Pitchers on anti-inflammatories must beware of liver trouble

Before any player throws on a uniform and hits the field for major-league spring training, he must undergo a thorough physical examination with the team doctor.

There are blood and urine workups, and height and weight checks, and many of the same drills that many non-athletes undergo on an annual basis.

But there's one measurement in particular that reminds players - and especially pitchers - that their job differs from most others'.

They get their livers examined.

"Every team I've been on, if you're on anti-inflammatory, you get a liver screening just to maintain, 'Oh wait, you're not having any problems,' " Phillies lefthander Jamie Moyer said. "Which is good. It tells me that they're looking out for your best interests."

"I'm not worried about that," Yankees righthander A.J. Burnett said of potential liver damage, "but I know some guys who probably should."

You could sometimes forget, through the noise of all the moralizing and finger-wagging, that illegal performance-enhancing drugs become illegal because they present too great a health risk. But even when they're playing within the rules, that doesn't mean that players risk nothing in getting onto the field.

And pitchers, everyone agrees, face the greatest chance of winding up in a doctor's office.

"The most unorthodox thing your body can do is throw a baseball, so the aches and pains come with that," Burnett said. "If it was easy, everybody would do it."

Options for players

To deal with those aches and pains - the most common condition is labeled as "inflammation" - some players use simple NSAIDS: non-steroidal, anti-inflammatory drugs such as Ibuprofen. NSAIDS can cause liver failure.

Some go even further, utilizing what's called a Medrol Dosepak, which features legal corticosteroids - cortisone in oral form, as opposed to the more familiar injection.

"You're not supposed to take more than two a year," said Yankees lefthander Andy Pettitte, who admitted to occasionally ingesting the tablet with a doctor's prescription.

When asked if he ever surpassed that maximum, he smiled.

"My job, and I get paid an awful lot of money, is to go out and to pitch," Pettitte said. "I just feel like, if you can figure out a way to get out there, you do it. It comes with having to get an injection, or a painkilling shot, or an anti-inflammatory.

"All these guys in there are fighting with me. My teammates are ready for me to go to battle with them, and it's my obligation to take the mound. If I can, I should take the mound. That's just the way I look at it."

It's a mentality that can be found throughout the game, although not everyone is as open as Pettitte when it comes to discussing the Dosepak.

"I won't talk about it," Mets ace Johan Santana said.

The Yankees' Javier Vazquez said he believes he used a Dosepak last year but isn't certain.

Tracy Ray is a sports physician who works with noted orthopedist James Andrews in Birmingham, Ala. In a telephone interview, he told Newsday, "I haven't come across a lot of people using a Medrol Dosepak the way you described it."

Ray added: "What good is the Medrol Dosepak doing, anyway, except to modify pain a little bit? It's not really healing. It's not really curing the problem. You might as well be taking Tylenol.

"But I can understand, you don't really care what you're taking if it works."

"Every medication has its baggage," Ray said, and the use of NSAIDs and corticosteroids mandate the liver tests. As Ray explained, "Some are metabolized by the liver" and therefore can cause damage. The kidneys also can be at risk, and too many anti-inflammatories can help create an ulcer.

"If I can take 400 mgs of Ibuprofen, and I do that three times a day so my shoulder doesn't hurt so I can perform, can I lose sight of what that does long-term?" Ray asked. "It's kind of natural that you would do that."

Working out a schedule

Yankees ace CC Sabathia said he uses Mobic, an NSAID, the day before he pitches and then the day he pitches. Former Mets and Yankees lefthander Al Leiter, now a broadcaster for YES and the MLB Network, said he perfected a schedule for taking Advil: "If I was pitching in three days, I'd take two. Tomorrow, I'd take four. On game day, I'd take two in the morning, then two in the afternoon.

"Because your arm always hurts. I know there are teams that were immediate to give cortisone shots. I don't know how it is now, because everything is really documented. Literally, a guy would come in and, if there was a little tweak, 'The doc's coming down to give you a cortisone shot.' Some teams were more aggressive with it."

Moyer, the game's oldest player at 47, said he hates taking pills, so he tries to avoid any such remedies. As does Burnett. Santana said, "If you stay on top of your program, do all of your exercises and you follow everything that you're supposed to be following, you're fine."

Yet pitchers take on the responsibility knowing that they're rarely going to feel "fine."

"If you were to take a pitcher's arm after he throws and do an MRI of every guy tonight, there's going to be adhesion teardowns, and there's going to be tearing," Leiter said. "There's tearing everywhere."

"It's our job, man," Vazquez said. "Whatever you've got to do to be out there."

It's why decent starting pitchers get paid so well. And it's why even those who don't break the rules - and to be clear, Pettitte admitted to using human growth hormone in the past - don't mind defying conventional medical wisdom.

"Your body's not meant to throw a baseball, you know?" he said. "So you get a lot of inflammation in areas of your body that you need to get it out. Sometimes you need to get it out."

And if the trade-off is a liver test that might actually turn up something, that's a deal enough pitchers appear willing to make.