David Lennon is an award-winning columnist and author who has been a staff writer at Newsday since 1991.
They are two of the most dreaded words among major-league pitching circles these days.
And now that Masahiro Tanaka has been diagnosed with the alarming condition, which prompted the Yankees to immediately place him on the disabled list Wednesday, that leaves only two worse words.
Tommy John, as in the ligament-replacement surgery.
It's not to that point yet with Tanaka, who flew back to New York for an MRI, and the Yankees were left to ponder an uncertain future as they waited for team physician Christopher Ahmad to read the test results.
Hold on. Let's correct that.
We pretty much know what the future will look like if Tanaka's injury is serious enough to require surgery. And it won't involve October baseball.
An already uphill battle in the AL East could turn into scaling Everest after the All-Star break. Removing Tanaka -- the rotation's only sure thing -- would make 39-year-old Hiroki Kuroda next in line for the stopper role.
Last season, Kuroda's ERA jumped nearly two runs (4.25) in the second half, a spike the Yankees attributed to fatigue. Brian Cashman did what he could Sunday in the patch-job trade for Brandon McCarthy. But short of dealing for Cliff Lee or David Price -- a very unlikely scenario -- there is no replacement for Tanaka.
"It goes without saying how important he's been," Derek Jeter said. "He's been our go-to guy."
The Yankees didn't drop $175 million on Tanaka as some kind of vanity purchase. They desperately needed to upgrade the rotation last offseason, and Tanaka, despite Cashman labeling him a preseason No. 3, was supposed to be its centerpiece.
Just as the Yankees hoped, Tanaka pitched like a bargain before Tuesday night's loss to the Indians, his third in four starts. And with the team's early season issues -- three starting pitchers going down, an underachieving lineup -- Tanaka Day was a welcome respite from the anxiety-ridden remainder of the week. The Yankees are 13-5 in games Tanaka pitches, 32-39 otherwise.
Until now, the Yankees' ultra-protective treatment of Tanaka seemed to be working with Joe Girardi giving him additional rest whenever possible.
Tanaka has made as many starts with an extra day off -- eight -- as on a regular four-day break in between. Once, Tanaka even had six days in between starts.
By being super-cautious, the Yankees figured they could avoid exhausting their new ace -- and maybe even prevent an injury. But what if the damage already had been done? What if all the mileage Tanaka accrued pitching for the Rakuten Golden Eagles had made him more vulnerable to something happening over here?
"He's passed every Japan-to-U.S. test with flying colors," one opposing team executive told Newsday's Erik Boland. "The only one left is the biggest of all, though. Durability."
Tanaka is signed for seven years, and any elbow injury -- even with T.J. surgery's remarkable success rate -- can have long-term implications. But the Yankees probably aren't looking that far ahead. Tanaka was part of an expensive winter makeover specifically designed to get them back into the playoffs after missing them for only the second time since the '94 work stoppage. And yet the Yankees were in third place, four games behind the Orioles, when they put Tanaka on the DL. As for the wild card, their deficit was 31/2 games, with four teams ahead of them.
If this becomes a prolonged absence for Tanaka, you can expect those margins to widen -- and Cashman could then be faced with a choice he never anticipated. Trade more young talent before the July 31 non-waiver deadline to fortify a damaged roster? Or shop some of his own valuable pieces in an effort to reload for 2015?
We don't see the Yankees waving a white flag, even if this Tanaka news goes from bad to worse. Not after spending nearly $500 million to return playoff baseball to the Bronx. But trying to rebuild a rotation on the fly might just be too much, especially when one of those pitchers has been as dominant as Tanaka.
"That's our job -- to survive and keep going," Girardi said.
Surviving is not the same as winning, of course. And only one can be done with any regularity if Tanaka is hurting in the second half.