Listed As Probable

Batman needs rabies vaccination

San Antonio Spur Manu Ginobli caused quite a stir recently when he swatted a bat out of mid-air during a recent game - on Halloween no less: 

I love how the athletic trainer is on the spot with some hand-sanitizer at the end of the clip. That move looks even better now that Ginobli has announced that he had to be vaccinated for rabies.

My initial thought was that the shots seemed like a bit of typical professional sports medical overkill until I read the CDC's page on bats and rabies. The rabies virus is transmitted from infected animals to humans either by bite or more rarely if infected material such as saliva gets into your eyes, nose, mouth, or an open wound. Surely Ginobli would have known whether or not the bat bit him wouldn't he? Not necessarily as apparently bat teeth are so tiny that a bite victim may not even know that his or her skin has been punctured.

Consider this chilling case report:

In February 1995, the aunt of a 4-year-old girl was awakened by the sounds of a bat in the room where the child was sleeping. The child did not wake up until the bat was captured, killed, and discarded. The girl reported no bite, and no evidence of a bite wound was found when she was examined. One month later the child became sick and died of rabies. The dead bat was recovered from the yard and tested--it had rabies.

As the stunned and captured bat was released outside of the arena - which still didn't keep the PETA folks off of Ginobli's back - the bat in question could not be tested, so he prudently opted to get vaccinated. 

Yao'uch

The recent headlines about Yao Ming's slower than expected recovery from his foot fracture ('Career-threatening' injury may derail Yao) demonstrate a difficulty team physicians face when laying out an injury prognosis. Since tissue healing, rehabilitation progress, and mental readiness cannot be predicted to the day we resort to providing a reasonable range of 4-6 wks. A baby's due date is similar in that it is simply a date in the middle of a range with an 8-15 day standard deviation. Just as moms can get fixated on the due date, players, coaches, and the media can get fixated on the recovery timeline, specifically the part that catches their attention the most. 4-6 weeks might as well mean 4 weeks because no one hears the '6' when hoping a star will return to the playing field.

Ric Bucher does a nice job explaining that the media and the Rockets may have chosen to emphasize different ends of the same range of possibilities provided by team physician Dr. Tom Clanton:

In the realm of possibilities, the fact that Yao Ming's left foot has made no improvement since he fractured it in May could mean the Rockets center will miss all of next season. It could also mean he never plays again. Or that he is limited in training camp but starts the season and has another All-Star campaign. Or misses the first 25 games of the season but leads them to another strong playoff run. Or he misses the first 50 and wins a title.

The quotes in the Houston Chronicle from Dr. Tom Clanton, who discovered Yao's foot hadn't responded to treatment, contains the same information he gave the Rockets last week, a team source said. Sources say the Rockets didn't emphasize in their subsequent release that Yao could miss the season because Clanton didn't emphasize it.

Each party may have heard what they wanted to hear, the media a headline grabbing possiblity that Yao's career could be over and the Rockets that this is a bump in the road to recovery.

As mentioned in the previous post, team physicians also need to be very careful and consider the impact on the patient and their role in the sports organization hierarchy when disclosing patient information:

For what it's worth, the Rockets and Yao's representatives are appalled that Clanton went public with the results of his examination. Yao was disappointed the exam showed no progress, but a source says he never contemplated missing all of next season.

Yao'uch indeed.

Quick Hitters

 

I buy this theory that Lamar Odom's relentless sweet tooth could at least contribute to his mercurial production on the court. My energy and focus certainly leveled out once I got off the caffeine and fructose corn syrup fueled soda roller coaster a few years back. Whenever a college athlete comes in complaining of fatigue one of the first things we investigate if he or she is consuming too many simple carbohydrates. Maybe Rasheed Wallace would benefit from working with a nutritionist.

Jonathan Ericsson of the Detroit Red Wings shows that pound for pound hockey players are the toughest athletes out there by returning to play 3 days after an emergency appendectomy and scoring on the 4th day. In my experience athletes don't even start asking about getting active again until a week has passed and the wounds in their abdominal wall have started to heal. Baseball players go on the 15 day disabled list while talk show hosts need 6 days.

If this guy really was supplying the Nationals with steroids he should give them their money back.

Dwight Howard's Eye Injury

Back in 1983 at the Isiah Thomas summer basketball camp, outfitted in wrist bands and knee pads but still a year or two before sporting the glasses-croakies combination that became my on court trademark (away from the court I pulled off the rare head gear - neck gear double dip that the 6th grade ladies loved) I was elevating for mid-range jumper when an outclassed, earth-bound defender had to resort to sticking his finger directly into my left eye. A trip to the eye doctor later that afternoon left me with a diagnosis of a corneal abrasion and an exotic new eye patch to add to my already formidable list of accessories.

After last night, Dwight Howard and I now have something, OK one lone thing, in common when it comes to basketball. Howard was swiped across the eyes by Samuel Dalembert and reported "seeing just a whole bunch of crazy stuff" and that his eyeballs felt like they were pulsating. The Magic center vowed he would be ready for Game 2 and if the diagnosis is corneal abrasion(s) then that is certainly likely.

The cornea is made up of a thin layer of skin-like cells that cover the pupil and iris of the eye. The classic symptom of a corneal abrasion are eye irritation with a feeling like something is in the eye that you just can't get out. Eye watering, sensitivity to light, and vision trouble can also occur.

Here are some of thoughts we team docs have when managing this injury:
1. The pirate look is out.
Sad but true. Patches have not been shown to help corneal abrasions heal any faster, which makes sense if you think about it. A patch holds your eyelid down over the injured eye which continues to move as you look around with the other eye possibly causing continued mild trauma to the cornea. Less oxygen may get to a patched cornea and so slow healing as well. The only way patching may help is if sensitivity to light is really a problem.

2. No drops, maybe ointment.
We try not to get in the habit of using anesthetic drops just to get someone back to play because they can slow healing and may blunt the ability of the eye to protect itself by blinking. As for antibiotics, infection is an uncommon complication of corneal abrasions but easy enough to prevent with preventive antibiotics, especially if the poking agent is a dirty object like a tree branch. We use antibiotic ointments because the lubricating effect lessens eye discomfort

3. When to return to activity.
We tend to hold people out of work or athletics if their vision is affected. Many negotiate with me by saying they can see fine by just keeping one eye closed. Sounds good in theory until the loss of depth perception that occurs with monocular vision causes big trouble when the linebacker in your rear-view mirror is a lot closer than he appears or your free throws come up a foot short. If vision is good and discomfort is manageable we let them back into the action, sometimes with protection such as a visor for a football helmet.

Fortunately almost all corneal abrasions resolve within 1-3 days. It is still important to see a physician, and usually a family doctor is very comfortable handling this type of case, to be sure the abrasion isn't large or complicated and that other injuries of the eye are not present.

Unfortunately I my jumpshot makes it look like I'm still wearing that patch on my eye. Aaargh .