Whiplash - Mizzou, not Mizzou, Florida, not Florida, Mizzou...

 I haven't posted since Ray's surgery because it has been rather uneventful.  Ray had his follow-up with Dr. Smith on June 21, and the doctor was very hopeful of complete recovery.  We reviewed the surgical procedure on film and how the sutures were placed to re-form the posterior "bumper" - Dr. Smith was quite proud of his work, which made me happy.  

Regarding the recovery so far, it's been a little too easy.  Ray had pretty strict orders to wear the sling 24 x 7 - it was to be removed every hour to do "pendulum" exercises.  Ray was unable to sleep in the sling and ditched it pretty early on at night.  He made it maybe a couple weeks wearing it steady and then gave it up despite my admonishments.  He has not been in any pain (which ironically is part of the problem) and while he isn't moving it in any drastic directions, he is moving it more than recommended.  I gave up harping on him.  Tomorrow he starts physical therapy and I'm sure the therapist will be a little surprised by his current mobility.

The biggest event this week was with Northwest Florida State College.  Mizzou rescinded Ray's scholarship offer earlier this year because they had too many guys on the roster and not enough scholarship money (impact of new Covid rules).  They still wanted him, but no scholarship money - and we took a hard pass on that.  We emailed the top 10 junior colleges (Iowa Western, San Jac, Northwest Florida State (NWFS), and I can't remember the rest now) and several replied with interest.  Iowa Western was ranked number one and they made Ray a great offer.  But if he was taking the JUCO route, he wanted to go somewhere warm which meant south.  So we visited NWFS and were wow'd by their facilities, coaches, and overall regimen.  We were super excited and Ray committed to them on that trip.   

Then, yesterday, Coach Martin called us and said he didn't think Ray should show up this year because he wouldn't be 100%.  I really like Coach Martin, I had researched him prior to emailing them - I just wish I would have called him instead of the assistant coach when we knew Ray needed surgery.  The assistant coach had said all would be well, that Ray was just going to have to work extra hard (I had even asked him about PT and rehab, because Ray would still need it down there).  Coach Martin said it was a tough call to make but with a two-year program he has to have guys 100% ready by the season - and that was not going to be the case with Ray.  Ray won't return to throwing until November, and the juco season starts in February.  Their program is military like, I was so impressed.  I understood, I just wish the message would have been delivered before I signed a lease and paid a deposit!  Coach Martin helped resolve that, so all is well, but Ray is no longer Florida bound.  Coach Martin also said he'd love to have Ray next year if all goes well.

I hung up from Coach Martin wondering what the hell I was going to do with this kid for a year - and texted Coach Bieser at Mizzou.  The text said something along the lines that Ray had a posterior, not SLAP, lubrum repair by Dr. Smith (who happens to be the Mizzou ortho doc).  The prognosis is good, but Ray won't be ready by spring.  I asked Coach Bieser if there were any opportunities at Mizzou for Ray to stay mentally and physically engaged in baseball to the level he's capable, and not lose a year of eligibility - and Coach Bieser replied asking if he could call me.  He called a little later and said he had always planned on getting Ray back, his roster was just too packed this year - and yes, he will get Ray good rehab at Mizzou and get him all the attention he can while maintaining his eligibility.  It was a good call and I really appreciated it!  The Mizzou baseball program has been struggling but they hired a new pitching coach that comes highly regarded, so that bodes well for them.  (https://mutigers.com/news/2021/6/10/baseball-mizzou-hires-brian-delunas-to-guide-pitching-staff.aspx)

So the new plan is for Ray to go to Mizzou, participate in their program to the extent of not using any eligibility - and Coach Bieser and I agreed that by the end of next spring we should know Ray's level of recovery and we will all re-evaluate the situation then.  That's not the way I wanted Ray to get a little more time (he's still 17), but at least he has options still and is getting the extra year.  Ray can go back to Florida if the juco route is still the right thing to do, or by then - if he does fully recover - maybe there will be other options on the table.  Only time will tell!  I'm really proud of how Ray is handling all this - he keeps getting knocked down and the kid really doesn't deserve it.  He stays positive for the most part and is ready to get to work!  

He Blew It Up

Surgery with Dr. Smith was yesterday.  He visited with us beforehand, going over what we had discussed before.  Ray received a nerve block before being taken back, and I was dismissed to the waiting room.

An hour and a half in, I knew the repair was needed and was likely on the challenging side.  An hour and 45 minutes in, my buzzer went off, and I was taken to a room to wait for Dr. Smith.  He came in and said, "Well, mom, he blew it up."  He made a kind of explosion sound and gave the appropriate motion with his hands.  Showing me the pics he explained the biceps was good, the rotator cuff was good, the anterior labrum was good - then the area that was "exploded", "a big huge piece, explosion".  I marveled to myself at how that could be fixed (using the only analogy I could think of - trying to hem frayed cut off shorts, lol) - then said out loud, "What do you do with that?"  Dr. Smith replied with a sigh, "Yeah, I know.... it came out pretty damn good."  😂  Yes, sir... that's what I want to hear!  He explained he smoothed it off a little bit, took a little of it off, then smoothed it back down to kind of fill the hole.  He put these little anchors in the bone, and placed two sutures through the labrum to the anchors.  Now there's continuity of the labrum, restoring the ring and stability.  He called it a radial split, a complicated tear.

I was given a ton of information, but everyone at Columbia Orthopedic Group was really spectacular, and the nurse was very patient with me.  Instructions on which meds when, changing the bandage, bathing, the ice machine, the stim machine, how to put the splint on and placement, what could move (fingers and elbow) and what shouldn't move (shoulder)... mercy.   He has to stay in the "gun slinger" position with wedge in place so he can't internally rotate his shoulder.  

We left, Ray was starving and we stopped for sandwiches to go - he didn't have any nausea or lingering effects of the anesthesia.  Everything went pretty well until early this morning when the nerve block had completely worn off.  He was uncomfortable, stiff from not moving and wearing the wedge splint, and tired from lack of sleep.  In general he was pretty miserable and uncomfortable.  I was attempting not to use the percocet - something Dr. Smith suggested and I agreed with - but it was becoming too much.  So he's been on ketorolac and percocet, and he's is doing a lot better now than this morning.

Tomorrow we remove the bandage and he gets to shower.

         

Decisions Decisions - Labrum Repair or Debridement

So, Ray had his "second opinion" appointment with Dr. Patrick Smith who is the orthopedic surgeon for Mizzou athletes and a member of some SEC medical council.  His credentials are vast.  Dr. Smith's physical exam of Ray's shoulder was a bit different than Dr. Paletta's.  

After all the twists, pushes, and pulls on Ray's arms that we had now seen a few times, Dr. Smith had Ray lay on the table with his shoulder at the edge or slightly off.   He gently pushed down on Ray's shoulder , and it "bumped" out of position, and then gently back in.  The doctor looked at me and said, "Did you see that, mom?"  I certainly did see, and I also saw the look on Ray's face which said - not cool, man.  😝 The doctor sat Ray up, looked at us both and said, "That needs to be repaired".  <sigh>

We then went into a room with a computer screen and a physical model of the shoulder.  He reviewed the MRI results, pointing to where the tear was visible on the scan - and correlating it to the shoulder model.  He talked about suture placement to repair the labrum - how where the sutures are placed are important to sustained stability through pitching- and how he would do the repair making sure the shoulder stayed loose.  I knew in regard to pitching that that's where the rub lies (no pun intended) - overtight post labrum repair means velocity doesn't come back.  So, this all made sense to me.  But the thing that really tripped me up was when I asked about debridement.  Dr. Smith's exact statement was "I'm not a fan of removing chunks of the labrum". 😳

I left that appointment rather confused about Dr. Paletta's treatment plan, despite his reputation.  I called Dr. Paletta's nurse and asked how debridement would address the stability issue.  Ray could feel his shoulder slipping - and while he was still able to throw fastballs (granted, not nearly as fast), the arm movement required for a curveball was not possible.  Dr. Paletta's nurse assured me that Dr. Paletta would do what was necessary "when he got in there" and address any issues he didn't see on the MRI.  Ugh - I'm a planner, I want a plan - then deviate if necessary, but "winging it" isn't my nature.  But, the guy is a legend - literally working on Wainwright, Carpenter (Chris, multiple times), Edmonds, the list goes on and on.  How can I logically feel uncomfortable?  Well, it didn't matter how I felt, the decision was  not mine and Ray was set on going to Dr. Paletta.  The surgery was scheduled for June 3.

And then... 17-year-old minds went to work and decided to take a once in a lifetime road trip the week of June 3, the only week this once in a lifetime trip could take place (seriously, that was fairly accurate given this stage of life).  Letting go as a parent is not easy - but the time is here, and I called both Dr. Paletta's office and Dr. Smith's office for options.  Dr. Paletta came back with June 8, but the road trip would go to the 9th - Dr. Smith came back with June 10.  And in the end, that's how the decision made! 😂  I'm literally afraid to say it, I don't know why I am -  I got my way.

Torn or Frayed Labrum in a RH Pitcher

    I haven't written a blog post in many years.  I decided to pick it back up to document my son's experience with a "tear to the posteroinferior and posterior aspects of the glenoid labrum".  In doing research, I couldn't find many (if any) first hand accounts of treatment and outcomes.... so here it goes

    My son, Ray, has been pitching since the age of nine.  He's played baseball since he was five.  He's had consistently good training and was consistent with arm health and care.  He literally hasn't had one significant injury in his life.  With a longer lean athletic body, he was targeted as a pitcher early on.  The projections came true - he's over 6'3" (long legs and good gluteus maximus that he refers to as his "cake", lol) and is about 190 lbs.  He just finished high school, still 17-years-old, sitting 88-90 mph fastball, topping 91.

    The short story, the mid-April Ray threw a complete game, 7 innings.  He had been dominating his high school season.  A couple days following that game, he was messing around with friends on a disc golf course, unleashed a frisbee, and felt a pop in his shoulder.  It wasn't overly painful, but was uncomfortable and remained so for many days.  He was up to pitch again, and pitched a five inning shutout with no walks.  However, his velocity was down to the low to mid-eighties, and he couldn't throw a curve ball (due to shoulder instability).  Soreness and "popping" followed, and we schedule a trip to the doctor.  The MRI showed "a pitcher's worst injury" - a torn labrum.  We both cried.

    A subsequent trip to St. Louis Orthopedic Surgeon Dr. Paletta yielded what we would now view as good news - it was "frayed" and required debridement, vs. the dreaded SLAP tear or other tear requiring a repair.  The doctor indicated three months of PT after surgery, followed by one month return to throwing100% - a four month recovery.  In his experience, post surgery with debridement, 85% of pitchers return to 100%.  Really fantasic news!  Of course, it is possible it will look differently when scoped in surgery - in which case he'll fix what he sees and we'll go from there.

    The next step is to schedule surgery.  And... we have another appointment with Dr. Smith here in Columbia for a second opinion.  Dr. Paletta is the orthopedic surgeon for the St. Louis Cardinals.  He's been inside many multi-million dollar arms.  Dr. Smith comes with great references and is the surgeon rumored to be the go to for Mizzou athletes.  Dr. Paletta spoke highly of him and indicated they were very collaborative and familiar with one another - he was supportive of a second opinion and confident Dr. Smith would concur with the diagnosis and treatment plan.  If he doesn't, Dr. Paletta said we would then have a decision to make.

    In the meantime, weekly updates are to be provided to Ray's college coach.  High school graduation was yesterday, May 22, and Ray is due in Florida by August 15.  To maintain his scholarship, he has to be fully recovered and ready to play next spring.  I wish there was a playbook for this.  Anyone know a great PT program for elite pitchers recovering from surgery... and a great recipe for lemonade?