Aug 15 2010 10:00 PM
Bay’s Concussion May Signal Need for Change in Mets’ Protocol
By DAVID WALDSTEIN
Published: August 15, 2010
| When Mets outfielder Jason Bay ran full speed into the padded outfield wall at Dodger Stadium last month after catching a long fly ball, then crumpled to the ground, it appeared he had hit his head, face first, against the blue padding. Bay lay motionless for an instant on the warning track. After he slowly got up, he said he told the Mets’ athletic trainer, Ray Ramirez, that he had injured his back and knee, but had not hit his head on the wall. Based on that, Ramirez and the Mets’ medical staff did not give Bay a complete neurological examination to determine if he had sustained a concussion. They allowed him to remain in the game, and play the next two games. It turned out that Bay did sustain a concussion, which a specialist in New York determined only after he returned home. It was not from the impact of his head hitting a wall, the doctor concluded, but from the trauma caused by his head snapping backward, causing whiplash. In essence, his brain slammed against his skull, and the symptoms did not surface until two days later on the flight home. Bay has not played in three weeks, and although he is improving and expected to recover, a concussion from whiplash can be severe enough to end a career. It did for Corey Koskie, a former Twins, Blue Jays and Brewers third baseman who retired after he sustained a similar injury in 2006. “It was two and a half years of my own personal hell,” said Koskie, who eventually recovered from the symptoms, but by then was 36 and had been out of baseball too long to get back in. As Bay waits at home for the symptoms to subside, the Mets appear to have learned a lesson from the episode and are expected to expand the conditions under which trainers will regularly check for neurological damage. “We are looking into that,” the assistant general manager John Ricco said. “I think we will probably change the protocol so that if there is a serious impact, even if the head doesn’t hit something directly, it will be checked out.” While Bay’s injury went undetected, he might have exacerbated it, according to Dr. David Hovda, the director of the U.C.L.A. Brain Injury Research Center, by continuing to play after it happened in the second inning of the Mets’ game against the Dodgers on July 23. In the immediate aftermath of a concussion, the brain is particularly vulnerable to further injury, including from relatively minor events like quickly rotating the head. “By playing again, he could have exposed the brain to a secondary injury, and that can make it worse,” Hovda said. But according to Hovda, Ramirez was not remiss in declining to order a neurological exam given the information he received from the 31-year-old Bay at the time. The Mets do not allow their medical staff to speak to reporters, but Hovda assumes Ramirez followed the Mets’ standard procedure, and strongly agrees with Ricco that it should quickly change to allow for the possibility of a concussion from whiplash. He said it would have taken a particularly diligent trainer to consider the possibility of a concussion even when the player said he did not hit his head, but he thought all teams should include that in their protocol. “It’s almost inexcusable if it’s not already based on data we have had since 2000,” he said. “But it’s really unfair for the trainer to be responsible if they are told by the player that he didn’t hit his head, and he is following the S.O.P. In hindsight, yes, of course they should have checked him out. But at the time, there was no indication from the player that something happened. “If I was the owner of a team, and I had a lot of money invested in this player, I would not take a chance. I would order a full neurological examination just to make sure.” Two years ago, the Mets were criticized for their handling of outfielder Ryan Church’s concussion. Church was allowed to fly and play in Denver before the symptoms were gone, and they became worse. But Hovda said, referring to Bay, that there was no evidence cabin pressure from a flight had any effect on the severity of concussions. He also noted that if Bay was still feeling the effects of the concussion three weeks on — including headaches, dizziness, nausea — he might continue to do so for another month, which would effectively end his season. Hovda said some of those symptoms could also be the result of a neck injury associated with the whiplash. Such an injury can affect the inner ear, causing vertigo, dizziness and vomiting. That is what Koskie said he thought happened to him. On July 5, 2006, Koskie fell while chasing a pop-up. He hit his head slightly and stayed in the game, but was later removed. It was determined that it was not so much the impact of his head hitting the ground, but the whiplash that caused the concussion. “It was awful,” he said. “I could barely move. I couldn’t be in the sun, I couldn’t get my heart rate over 110. Everything seemed strange. It was like I was watching my life through the lens of a video camera.” Now the owner of two health club franchises in Minneapolis, Koskie said it was not just the concussion that caused his enduring symptoms, but also the neck injury. When he finally saw a specialist who did osteopathic manipulations of his neck, everything changed. “I would wake up sometimes and I couldn’t feel one side of my body,” Koskie said. “I was told I had an anxiety disorder. You would feel pretty anxious, too, if you couldn’t feel one side of your body. People say brain, brain, brain. Yes, it’s that, but I think the neck and the upper cervical column was just as critical. I don’t have any medical evidence, but once they fixed that, I was fine.” |
http://www.nytimes.com/2010/08/16/sport ... 16bay.html