When Johan Santana said last week that he received an injection of Toradol, a powerful anti-inflammatory medication, to stay on schedule for his Opening Day start, it hardly raised eyebrows in the clubhouse.
Toradol is an NSAID, or nonsteroidal anti-inflammatory drug; it's in the same class as over-the-counter medication like Advil, Aleve and Motrin. The difference is that Toradol is far more potent - it must be prescribed by a physician - and it is injected, usually into the buttocks.
R.A. Dickey said he relied on numerous injections last season to cope with a painful case of plantar fasciitis. Mike Pelfrey credited the drug for allowing him to make 33 starts in 2010 and throw a career-high 204 innings that season. Without Toradol, Pelfrey said, that would have been impossible.
"I'm a big fan," Pelfrey said. "I think it should be mandatory. I really think it's that good."
Toradol is different from cortisone-type treatments, which are injected directly into the problem area and do not have a systemic effect on the entire body. David Wright received a cortisone shot during spring training to help heal his abdominal strain. Scott Hairston took three injections in roughly a six-inch radius to help a strained oblique.
But that focus on one particular area does not produce the same overall feeling of invulnerability that Pelfrey described after getting his shots of Toradol, which he regularly did an hour before his starts if something was bothering him.
"You don't feel anything," Pelfrey said. "If someone punched me in the stomach, I wouldn't feel it."
That's because Toradol is most often used to treat patients suffering from postoperative pain or other serious trauma, according to Dr. Nathaniel Berman, a nephrologist at Manhattan's Rogosin Institute and an assistant professor at Weill-Cornell medical school.
"When somebody comes into the hospital with acute pain, a kidney stone, say you just had hip surgery or you're going to set a broken arm or something, you might give them a shot of Toradol," Berman said. "It's use has only been established in short-term treatment, and from what I understand the studies are all short-term treatment, so I don't think anybody can really tell you what the long-term effects are."
Under its listing on the U.S. National Library of Medicine website, Toradol - also known as Ketorolac - carries a yellow warning label before anything else is described about the drug. The warning states that the drug is used for "short-term relief of moderately severe pain" and "should not be used for longer than five days, for mild pain or for pain from chronic [long-term] conditions."
For starting pitchers, that would seem ideal, with their workload spaced out long enough to cycle on and off the strong anti-inflammatory. Earlier this year, The HBO series "Real Sports" documented Toradol's widespread use in the NFL, so it's hardly unique among the Mets or around baseball, as Pelfrey said he had heard other MLB teams use it as well.
Players in every professional sport take a variety of medications to stay on the field, but with Toradol - like the other NSAIDs - it's important to monitor the usage because of the potential damage to the kidneys.
"This is what you would give somebody instead of morphine," Berman said. "But it doesn't have the same neurological effect. It doesn't work on pain receptors. It's sort of upstream from pain - you don't feel the pain because you don't have the [inflammation] that's stimulating the pain."
While Berman understands why Toradol would be prescribed for athletic performance, he also stressed the need for caution. "I think the main thing is that nobody's ever used it frequently," Berman said. "So this is the first experience of that. We have no idea what it's going to do."
Chipper is no Mo, lets everyone know
While Mariano Rivera, at age 42, remains mum on his plans for beyond this season, the Braves' Chipper Jones ended the speculation early when he announced in spring training that his 19th year with Atlanta would be his last. As for a farewell tour, Jones hasn't planned on any special treatment.
"I'm not really expecting anything," said Jones, who is forced to sit this series as he recovers from knee surgery. "I mean, obviously in Atlanta it's a little bit of a big deal. But I never considered myself in the Cal Ripken or Tony Gwynn range.
"If somebody finds it nice enough to say goodbye to me my last time in a city, then I certainly am much appreciated. I just want to be another one of the guys, go out there and play and hopefully ride off into the sunset on a positive note."
He'll do so under a shower of boos during his last visits to Citi Field, but Jones will always have good memories of New York - and dream what it might have been like to play here. The Braves never let that happen, paying him more than $155 million during his tenure there.
"You always sit back and wonder, how it would have been to don the pinstripes or play at Shea," Jones said, "but it's just wishful thinking. I never really wanted to see if the grass was greener. I was always real comfortable in my skin right there in Atlanta."