Dotel's Surgery - Q and A

When Octavio Dotel decided to buck the advice of 4 doctors, including Allan Pont, James Andrews, and Lewis Yocum, and undergo Tommy-John surgery, many felt that Dotel was doing a disservice to the team. However, when the surgical procedure was complete, important details came to light which should change the minds of the maligned fan.

... In addition, Andrews took out two large calcifications.

"I'm telling you, they were big," said Dotel, who will start rehab a week from today.

...

A reason the doctors advised against surgery was that MRI exams showed that things might not go smoothly, but, Dotel said, "Once he got in there, everything was different from the MRI. When he saw that, he said I could be pitching in April."

Doctors go to school for 7 years of their lives in order to practice their profession, but even they can be wrong. They have to rely on what the data shows them and in this case, all 4 doctors felt that Dotel's MRI did not indicate a need for surgery.

Putting that aside for the moment, I would like to show you the case of Scott Williamson, the former Reds and Red Sox reliever. Earlier in his career, he had Tommy-John performed on his right elbow. Last year, he started to experience pain in said elbow and it took seven months before it was discovered that he had a serious injury. Why did it take seven months? Well, even Dr. Andrews did not know the severity of his condition.

But a third opinion conducted by renowned surgeon James Andrews advised Williamson to try rest and strengthen his elbow.

It was discovered later that Williamson indeed needed to have his Ulnar ligament replaced:

"'I couldn't believe what I saw,' said Kremchek, who is the Cincinnati Reds team physician. 'It looked like a grenade had gone off in there. The damage was far worse that the MRIs or any examination alluded to.'

As it turned out, Williamson pitched the last month of the regular season with a completely torn ulnar collateral ligament, mangled cartilage ripped from the bone on the outer part of the elbow and several bone chips and loose bodies within the cavity of the joint. Kremchek performed Tommy John surgery on the Red Sox reliever, taking a hamstring tendon from his right leg and transplanting it to the elbow to form a new UCL.

'I can't believe he was able to pitch with the elbow like that,' Kremchek said."

So just as in Williamson's case, Dotel needed to have surgery; in both situations, the pitchers were handcuffed by the injury and thus they were unable to perform to their abilities.

With that aside, let's look at a major benefit the A's can have by retaining Dotel:

Dotel said that a tendon was taken from his leg and it was so long that Andrews was able to wrap it three times around the elbow, which is unusual.

The point to notice here is that former A's reliever, Billy Koch, also had Tommy John surgery and he actually pitched with a higher velocity because of extra loops.

Like Wood, Gordon and Koch say, they throw harder than before the surgery. Koch, typically in the high-90s, has hit 108 and 103, according to various reports. But in his first season with the White Sox last season, struggled as their closer and couldn't maintain consistent velocity of his fastball.

A strengthened elbow probably helps. "Dr. Andrews said the tendon from my wrist was a lot longer than normal, so he was able to get an extra loop out of it in my elbow, making that new ligament extra thick," Koch says.

Seeing as how Dotel actually had his replacement ligament removed from his leg, it is highly likely that he will be throwing at a higher velocity then he did before this year. The A's should pounce on the opportunity to have Dotel come back for '06 and possibly '07 as a middle reliever to create a certainty in regards to Major-League talent.

Here is a description of the average schedule a recovering patient endures. Something to watch out for is that Dotel may be on an accelerated route by 3 months or so because Andrews had told him that he could be ready by Opening Day 2006.