Tuesday, August 22, 2006

Another Med Student Perspective: Glavine's "Clot"

by Alan Eliot

The beauty of baseball is that, as we as fans gain life experience, the game reveals more to us- and we are privy to a much more enriching experience as a result. The act of being a die-hard fan, so primal and irrational at one level (for most fans, you pick your favorite team like you pick your religion, aka not really), is enhanced at another level by our intellectual gains.

For example, the physics major has a newfound respect for batted balls, paying particular attention to the angle of trajectory and mass of the bat, along with its velocity and acceleration, in determining its ultimate flight path. The economist is more interested in the backroom negotiations, along with the forces of supply and demand that drive the business of baseball. The ten-year old might not appreciate the subtle undertones inferred when a guy like Pat Burrell reportedly says that he's slept with half of the female population of Philadelphia. To other, older fans, they might infer that he is referring to a phenomenon common to men of high status and possessing vast amounts of wealth- and to the social and sexual access they have to society's most beautiful women.

So it alarmed me, as a medical student, when I heard of a possible blood clot in Tom Glavine's shoulder. However, what alarmed me even more than that was the sort of misinformation that I had seen in the press. Specifically, to this following statement:

"Blood clots restrict blood flow and can lead to a heart attack or a stroke"

Even more disappointing was the source of this piece of information- the normally very reliable New York Times. Source is here. The same was found in an article by the Daily News.

Now, to be clear, that quote is actually 100 percent correct, scientifically speaking. However, given that the article was clearly discussing a clot somewhere in an artery in Glavine's arm, the inferred conclusion is that worst-case scenario, Glavine's presumed clot could lead to a heart attack or a stroke. And that is completely untrue.

To bring it into perpective, I'll make an equivalent but equally ridiculous assertion. Let's say there were an article about a man shot in the arm. Here is how I would cover it, Daily News or New York Times style:

Last night, Tom Glavine, of New York, NY, was shot in the left arm by an unknown gunman. Gunshot wounds to the heart or brain are fatal.

It's alarmist at best, and given that most people don't know much about blood clots, it borders on misinformation.

The reason is that if you have a clot that forms in a heart vessel, yes you can have a heart attack, because it may end off cutting off blood supply to your cardiac muscle. And if you have a clot that forms in the brain, or leading to the brain, yes a stroke may occur, for the same reason. But we are not living in lala-land full of hypotheticals, we are living in the real world. And in this real world, there is a man with a possible clot in his arm. HIS ARM.

This is something we should have fun with though. Imagine the following exchange:

Tom: Hey David, slap me five!

<slaps him five>

Tom: You know, that was great. You slapped my hand.
David: That I did.
Tom: But you know, had you slapped my face that would be considered battery.
David: Um...yes, but...
Tom: And if you slapped my ass that would be sexual harrassment
David: Um. OK. But I didn't slap your ass. I slapped your hand.
Tom: Right, I'm just saying. It would have been sexual harrassment.
David: <silence>
Tom: Same slap, different location, totally different results.
David: Yeah. So I'm questioning both the relevancy of the preceding fact, as well as your sanity...

To be absolutely clear, if there is a blood clot in Glavine's artery in his arm, there is a ZERO percent chance it will lead to a heart attack or a stroke.

Blood is carried away from the heart in arteries. They are like one-way streets. If the clot dislodged from the presumed shoulder site, it would be carried down further into the arm towards the hands, and only in that direction. And sure, damage could result, but at worst, it would involve cutting off blood supply to parts of the arm or hand, and would necessitate emergency surgery to prevent death of tissue. But certainly not death itself.

Now, blood is returned to the heart in veins. It is also possible that a vein has a clot in it, which could cause symptoms as well. Now technically that CAN dislodge and travel to the heart, but not to the heart's vessels. It would travel to the heart's chambers itself, like regular blood, and then would be pumped to the lungs, where it would get stuck. That would be called a pulmonary embolism, and that could be fatal, but would most likely not be. The only time a clot travelling to the heart could cause a stroke is in the very rare chance that Glavine has a hole in his heart.

Regardless, the issue, as seen on imaging, is presumably in one of his arteries. So we won't go into a vein hypothetical.

Finally, articles on the issue have brought up that Glavine has had Raynaud's Phenomenon for at least 16 years, which is a condition that causes sudden decreased blood (and thus oxygen) supply to fingers/toes, especially in cold weather. Experiences like Glavine's, in which he'll complain of intermittent finger coldness, is common. In a person with a history of Raynaud's, a sudden cold finger, then, isn't very alarming, even if it is one that was previously unaffected. It is possible that there is no serious issue in the shoulder at all, and that this is just a natural progression of his underlying condition. This was my first reaction when I'd heard about the Raynaud's. In fact, with how vague the reports have been detailing what, if any, clots have been found, Mets fans for the time being can continue to hope that there is no clot to worry about at all. Amazingly, without any official released reports, media outlets are already presuming a clot. How to treat? How long will he be out? Are the Mets finished? With so much still unknown, they would do well to stick to the facts, both actual and contextual.

Interestingly, the debate occasionally comes up wondering which sport Glavine would have excelled at more: hockey or baseball. Glavine was an ice hockey phenom growing up, and was drafted into the NHL the same year he was drafted into MLB. Given the fact that we now know Glavine has an underlying condition brought on and worsened by cold, I think baseball was a wise choice.

Just another foray into the mind of a medical student. Like I said, we all think of baseball- that same game of pitchers and catchers- very differently, based on our personal past experiences and interests. And when you consider 50,000 fans in the stands with 50,000 very unique experiences of the very same plays, it sheds a light onto how truly awesome baseball is. You may all be cheering or booing at the same time, but baseball's still a lot of different things to a lot of different people, and that's what makes it great.

You can read some previous medical ramblings about steroids here.

Alan Eliot's column, "The Stories We Tell", appears alternate Tuesdays. He is currently in his final year of medical school.

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