Did the Reds/Kremchek err in regards to Volquez?

[Blitz Dorsey]

Shouldn't this have been diagnosed earlier? He's been having the exact same problem for two months and it took this last failed simulated game for them to figure out he needed Tommy John surgery? I'm sure they didn't wait this long to give him an MRI. Did they just notice something new this time/missed something before? Or did Volquez really hurt his arm even more in that simulated game? I just find it hard to believe that a good doctor/training staff wouldn't have picked up on this earlier. Now, instead of him possibly being ready by June next year, he'll be out perhaps until August.

Kremchek just doesn't have a very good history in these areas. "Sure, let Junior pinch hit for a month even though he can barely walk." (One month later...) "He needs surgery and we probably should have put him on the DL to start the season."

Does he ever step in and find something before it's completely obvious to even a novice that something is seriously wrong?

[paulrichjr]

I have to believe Kremchek knows how to read an MRI. The way I read it the tests didn't show it to be that bad until they opened it up and looked inside. This isn't that hard for me to believe. All I know is that a lot of other teams appear to use him also and why not. The Reds have done an incredible job over the years training him. He should be the best team medical doctor in the world considering some of our injuries over the past 10 years.

[Brutus]

Shouldn't this have been diagnosed earlier? He's been having the exact same problem for two months and it took this last failed simulated game for them to figure out he needed Tommy John surgery? I'm sure they didn't wait this long to give him an MRI. Did they just notice something new this time/missed something before? Or did Volquez really hurt his arm even more in that simulated game? I just find it hard to believe that a good doctor/training staff wouldn't have picked up on this earlier. Now, instead of him possibly being ready by June next year, he'll be out perhaps until August.

Kremchek just doesn't have a very good history in these areas. "Sure, let Junior pinch hit for a month even though he can barely walk." (One month later...) "He needs surgery and we probably should have put him on the DL to start the season."

Does he ever step in and find something before it's completely obvious to even a novice that something is seriously wrong?

Having no formal medical training, I would not be as prepared to answer this as perhaps some others. But my understanding is that it's pretty common procedure to proceed the way they did if nothing shows up on the MRI. Often they can't know what is necessary until it's determined surgery is the way to go. Usually they don't opt for surgery unless they find a recurring problem.

It seems to me the way they approached this is common practice among teams' medical staffs (see Brandon Webb).

[nate]

I was just going to post that I think the same thing happened with Brandon Webb. I wasn't sure if it was the same injury though.

[Caveat Emperor]

As a casual follower of sports, it's been my observation that things always follow this pattern:

1. Injury
2. Least severe method of treatment (usually therapy)
3. Setback
4. Surgery

This seems no different. Probably would've been best to get Volquez 'scoped, but obviously that would've set his timetable back.

[Strikes Out Looking]

I have criticized Kremchek in the past on these boards and have been roundly told I am crazy. Well craziness rules the day.

[Unassisted]

It has been discussed in other threads that media reports obliquely imply that the Reds, Volquez and Kremchek knew this was a possible outcome all along, but did not disclose it. Either Volquez didn't want it disclosed (and the club's hands were tied because of HIPAA) or Walt didn't want it disclosed, since public knowledge that a starter was facing TJS would affect the team's bargaining position in trades.

That's why I don't believe anyone erred.

[durl]

Surely an organization that has MILLIONS of dollars wrapped up in an athlete are going to make sure they have a doctor who can accurately diagnose a problem.

A friend of mine had surgery on his shoulder to clean out some damage and his doctor said that, when they got inside, the damage was worse than they anticipated.

[RED VAN HOT]

As a casual follower of sports, it's been my observation that things always follow this pattern:

1. Injury
2. Least severe method of treatment (usually therapy)
3. Setback
4. Surgery

This seems no different. Probably would've been best to get Volquez 'scoped, but obviously that would've set his timetable back.

Well said. There is also a 'play through pain' ethic that is highly valued by top athletes.

[Always Red]

I have to believe Kremchek knows how to read an MRI. The way I read it the tests didn't show it to be that bad until they opened it up and looked inside. This isn't that hard for me to believe. All I know is that a lot of other teams appear to use him also and why not. The Reds have done an incredible job over the years training him. He should be the best team medical doctor in the world considering some of our injuries over the past 10 years.

I agree.

I work in the same general field, so I have some perspective and insider info.

You can bet your last dollar on the fact that radiologists actually read those images (first) and help Doc Hollywood interpret them.

Kremchek is a very fine surgeon, and works very hard to be on the cutting edge. He is also mostly insufferable. Thus: "Doc Hollywood"

Baseball players would not come from all over the US to have him operate on them if he was a 2 bit hack. He is perhaps the only reason that Junior is still playing baseball today.

The area of medical diagnosis is not nearly as cut and dry as most on this board think. Most folks here think that people come with a diagnosis stamped right on their forehead. Sometimes it's clear, but sometimes it is very, very difficult. If it were easy, everyone would be doing it.

Kremcheck made the final diagnosis on Volquez by arthroscopy and actually looking at it.

It is very easy just to over diagnose and operate at the drop of a hat. But that is not what he is paid to do. Not everyone needs operations. The very best surgeons know when to operate and better yet- when not to operate. An operation is irreversible. Scar tissue builds up and is present. Rehab is longer. Arthritis, long term, is a probable sequela for most sports knees and arms that have been operated on. And joint replacement, as a senior, often follows that.

No matter what folks here think it the man is not a "novice." Folks train until their mid-30's before they gain enough knowledge to do this for a living. And then they keep training, continuously learning until they retire.

I have tremendous respect for what Tim Kremchek does.

I do not expect that you all will, or even listen to what I have to say. No matter. I needed to say it.

[Redlegs]

The way I read it the tests didn't show it to be that bad until they opened it up and looked inside. This isn't that hard for me to believe. All I know is that a lot of other teams appear to use him also and why not. The Reds have done an incredible job over the years training him. He should be the best team medical doctor in the world considering some of our injuries over the past 10 years.

Agreed, agreed, agreed. Speaking from experience, I had a ruptured disc in my back and the surgeon told me the exact same thing. They can tell a whole lot more by going in and looking.

[nate]

I agree.

I work in the same general field, so I have some perspective and insider info.

You can bet your last dollar on the fact that radiologists actually read those images (first) and help Doc Hollywood interpret them.

Kremchek is a very fine surgeon, and works very hard to be on the cutting edge. He is also mostly insufferable. Thus: "Doc Hollywood"

Baseball players would not come from all over the US to have him operate on them if he was a 2 bit hack. He is perhaps the only reason that Junior is still playing baseball today.

The area of medical diagnosis is not nearly as cut and dry as most on this board think. Most folks here think that people come with a diagnosis stamped right on their forehead. Sometimes it's clear, but sometimes it is very, very difficult. If it were easy, everyone would be doing it.

Kremcheck made the final diagnosis on Volquez by arthroscopy and actually looking at it.

It is very easy just to over diagnose and operate at the drop of a hat. But that is not what he is paid to do. Not everyone needs operations. The very best surgeons know when to operate and better yet- when not to operate. An operation is irreversible. Scar tissue builds up and is present. Rehab is longer. Arthritis, long term, is a probable sequela for most sports knees and arms that have been operated on. And joint replacement, as a senior, often follows that.

No matter what folks here think it the man is not a "novice." Folks train until their mid-30's before they gain enough knowledge to do this for a living. And then they keep training, continuously learning until they retire.

I have tremendous respect for what Tim Kremchek does.

I do not expect that you all will, or even listen to what I have to say. No matter. I needed to say it.

Thanks for the professional opinion, AR.

[SMcGavin]

As a casual follower of sports, it's been my observation that things always follow this pattern:

1. Injury
2. Least severe method of treatment (usually therapy)
3. Setback
4. Surgery

This seems no different. Probably would've been best to get Volquez 'scoped, but obviously that would've set his timetable back.

Right. And not just sports injuries, that's the general plan for pretty much any medical problem that's not life threatening. Kremchek likely doesn't deserve any flak here, and he definitely doesn't deserve any flak from anyone who doesn't know the details of the case (every one of us).

[Col_ IN Reds fan]

Well I 'm not a doctor,but I did stay at a Holiday Inn once.

[Topcat]

I agree.

I work in the same general field, so I have some perspective and insider info.

You can bet your last dollar on the fact that radiologists actually read those images (first) and help Doc Hollywood interpret them.

Kremchek is a very fine surgeon, and works very hard to be on the cutting edge. He is also mostly insufferable. Thus: "Doc Hollywood"

Baseball players would not come from all over the US to have him operate on them if he was a 2 bit hack. He is perhaps the only reason that Junior is still playing baseball today.

The area of medical diagnosis is not nearly as cut and dry as most on this board think. Most folks here think that people come with a diagnosis stamped right on their forehead. Sometimes it's clear, but sometimes it is very, very difficult. If it were easy, everyone would be doing it.

Kremcheck made the final diagnosis on Volquez by arthroscopy and actually looking at it.

It is very easy just to over diagnose and operate at the drop of a hat. But that is not what he is paid to do. Not everyone needs operations. The very best surgeons know when to operate and better yet- when not to operate. An operation is irreversible. Scar tissue builds up and is present. Rehab is longer. Arthritis, long term, is a probable sequela for most sports knees and arms that have been operated on. And joint replacement, as a senior, often follows that.

No matter what folks here think it the man is not a "novice." Folks train until their mid-30's before they gain enough knowledge to do this for a living. And then they keep training, continuously learning until they retire.

I have tremendous respect for what Tim Kremchek does.

I do not expect that you all will, or even listen to what I have to say. No matter. I needed to say it.

I want top thank you for this informative opinion truly, thru bias and ignorance I myself have always believed Doc Hollywood was a hack butcher. Now I have a better understanding and reference point of his work.