Friday, March 28, 2008

Hamilton's 'Stiff Back' Could Be More Serious

According to the Dallas Morning News:

"... outfielder Josh Hamilton said he was taking some different anti-inflammatory medication for a slightly stiff back and it didn't sit well with him Tuesday. He was clearly feeling better Wednesday when he hit a homer off Padre's Ace Jake Peavy ..."

We wonder what "inflammatory" condition the Rangers' outfielder is suffering from? A slightly stiff back? That's inflammation?

The lemming public are no different from athletes ponying up to various medical treatments designed to relieve various maladies from headache to fever to muscular aches and pains. These anti-inflammatory medications work because they disrupt the formation of prostaglandin, a biologic mediator of pain and inflammation, from a natural biologic substrate knows as arachadonic acid. Corticosteroids (e.g. prednisone), not to be confused with muscle-building anabolic steroids, do the same thing.

Why isn't that widely prescribed for this so-called inflammation? Because every treatment carries an inherent risk-benefit ratio. Corticosteroids work very, very well. Prolonged use can also can result in cataracts, psychosis, thinning of the bones, elevation of the blood sugar, and gastrointestinal bleeding. So they are prescribed cautiously where the benefit exceeds the risk.

Recent reports say Richie Sexson just received a corticosteroid injection in his ailing shoulder. Direct injections into the offending anatomy are believed to work better, faster, and may avoid some of the adverse systemic effects of the medication, although there is dubious scientific evidence of that.

But, back to Hamilton's apparent medication-induced stomach distress. Clearly, he is not taking oral corticosteroids but is taking one (or more) of about a dozen NSAIDs (nonsteroidal anti-inflammatory drugs) such as Motrin, Naprosyn, Voltaren, etc. We have such a penchant for anti-inflammatory drugs in this country that these agents produce 200,000 hospitalizations annually in the United States including 2,000 deaths due to NSAID-induced gastropathy -- gastrointestinal erosions causing severe and life-threatening bleeding.

True, the vast majority of these adverse medication effects are produced in older Americans who have multiple underlying medical risk factors including taking other medications that can potentate the adverse effects. But the vast majority of NSAID prescriptions are for joint pain -- degenerative arthritis that is ubiquitous in the aging population. This is vastly contrary to inflammatory arthritis, e.g., rheumatoid arthritis which is a rare problem.

So, Josh Hamilton has a stiff back? Is there local physiologic heat, swelling, and various cellular proteins causing Mr. Hamilton's stiff back? No, he has a muscle strain not dissimilar from a superficial injury to the skin. If you suffered a paper-cut, would you run for a bottle of ibuprofen? No, you'd wash it and put on a Band-Aid and in 24 hours the skin would be healed. So it true for minor muscle strains.

Muscle strain (i.e., micro tears or small ruptures of the muscle fibers suffered from overuse) is not an inflammatory condition and bouncing around between one NSAID or another, waiting for nature to heal the injury, is preposterous. Now, as we all know, Hamilton is no stranger to using a wide variety of medicinals including those for recreational purposes. But, why would anybody want to risk a gastric or peptic ulcer when all he needed was a little rest, local heat, and some acetaminophen (e.g., Tylenol) for the pain?

It is just as possible that instead of reading the report that the medication didn't "sit with him," we could be reading: "Texas Rangers' outfielder Josh Hamilton will start the year on the disabled list as he is admitted to a local Dallas hospital for endoscopy in evaluation and treatment of gastrointestinal bleeding ..."