Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 2

This past Sunday, October 3rd, Team USA played Aruba in game 2 of the Pan Am Qualifying Pool Play in Puerto Rico. Team USA defeated Aruba 14-0 in a 7 inning game. Below are some highlights from the game.

OLYMPIC BLAST: Team USA shortstop Brian Barden crushed a two-run homerun to right-center in the third inning to put the U.S. up 2-0. Barden went 2-for-4 on the night with 4 RBIs and 3 runs scored. This is Barden’s second stint with Team USA. In 2008 he was a member of the Olympic squad that won bronze in Beijing. In eight Olympic Games, Barden hit .265 with a homer and five RBIs.


COACHES CORNER: Former major leaguer Jay Bell begins his first stint as first base coach for Team USA. A two-time All-Star, Bell played 18 seasons in the majors, compiling 1,963 hits for five different teams. His teams reached the postseason five times, and in 2001 while with the Arizona Diamondbacks, Bell scored the winning run in the bottom of the 9th inning of Game 7 of the World Series to beat the New York Yankees in one of the most thrilling World Series games in MLB history. Bell won the Rawlings Gold Glove award in 1993 as a shortstop with the Pittsburgh Pirates.



DOCTOR K: Tonight’s U.S. starter Everett Teaford, currently in the Kansas City Royals organization, surrendered a single to Aruba’s first batter then pitched a five perfect innings, striking out 10 of the 15 batters he faced, to record the win and push Team USA to 2-0 in pool play.



GOOD EYE: U.S. first baseman Eric Hosmer has walked six times in nine plate appearances over the first two games. Hosmer walked 59 times in 579 plate appearances in the Minor Leagues this year.



GOOD GENES: USA reliever Bryan Henry entered the game in the sixth and retired the side in order, striking out two. Henry’s grandfather Larry Callaway is a member of the Senior Softball Hall of Fame. Callaway holds 35 national softball titles.



WELL TRAVELED: USA outfielder Jaime Hoffman of the Los Angeles Dodgers organization went 3-for-3 with 3 runs scored. Hoffman was selected by the New York Yankees in the 2009 Rule 5 Draft and was sent back to the Dodgers after Spring Training.

TODAY’S OTHER ACTION:

Nicaragua 8 – Netherlands Antilles 4

Venezuela 5 – Canada 3

Panama 5 – Colombia 3

Cuba vs. Argentina – Late

Puerto Rico vs. Dominican Republic – Late

Dr. Mattalino's travels with USA Baseball in Puerto Rico, October 2010- Entry 1

I am currently traveling with USA baseball, as the team physician, as they compete in the 2010 COPABE Pan American Qualifying Tournament in Puerto Rico. Yesterday, October 2nd, was our first game in the series against team Puerto Rico. Team USA defeated Puerto Rico (7-4) in front of a friendly, partisan baseball savvy crowd in Ponce, Puerto Rico.

Tonight, October 3rd, we play Aruba, once again in Ponce, Puerto Rico.


U.S. DEFEATS PUERTO RICO, 7-4, IN PAN AM QUALIFYING OPENER


Team USA to face Aruba, Sunday, at 7:30 p.m. EDT in Ponce

PONCE, Puerto Rico -- The USA Baseball Pan American Qualifying Team (PAQT) defeated host Puerto Rico, 7-4, Saturday night, in its opening game of the COPABE Pan American Qualifying Tournament. Saturday marked the first of five pool play games for the U.S., as it took its first step toward attempting to qualify for the 2011 Pan American Games.

Brett Jackson led all U.S. hitters, going 3-for-4, including a three-run home run in the sixth inning with Team USA leading, 4-3. Todd Frazier also hit a three-run shot, his highlighting a four-run second inning for the United States.

U.S. starter Todd Redmond (1-0) picked up where he left off as an ace with the gold medal-winning 2009 World Cup Team, going five and two-thirds innings, allowing three runs (two earned) and striking out four for the win. Tim Collins and Justin De Fratus combined for three and one-third innings of three-hit, one-run (none earned) relief.

The three-run blasts from Jackson and Frazier were the headlines for Team USA, as all of its runs came in the decisive second and sixth innings. Brad Eldred opened the second frame with a stand-up triple, and first baseman Eric Hosmer followed with a four-pitch walk. Frazier, a top prospect in the Cincinnati Reds organization, then hit the first pitch he saw from Puerto Rico starter Hiram Burgos over the left field fence to put the U.S. ahead 3-0. Later in the inning, Mike Trout lined a shot to left-center – hitting the wall in nearly the same place Eldred did earlier in the inning – and legged out a triple of his own on a close play at third, eventually scoring on the play via an errant relay by the shortstop.

Puerto Rico came back to within one, pushing a run across in the top of the fourth and two more in its half of the sixth, but in the bottom sixth frame, the U.S. put the game away for good. Frazier and Kratz led off the inning with back-to-back singles, and Trout executed a perfect sacrifice bunt to advance both runners. Two batters later Jackson unloaded on an Efrain Nieves offering to right-center to push Team USA to a 7-3 lead.

De Fratus allowed one unearned run in the ninth as Puerto Rico attempted to mount a rally, but the right-hander got Neftali Soto to ground out to first to end the game.

Burgos (0-1) took the loss for Puerto Rico, and Jorge Padilla and Gabriel Martinez led all hitters for the host nation, both going 2-for-4.

The U.S. (1-0) next faces Aruba (0-2) at 7:30 p.m. on Sunday night in Ponce.

Live scoring for all U.S. games will be available at www.USABaseball.com, the online home for USA Baseball. Please visit the site for schedule and roster information, tournament updates and more. Overall tournament information can be found by clicking here. Saturday night’s box score, cumulative stats and play-by-play are attached.

NOTES:

OPENING GAME TRENDS: Team USA lost the opener of the 2009 IBAF World Cup, a 13-9 loss to Venezuela, in extra-innings. Team USA went onto win its next 14 games en route to the 2009 IBAF World Cup gold medal. Team USA is 4-2 in its last six professional team tournament openers dating back to 2006.

COACHES CORNER: Former major leaguer Ernie Young begins his first stint as Manager of Team USA. Young was a member of the 2000 U.S. Olympic Team that won gold in Sydney, Australia and also served on the Team USA coaching staffs at the 2009 IBAF World Cup in Europe (gold) and the 2003 Olympic Qualifier in Panama.

ACTION JACKSON: Brett Jackson, who led Team USA with a .545 batting average during training camp in Cary, N.C., continued his torrid hitting going 3-for-4 with a walk, a run scored and a three-run home run in the sixth inning. Jackson is an outfield prospect in the Chicago Cubs organization and attended and played baseball at Cal-Berkeley.

SMOKIN TODD FRAZIER: Cincinnati Reds prospect Todd Frazier put Team USA on the board with a three-run blast to left in the second inning. Frazier finished the night 2-for-4 with a HR, three RBIs and two runs scored. Frazier was the winning pitcher in the 1998 Little League World Series for champion Toms River, N.J., in Williamsport, Pa.

ACE RETURNS: U.S. starter Todd Redmond who went 3-0 with a 1.21 ERA in three starts for the 2009 World Cup gold medal team pitched 5.2 innings giving up 2 earned runs while striking out four and walking only one in his second stint with team USA.

NOTEABLE FANS IN ATTENDANCE: Former scout and Puerto Rican League star Jorge Posada, Sr., father of Yankee catcher and Puerto Rico native Jorge Posada, and former Chicago Bulls GM Jerry Krause were in attendance at tonight’s game.


TODAY’S OTHER ACTION:

Colombia 9 – Aruba 2

Venezuela 4 – Argentina 0

Canada 7 – Nicaragua 6

Cuba vs. Netherlands – Postponed

Panama vs. Dominican Republic – Late



*Follow Dr. Mattalino updates as he travels in Puerto Rico with USA Baseball this month.*

In Defense of Physician Autonomy

By SAUL GREENFIELD
September 7, 2010


The auditorium was filled with young, newly minted physicians sitting nervously in white jackets. When the chairman of surgery mounted the stage to address me and my fellow surgical interns, we immediately hushed and gave him our attention. I don't now recall most of what he said, but one remark has stayed with me through my 25 years of surgical practice: "You can't practice medicine by committee."

He didn't mean that we shouldn't listen to associates or seek their advice, or that we shouldn't be aware of scientific literature conveying the opinions and research of others. He meant that every physician must, at some point in the patient-care process, make decisions and take responsibility for them. And unless the doctor does so, the outcomes will be compromised. He was warning against groupthink and telling us that patients often present challenges that cannot be solved by easily consulted algorithms.
The chairman's admonition was a succinct definition of the parameters of the doctor-patient relationship. And in the eyes of many contemporary medical thinkers—those who seek to reorder the universe of medical care in this country—it would be heretical.
In recent political debates, the autonomous physician has been portrayed as a problem to be solved, an out-of-control actor motivated by greed—and a major cause of rising health-care costs. Insurance companies and the federal government have sought to control physician behavior with the dual aim of decreasing costs and improving care. In their view, individual and regional disparities in rates of medical testing, hospitalization and surgical procedures are ipso-facto demonstrations of physician autonomy run amok.
In the United Kingdom, the National Institute for Clinical Effectiveness (NICE) provides guidelines for clinical care in order to ensure greater uniformity of practice and, it claims, better care. In this country, the recent health-care reform law established a Comparative Effectiveness Institute with the same aims.
Such institutions are illegitimate and undesirable. My field of pediatric urology is only a small subset of medicine, but recent experience demonstrates the dangers of bureaucratic, committee-based practice.

In 2007, NICE published guidelines for the care of children with urinary tract infections. A committee of diverse specialists reviewed the literature and voted on the final recommendations. Without going into great detail, these guidelines enacted a significant departure from then-current practice by recommending against thorough radiographic evaluation in many instances.

One member of the committee who was out-voted on the final guidelines publicly castigated NICE and accused the committee of misusing statistics, failing to involve the proper specialists, and seeking mainly to decrease costs. The criticisms were correct.

Since the NICE recommendations were promulgated, publications in peer-reviewed journals have shown that many children with significant underlying conditions—some leading to serious kidney disease—would go undiagnosed if the NICE guidelines were followed.

Over a decade ago, researchers at Dartmouth College documented disparities in rates of tonsillectomy in children. They famously asserted that certain high rates of tonsillectomy were inappropriate and did not improve health outcomes. To do this, they relied only on insurance claims and hospitalization rates; they had no data on the prevalence of recurrent tonsillitis or long-term cardiovascular morbidity from obstructive sleep apnea. In fact, they had no data comparing the quality of life of individuals denied the procedure with that of individuals who underwent surgery. Their broad statistical overview was simply unable to answer many important questions.

Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based on concerns other than an individual patient's welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.

This is not to say that clinical research, randomized controlled trials, literature meta-analyses and guidelines are not necessary and useful. They are all essential. It is also not an argument against rigorous oversight of physician behavior, licensure and training. But we must recognize that many physicians will often make decisions that deliberately do not conform to "community standards"—and that patients will be better for it.

Dr. Greenfield is director of pediatric urology at the Women and Children's Hospital of Buffalo and a professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences.

Why Trainers Say, 'Slow Down'

The Wall Street Journal
September 7, 2010
By KEVIN HELLIKER

When his running coach implored him to take rest days, Bill Carr didn't listen. Slated to run a 100-mile ultramarathon this month, the 36-year-old cranked up his workouts over the summer, running more and harder miles than his coach recommended.

"I wanted to make sure that I got to the event fully prepared," he says. But Mr. Carr won't get to the 100-miler at all. Last month, his ankle sustained an over-use injury during a workout, sidelining the Rancho Cordova, Calif., project manager for a vision-benefits company.
"Type A personalities will increase their training load until something backfires," says Julie Fingar, Mr. Carr's running coach, who says her biggest challenge is convincing her clients to take an adequate amount of rest. "In their minds, taking rest means they're not working hard enough."
Today, says Mr. Carr: "I'm taking Julie's advice and starting to cross train."
Roughly 10% of athletes preparing for an endurance event are training too hard, estimates Jack Raglin, director of graduate studies at the Indiana University's department of kinesiology. Research in the field has shown that injury rates rise as runners increase their weekly mileage. Besides injury, excessive training can contribute to or cause major depression, loss of sleep, anorexia and sometimes death.
"The overtrained athlete is so fried by race time that he either performs very poorly or can't perform at all," says Dr. Raglin, who specializes in overtraining problems.
A more-is-better mentality permeates the endurance-exercise culture. Novice runners in particular tend to think that finishing a marathon requires no end of training. In fact, however, under-training is rare. After all, more than 95% of marathon starters reach the finish line.
Statistically, the harder line to reach is the start line. Of the tens of thousands of Americans who pay as much as $180 to register for marathons, as many as 25% fail to make it to the race. Injury, illness and loss of motivation as a result of overtraining are major reasons for this.
But moderation is a hard message to promote among runners determined to reach extremes. For such athletes, no matter how conclusively science may prove the value of rest and recovery, the culture of endurance sports lionizes those who seemingly never rest.
"In running circles, there is huge pressure to do big mileage, to do the big training, to do the biggest races," says Sandra Ross, a 47-year-old runner in Auburn, Calif.
It also can be difficult for runners to know when they are training too hard. One red flag, sports-medicine specialists say, is an intensifying obsession with performance. Exercise, after all, is supposed to be stress-reducing, and amateur competitions by definition are recreational. Yet marathon fields are populated with runners who are visibly stressed out about whether they'll set a personal record or win their age group.
To head off overtraining, some coaches urge athletes to remain alert for the point at which greater doses of exercise cease to produce improvement.
"The body responds beautifully to the right schedule of training stresses," Lynn Bjorklund, who in 1981 set the still-standing female course record for the Pikes Peak Marathon, wrote in an email. "However, too much stress and not enough nutrition or recovery pushes your body toward injury and illness. You need to stay in that zone of just enough, and that takes a very high tuned and honest appraisal of yourself."
Ms. Ross, the California runner, says that for years she would suffer injuries while training for marathons. To help pace herself, Ms. Ross hired Ms. Fingar, the running coach, who enforced rest days, cross-training and trail-running as a lower-impact alternative to pavement.
The discipline paid off, and this summer Ms. Ross completed a 100-mile race. That accomplishment wouldn't have been possible if she hadn't resisted the impulse to match the weekly mileage of her younger running partners, she says. "If I ran as much as they do I'd be faster. But as an older runner I need more rest, and I also have a child, a husband and a career," says Ms. Ross, who works as an environmental consultant.
Overtraining can contribute to exercise-related anorexia, a potentially fatal syndrome that strikes nearly half of all women in so-called lean sports such as running, according to a book published this year, "Eating Disorders in Sport."
"I was diligent about cutting down the calories and increasing my workout schedule. The pounds fell away and it seemed to result in better racing," recalls Ms. Bjorklund, who says that soon after setting a Pikes Peak Marathon record she entered a hospital near death from anorexia.
"It is easy to think that if a little is good, more should be better. After a period of time, however, I would always crash and be forced to cut back," the 53-year-old wrote in an email.
Ms. Fingar, the running coach, says that early in her athletic career she was prone to overtraining and exercise-related anorexia. As a result she says she studies her clients and friends for signs of chronic fatigue, depression, compulsive training or privation. "It can be really destructive," the 35-year-old says. "When someone becomes addicted in a non-healthy manner, all other things suffer—work, family, friends and of course their performance."
Ms. Fingar says she tries to set an example for her clients. She refrains from aerobic exercise one day a week. Often, if she listens to her body instead of her mind, "I'll realize that I'm tired and I'll take another day," she says.

When training for an ultramarathon, Ms. Fingar runs about 70 miles a week, far fewer than the 100 miles that many other ultramarathoners log weekly. But unlike some other runners she is rigorous about cross-training weekly in the pool, on a bicycle and in yoga and Pilates studios. She says this training offers a break from the monotony and physical pounding of running, and provides flexibility, enhanced aerobic fitness and a strengthening of core muscles.

"Especially with trail running and endurance events, you need upper-body and core strength to ascend and descend the hills," she says.

Click Here to Access Article Online

Mesquite High School 2010 Football Opening Night Win

Dr. Mattalino attended the opening night football game of Mesquite High School on Friday, August 27th. The game turned into yet another great performance by the Mesquite Wildcats as they faced off against their rival No. 5 Desert Ridge. The game was close, similar to the game the teams played last year against each other where Mesquite beat Desert Ridge and knocked them out of the 2009 Playoffs. Mesquite was not the favored team for this game, but they were still able to pull out a 28-27 win against Desert Ridge in the final minute of the game.

Dr. Mattalino served as the Mesquite HS team physician for the past 2 years and is excited to continue in this position for the 2010-2011 season.

Check out game highlights at http://www.azfamily.com/sports/high-school/Opening-Friday-high-school-football-highlights-101700643.html

Or read more about the team's win at http://varsity.evtrib.com/story/154576

What are PRP Injections?

Platelet Rich Plasma Therapy, more commonly known as PRP, is an emerging, non-surgical biological tool for patients with severe elbow, shoulder, knee or tendon injury and/or pain. The procedure is done by drawing the patient's blood and placing it in a centerfuge to concentrate platelets. Once this process is complete, the platelets are ready for injection. The PRP is then injected into the injury location under the guidance of an ultrasound. After the injection is complete, the patient is ready to go home and continue their daily activities.


PRP Therapy has shown to be an alternative to cortisone injections and surgery for patients with tennis elbow, Achilles tendon repair and may be helpful in arthroscopic surgeries such as rotator cuff repair.

To learn more about PRP and see if it is the correct treatment for your injury, visit our website's PRP information page at http://mattalinoorthopaedics.com/services/553.html

New Hip Replacement Technology

I recently attended a lecture about the recently released Stryker ADM X3 mobile bearing hip replacement system. I was very intrigued by this product and thought I would pass some information on this new technology along to my patients.

The Stryker ADM X3 hip replacement system is the first anatomic mobile bearing hip system from Stryker. This device is designed to offer the benefits of a large diameter bearing without metal-on-metal articulation. Meaning that the combination of a mobile bearing hip design and the advanced bearing technology allow this hip replacement system to wear better and offer more stability for the "active" patient.

With the implementation of the ADM X3 hip replacement device, the patient exhibits a greater range of motion, may reduce the risk of groin pain caused by iliopsoas tendon impingement, designed to help minimize the risk of wear and consequently may prolong the life of the implant (X3 laboratory testing shows a 97% reduction in wear compared to conventional polyethylene), and based on laboratory testing, ADM allows more than 3 times greater jump distance than competitive hard-on-hard bearings.

To see an animation of this new technology please visit the following link: http://www.stryker.com/en-us/products/Orthopaedics/HipReplacement/PrimaryAcetabular/mobilebearing/ADMX3Animation/index.htm

To find out more information on the ADM X3 hip replacement system visit http://www.styker.com/