitors) can, and probably do, inhibit the mechanism(s) necessary for adaptation to training. In general, Cox2 inhibitors will inhibit prostaglandins. But surely that is a good thing, you say. Not necessarily. Prostaglandins, as a result of exercise training, are necessary to get macrophages to degrade damaged tissue. Those macrophages then release cytokines such as interleukin 6. But isn't interleukin 6 a bad thing? Again, not necessarily. Acute IL6 increases from exercise, as opposed to chronic elevated IL6 as seen in say type 2 diabetes or CVD, appears to be probably necessary to stimulate satellite cell proliferation and differentiation in response to exercise training. Interestingly, older men, in response to exercise training, have decreased, and also, slower IL6 response, and incresed SOCS3 (surpressor of cytokine signalling 3) response, compared to young men. More importantly, that decreased, and slower IL6 response, and increased SOCS3 response, occurs in conjuction with decreased satellite cell response to exercise.

3. That's why recovery from exercise is complicated. As scientists increasingly understand the molecular mechanisms of exercise adaptation, they are increasingly realising that "damage" from exercise is necessary for adaptation, and if you use (too much) various means that shut of those mechanisms, you don't get the positive adaptation. IOW, no pain, no gain.
   18. Zach Posted: February 16, 2013 at 04:52 PM (#4370787)
What is it with the Red Sox and hiring flaming $#$!$!$? Is it really so very important to have a genius trainer that it's worth dividing the clubhouse and creating unnecessary controversy? Whatever happened to hiring a nice, competent person who makes conventional decisions and is easy to get along with?
   19. ellsbury my heart at wounded knee Posted: February 16, 2013 at 05:06 PM (#4370793)
1. There are health concerns, eg liver disease, about long term high dosage NSAID use. With aspirin, those health concerns are balanced out by aspirin's potential benefits viz cardiovascular health, and also potentially (some types of) cancer.

2. Even putting aside concerns about health, there are also concerns from a sports performance standpoint. In the short term, obviously painkillers allow you to play / train through pain. But, in the long(er) term, painkillers (ie Cox2 inhibitors) can, and probably do, inhibit the mechanism(s) necessary for adaptation to training. In general, Cox2 inhibitors will inhibit prostaglandins. But surely that is a good thing, you say. Not necessarily. Prostaglandins, as a result of exercise training, are necessary to get macrophages to degrade damaged tissue. Those macrophages then release cytokines such as interleukin 6. But isn't interleukin 6 a bad thing? Again, not necessarily. Acute IL6 increases from exercise, as opposed to chronic elevated IL6 as seen in say type 2 diabetes or CVD, appears to be probably necessary to stimulate satellite cell proliferation and differentiation in response to exercise training. Interestingly, older men, in response to exercise training, have decreased, and also, slower IL6 response, and incresed SOCS3 (surpressor of cytokine signalling 3) response, compared to young men. More importantly, that decreased, and slower IL6 response, and increased SOCS3 response, occurs in conjuction with decreased satellite cell response to exercise.

3. That's why recovery from exercise is complicated. As scientists increasingly understand the molecular mechanisms of exercise adaptation, they are increasingly realising that "damage" from exercise is necessary for adaptation, and if you use (too much) various means that shut of those mechanisms, you don't get the positive adaptation. IOW, no pain, no gain.


Not sure if it's clear the way you said it, but things like ibuprofen and other COX-2 inhibitors are hypothesized to have similar cardio and chemo-protective effects to aspirin in certain circumstances, although they haven't been as well studied as aspirin, and have different contraindications and side effects. And of course, what is meant by 'long-term' and 'high dosage' is important too.

I'm not sure anyone fully understands what's going on with cytokines. There are so many pathways and interactions through and between cytokines that it's a little intimidating to precisely tease apart specific exposure -> cytokine -> disease relationships.
   20. ellsbury my heart at wounded knee Posted: February 16, 2013 at 05:15 PM (#4370796)
What is it with the Red Sox and hiring flaming $#$!$!$? Is it really so very important to have a genius trainer that it's worth dividing the clubhouse and creating unnecessary controversy? Whatever happened to hiring a nice, competent person who makes conventional decisions and is easy to get along with?


It seems unclear exactly where the blame lies in the medical staff / training staff disagreements, but my experiences with Mass General physicians is that most of them are not exactly lacking in self-confidence.
   21. Walt Davis Posted: February 16, 2013 at 06:21 PM (#4370815)
If it is not illegal and not banned

"Legal" is a rather useless concept when it comes to drugs. There's OTC and there's requiring a prescription. But virtually any drug is legal under virtually any circumstance as long as it is prescribed by a doctor. For example, Bosch likely violated no laws when prescribing winstrol to a 40-year-old woman who felt here workouts were lagging.

Toradol is a prescription drug (in the US and sounds like most of Europe, but not Mexico and Latin America) and therefore not legally provided by a trainer. But then I think that's true of injected cortisone too so this is a bit like roids bad, amps OK.

Some other countries are apparently more concerned than the US. From the Wiki page:

Concerns over the high incidence of reported side effects with ketorolac trometamol has led to its withdrawal (apart from the ophthalmic formulation) in several countries, while in others its permitted dosage and maximum duration of treatment have been reduced.

Unless that's crappy writing and "withdrawal" means withdrawal of an OTC version.
   22. attaboy Posted: February 16, 2013 at 09:27 PM (#4370855)
No matter how F'ed up the sox team is medically, they take a back seat to the Mets!
   23. Jose Can Still Seabiscuit Posted: February 16, 2013 at 10:50 PM (#4370869)
What is it with the Red Sox and hiring flaming $#$!$!$? Is it really so very important to have a genius trainer that it's worth dividing the clubhouse and creating unnecessary controversy? Whatever happened to hiring a nice, competent person who makes conventional decisions and is easy to get along with?


We're barely a decade removed from a part-owner of the club being the team's doctor. Frankly, I think we're making progress.
   24. Walt Davis Posted: February 16, 2013 at 11:12 PM (#4370880)
We're barely a decade removed from a part-owner of the club being the team's doctor. Frankly, I think we're making progress.

Now that he's not on TV anymore, House is available.

"He's complaining of a sore shoulder."

"There's nothing wrong with him, have him pitch."

"He gave up hits to the first 12 batters and now he can't raise his arm above his shoulder."

"Oh, it's diatrictacampolytis. Chase, give him a shot of methyldethylpropylene and get him back out on the mound."

"He walked the first 3 guys he faced on 12 pitches, then he went into convulsions."

"He went into convulsions? I had $50 on that game and had sudden onset Tourrette's."

"House! His pressure has dropped to 20 over 5!"

"That was his record last year, this year he's oh and 9."

"House!"

"OK, give him a dose of .... what are those things called again ... oh yeah, amphetamines."
   25. ptodd Posted: February 16, 2013 at 11:59 PM (#4370896)
It's interesting that the beat writers for the Globe and Herald won't touch the story with a long pole.

The story is fascinating on so many levels. The trainer is actually the guy Schilling said suggested he use HGH. So he has actually been the subject of 2 separate MLB investigations.

The use of Toradol is a worthy subject in it's own right. This is clearly a permitted PED that some players or teams avoid due to health concerns. Exactly the same issue as steroids had before testing. Those who chose to use it clearly have an advantage over those who don't.

It is far more potent as a pain reliever than OTC NSAID's and with serious side effects, and it's use may have led to Buchholz life threatening esophagitis. It's potency may also contribute to more injuries, since players may be coming back too quickly for injuries or playing through injuries that make them worse. Exactly what we have seen with the Red Sox the past few seasons.

It is also interesting in the sense that its use chronically, is not consistent with the use that FDA approved the drug, so it's safety when used in such a manner is unknown.

Papelbon claimed the docs never told him about the side effects of Toradol. Buchholz claims he was using other NSAID's beside Toradol despite the fact the instructions explicitly warn against doing so as it can worsen the side effects. That's why it's illegal for anyone but a Doctor to administer Toradol so patients will be aware of this.

The conflict between medical staff and others is consistent with Titos book where he talks about the egos on the staff created some tough situations.

The other interesting bit is that not a single MLB team has a full time Doctor, which is why the trainer was giving the injections. The Red Sox part time Doctors do not go on road trips and come to the park too late to give the injections.

While the Red Sox have made changes to their medical staff, they fired Dr Gill as Medical Director. However, they use the Doctors at MGH sports department which is run by Dr Gill, who also treats the Patriots (wonder how Bronk is doing with that forearm). It is interesting to know that MGH is forced on the team by JWH because of his connections with them.

So obviously, this is not a story interesting enough to report on by the Globe and Herald .

Thank god for national reporters (Passan had a good story on this also) and ESPN Boston reporters.
   26. ptodd Posted: February 17, 2013 at 12:21 AM (#4370906)
As far as I know, there is no more reason to be concerned about long-term Toradol use than long-term Tylenol or Advil use.


Yeah, there is, that's why Toradol is prescription only.

There is much more reason to be concerned about long-term corticosteroid use (which has been going on for a long time in sports) than long-term NSAID use


I would definitely be concerned with the inappropriate use of corticosteroids that are not used in accordance with the manufacturers and FDA's approved use and administered without a Doctors approval and without medical supervision to watch for side effects.

Do you have a link showing this is happening?
   27. TVerik, the gum-snappin' hairdresser Posted: February 17, 2013 at 12:32 AM (#4370908)
If there's one MLB market where you would expect the team to have top-flight medical care, it would be Boston. To have something like this happen there is absurd.

There are "generals" and there are "soldiers". Leaders don't like to be told what to do, they like to decide what they and everyone else is going to do. You can have too many of one or the other, and the total of the staff is a lot less than the sum of it's parts.

There's no evidence that this is what's going on here, but if the town of Boston indeed has a ton of those order-givers and not enough of those order-takers, the staff can indeed be problematic. Heck, it's probably worse in that particular city - the people who have risen to the top are absolutely not used to playing nice with others and following someone else's treatment plan.
   28. Walt Davis Posted: February 17, 2013 at 03:15 AM (#4370931)
MCoA sorta asks "why is this a big deal? This is no different than the use of other NSAIDs."

And that's fair enough and I don't have a good answer for him. But then I'm one of those guys who can't figure out why roids are evilevilevil while amps are ho hum. Still I'll draw that analogy to amps.

It's certainly true that cortisone and others painkillers and anti-inflammatories have been around sports forever. But a lot of the use was kept out of the public eye. You'd certainly read the occasional "X complained of shoulder pain so they're giving him a cortisone shot and skipping his next start." I don't recall ever reading prior to this "X gets a shot of a major painkiller before every start and has for the last 10 years."

I've well established my bona fides as a guy who doesn't have a clue how and where to draw the line between allowable and unallowable performance enhancement but I assume some folks start to draw the line when a player is getting an injection before every start or once a week and when it starts to be pretty much every player by the sounds of it. Occasional use is easy enough to pass off as "medical" -- constant use (and injection by a trainer), not so much.
   29. john_halfz Posted: February 17, 2013 at 09:41 AM (#4370945)
Not trying to be rude, but having a hard time understanding why Matt Clement has been a persistent defender of Toradol in these threads. Even after hearing from a pharmacologist (and others) about why it's a bad idea to be injected with high doses of high-wattage analgesics for weeks and/or months on end, Matt seems to have a vested interest in persuading us that the treatment is as benign as popping a couple of Advil.

In any event, if a medical professional is providing limited or incomplete information about a proposed treatment course, that's an ethical problem. We can safely presume that not every professional ballplayer has high health and medical science awareness. Papelbon, for instance.
   30. Matt Clement of Alexandria Posted: February 17, 2013 at 09:43 AM (#4370947)
Ben Cherington weighs in on the medical staff / training staff controversy. Shorter version: "Well, yeah, but we fired those guys." Longer version:
As everyone knows, we’ve gone through quite a bit of change the last two years. We really had a two-year process of reorganizing the medical staff. This offseason was Year Two of two years,” said Cherington. “It was all done with the intent of putting not just the most talented group together, but a group that would work together seamlessly, put the players first and earn the players’ trust and develop credibility with the players. There’s a number of changes that have happened toward that goal. The irony is that if things are going well in that area, we’re not talking about it nearly as much as we have, and you’re not hearing from the medical staff. That’s our hope going forward, that we’re hearing from the guys in uniform a lot more and the guys in the training room less. That’s our expectation. Everything that I’ve seen, these stories that have been out there, they’re really about things that happened in the past and not things going on right now. Our focus is right now.”
   31. Matt Clement of Alexandria Posted: February 17, 2013 at 09:51 AM (#4370949)
Not trying to be rude, but having a hard time understanding why Matt Clement has been a persistent defender of Toradol in these threads.
Short form: I talked to some medical folks - an internist, an ortho surgeon, and a nurse - and they all thought that the media discussion of Toradol massively misunderstood the drug, its risks and benefits, and its analogues. The risks of Toradol are all the same risks that attend to taking lots of advil over a long period of time. That's a real risk - lots of OTC drugs can harm you - but it's not a new risk.
Even after hearing from a pharmacologist (and others) about why it's a bad idea to be injected with high doses of high-wattage analgesics
The pharmacologist argued that Toradol is risky for the same exact reason high doses of advil are risky - possible renal/GI problems, along with some other side effects. This doesn't contradict my "strong advil" comparison (which again I'm relaying from several doctors). The pharmacologist also said that in terms of long-term use, Toradol is a problem in the same way that long term use of any most any NSAIDs or corticosteroids are a problem. It's not an approved use, but it's a type of non-approved use of anti-inflammatories that's been going on in sports for years and years.

The known and studied risks of renal/GI side effects from advil are primarily short-term risks. You take too much advil, you screw with your kidneys and you start presenting kidney problems. If Toradol has been used with the frequency reported, and playes haven't been having high rates of renal/GI problems, then it's hard for me to see how the short-term side effects should militate too strongly against the use of the drug in the doses used among ballplayers. There are long-term risks, but that's not something new to Toradol.
   32. Joe Bivens, Minor Genius Posted: February 17, 2013 at 10:22 AM (#4370953)
I see trainers in the same way I see physical therapists. I've never heard of a PT administering injections.


edit...also, trainers and PT's can't prescribe drugs.
   33. rfloh Posted: February 17, 2013 at 11:40 AM (#4370978)
"m not sure anyone fully understands what's going on with cytokines. There are so many pathways and interactions through and between cytokines that it's a little intimidating to precisely tease apart specific exposure -> cytokine -> disease relationships."

Yeah, that's what I was trying to say.

Many of the pathways and mechanisms, involved in disease, and exercise, are not well elucidated. In some cases, they are not elucidated at all. For example, don't believe anyone who claims that within the next few years, sports scientists will be able to look at the genetic profile of a kiddie, and select for sporting talent.

And personally, that's why I find the molecular, cellular, genetic, epigenetic mechanisms of exercise fascinating, because they are not well / poorly elucidated, because the different pathways often interact with each other, often "cross talk". Especially interactions with gender (estrogen; despite what many "lay" people think, estrogen might be / can be a sports performance enhancing substance, in women) and how a mechanism might work in both a sporting viewpoint vs a clinical viewpoint. Eg, from a sporting viewpoint, some mechanisms, eg the mTOR (mammalian target of rapamycin) nexus are viewed as something to be activated / potentiated, whereas from a clinical standpoint (type 2 diabetes, some types of cancer), those very same pathways are viewed are looked as something to be inhibited (possibly because in disease states, there is some missignalling at certain points of the pathway).
   34. rfloh Posted: February 17, 2013 at 12:04 PM (#4370983)
"This is clearly a permitted PED that some players or teams avoid due to health concerns. Exactly the same issue as steroids had before testing. Those who chose to use it clearly have an advantage over those who don't."

No, not necessarily. Putting aside all health concerns, there is no clear performance advantage of using painkillers over not using painkillers. You might get very short term advantages in that those painkillers allow you to play / train through pain. You might also be disadvantaged over the longer term, in that those painkillers might actually delay both healing, and adaptation. There is also the issue that playing / training through pain with the aid of a painkiller might not be a good idea in its own right, in that the painkiller blocks out pain as a warning sign.

This actually is one thing that exercise physiologists / trainers (assuming that that trainer has a good background in exercise physiology), have to consider nowadays, when evaluating a recuperative measure, even putting aside all concerns about health, and practicability (ie pro athletes, especially in team sports have fixed schedules, a recuperative measure is useless if it makes ridiculous demands on their schedules). Could it be that by blocking out pain / "damage", you are also blocking out positive adaptations to exercise training? IOW, when evaluating a recuperative measure, it isn't enough to know that that recuperative measure by reduces pain, or inflammation, or some markers of muscle damage / inflammation. You need to know whether that use of that recuperative measure results in improved sporting performance, especially over the longer term, or might actually reduce sporting performance.

For example, around 10 years ago or so, it was popular in some circles to take very high does of antioxidants, eg vit C, after exercise. The reasoning went that these high doses of anti-oxidants would block the damaging oxidisation that exercise can produce. Sounds reasonable and scientific. The problem: it appears that reactive oxidisation species are a very important signal for activation of the PGC1 alpha (peroxisome proliferator activated receptor gamma coactivator 1) mechanism, the activation of which results in mitochondria biogenesis and increased capilisarisation of muscle. So, block exercise induced ROS with high doses of post exercise vit C, you block activation of PGC1 alpha, and thus, block mitochondria biogenesis (as a result of endurance training). Also, PGC1 alpha might play a supporting role in muscle hypertrophy, though that possible role is much less understood / elucidated.
   35. Joey B. "disrespects the A" Posted: February 17, 2013 at 03:50 PM (#4371065)
.
   36. Joey B. "disrespects the A" Posted: February 17, 2013 at 03:53 PM (#4371066)
Not trying to be rude, but having a hard time understanding why Matt Clement has been a persistent defender of Toradol in these threads. Even after hearing from a pharmacologist (and others) about why it's a bad idea to be injected with high doses of high-wattage analgesics for weeks and/or months on end, Matt seems to have a vested interest in persuading us that the treatment is as benign as popping a couple of Advil.

It's the team, not the Toradol. MCOA is BTFs preeminent self-appointed propagandist/apologist for the Red Sox organization. Any story that makes the team look bad, and he's all over it like white on rice. If it was any other team, he would have a fraction of the interest that he does.
   37. McCoy Posted: February 17, 2013 at 04:23 PM (#4371073)
If it was any other team, he would have a fraction of the interest that he does.

This applies to virtually everyone here.
   38. Dale Sams Posted: February 17, 2013 at 04:43 PM (#4371081)
MCOA is BTFs preeminent self-appointed propagandist/apologist for the Red Sox organization


Or it could be that since his team is The Red Sox, he feels qualified to comment upon their activities. And if he were an apologist, he could poo-poo the slightest hint of 'chemistry' and hide behind SABR-skirts doing so.
   39. Matt Clement of Alexandria Posted: February 17, 2013 at 04:47 PM (#4371084)
My introduction to the article highlighted the "dysfunction and incompetence" of the Red Sox organization. I've been blogging and posting here about "crazy clown town" since midseason last year.

It's not that I need to defend myself to Joey, exactly. It's just that he's once again confirming he is BTF's single worst poster by not understanding at all what I've said here.
   40. Walt Davis Posted: February 17, 2013 at 05:47 PM (#4371109)
there is no clear performance advantage of using painkillers over not using painkillers.

Of course there is, especially as used by Schilling (and apparently others on the team). Schilling was getting injected BEFORE every start. This suggests that, without the painkiller, Schilling would have been in sufficient pain at some point in the start to become ineffective or leave the game. If he can only make it 4 innings without painkiller but can go 7 to 9 with it, it's hugely performance enhancing.

(Note, if he was getting it only after a start, you could argue that it was "recovery enhancing" not "performance enhancing". I don't really see any point in distinguishing between those but in this case, it was clearly being used immediately prior to his performance to enhance that performance.)

You are possibly suggesting that this short-term benefit might, for all we know, be more than cancelled out by the long-term harm of masking the warning signs of pain. That's certainly possible but one assumes they wouldn't be getting painkillers before every start unless the player, trainers and doctors knew the pain was there ... so the warning has been received and is being worked around to keep the pitcher effective. Any increase in long-term risk is further evidence it is being used to enhance performance.

It's of course possible that it's just a crutch/placebo effect and Schilling et al didn't really need shots before every start. That wouldn't speak to intent though.

Not that I exactly trust Schilling to be accurate but he did say he was doing this for 10 years which is long before he got to the Sox so it's not just a Sox thing.

And I don't mean to single out Schilling, it's just that he's quoted in one of the other threads about using Toradol (or was it painkillers generally) before every start for about 10 years. I'm sure this is true of many, maybe most starting pitchers, he's just the one who's put his name to it. Clemens' use of Vioxx is no different.
   41. The Yankee Clapper Posted: February 17, 2013 at 06:50 PM (#4371123)
I've been blogging and posting here about "crazy clown town" since midseason last year.

Late to the show, eh?
   42. Darren Posted: February 17, 2013 at 07:45 PM (#4371139)
It's not that I need to defend myself to Joey, exactly. It's just that he's once again confirming he is BTF's single worst poster by not understanding at all what I've said here.


Woah, that's a high bar to clear, but if any one sentence can do it, it's this:

MCOA is BTFs preeminent self-appointed propagandist/apologist for the Red Sox organization.



Hilarious.
   43. Scientist guy Posted: February 17, 2013 at 08:21 PM (#4371143)
#5

Pretty much any use of aspirin is legal, but it will still screw your liver all the way up if you take a bunch.


I think you're thinking of acetaminophen (Tylenol) which is much more toxic to the liver than Aspirin.

Aspirin can screw up your liver like practically anything else at high enough doses, but GI irritation and bleeding is more of a problem.
   44. Jack Carter, calling Beleaguered Castle Posted: February 18, 2013 at 04:40 AM (#4371232)
This will be interesting to a friend of mine who's dealing with chronic physical pain, the worst symptom of which comes with waking in the morning, when the previous day's dose of Oxycodone has worn off. As he wakes he has the sensation of 2nd degree burns over a lot of his body (but with no visible signs--no redness, no rash).

He just found out if he doubles his daily dose of 500mg of Naproxen, an NSAID with analgesic properties, to 1,000 mg/day, that most of the burning sensation goes away. It's the first time in a couple of years that has been the case. The problem is that even at 500mg a day docs want you to take Naproxen only as needed, or at most 25 days out of a month. I think it the analgesic part of the drug is known to lead to heart problems.

My friend is a bright guy but has no science background. Is there a go-to book or website for people like that with issues like this? I think he'd be happy to trade a much shorter lifespan for one that's comparatively pain free, but if there's a middle ground I'm sure he'd like to find out about it. He's one of those people with basic insurance who's been passed around from doc to doc for the last couple of years because none of them can figure out what the root cause is.
   45. Joe Bivens, Minor Genius Posted: February 18, 2013 at 08:52 AM (#4371241)
"Burning sensation" can be related to sensory nerve damage. The spinal cord is one of the last frontiers of medicine. It's unfortunate.
   46. villageidiom Posted: February 18, 2013 at 09:08 AM (#4371244)
I'm disappointed in both #36 and #39. I have to be at least one of "BTFs preeminent self-appointed propagandist/apologist for the Red Sox organization" and "BTF's single worst poster". Guess I'm not trying hard enough.
   47. Jack Carter, calling Beleaguered Castle Posted: February 18, 2013 at 06:50 PM (#4371535)
@45: that's what we're/he's guessing. A soft tissue back injury 30 years ago, a pinched nerve ten years ago that began with numbness in the last two fingers of each hand, worsening over time, turning into irregular burning a few years ago, and now constant. Perhaps pressure on the original pinched nerve worsening with age. I'm familiar with the details what with being the designated driver to some appointments. It's sad to watch this happening. For all the value of the 'net, in a case like this it tends to increase the possibilities rather than narrow them down, and when a doctor doesn't understand something she tends to act like an early sabermetrician: if it can't be measured, it's because you're crazy.

@46: I'm pretty sure not understanding what Matt had to say isn't really the criterion for "worst poster". I'm pretty sure that's evidence of "reading comprehension".
   48. Gonfalon Bubble Posted: February 18, 2013 at 07:30 PM (#4371557)
Just imagine the posts, if Matt CoA's favorite team had ridden the arm of accused Biogenesis BFF Gio Gonzalez to a division title.
   49. Jack Carter, calling Beleaguered Castle Posted: February 18, 2013 at 09:02 PM (#4371587)
there is no clear performance advantage of using painkillers over not using painkillers.


I'm guessing the writer has limited experience with painkillers.

There are guys whose entire careers would be impossible without painkillers. Painkillers render the value of every other performance enhancer a distant second.
   50. ellsbury my heart at wounded knee Posted: February 18, 2013 at 10:53 PM (#4371620)
There are guys whose entire careers would be impossible without painkillers. Painkillers render the value of every other performance enhancer a distant second.


Definitely. I'd guess nearly every major league pitcher (maybe every player) has used painkillers pretty extensively, and likely in larger doses for longer than recommended. Professional sports in their present form would probably be impossible without painkillers. I can't say how representative Bob Ojeda's account is (although he says his experience was typical), but I get the sense that chronic, aching pain is basically a daily fact of life for many pitchers:

Relationships between pitchers and their arms are unique — extremely, even excessively, focused partnerships full of fear and pain and trust and hope. The relationship starts early and can end badly. Anytime. Mike Pelfrey of the Mets is off for Tommy John elbow surgery. Michael Pineda had his shoulder repaired. Johan Santana is coming back from surgery. Medicine has made advances. Miracles happen. Still, ruin is always one pitch away, especially if you are already making those pitches in pain.

Once I started pitching, I’m not sure my left arm ever didn’t hurt. For more than three decades, whether in Little League or the minor leagues or Fenway Park in Boston, there was pain. Sharp or dull, in the elbow or at the shoulder. Throwing fastballs as a kid or junk as a lefty trying to stay in the big leagues, it all led to pain. It would be dulled by aspirin or beer or more powerful cocktails of medicine and booze. But it would never leave.
   51. Jim Wisinski Posted: February 18, 2013 at 11:09 PM (#4371624)
Bouton's talk of pain and the relationship of a pitcher and his arm (both from personal experience and that of his teammates) pretty much mirrors what Ojeda said
   52. ellsbury my heart at wounded knee Posted: February 18, 2013 at 11:11 PM (#4371626)
Oh, and of course I left out the most relevant section:

I told Steve that I took eight aspirin a day but that sometimes I needed a little more help. Anti-inflammatories, stuff like that. I started the season in the bullpen and got my first start April 22. Our routine was that after every start, I sunk my elbow in a bucket of ice (doubled as a beer cooler) for 20 to 30 minutes. A few cigarettes and beers later, no pain. Imagine. Not much other than that.

By then, my love affair with my changeup was in full bloom. Quite simply, it hurt less to throw. By June, we were eight or nine games up, and it was over for the rest of the N.L. East. But I had a problem: my elbow was flat-out quitting on me. Time to get in the jar. The team doctor examined me and said I needed to rest it. That wasn’t going to happen, I told him. I played the “this conversation never happened” card, and he respected my decision to take responsibility for the consequences. He prescribed the pills I needed.
   53. Joe Bivens, Minor Genius Posted: February 19, 2013 at 07:58 AM (#4371704)
Throwing overhand is an unnatural motion, meaning, we're not built to throw overhand. It kills the shoulder, over time. The arm is meant to throw underhanded. That arc is our natural motion. "King of the Hill" Eddie Feigner pitched until he was 75. He was unhittable for most of his life.

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