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Headache Care

A Headache That Won’t Go Away

Tuesday, Sep 14 2010


The entire sequence segues from grace to violence in a heartbeat, and Jason Bay has seen the replay more times than he cares to count: his full sprint after Jamey Carroll cracks a deep fly ball to left field, the backhand catch he makes without breaking stride, the impact when he splatters against Dodger Stadium’s outfield fence as if he were a character in a Looney Tunes cartoon.

On July 23, Mr. Bay, the Mets leftfielder, sustained a concussion during the team’s 6-1 victory over the Dodgers when he collided with a padded bar jutting from the ballpark’s metal fence. In retrospect, it is difficult to decide what’s less surprising: that Mr. Bay remained in that game and started the Mets’ next two, or that he later began experiencing post-concussion symptoms, was put on the disabled list, and hasn’t played since July 25.

Mr. Bay has insisted he wants to try to play again this season, and he is eligible to come off the 60-day disabled list on Sept. 24. Including that night’s game against the Philadelphia Phillies, the Mets at that point will have 10 games left in their season.

He and the team, then, face a decision that must balance two of contemporary sport’s most powerful forces: the ever-increasing knowledge of how dangerous and unpredictable head injuries are, and an athlete’s competitive impulse to play through physical trauma—even through the fog left by a blow to his brain.

“There’s a part of me that says, ‘If you’ve gone through all the stuff and you’re ready to play, why not?’ “ Mr. Bay said. “More than anything, it’s peace of mind.”

Mr. Bay’s desire to reassure himself that he can withstand the stress of a regular-season game and extend what has been an accomplished career is a common reason athletes try to return quickly from head injury, said Joel Fish, director of the Center for Sport Psychology in Philadelphia. That feeling is particularly strong in Mr. Bay, who turns 32 next week and has labored through a subpar year after signing a four-year, $66 million, free-agent contract with the Mets in January. In 95 games this season, he is batting .259 with six home runs after averaging 30 home runs over his previous six seasons.

There are two other strong influences, Dr. Fish said in a phone interview, that might pull athletes toward the playing field before they are ready. First, the immediate gratification they receive from competition can overwhelm the prudence of waiting until they have healed fully. Second, their athletic endeavors so define their identities that they “just want to put the uniform on and be one of the guys again.”

After Mr. Bay suffered headaches and nausea in the days following the collision, he finally went through two consecutive days last month in which he didn’t experience a headache. Team doctors and trainer Ray Ramirez then cleared him to come back to the ballpark.

Mr. Bay has since engaged in light workouts with the Mets, such as running drills, and has sat in the dugout with his team during games.

In weighing whether Mr. Bay will play before the season ends, Mets general manager Omar Minaya will consult with the team’s doctors and Mr. Bay, and the group will make a collective decision, a member of the front office said. Though Mr. Minaya has repeatedly used the word “cautious” in describing how the team is handling Mr. Bay’s status, such an approach would be a bit of a break from how the Mets recently have dealt with other player injuries, including one that was head-related.

In 2008, the Mets allowed outfielder Ryan Church, who had just sustained a concussion, to fly to Denver on a team road trip, exacerbating his symptoms. When asked whether he and other members of the Mets’ organization had increased their research into concussions in light of Messrs. Church’s and Bay’s injuries, Mr. Minaya said, “We trust our doctors. This is a field that continues to get more and more information. I’m confident in our doctors that we’re…I’m trying to word it right...that they are [giving] the best advice. I have full confidence in them.”

This season also has provided two examples of the Mets’ relative haste in getting important players back into the lineup: The team did not place shortstop Jose Reyes on the disabled list when he strained an oblique muscle in late June, and by trying to play through the injury, Mr. Reyes needed more time to recover than he otherwise might have. And centerfielder Carlos Beltran so struggled at the plate and in the field after offseason knee surgery that manager Jerry Manuel later admitted Mr. Beltran had returned too soon.

Those episodes, however, transpired when the Mets were still viable postseason contenders and were desperate to remain so; they’ve since fallen to fourth place in their division. More, the timetables for Messrs. Reyes’s and Beltran’s returns would seem easier to plot than Mr. Bay’s because of the nature of their respective injuries and the public attention recently paid to concussions.

But there remains little uniformity in the length and severity of a concussion’s short-term effects. After the Giants’ Matt Cain struck him in the head with a 94-mph fastball last August, for instance, Mets third baseman David Wright felt post-concussion symptoms for only one or two days.

“It is a very person-dependent kind of phenomenon,” said Bob Stern, the co-director of Boston University’s Center for the Study of Traumatic Encephalopathy. “There is no typical recovery time.’’

What is certain, Dr. Stern said, is that a person who suffers one concussion is more susceptible to another. Keith Primeau would seem living proof of that. Mr. Primeau, who spent 15 seasons in the National Hockey League before retiring in 2006 at age 34 because of post-concussion effects, has agreed to posthumously donate his brain to BU’s medical school so head trauma experts can study it.

Mr. Primeau doesn’t know how many concussions he has sustained since he began playing ice hockey as a boy. “It’s north of 10,” he said in a phone interview. His last occurred in October 2005 while he was with the Philadelphia Flyers.

The previous year, though, Mr. Primeau had missed 21 games because of a concussion before coming back in time for the playoffs.

“That’s the biggest dilemma,” said Mr. Primeau, who still suffers severe headaches and fatigue from time to time. “A trainer goes to a player and says, ‘How do you feel?’ If you’re competitive by nature, you don’t give the honest truth. Try to tell a competitive, professional athlete—whether it’s hockey or baseball or football or whatever—to tell the honest truth. You’re probably not going to get it. And that’s what players have to come to understand: There is a consequence to that decision.”

Mr. Bay has spoken with other major leaguers who have suffered concussions, including the Minnesota Twins’ Justin Morneau. But Jeff Francoeur, who was perhaps Mr. Bay’s closest friend on the team until the Mets traded him to Texas last month, said he never discussed the potential long-term ramifications of the concussion with Mr. Bay.

Even if he had, it seems unlikely he could have said anything to give Mr. Bay pause. At no time since crashing into the fence, Mr. Bay said, has he considered his playing career to be in jeopardy.

“If there are two games left [in the season], OK, maybe not,” he said. “But if there’s more than that, I could and should play.”



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