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Monday, February 11, 2013

Edes: Jonathan Papelbon used Toradol

Pharesthesia, running wild!

Former Boston Red Sox closer Jonathan Papelbon, who was with the team from 2005-11, said Saturday that he and numerous other Red Sox players were regularly injected with Toradol, a legal anti-inflammatory drug whose use has become increasingly controversial in sports.

Toradol is the nonsteroidal drug that Red Sox pitcher Clay Buchholz acknowledged last season might have contributed to the esophagitis that sidelined him for 20 games. Buchholz was hospitalized in intensive care and lost three or four pints of blood while dealing with the condition, which is a known side effect of the painkiller.

Papelbon said that when he was administered a physical by the Philadelphia Phillies prior to signing as a free agent after the 2011 season, doctors asked him if he used Toradol. When he answered in the affirmative, he was told that he would have to stop.

“They told me, ‘We don’t do that here.’ That kind of surprised me,” Papelbon said Saturday, speaking by phone from Phillies camp in Clearwater, Fla. “I haven’t had a single Toradol shot since.

“But here’s the thing you have to understand. There are so many organizations that do it. Not only baseball, but every sport. Football, basketball, hockey. It’s not just the Red Sox.”

Repoz Posted: February 11, 2013 at 06:33 AM | 94 comment(s) Login to Bookmark
  Tags: phillies, red sox

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   1. Austin Posted: February 11, 2013 at 07:16 AM (#4366895)
You definitely have to wonder if the use of this stuff has contributed to the constant injury problems of the Red Sox. If a player is in pain, it can definitely indicate a small tear or strain that would heal itself with a couple days' rest. So anything that lets players play through pain has a chance of causing a small injury to become a big one. If they were using Toradol as frequently as Papelbon implies, particularly on a team with a lot of older players, they were asking for the slew of DL trips they've gotten.
   2. Matt Clement of Alexandria Posted: February 11, 2013 at 07:34 AM (#4366897)
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.

Of course, any anti inflammatory can be misused in treatment of injury. To get esophagitis from Toradol, you would have to be taking some ridiculous doses. You know how an advil overdose can inflame your stomach? Same thing.

So, the guess of the doctor in the house is that Toradol itself is not controversial. Perhaps team doctors are prescribing large and repeated dosage of Toradol which exceed by a significant amount best practices / recommended doses - if Buchholz was taking enough to get esophagitis - then that would be the problem.
   3. Bug Selig Posted: February 11, 2013 at 07:57 AM (#4366899)
I'm not sure anybody here will argue that it's a "PED". A "bad idea" maybe, but not a "PED".
   4. Fancy Pants Handles lap changes with class Posted: February 11, 2013 at 09:03 AM (#4366913)
Considering they often believe in the healing power of metal bracelets, and that not changing your underwear will make you play better, perhaps we shouldn't be asking ballplayers to determine cause and effect here.
   5. Bhaakon Posted: February 11, 2013 at 09:29 AM (#4366929)

Considering they often believe in the healing power of metal bracelets, and that not changing your underwear will make you play better, perhaps we shouldn't be asking ballplayers to determine cause and effect here.


Playoff beards don't boost testosterone, they reveal it.
   6. TJ Posted: February 11, 2013 at 09:33 AM (#4366931)

"Playoff beards don't boost testosterone, they reveal it. "

Only if you're Chuck Norris...
   7. morineko Posted: February 11, 2013 at 10:12 AM (#4366942)
This isn't news in baseball either; the article mentions R.A. Dickey. The news is, once again, that the Red Sox doctors are kind of dodgy--no surprise.
   8. Der-K and the statistical werewolves. Posted: February 11, 2013 at 10:39 AM (#4366954)
that's what i got from this as well, morineko
   9. Pops Freshenmeyer Posted: February 11, 2013 at 10:50 AM (#4366958)
A former USC football player is suing the school for giving him regular toradol; allegedly without warning of potential side effects. He had a heart attack around the age of 21 which basically ended his college career (doctors wouldn't clear him to play... he just recently signed with an NFL team).

It seems this particular anti-inflammatory is going to become a controversial issue in sports.
   10. Joey B. has reignited his October #Natitude Posted: February 11, 2013 at 11:02 AM (#4366966)
The abuse of legal painkillers in sports is a giant controversy just waiting to be blown wide open.
   11. Matt Clement of Alexandria Posted: February 11, 2013 at 11:02 AM (#4366967)
Just to reiterate, Toradol is basically ibuprofen. It isn't some secret new thing with untested risks and benefits.

If athletes are suffering because of Toradol, it's because doctors are letting them take far more than everyone knows a person should take.
   12. Vailsoxfan Posted: February 11, 2013 at 11:16 AM (#4366978)
That could be true but not neccessarily. Some people have magnified reactions to normal doses of OTC meds, hence the 50 page side affect warning message when you buy them. I have a not insignificant number of clients who cant take ibuprofen at all because of stomach issues. It would not surprise me if a certain number of players had reactions to "normal" doses.

The real issue is, if it is being taken like this is, turning mild inflammatory issues which should be rested into bigger ones. Pain is the body's smoke detector. We can listen to it and check if there is a fire, or pull the batteries out and move along and hope for the best.
   13. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 11:22 AM (#4366980)
I had a long conversation a couple of weeks back with a scientist who teaches and researches at a highly thought of institution and he told me they're discovering that people forcing themselves to go to work and stay active despite not being well is being linked to Alzheimer's disease and other problems. His advice to me was to get some rest if I get a cold or something. So, forcing yourself to get on with it when your body is telling you to take it easy may not be a problem for just athletes.
   14. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 11:26 AM (#4366981)
His advice to me was to get some rest if I get a cold or something.

Not to mention infecting the rest of the office.
   15. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 11:31 AM (#4366983)
Not to mention infecting the rest of the office.

Ah, #### those guys!

Naw, I kid. My situation now is I could just stay home and no one cares. I've worked in other situations where they assume you're malingering if you call in sick, so it gets tricky.
   16. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 11:36 AM (#4366986)
Naw, I kid. My situation now is I could just stay home and no one cares. I've worked in other situations where they assume you're malingering if you call in sick, so it gets tricky.

With modern technology, you can work from home and have access to your work PC and all your files. It's not either-or.

I rarely actually "call-in sick" anymore. I just work from home, unless I'm literally sick in bed. I worked from home for a full month-and-a-half before my last surgery.
   17. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 11:40 AM (#4366988)
With modern technology, you can work from home and have access to your work PC and all your files. It's not either-or.

Sure. Office drones like us have it made now. There's actually no reason our firm needs an office at all, really. The actual office and the commuting seem like a waste of time and money to me.
   18. villageidiom Posted: February 11, 2013 at 11:45 AM (#4366992)
I had a long conversation a couple of weeks back with a scientist who teaches and researches at a highly thought of institution and he told me they're discovering that people forcing themselves to go to work and stay active despite not being well is being linked to Alzheimer's disease and other problems.
mrsidiom had a stroke almost 7 years ago, despite an absence of known risk factors. But what you say above described her pre-stroke pretty well... After an insufficient amount of recuperation she'd "decide" she was all better, and get right back to whatever she had been doing when healthy. The best was when she "decided" her stomach bug was done when she'd gone maybe 2 hours without vomiting. She proceeded to consume a lot of milk. Big mistake.

I'm wondering if not getting rest is a cause of later neurological issues, or if both the behavior pattern that leads to not getting rest AND later neurological issues are symptoms of something else.
   19. Jose Is The Most Absurd Thing on the Site Posted: February 11, 2013 at 11:46 AM (#4366995)
With modern technology, you can work from home and have access to your work PC and all your files. It's not either-or.


My company doesn't allow this. For intellectual property reasons we cannot dial in from outside the office so if I don't come in it's a sick day or a vacation day. Working from home is not allowed.

EDIT: I hope Mrs. Idiom is OK.
   20. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 11:46 AM (#4366996)
Sure. Office drones like us have it made now. There's actually no reason our firm needs an office at all, really. The actual office and the commuting seem like a waste of time and money to me.

The IT dept in my company is up to 60-80% WFH now. They have hotelling space or shared cubes in the office. They've cut their real estate needs by 2/3.

I think that is the future. Be in the office with your team 2 days a week, and WFH the rest. Another team shares your space, and is in a different 2 days.
   21. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 11:49 AM (#4367000)
I'm wondering if not getting rest is a cause of later neurological issues, or if both the behavior pattern that leads to not getting rest AND later neurological issues are symptoms of something else.

My wild-ass, I AM NOT A SCIENTIST guess would be the immune system might be involved, that not allowing yourself to heal may wear it down over time. Also, recent studies have shown that intense mental activity involves a lot more energy that we previous thought, so maybe there's a connection there, too.

edit: I also hope your better half is ok and getting better. I know something happening to Mrs. Shooty fills me with terror.
   22. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 12:10 PM (#4367013)
I know something happening to Mrs. Shooty fills me with terror.

Did you get married, or are you just being colloquial?
   23. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 12:12 PM (#4367016)
Did you get married?

Not quite yet. Mrs. pre-Shooty is clunky to type, though.
   24. Ulysses S. Fairsmith Posted: February 11, 2013 at 12:18 PM (#4367024)
Isn't Toradol controversial because it ends in -ol?
   25. base ball chick Posted: February 11, 2013 at 12:28 PM (#4367035)
i can't believe all the screaming about toradol - probably because it is injected!!! and i bet it is into the BUTTOCKS!!! which means that the team is encouraging homosexual thoughts!!!

or is it that the players should just play with pain? seeing as how they make all that $$$

teams are not gonna let their good/expensive players just rest - i've watched more elbows and shoulders destroyed because when they first started hurting, the players were either afraid to say anything - seeJD "nancy boy" drew and turning into - or the team said - like - rub some dirt on it - or even worse, injected the STEROID cortisone into the joint

and now they are treating papelbon like he's using illegal drugs?

this is such BULLSTUFF

this screeching is how religious fanatic groups like puritans (etc) get starated
   26. bunyon Posted: February 11, 2013 at 12:29 PM (#4367037)
The immune system is a vengeful #####.
   27. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 12:30 PM (#4367039)
or is it that the players should just play with pain?

No, they should be allowed to rest and recover.

teams are not gonna let their good/expensive players just rest - i've watched more elbows and shoulders destroyed because when they first started hurting, the players were either afraid to say anything - seeJD "nancy boy" drew and turning into - or the team said - like - rub some dirt on it - or even worse, injected the STEROID cortisone into the joint

It's long past time that stopped.
   28. Darren Posted: February 11, 2013 at 12:34 PM (#4367042)
To the Red Sox credit, none of their pitchers have yet had a heart attack on the mound... that they've told us about. I have my suspicions about a couple.
   29. Jose Is The Most Absurd Thing on the Site Posted: February 11, 2013 at 12:36 PM (#4367046)
none of their pitchers have yet had a heart attack on the mound


They've certainly given some heart attacks.
   30. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 12:38 PM (#4367047)
They've certainly given some heart attacks.

TBF, some of that was probably just excessive angina.
   31. Voros McCracken of Pinkus Posted: February 11, 2013 at 12:52 PM (#4367058)
Of course Toradol is a PED. It's a drug and it enhances a player's performance (or at least some think it does) so it's a PED.

It's just that it hasn't been pronounced an evil one by our overlords...yet.
   32. Matt Clement of Alexandria Posted: February 11, 2013 at 12:55 PM (#4367060)
Just to be clear, your position is that aspirin is also a performance-enhancing drug?
   33. Never Give an Inge (Dave) Posted: February 11, 2013 at 12:59 PM (#4367064)
With modern technology, you can work from home and have access to your work PC and all your files. It's not either-or.

The main problem for me working from is that while I can view and edit files on my work PC, I can't print them at home for data security reasons (I can't connect a home printer to the office network, effectively). I guess I could get a fax machine and have someone fax documents to me at home but that seems excessive given how close I live to the office.

I rarely get sick anyway. I did have some medical issues that landed me in the emergency room last year, and stupidly went to work the next morning, just a few hours late. I didn't have any follow-up problems as a result, but it was stupid and drove (still drives) my wife crazy. I definitely would not do that again today -- work just isn't that important.
   34. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 01:10 PM (#4367071)
The main problem for me working from is that while I can view and edit files on my work PC, I can't print them at home for data security reasons (I can't connect a home printer to the office network, effectively). I guess I could get a fax machine and have someone fax documents to me at home but that seems excessive given how close I live to the office.

Can't you down load them onto a secure thumb drive and then print?
   35. morineko Posted: February 11, 2013 at 01:11 PM (#4367073)
25) I don't know, but if my mom's docs would rather prescribe opiates than mess with injectable Toradol (or cortisone, for that matter, which we now know from studies doesn't do much good) there's got to be some serious contraindications with some patients. It sounds like the Phillies docs are erring on the side of caution with this particular NSAID. The Red Sox docs appear to have gone in the opposite direction, especially with Buchholz.
   36. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 01:13 PM (#4367074)
I don't know, but if my mom's docs would rather prescribe opiates than mess with injectable Toradol (or cortisone, for that matter, which we now know from studies doesn't do much good) there's got to be some serious contraindications with some patients.

Non-synthetic opiates are remarkably safe. Even hardcore addicts take decades to die from high morphine consumption. Heck, they put codeine in OTC cough medicine well into the 1970's.

Advil can ruin your liver in as little as a year with overuse.
   37. smileyy Posted: February 11, 2013 at 01:22 PM (#4367083)
Pain is the body's smoke detector. We can listen to it and check if there is a fire, or pull the batteries out and move along and hope for the best.


Inflammation (a very common source of pain, hence why most painkillers are actually anti-inflammatories) can also cause injuries, or prevent healing, due to the inflamed tissue rubbing against things it wouldn't normally rub against if it weren't inflamed.

So there are real legitimate reasons to use anti-inflammatories to treat injuries.

Edit: Its too bad Vioxx kills people; it was high-leverage in my recovery from a pulled hamstring, and not just from a make-the-pain-go-away point of view.
   38. valuearbitrageur Posted: February 11, 2013 at 01:42 PM (#4367096)
Just to be clear, your position is that aspirin is also a performance-enhancing drug?


Of course not, Babe Ruth was able to take aspirin. Any drugs in common use by Ruth or Mantle era players are fine.

Any new drugs created since their times open avenues of performance enhancement denied our heros and taints their magnificent records.

If Ty Cobb were alive today he'd be disgusted that such a huge PED cheat like Bonds holds the records he does. Not because of steroids mind you, Cobb would have taken more than Bonds given the chance, his disgust would at baseball allowing players with such high melatonin levels to play at all.
   39. Never Give an Inge (Dave) Posted: February 11, 2013 at 01:57 PM (#4367104)
Can't you down load them onto a secure thumb drive and then print?

Definitely not from my home PC, and even in the office thumb drives have been disabled. Very concerned about data security.
   40. greenback calls it soccer Posted: February 11, 2013 at 02:11 PM (#4367116)
The main problem for me working from is that while I can view and edit files on my work PC, I can't print them at home for data security reasons (I can't connect a home printer to the office network, effectively). I guess I could get a fax machine and have someone fax documents to me at home but that seems excessive given how close I live to the office.

You also could print the file to a PDF, then email the PDF to yourself. Same basic idea as faxing, only the paper is digital.
   41. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 02:12 PM (#4367118)
You also could print the file to a PDF, then email the PDF to yourself. Same basic idea as faxing, only the paper is digital.

Even better.
   42. Never Give an Inge (Dave) Posted: February 11, 2013 at 02:14 PM (#4367120)
You also could print the file to a PDF, then email the PDF to yourself. Same basic idea as faxing, only the paper is digital.

Emailing a work document to my home email account in any format is expressly prohibited. Although I have occasionally done it when there was no other alternative, it's something we can be terminated for and we are frequently reminded of that fact.
   43. Never Give an Inge (Dave) Posted: February 11, 2013 at 02:16 PM (#4367122)
At some point they are going to develop capability for us to mark up a document with a stylus on a tablet - that's probably the best solution although not perfect (makes it hard to simultaneously look at two different documents, for example).
   44. smileyy Posted: February 11, 2013 at 02:38 PM (#4367136)
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.
   45. Joey B. has reignited his October #Natitude Posted: February 11, 2013 at 02:53 PM (#4367145)
teams are not gonna let their good/expensive players just rest - i've watched more elbows and shoulders destroyed because when they first started hurting, the players were either afraid to say anything - seeJD "nancy boy" drew and turning into - or the team said - like - rub some dirt on it - or even worse, injected the STEROID cortisone into the joint

This is going to be a really tough issue, because most high level pro athletes DON'T WANT to rest. Most of them want to take that painkiller and get right back out there, primarily because they're terrified of losing their job to the next guy down the line, and in this day and age that can potentially cost them their lifetime financial security.
   46. Jolly Old St. Nick Is A Jolly Old St. Crip Posted: February 11, 2013 at 03:23 PM (#4367157)
If Ty Cobb were alive today he'd be disgusted that such a huge PED cheat like Bonds holds the records he does. Not because of steroids mind you, Cobb would have taken more than Bonds given the chance, his disgust would at baseball allowing players with such high melatonin levels to play at all.

Now why in the hell would Ty Cobb have ever cared if his opponents were dozing off between pitches?
   47. dr. scott Posted: February 11, 2013 at 03:37 PM (#4367167)
Advil can ruin your liver in as little as a year with overuse.


Does this mean I should not be popping 3-4 advil a day to help the hangover from excessive intake of alcohol?
   48. Tulo's Fishy Mullet (mrams) Posted: February 11, 2013 at 03:37 PM (#4367168)
At some point they are going to develop capability for us to mark up a document with a stylus on a tablet - that's probably the best solution although not perfect (makes it hard to simultaneously look at two different documents, for example).


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'
   49. Jim Wisinski Posted: February 11, 2013 at 03:41 PM (#4367171)
The abuse of legal painkillers in sports is a giant controversy just waiting to be blown wide open.


Joey makes a good point here that didn't get any response. Sports teams, and I'm sure the NFL is by far the worst offender, regularly utilize legal but almost certainly reckless and unhealthy drugs to keep their players on the field and playing well. 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? So far it gets ignored or swept under the rug but at some point, like head trauma in football, it's going to blow up and everybody is going to get the details of how badly teams/athletes abuse legal means of performance enhancement/recovery/pain blocking and how it can affect their bodies over time.

Maybe I wasn't paying much attention when he was dealing with it but this is the first I've heard about Buchholz's condition being the result of Toradol use, it certainly didn't get any significant attention before.
   50. snapper (history's 42nd greatest monster) Posted: February 11, 2013 at 03:49 PM (#4367180)

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


Yes.

Take aspirin if you must take something every day. At least you'll only get an ulcer.
   51. dlf Posted: February 11, 2013 at 03:53 PM (#4367184)
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.
   52. Johnny Sycophant-Laden Fora Posted: February 11, 2013 at 03:56 PM (#4367189)
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.
   53. Shooty Survived the Shutdown of '14! Posted: February 11, 2013 at 03:56 PM (#4367192)
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....
   54. tfbg9 Posted: February 11, 2013 at 03:56 PM (#4367193)
3-4 Advil a day is OK. 3-4 Advil at a time, for days, not OK.
   55. Voros McCracken of Pinkus Posted: February 11, 2013 at 04:03 PM (#4367204)
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.
   56. smileyy Posted: February 11, 2013 at 04:04 PM (#4367206)

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.
   57. Voros McCracken of Pinkus Posted: February 11, 2013 at 04:11 PM (#4367215)
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.
   58. smileyy Posted: February 11, 2013 at 04:19 PM (#4367226)
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).
   59. Yeaarrgghhhh Posted: February 11, 2013 at 05:20 PM (#4367260)
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.
   60. jack the seal clubber (on the sidelines of life) Posted: February 11, 2013 at 05:32 PM (#4367268)
Toradol sounds like something you would give to injured bullfighters.
   61. steagles Posted: February 11, 2013 at 05:33 PM (#4367270)
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.
   62. Nasty Nate Posted: February 11, 2013 at 05:53 PM (#4367287)
'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.
   63. Jesse Barfield's Right Arm Posted: February 11, 2013 at 06:30 PM (#4367311)
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.
   64. The Id of SugarBear Blanks Posted: February 11, 2013 at 06:33 PM (#4367316)
'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.

   65. Gonfalon Bubble Posted: February 11, 2013 at 06:43 PM (#4367323)
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.
   66. Dale Sams Posted: February 11, 2013 at 07:12 PM (#4367347)
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.
   67. smileyy Posted: February 11, 2013 at 07:31 PM (#4367360)
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.
   68. ptodd Posted: February 11, 2013 at 07:47 PM (#4367369)
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.
   69. Matt Clement of Alexandria Posted: February 11, 2013 at 07:48 PM (#4367371)
'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.
   70. Never Give an Inge (Dave) Posted: February 11, 2013 at 08:03 PM (#4367380)
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.
   71. Nasty Nate Posted: February 11, 2013 at 08:20 PM (#4367388)
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?
   72. Jick Posted: February 11, 2013 at 08:27 PM (#4367396)
####, 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.)
   73. dr. scott Posted: February 11, 2013 at 08:31 PM (#4367397)
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.
   74. Moeball Posted: February 11, 2013 at 08:33 PM (#4367400)
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).
   75. smileyy Posted: February 11, 2013 at 08:36 PM (#4367403)
[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.
   76. Dale Sams Posted: February 11, 2013 at 08:39 PM (#4367405)
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.

   77. dr. scott Posted: February 11, 2013 at 08:42 PM (#4367406)
Gluten is apparently the devil, but I love it so.
   78. Dale Sams Posted: February 11, 2013 at 08:44 PM (#4367407)
(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....
   79. Jick Posted: February 11, 2013 at 08:44 PM (#4367408)
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.
   80. Morton's Fork Posted: February 11, 2013 at 08:47 PM (#4367409)
To - orado - ol
Helps me catch the ball
Summer, Spring, and Fall
So I'll gain the Hall
   81. Gonfalon Bubble Posted: February 11, 2013 at 08:48 PM (#4367410)
Isn't Toradol controversial because it ends in -ol?

Yes. That's why I won't allow my children to attend school.
   82. Matt Clement of Alexandria Posted: February 11, 2013 at 08:54 PM (#4367414)
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.
   83. Nasty Nate Posted: February 11, 2013 at 09:07 PM (#4367420)
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.
   84. Jick Posted: February 11, 2013 at 09:09 PM (#4367423)
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.
   85. 'Spos stares out the window, waits for spring Posted: February 11, 2013 at 10:13 PM (#4367475)
Jick: Have you tried Zolmitriptan? My ex had good results with it, & no rebound headaches.
   86. Jick Posted: February 11, 2013 at 10:35 PM (#4367500)
'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?
   87. 'Spos stares out the window, waits for spring Posted: February 11, 2013 at 10:42 PM (#4367507)
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.
   88. Dale Sams Posted: February 11, 2013 at 10:58 PM (#4367525)
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.
   89. Walt Davis Posted: February 12, 2013 at 12:21 AM (#4367573)
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).
   90. Jick Posted: February 12, 2013 at 01:13 AM (#4367606)
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.
   91. valuearbitrageur Posted: February 12, 2013 at 11:40 AM (#4367734)
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.

   92. Tom Nawrocki Posted: February 12, 2013 at 11:51 AM (#4367750)
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.
   93. valuearbitrageur Posted: February 12, 2013 at 12:53 PM (#4367859)
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.
   94. zenbitz Posted: February 12, 2013 at 04:55 PM (#4368191)
Once again, sacrificing your body for sport is the essence of it.

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