Archive for the ‘The Quiet Room’ Category

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Sudden cardiac arrest. The absolute last thing you want to hear as a player is hustled off the bench after a collapse. It rarely has a good outcome, but Rich Peverley and the medical staff of the Stars and Blue Jackets have beat the odds.

 

UPDATE: New information has surfaced in the recent days – it seems that the preseason procedure Peverley chose was an elective cardioversion followed by ongoing medication, so as to minimize his recovery time. Cardioversion is a non-invasive procedure that involves a shock delivered at a certain phase of the cardiac cycle that essentially resets the heart so that it can resume a normal rhythm. After his collapse March 10th and subsequent resuscitation, Peverley was wearing what the NHL calls a “monitoring vest” until he could have a corrective procedure (an ablation – described below), which was done Tuesday at the Cleveland Clinic. There’s been no word about whether he also had an ICD (implantable cardioverter-defibrillator) put in, but that can be done with just an overnight stay.

The monitoring vest is actually a LifeVest – a wearable cardioverter/defibrillator. It’s a vest that continuously monitors the heart rhythm, and delivers a shock if it senses an arrhythmia.

 

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The vest also sounds an alarm first so that if you’re still conscious you can stop it from shocking you. Why? Because if you’re conscious you’re (more or less) okay. You need to call 911 immediately and get to the ER, but you’re okay(ish). You really don’t want to get shocked unless you absolutely need it. While the shock can reset your heart and save your life, more shocks actually increase mortality – so you want to minimize your exposure to those times it’s truly absolutely unavoidable. If you’re unconscious, the vest gives you plenty of chances to deactivate it, and you won’t take any of them (because unconscious people can’t press buttons). It deploys conductive gel onto the pads in the back of the vest, and lights you up. The manufacturer (Zoll) has a pretty graphic demonstration of an EKG that degenerates into a shockable rhythm, the warnings the vest delivers, and what happens when a shock is applied. Turn your volume down a bit for this one, be patient and wait for the arrhythmia. It’s a hell of a process.

Peverley’s season is over, and his ablation will have a four to six week recovery, longer if he also had an ICD placed (and we have no idea if he did at the moment, but no mention was made of it at the Stars’ press conference). There’s been no move on the part of the Stars to commit to Peverley ever playing again after this season. Tincture of time is indicated on this one.

 

As part of preseason physical testing, Rich Peverley had an EKG that showed a “blip” (a term I apparently wasn’t fond of).

 

 

It turns out the blip was atrial fibrillation (afib) – the most common arrhythmia, present in about 5 million Americans. It happens when the part of the heart responsible for setting the pace doesn’t do its job properly, explained quite eloquently here (Pevs forgive me for the heinous misspelling):

 

Afib is exactly what it sounds like – the atria (upper chambers of the heart) don’t squeeze in a nice organized regular manner – they fibrillate (quiver). That increases the likelihood of stroke because blood doesn’t zoom through, it swirls around in the atria. Blood standing still is blood that likes to clot, and clots are things you don’t want in your body. The ventricles are responsible for pumping blood out of the heart to the lungs and the body, and they’ll keep doing their job, just irregularly as they follow the irregular impulses sent down from above by the pissy atria. Afib is something a lot of people live with (on anticoagulation), but in someone like Peverley, it had to be fixed. The odds of sudden cardiac death are already doubled during physical activity, and hockey is a sport with a lot of very intense activity in short bursts, which also increases cardiovascular risk.

 

Those are the atria.

Those are the atria.

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The Pittsburgh Penguins broke their silence Friday and announced that the mysterious injury that has kept Kris Letang out since January 27th is a stroke. Not the flu, not mono, not any of the other usual garbage that young healthy people get, but a stroke. Strokes are uncommon in young people (but not impossible), and the team has said that they believe a congenital heart abnormality may have been the cause. How can this happen? And how can only six weeks possibly be how long he’ll be out?

 

Kris Letang’s last game was January 27th against Buffalo. An episode of nausea and dizziness on the 29th kept him out of the LA game on 30th, but he continued to travel with the team. When his symptoms still hadn’t cleared by the time the team hit Phoenix a couple of days later, he underwent some tests. Those tests were suspicious for a stroke, and Letang was sent back to Pittsburgh for yet more testing. In the course of all the diagnostics, doctors discovered “a very small hole in the wall of his heart since birth”, which could have precipitated the stroke. That’s a lot of information to take in all at once, and none of it seems to make sense in the context of a young, healthy athlete.

 

Nausea and Dizziness? That’s a stroke?

 

While there are two kinds of strokes – ischemic and hemorrhagic – the outcomes can run the gamut from death to major (or minor) disability to almost no side effects at all. Ischemic stroke is caused by an interruption in blood supply to a certain part of the brain – like from a clot. Hemorrhagic strokes are caused by bleeding into the brain. Letang’s stroke was ischemic, and his symptoms were mild enough that he obviously had no idea there was anything wrong with him until several days later.

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Everyone in Vancouver had a case of the sads in mid-January when Henrik Sedin’s ironman streak ended. After 679 games (not counting playoffs), it was a case of not very impressive-sounding bruised ribs that shut him down. The good news is that he’s back to full practice, and should be back soon to start a new streak.

 

There aren’t a whole lot of ironmen in the NHL at all, let alone currently, and the injuries that end streaks aren’t always the world-ending massive traumatic disasters that you might expect. And then again, sometimes they are.

Martin St Louis is several shades of awesome.

Martin St Louis is several shades of awesome.

 

Martin St Louis – 499 Games

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Steven Stamkos in happier times with an intact leg.

Steven Stamkos in happier times with an intact leg.

You’ll need more than two hands to count all the NHL players currently out with broken legs, ankles or feet. If you include “lower body injuries” on IR who may or may not have broken limbs (or no limbs, or a really bad cold, or an upset tummy), you may need to take off your socks and keep on counting.

Did somebody grease the ice?

Shot-blocking – inadvertent or on purpose – is a frequent culprit in the land of broken legs. Boston’s Gregory Campbell was last year’s poster child after a Malkin slapshot to the leg left him with a broken right fibula, on which he notoriously finished a shift on the PK. Fractures (and their aftermath) aren’t always that dramatic. Sometimes they’re picked up later on an MRI when a leg won’t stop hurting, and sometimes they’re obvious on tv from thousands of miles away by the screaming player or the fact that legs aren’t supposed to bend in between the joints. This season has produced fractures at both ends of the spectrum and all points in between.

 

LEGS!!!

LEGS!!!

 

Chris Kelly (Boston) – Fractured right fibula

The Bruins-Penguins game December seventh was one of the uglier debacles in recent memory. Loui Eriksson missed five weeks with a concussion from a Brooks Orpik hit, Shawn Thornton missed those same five weeks serving a suspension for his retaliatory slewfoot/suckerpunch on Orpik, James Neal took a five-game hit for kneeing Brad Marchand in the head, villages were sacked and burned, etc. Pascal Dupuis slashed Chris Kelly’s right leg, and though Kelly played in the third period of the game, it turned out he’d broken his fibula. A broken left tibia last year only kept Kelly out a month, but this time his timeline is closer to six weeks, as he’s only just resumed skating within the last few days. How? The tibial fracture wasn’t very serious. The team actually wasn’t even aware of it initially. X-rays aren’t always obvious right away, which is where the infamous “We have to wait for the swelling to go down” line comes from. Sometimes it takes a while for things to show themselves. This time there was nothing sneaky about the fracture, and Kelly has been spending his time in a walking boot. A fibular fracture will generally heal on its own, and was the injury that Toronto’s Bob Baun infamously fought through in the 1964 Stanley Cup Final.

Joni Pitkanen (Carolina) – Fractured left calcaneus (heel)

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If this doesn't break your heart, you're a monster.

If this doesn’t break your heart, you’re a monster.

 

There are few players as universally well-liked or as incredibly talented as Steven Stamkos, and few injuries as overtly horrifying as the broken leg he sustained Monday against the Bruins. Viewers had a front-row seat to a leg bending a way legs aren’t made to bend, and to Stamkos’ considerable pain.

Stamkos broke his right tibia, and there’s video here if you’re of the rubbernecker variety. Be warned that it’s difficult to watch, not just because of the injury, but because of his reaction to it. He tries to get up and skate on it twice, then finally gives up and lies on the ice alternately covering his face and clutching at Tom Mulligan, Tampa’s head athletic trainer. It was every bad injury from the past several seasons all over again, and like Pitkanen’s heel, Fedun’s femur, Pronger or Laperriere’s puck to the face, it was one of those injuries that you instantly knew was going to be very, very bad.

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This is why goalies have bad hips.

This is why goalies have bad hips.

 

Being an NHL goalie without destroying your hips is near-impossible feat, and Nashville’s Pekka Rinne is no exception to the rule. The Predators announced last week that he’s out at least a month after arthroscopic hip surgery October 24 to clean out a bacterial infection in his surgically repaired left hip.

The curious thing about this is that Rinne had the hip done in May. How does a hip surgery five months ago lead to a joint infection? It generally doesn’t, which is why Rinne’s case is so interesting.* After last season ended, it was revealed that Rinne had been playing through pain all year. The official word was initially that he’d be rehabbing his hip, but shortly thereafter the official word was “jk guys, he just had surgery!

*You never want to be referred to as “interesting” in a medical capacity.

 

Hockey Hips: They suck

Hip surgery is relatively commonplace in NHL goalies (and Ryan Kesler – twice), and it generally has to do with labrum problems. The hip is a ball-and-socket joint, with the ball being the top of the femur, and the socket (or acetabulum) being the hole it sits in on the side of the pelvis. That hole is surrounded by a tough ring of cartilage called the labrum. The labrum makes the socket deeper, helps seal the joint together, and increases the surface area to spread out the load on the hip. It can also tear, which not only hurts but destabilizes the joint. Read the rest of this entry »

Smell my glove! SMELL IT!

Smell my glove! SMELL IT!

The Tampa Bay Buccaneers grossed out the sporting world recently with the announcement that several of their players are fighting MRSA infections. Football doesn’t get to have all the fun where nasty bugs are concerned, so this week we’ll take you on a tour of some disgusting locker room infections. You’re welcome.

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