The Pains Of Diagnosing

For NFL doctors, making decisions on the sidelines isn't always easy.

October 13, 2006|By Childs Walker | Childs Walker,Sun reporter

Chris Simms thought the hit had rattled his insides like so many before it and that if he simply kept playing, he'd be fine.

Corey Ivy thought he felt rib soreness, a condition so common in the NFL that it's the equivalent of a regular person's sore throat. He sat out a few plays and went back into the game.

A few hours after a game less than a month ago, Simms lay in a hospital bed, having his spleen removed. A few hours after he played Monday night, Ivy was rushed to a Pittsburgh hospital with a kidney tear that had forced the Ravens to divert their plane unexpectedly. Either conceivably could have died from an injury that he chose to play through.

Simms is expected to make a full recovery. It takes about six weeks to heal from having your spleen removed, and the Tampa Bay Buccaneers and Simms have not ruled out Simms playing again this season. Ivy was released from the hospital yesterday and is driving back from Pittsburgh with his wife. His prognosis for the rest of the season is unknown.

Veteran NFL doctors say they've rarely seen two such injuries happen so close together. But both cases were reminders that when men crash into each other at full speed, body parts can rip, bruise and shatter. For the doctors on the sidelines, it's not easy to tell who broke what when.

"If you took a guy out after every vicious hit, you'd end up with nothing but cheerleaders playing each other pretty quickly," said Dr. Bill Howard, a longtime sports surgeon at Union Memorial Hospital.

More threatening conditions can be hard enough to diagnose in an ideal clinical setting.

Now, imagine having to interpret the bodies of players who embrace pain with every action they take in their chosen profession. Imagine having to make snap decisions about their well-being with 65,000 people screaming in the background and limited technology at your fingertips. Imagine having to talk down guys who've gotten where they are because they always play on.

"It's a hell of a hard job," said Dr. Andrew Bishop, who served as team physician for the Atlanta Falcons for 12 years. "You've got the crowd, lots of commotion, the coach yelling at you, `Can he play or can he not play?' You have to be able to tune it all out, and it's not easy if you don't have the experience."

But Bishop said once he got used to the chaotic context, a football sideline became just another clinical setting. He saw one injury like Ivy's during his tenure.

"It was a guy who got kicked while he was down and had a lot of pain, but that's something you see every game," he said.

The player sat out a few plays in the second quarter but returned for the rest of the game. He still felt unusual pain near his kidney after the game, so Bishop insisted he urinate before leaving the stadium. The blood in his sample indicated he had an internal injury.

"It was really just a gut feel from being around it that something wasn't quite normal," Bishop said.

He said that if a player came to him complaining of rib soreness, as Ivy did, he would poke around and see if he felt anything crackling. "But if he just had soreness around his lower posterior ribs, that's extremely common," he said. "Given those symptoms, I would probably let him go back in and play."

He praised Ravens doctor Andrew M. Tucker as one of the best and most experienced, and lauded him for having the plane land when he noted Ivy's worsening symptoms.

"I applaud his guts and courage," he said.

Nothing new planned

Ravens spokesman Kevin Byrne said the organization has faith that Tucker will use the right procedure in any injury situation. Tucker declined to be interviewed for this story. An NFL spokesman said the league is always reviewing its policies but has no plans to recommend new procedures based on the unusual injuries to Simms and Ivy.

Howard, a colleague of Tucker's at Union Memorial, has seen his share of kidney bruises and ruptured spleens, and said they're not easy to diagnose.

"Anything abdominal can be very treacherous," he said. "You see the shot, but the player doesn't get into trouble for minutes or much longer. Believe me, it's not always obvious."

Howard said if he sees a player take a vicious hit, he'll monitor him to see if he behaves differently. He might also follow up with a few questions once the player reaches the sideline. A player with a kidney injury will probably ultimately have blood in his urine, and one with a ruptured spleen is likely to become pale and sweaty. But until those symptoms manifest, the injuries are nearly impossible to diagnose, doctors said.

"It isn't like a guy falls over and says, `Oh yeah, I ruptured my spleen,' " said Dr. Pete Indelicato, a former team physician for the Miami Dolphins who works with University of Florida athletes. "It's not like a knee injury where a guy tells you he blew out his knee. Even for the most astute doctor, abdominal injuries can seem very benign clinically for a long time."

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