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ice-9
06-24-2013, 06:10 AM
Check out the Simmons-Rose job interview with Alex Len. There was a really interesting tidbit from that interview: http://www.youtube.com/watch?v=kqkEo_Pk9HI

When Len thought he was injured during the season and told the Maryland staff about it, all they did was ice and steam his ankle and promised an MRI after the season. Of course, that MRI revealed a partial stress fracture. Is it just me, or is that kind of messed up?? If I thought I had an injury I would get an MRI immediately; and I'm not even an athlete whose future livelihood depended on my physical health. The implication with Len of course is that the Maryland coaches didn't want to know what an MRI could reveal in-season, and so took advantage of the situation by delaying it until after the season.

Never mind, it's not just me, that IS pretty effing messed up.

I hope it's not something the Duke coaches would do to our players.

BD80
06-24-2013, 08:00 AM
Check out the Simmons-Rose job interview with Alex Len. There was a really interesting tidbit from that interview: http://www.youtube.com/watch?v=kqkEo_Pk9HI

When Len thought he was injured during the season and told the Maryland staff about it, all they did was ice and steam his ankle and promised an MRI after the season. Of course, that MRI revealed a partial stress fracture. Is it just me, or is that kind of messed up?? If I thought I had an injury I would get an MRI immediately; and I'm not even an athlete whose future livelihood depended on my physical health. The implication with Len of course is that the Maryland coaches didn't want to know what an MRI could reveal in-season, and so took advantage of the situation by delaying it until after the season.

Never mind, it's not just me, that IS pretty effing messed up.

I hope it's not something the Duke coaches would do to our players.

One, with Duke's history of foot injuries, I believe the entire team undergoes regular MRIs every Friday during the season, and every other Friday during the off-season.

Two, Maryland's athletic department is in bad shape financially, maybe they were just controlling costs ...

DukeAlumBS
06-24-2013, 08:31 AM
MRI are not done that freely on a routine ankle exam. It is done to assess soft tissue and ligament injury. But it is not your routine thing an orthopedist or ER type does. I am sure he had the correct exam and correct documentation of exam for the ankle. There is certain protocol an ER type or ortho type that does the exam and documents the exam. If you have a negative Xray and suspect stress injury. It is appropriate to have the patient come back. Redo the xray to document stress injury or calcifications on bone 2 weeks to 30 days after first. Again, MRI is not the first thing done in this situation, but xray. I am sure he got great care. Maryland gave us shock trauma BTW. And a great system. Nice day, Jimmy

FerryFor50
06-24-2013, 12:35 PM
MRI are not done that freely on a routine ankle exam. It is done to assess soft tissue and ligament injury. But it is not your routine thing an orthopedist or ER type does. I am sure he had the correct exam and correct documentation of exam for the ankle. There is certain protocol an ER type or ortho type that does the exam and documents the exam. If you have a negative Xray and suspect stress injury. It is appropriate to have the patient come back. Redo the xray to document stress injury or calcifications on bone 2 weeks to 30 days after first. Again, MRI is not the first thing done in this situation, but xray. I am sure he got great care. Maryland gave us shock trauma BTW. And a great system. Nice day, Jimmy

Regardless, they wanted to do one after the season... so why wait until then? Unless you knew you were likely to find something you didn't want to find...

ice-9
06-25-2013, 07:38 AM
Regardless, they wanted to do one after the season... so why wait until then? Unless you knew you were likely to find something you didn't want to find...

Precisely! If I was Alex Len I would be furious. What if he had aggravated the injury into something more serious during the season?

davekay1971
06-25-2013, 08:04 AM
Definitely appreciate DukeAlumBS's knowledge here. But I have to agree that it sounds really bad that an MRI was, apparently, recognized as something that would need to be done, but was postponed until after the season. If the medical staff felt that an MRI was, ultimately, necessary, then why wait?

I could understand the situation if Len got a good exam and the staff didn't feel an MRI was necessary, but later decided to do an MRI because symptoms were persisting. However, if they decided early on that an MRI would be needed, then there is no good reason (but plenty of bad reasons) to wait until after the season.

JasonEvans
06-25-2013, 09:08 AM
As time goes by, I think more and more that losing Maryland won't be that big a deal to the ACC. I am not sure they brought very much to the table and the stench of impropriety and scandal seems to emanate from College Park a bit too often for my taste.

-Jason "I agree with others -- if a MRI was needed, the only reason to wait was to keep him playing as long as possible" Evans

DukeAlumBS
06-25-2013, 09:49 AM
Let me try again. There are protocols (ER) that are done to evaluate the ankle and the foot. This is a very involved exam when the patient is first seen and an Xray is done also. The MRI is again not indicated for this type of injury if your "exam" is "negative." If vascular compromise or neurological then maybe. Again, the MRI is not used emergently in assessing the ankle or foot. Any ER or orthopedic surgeon the MRI is not part of the care immediately and after injury resolves(6-8 weeks).It is used to assess a chronic type of issue. Such as microscopic stress injury. IMO Maryland does great medicine. This guy was seen by a very solid sports medicine type on his first exam! Have nice day, Jimmy

bob blue devil
06-25-2013, 10:11 AM
for those that don't want to sit through the whole video, it's at the 9 min mark.

i laugh at maryland as much as the next guy, but i think we're jumping to conclusions a bit here. suggesting that maryland intentionally avoided getting a proper diagnosis so that they could benefit themselves is very serious and shouldn't be tossed around so lightly.

in this case len's exact words could be interpreted a few ways, and that ignores the fact his rough english could easily lead to misunderstandings. specifically, he says, "i told my trainers, but we treated it like a regular ankle sprain. we did a lot of treatment: icing, stuff like that, steam. but we decided to do an mri after the season". that could very easily mean, "we thought it was an ankle sprain, treated, but then decided to do an mri after the season because it hadn't healed." len seems to use "but" as a filler, so i'm not going to overanalyze the exact wording. note, the alternative interpretation of his comments match pretty well with what DukeBS is saying - mri if you have a chronic situation.

btw, rose and simmons (not a fan of either) missed an opportunity. they could have tried to conduct an actual nba interview, which would have been fascinating, but instead did a regular old media interview (which was fine). simmons is a real feminine product.

Henderson
06-25-2013, 10:27 AM
Let me try again. There are protocols (ER) that are done to evaluate the ankle and the foot. This is a very involved exam when the patient is first seen and an Xray is done also. The MRI is again not indicated for this type of injury if your "exam" is "negative." If vascular compromise or neurological then maybe. Again, the MRI is not used emergently in assessing the ankle or foot. Any ER or orthopedic surgeon the MRI is not part of the care immediately and after injury resolves(6-8 weeks).It is used to assess a chronic type of issue. Such as microscopic stress injury. IMO Maryland does great medicine. This guy was seen by a very solid sports medicine type on his first exam! Have nice day, Jimmy

1. I don't purport to be an expert on this, but if an MRI wouldn't have been indicated here, why would the coaching staff promise him one, but only AFTER the season?

2. The University of Maryland may do great medicine at their medical school. But we're talking here about the coaching staff purportedly stepping in and making a call that an MRI would be done, but not until after the season. If you don't want to know the answer, you don't ask the question.

DukeAlumBS
06-25-2013, 10:56 AM
1. I don't purport to be an expert on this, but if an MRI wouldn't have been indicated here, why would the coaching staff promise him one, but only AFTER the season?

2. The University of Maryland may do great medicine at their medical school. But we're talking here about the coaching staff purportedly stepping in and making a call that an MRI would be done, but not until after the season. If you don't want to know the answer, you don't ask the question.

I am assuming they had a negative foot and ankle exam except for a sprain. We saw this with Kelly. 6-8 weeks to get better from a foot/ankle sprain. I sense he had a forefoot dislocation IMO which is not seen on first exam. And routinely missed.
Emergency medicine and orthopedic do not routinely get an MRI of bone and soft tissue. For instance, it takes the sprained ankle to get better 6-8 weeks.
It has nothing to do with costs , some places yes. Not a D1 basketball team that has great medicine. Again, they are not done on a routine basis for a sprain of the ankle or foot.
I can see a chronic situation such as this crop up. And it is OK to put off the MRI to see if microscopic calcifications develop.
Again in any emergency room or orthopedic setting. An MRI is "not indicated" to evaluate the ankle.
Have nice day my friends.

Here is a Turtle
06-25-2013, 11:04 AM
I think everyone is jumping to conclusions too quickly. Like mentioned earlier, Maryland has a great sports medicine program he had great care. Most people I talked to about it that know Len said what he said in an interview: it was a sprained ankle. It's not unheard of. Look at Kevin Ware. Apparently he had a stress fracture that no one knew about. It happens.

I have a really hard time to believe that Turgeon would not shut him down and ruin his chance at a number 1 pick by not allowing him the chance for pre draft drills. And if he stayed an extra year in college, you don't think they would shut him down for next year?

When Pe'shon Howard was injured, the coaching staff thought it was bad enough for an MRI and shut him down for the season. If the numerous season wnding injuries to the women's team and football team is any indication, the staff has no issue doing MRI's if they honestly believe its something bad enough to warrant it. If they shut down the starting point guard coming off a decent season, you don't think they would do the same to a starting center with mediocre stats who may benefit Maryland more in recruiting by going number 1 and being a talking point to recruits like Goodluck Okanoboh or Trayvon Reed?

I'm sorry, I can't buy it, and I think people here are overreacting.

DukeAlumBS
06-25-2013, 11:06 AM
FUI sports medicine and orthopedics evolved at Duke by Dr. Bassett god rest his soul. He was the chair of orthopedics at Duke and was the "pioneer" in sports medicine. He wrote the sports medicine books.
An MRI is not done on a foot or ankle injury . It is not indicated there as well at DUKE.
Maryland has great medicine. The player got great care IMO

Nice day

cato
06-25-2013, 12:12 PM
I don't purport to be an expert on this, but if an MRI wouldn't have been indicated here, why would the coaching staff promise him one, but only AFTER the season?

Well, let's start with the non-expert stuff: how do we know that MD (heh, heh) promissed an MRI after the season?

billy
06-25-2013, 12:21 PM
FUI sports medicine and orthopedics evolved at Duke by Dr. Bassett god rest his soul. He was the chair of orthopedics at Duke and was the "pioneer" in sports medicine. He wrote the sports medicine books.
An MRI is not done on a foot or ankle injury . It is not indicated there as well at DUKE.
Maryland has great medicine. The player got great care IMO

Nice day

I doubt that MD did anything suspicious like withhold a MRI from Len - I agree that a MRI isn't the first choice for most people. That said, doing a MRI in an athlete (especially pro) is fairly common, even for a sprained ankle. I believe the guidelines you were mentioning above for determining whether an XRAY is indicated after an ankle injury (i.e. sprain) are the "Ottowa Ankle Rules" which assist in determining the necessity for an xray but don't replace clinical intuition.

Frank Bassett was a great, great man, a true pioneer (if not "the") in the field of sports medicine. I don't believe he was ever the chairman at Duke however. That line went Lennox Baker, Leonard Goldner, and James Urbaniak while Bassett was at Duke.

Henderson
06-25-2013, 12:52 PM
Well, let's start with the non-expert stuff: how do we know that MD (heh, heh) promissed an MRI after the season?

Because Len said so in the interview? (9:00 - 9:38).

Jalen Rose made the point that college staff don't want to get a diagnosis during the season (reasons unspoken but obvious). Simmons said, yeah I don't like that waiting to the end of the season. And the MRI may not have been indicated for a non-athlete, but (a) it was discussed and rejected until the end of the season; (b) the MRI is what showed the stress fracture he'd been playing on in the interim; and (c) Alex Len is not some guy who showed up at the doctor's office or ER with a sore ankle. He had a LOT riding on making sure his ankle's health was protected. And it seems the MD staff let him down. MRI's are expensive and (for most of us) have to be justified for the physician to get insurance reimbursement. Major college athletic departments don't withhold diagnostic analyses to save money like that. Not even a struggling MD would fail to pay for an MRI if it would be helpful to them.

Classic case of "Let's not look in case we don't like what we see." Shame they did that to a guy poised to make huge $$ in the NBA if healthy.

Edit: P.S. Loved the fact that when asked, he identified Mason Plumlee as the most physical guy he played against in college. That remark came right around the time they showed a film of Len going up against Nerlens Noel.

Zeke
06-25-2013, 02:49 PM
Please forgive me for being so dumb! I, however, have a hard time understanding why an MR is not "indicated" in a possible stress fx situation. As I understand it, plain x-rays often/usually are negative is stress fx's, so you often/usually don't really have a confirmed dx after them. Granted that the initial treatment is about the same but to have a confirmed dx for planning purposes would be nice.

bob blue devil
06-25-2013, 05:11 PM
Because Len said so in the interview? (9:00 - 9:38).


He does not exactly say what you claim, no. I can see how you might interpret it that way, but that is not how I took it.

Henderson
06-25-2013, 05:58 PM
He does not exactly say what you claim, no. I can see how you might interpret it that way, but that is not how I took it.

What he said (see the video) is that he told the trainers at MD he had a problem despite the icing and steam treatment, but "we decided to get the MRI after the season, and after the season then we found out I had a problem."

So who do you think was saying, "Let's do an MRI, but after the season"? Alex Len? If an MRI was being contemplated during the season to find out why his ankle wasn't responding to the ice and steam, why wait until the end of the season? [Rhetorical question alert].

sagegrouse
06-25-2013, 06:06 PM
I don't for one second believe that the Maryland coaching staff or team doctors put off an exam until the end of the season because they didn't want to hear the wrong answer: i.e., discover a medical problem that would sideline Alex Len for the rest of the season. And I personally don't care what Jalen Rose and Bill Simmons are saying on the subject.

sagegrouse
'And I thank DukeAlumBS and resident orthopod Billy for weighing in'

bob blue devil
06-25-2013, 06:15 PM
What he said (see the video) is that he told the trainers at MD he had a problem despite the icing and steam treatment, but "we decided to get the MRI after the season, and after the season then we found out I had a problem."

So who do you think was saying, "Let's do an MRI, but after the season"? Alex Len? If an MRI was being contemplated during the season to find out why his ankle wasn't responding to the ice and steam, why wait until the end of the season? [Rhetorical question alert].

I quoted Len's comment in an earlier post. He does not say what you've said here; you are taking liberties with his comments to support your argument. Sorry, but sometimes you need to call a spade a spade. I suggest you focus only on Lens words and not the 2 interviewers.

Henderson
06-25-2013, 07:59 PM
I quoted Len's comment in an earlier post. He does not say what you've said here; you are taking liberties with his comments to support your argument. Sorry, but sometimes you need to call a spade a spade. I suggest you focus only on Lens words and not the 2 interviewers.

Your quote cut out parts -- the critical part where he says they decided to do an MRI but only after the season ended, and only then it became clear he had a stress fracture problem. I stand by what we can all see Len say in the video, and which I quoted verbatim. Nutshell: They agreed to do an MRI, but only after the season ended. And when they did the MRI, it revealed the stress fracture he'd been playing on for a month AFTER complaining that the steam and ice weren't working.

toooskies
06-25-2013, 11:07 PM
Your quote cut out parts -- the critical part where he says they decided to do an MRI but only after the season ended, and only then it became clear he had a stress fracture problem. I stand by what we can all see Len say in the video, and which I quoted verbatim. Nutshell: They agreed to do an MRI, but only after the season ended. And when they did the MRI, it revealed the stress fracture he'd been playing on for a month AFTER complaining that the steam and ice weren't working.

I'd be careful about medical malpractice claims, especially if you support Duke. Ryan, Seth, Josh, and Marshall all had injuries which required surgery in the offseason.

Marshall's surgery was explicitly to fix the stress fracture he'd had all year, and it sounds awfully like Len's injury. Ryan also delayed surgery, perhaps unwisely. Seth was injured in the preseason, but only needed 3 months off for surgery. Josh was injured February 16th, and played a month and a half with torn ligaments in his thumb.

I'm not saying Duke did anything wrong in any of these situations, but you're reading into the words of a guy who has spoken English for all of two years, just because you dislike Maryland. They'd probably say the same, or worse, about us.

Henderson
06-25-2013, 11:22 PM
Do we have any evidence that a Duke player was delayed a critical diagnostic procedure to wait until the end of the season?

bob blue devil
06-26-2013, 08:24 AM
Your quote cut out parts -- the critical part where he says they decided to do an MRI but only after the season ended, and only then it became clear he had a stress fracture problem. I stand by what we can all see Len say in the video, and which I quoted verbatim. Nutshell: They agreed to do an MRI, but only after the season ended. And when they did the MRI, it revealed the stress fracture he'd been playing on for a month AFTER complaining that the steam and ice weren't working.


okay, humor me for a second, what parts of importance to this debate did I leave out and specifically when in the interview were they said? my quote (which I've included below for ease of reference) includes the part about doing an MRI after the season.


... specifically, he says, "i told my trainers, but we treated it like a regular ankle sprain. we did a lot of treatment: icing, stuff like that, steam. but we decided to do an mri after the season".

i believe you are interpreting the last sentence to mean that during the season they decided to do an mri after the season, however it could just as easily mean (and I do believe it does mean) that they didn't decide to do an mri until after the season. but again, since you claim i'm leaving out parts of the quote, i suppose you should be referring to a different part of the interview, which i look forward to reviewing once you point me to it.

thanks for clearing this up. i look forward to your response with exact quotes and references to specific times in the interview.

cato
06-26-2013, 11:29 AM
Because Len said so in the interview? (9:00 - 9:38).

No. He didn't. You are taking what he actually said, and inferring what you want to infer.

Your inference could be correct, I suppose, but I read his quote as something much more prosaic. They treated the injury as a sprain, but when it did not resolve, ordered an MRI.

Also, if a medical staff is corrupt enough to commit malpractice and delay necessary care in order to get an athlete on the floor, I assume they are also smart enough not to tell the athlete what they are doing. Then again, I am just assuming they care about their license and avoiding malpractice claims.

sagegrouse
06-26-2013, 11:48 AM
I quoted Len's comment in an earlier post. He does not say what you've said here; you are taking liberties with his comments to support your argument. Sorry, but sometimes you need to call a spade a spade. I suggest you focus only on Lens words and not the 2 interviewers.


Your quote cut out parts -- the critical part where he says they decided to do an MRI but only after the season ended, and only then it became clear he had a stress fracture problem. I stand by what we can all see Len say in the video, and which I quoted verbatim. Nutshell: They agreed to do an MRI, but only after the season ended. And when they did the MRI, it revealed the stress fracture he'd been playing on for a month AFTER complaining that the steam and ice weren't working.


okay, humor me for a second, what parts of importance to this debate did I leave out and specifically when in the interview were they said? my quote (which I've included below for ease of reference) includes the part about doing an MRI after the season.



i believe you are interpreting the last sentence to mean that during the season they decided to do an mri after the season, however it could just as easily mean (and I do believe it does mean) that they didn't decide to do an mri until after the season. but again, since you claim i'm leaving out parts of the quote, i suppose you should be referring to a different part of the interview, which i look forward to reviewing once you point me to it.

thanks for clearing this up. i look forward to your response with exact quotes and references to specific times in the interview.


No. He didn't. You are taking what he actually said, and inferring what you want to infer.

Your inference could be correct, I suppose, but I read his quote as something much more prosaic. They treated the injury as a sprain, but when it did not resolve, ordered an MRI.

Also, if a medical staff is corrupt enough to commit malpractice and delay necessary care in order to get an athlete on the floor, I assume they are also smart enough not to tell the athlete what they are doing. Then again, I am just assuming they care about their license and avoiding malpractice claims.

Am I the only one who thinks this particular colloquy needs to be continued via Private Messages?

sage

cato
06-26-2013, 01:05 PM
Am I the only one who thinks this particular colloquy needs to be continued via Private Messages?

sage

Should the whole thread be taken off the board and moved to private message? The issue goes to the central conceipt of this thread (and the title itself), so it seems relevant to me.

sagegrouse
06-26-2013, 01:10 PM
Should the whole thread be taken off the board and moved to private message? The issue goes to the central conceipt of this thread (and the title itself), so it seems relevant to me.

Naw, it's a very valid thread. But several posts have had a bickering tone of interest only to the participants.

sage

billy
06-26-2013, 03:08 PM
Please forgive me for being so dumb! I, however, have a hard time understanding why an MR is not "indicated" in a possible stress fx situation. As I understand it, plain x-rays often/usually are negative is stress fx's, so you often/usually don't really have a confirmed dx after them. Granted that the initial treatment is about the same but to have a confirmed dx for planning purposes would be nice.

A MRI is indicated to assess for a stress fracture. If Len had been severely debilitated by ankle pain, I imagine he would have a MRI earlier. Perhaps it was just a nagging ache that he could play through, thus the decision to wait until the end of the season. The issue is whether any further damage could occur through not knowing exactly what the problem is - in this situation, if he did/does have a stress fracture that didn't progress to a "true" fracture, I don't think any real harm occurred. I don't recall how well Len did or didn't play toward the end of the season, but I don't think he did anything to hurt his NBA chances by playing and perhaps even looks a bit "tougher" to the teams looking at him by letting them know he can play well even with an injury.

Regarding the discussion above about the Ottowa Rules for when to xray ankle injuries (usually sprains), the rules are intended for urgent care, ER, and primary care situations when one is trying to decide whether an injury necessitates an xray. Xrays expose the recipient to significant radiation. They are about a tenth of the price of a MRI but more than double the bill for an office visit. It simply isn't economical, safe for the patient, or good health policy to xray every ankle sprain.


I'd be careful about medical malpractice claims, especially if you support Duke. Ryan, Seth, Josh, and Marshall all had injuries which required surgery in the offseason.

Marshall's surgery was explicitly to fix the stress fracture he'd had all year, and it sounds awfully like Len's injury. Ryan also delayed surgery, perhaps unwisely. Seth was injured in the preseason, but only needed 3 months off for surgery. Josh was injured February 16th, and played a month and a half with torn ligaments in his thumb.

Good points. There are a lot of reasons for delaying surgery (the primary one being that the stress fracture could heal on its own with time). I have never heard explicitly that Seth had a tibial stress fracture all season, but, I assume that he did based on the boot, modified practice time, and how quickly he's expected to recover. I assume that he, his parents, the MD's, and the coaches all discussed his injury and various ways to treat it. He could have had surgery last fall and perhaps been healed by late ACC, at least the tourney (depending on when the definitive diagnosis was made - I recall him saying he wasn't exactly sure what the injury was initially). Rather, he played (very well) on a "bum leg" and had surgery after the season.

rsvman
06-26-2013, 03:24 PM
...... simmons is a real feminine product.

What is this supposed to mean?

bob blue devil
06-26-2013, 03:46 PM
What is this supposed to mean?

C'mon, you are making me blush! Slang for arrogant punk. Not homophobic, if that's where you are going.

ice-9
06-27-2013, 04:27 AM
It's possible that Alex Len's English isn't great, and he wasn't quite comprehending what Simmons and Rose were implying, but if there was no impropriety he could have addressed it right away during the interview.


AL: “Yeah, I told my trainers, but we treated it like a regular, like, ankle sprain. We did a lot of treatment. Icing, stuff like that, steam. But we decided to do MRI after the season. After the season, we found out I had a problem in there.”

Jalen Rose: “Bill, when you’re in college they don’t want you to get [the MRI] during the season. It benefits them for you to finish the season.”

BS: “I don’t love that idea. The MRI should have happened before.”

Len could have stepped in at that moment and clarified the situation. I.e., "The Maryland staff didn't do anything wrong -- I got the best medical treatment." That he didn't correct the implications made on air, in public says volumes to me. But maybe we can chalk this down to his crappy English. Maybe.

Also did a quick search on the Internets to see what else people were saying about it. The Washington Post article goes into the most depth: http://www.washingtonpost.com/blogs/terrapins-insider/wp/2013/06/25/timing-of-alex-lens-partial-stress-fracture-remains-a-mystery/ One interesting tidbit is that the stress fracture may not have occurred until the later in the season, and definitely by the ACC tournament. Still, you'd think they'd take an MRI then if they thought one was necessary, rather than keeping him going into the NIT.