Dr. Michael Rohrenbach joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about health for baseball players at the AquaSox stadium.
Read the transcript of Dr. Rohrenbach's talk on heath for baseball players.
Health Matters: Joining us right now is a practicing osteopathic family physician. He is an associate medical director of Physician Services at The Everett Clinic. Dr. Michael Rohrenbach joins us.
Health Matters: You have the Aquasox hat and a Mariner's shirt. You're my kind of guy. You're a baseball guy, right?
Dr. Rohrenbach: Right. Health Matters: Now, are you the team physician? Is that what you are, what you do?
Dr. Rohrenbach: That is correct. I have been the team doctor for the last six years for the Aquasox and before that I was team doctor for Everett High, Cascade High, Mariner High, and then Kamiak High, depending on how old the kids were.
Health Matters: So, you're a family physician who likes athletics?
Dr. Rohrenbach: Yes.
Health Matters: And it has afforded you the opportunity to get involved in that population and here you are with the Aquasox. Tell us. What is the day in the life or life in the day or season of a family practice doc taking care of a baseball team?
Dr. Rohrenbach: Great. So it's pretty quiet in the off season, obviously, but when the draft picks come in June and they hit the door, we have to be there to do their physicals and make sure they are ready to go. Most of the time they get drafted, they come in the door, and the team wants to make sure they’re orthopedic exam is done, their physical exam is done, and they are ready to get on the field and start, so it is pretty hairy at the beginning of the season.
Health Matters: Now, I have a quick question. You know, normally, you read where there is just a pending physical. You know, when they make a trade or somebody's draft, but these guys aren't just... turning their head and coughing, right?
Dr. Rohrenbach: That's a great question. Yeah, at spring training, we do physicals for half of the team and then after the draft picks, we will do physicals for the other half that are new, but it is a line. We have a dentist that is looking at the teeth and gums. We have an eye doctor who examines the eyes. We have orthopedic surgeons for the upper extremity, orthopedic surgeons for the lower extremity. We have heart and lung check, eyes, ears, nose, and throat, and we have, obviously, the abdominal exam and the hernia check.
Dr. Rohrenbach: It is very comprehensive.
Health Matters: So, as a physician, have you ever had to deny someone from a draft pick?
Dr. Rohrenbach: Never a denial. We always have to dig into any heart murmurs or any findings that are abnormal or unusual, but we have not had to, in my career here, turn someone away due to a medical condition.
Health Matters: Now, you know, I have been looking at this little piece of paper from you, and I don't even think about this, but some players, have to take a daily medication that you don't think about and so you take care of their refills and that as well, too, right?
Dr. Rohrenbach: Yep, I will assume their care as their primary care doctor while they are in town. So, any refills, any illnesses, any injuries will be assessed by myself.
Health Matters: So, what happens if they are on a road trip and one of the players gets sick and needs to have some kind care on a road trip. Are they calling you for recommendations and you're going to direct them to go to urgent care, go to the ER, or whatever they need to do?
Dr. Rohrenbach: That happens from time to time. They will triage a phone call to me, but sometimes it will be serious enough that they will just get a hold of the team doctor at Vancouver or Spokane and then that team doctor will see him, assess him, and get him set up.
Health Matters: So, that is part of what your job is too, is also the other players if they need medical care when they are here, they are calling you.
Dr. Rohrenbach: Exactly, I will assess a player or two from time to time from the visiting team.
Health Matters: Now, let's talk about typical day at the ballpark. Are you at every game?
Dr. Rohrenbach: No, I come to about 1 in 3 games, I come to as many games as I can...
Health Matters: So, if a player needs stitches, for example, I mean, are they going just to the ER here in North Everett or are they going to call you?
Dr. Rohrenbach: They call me first and I can fit them in and do the stitches, or get them lined up at one of my Clinics. We have nine Clinics throughout Snohomish County here at The Everett Clinic...
Health Matters: So, you are on call essentially 24/7 then with the baseball program during the season?
Dr. Rohrenbach: Yes.
Health Matters: We are talking to Dr. Michael Rohrenbach. He is the family physician. He is the physician for the Aquasox and he is also a family physician from The Everett Clinic. We are live at Everett Memorial Stadium. Let's talk about nutrition and advice. You know, I know some of these kids just graduated from high school. They are pretty young. There's fast food places right down the block, so I have three things I want to you to talk about - their nutrition, caffeine energy drinks are pretty popular with these guys, and then tobacco. You know, is that still...is it banned here?
Dr. Rohrenbach: The training staff here is pretty good. The Mariner organization is good about having food before the game - carbs and healthy carbs and fruits and snacks. You don't see a lot of junk food up there.
Health Matters: Are these guys a little more educated than say players from years ago?
Dr. Rohrenbach: I am really impressed with the kids, the quality of kids, and their coachability and just the way they handle themselves. They seem to toe the line here with pregame meals. They do a good job of providing fruits and veggies and snacks and peanut butter and good carbs and so the trainer and the coaching staff is really good about that.
Dr. Rohrenbach: They definitely not only discourage chewing tobacco, but in the minor leagues it is actually not allowed. The minor league players are not on union contracts and they don’t have a union that will protect them, so the team just sets the ground rules and say no tobacco and there are fines that will come. Major league players are allowed to chew tobacco, but they are not allowed to be interviewed with tobacco in sight. They are not allowed to have their Skoal cans...Copenhagen in their pocket. If they get three offenses for being caught with a chew in during an interview, they get fined $1,000. If it is multiple infractions, it is $5,000, so the league is taking it seriously since Tony Gwynn and some of the other ballplayers have struggled with complications.
Health Matters: How about the energy drinks?
Dr. Rohrenbach: Energy drinks are so pervasive in our culture these days. My generation, none of us really drank energy drinks. It is a diuretic. Caffeine is a diuretic. You lose your fluids and then you can get in trouble quicker, so....I say moderation. Don't do the super-loaded ones like the Bang energy drink, which actually has 357 mg of caffeine in it.
Health Matters: Red Bull is 80.
Dr. Rohrenbach: Coffee is 150. If you have a venti Starbucks coffee, it is 415.
Dr. Rohrenbach: So caffeine drinks, can trigger heartburn, they can trigger insomnia, they can trigger headaches, they can trigger irritability, agitation, and they can make you more dehydrated. The training staff and the coaches are aware of that and the recommendation is on the hot days and big workout days, don't overdo it with energy or caffeinated drinks.
Health Matters: One of the things that we see, particularly in July, August, September in Seattle here is the sun and we don't appreciate the sun's effect on the skin, particularly living in the Northwest, but some of these kids are coming in from other areas of the country...but you still have to talk to about skin protection.
Dr. Rohrenbach: That is a huge issue in baseball. Like, no other sport, baseball players have long, long days, long workouts, they are out in the sun, so sun exposure is a huge deal for baseball players. Some of the recommendations regarding sun protection is to try and avoid the real hot times of the day of being out between 10 in the morning to 4 in the afternoon, Daylight Savings Time that is 9 in the morning to 3 in the afternoon, because that is the maximum ultraviolet radiation you get. I also say wear hats, wear SPF lip ChapStick because SPF of 15 or more is needed to protect the lips, and then SPF of 15 or above. We used to be pretty stringent and say 50, 45, now we say 15 and above because they are all pretty similar in their sun protection.
Health Matters: Now, they all wear hats, but I didn't even realize it until I knew we were going to talk about this, and noticed this weekend on like some very hot days, I noticed a lot of players are wearing long sleeves. Is that part of the deal too?
Dr. Rohrenbach: The gear that the Aquasox have is really breathable and it is good protection against the UV rays and it's a good idea if you can to have the 3/4 or full sleeve covering the arms. Also, sunscreen, multiple applications, is important because you sweat and you lose a lot of your protection, so multiple applications is something that you have to think about.
Health Matters: Are there any mandates by major league baseball regarding sun protection?
Dr. Rohrenbach: There are not.
Health Matters: But we know there are mandates regarding concussion.
Dr. Rohrenbach: Yes, there are. There are some federally adopted rules on concussion/head injury which are basically if you suspect a concussion, the player gets pulled from practice and games and they will not be allowed to return until they have been fully assessed and symptom-free. It used to be in the early days - a good player, star player - Is he going to be better by halftime? Now, you pull him if you think that there is a concussion.
Health Matters: Is that mandate, is that in minor leagues or is that in all of baseball?
Dr. Rohrenbach: That's adopted by MLB and in the minor leagues.
Health Matters: Let's talk about good old fashioned musculoskeletal bumps and bruises, sprains and strains, and those types of injuries in baseball. The ball is bouncing, bad hops. I mean what kind of facial injuries do you see?
Dr. Rohrenbach: The more serious injuries I've seen are the orbital fractures where you take one right at the eye.
Health Matters: Like a bad hop type injury?
Dr. Rohrenbach: Yeah, it just gets you just square, so it gets the upper and lower, and that has enough force that it actually fractures the obit, which is part of the skull. And, the main thing you look for there is if they have an orbital fracture, they are going to get a lot of swelling and they are going to potentially get double vision and so you really have to assess those carefully and make sure there if there is double vision that that gets surgically fixed so you don't have a situation where you have lifelong double vision.
Health Matters: Well, even like a bad hop with knocking out a tooth. I mean, if a tooth is knocked out. I mean, you're saving that tooth, you're going try to get that tooth back in.
Dr. Rohrenbach: And you also get him seen right away and time is of the essence. You also get a lot of lacerations. The ball is hopping up in the chin. All of the bony prominences of the face. You also see a lot of testicle injury from time to time.
Health Matters: And, how much more common is Tommy John is in the minor leagues where they used to never see it and now the percentage of kids have already had Tommy John surgery before they even get into the double A is increasing.
Dr. Rohrenbach: We have seen this year in the majors a rash of elbow injuries and shoulder injuries and it's just almost an epidemic.
Health Matters: Well, look at the bullpens. Look at the Mariner bullpen. Those kids are throwing 98, 99, 95...they are all above 95 miles an hour.
Dr. Rohrenbach: So the kids are throwing hard. There is a lot of emphasis on sliders and curves and it just is a repetitive overuse injury and all of your mechanics have to do is be off a little bit and then you're in for an overuse injury of a ligament or a tendon, so very common. There are a lot of different theories as to why there are more these days. It used to be that they let pitchers go a little longer and in some fields the pitchers were in little better shape in the years past.
Dr. Rohrenbach: Cross training is important, too, because we see that over and over again. Young kids in these 4A schools, 3A schools, you have to get in a sport, you have to do it year round, you have to be on a select team. And my daughters would play volleyball eight months a year and we would be travelling all over playing volleyball and when they were younger, there was softball and then soccer and then volleyball and basketball. When they get older they get plugged into one sport, same repetitive use, same muscle groups, and so it sets them up for injuries.
Health Matters: A lot of times patients and particularly athletes that have a repetitive trauma or sprain/strain and anti-inflammatory medication, I mean, are you going to prescribe it or are you going to wait and try ice first.
Dr. Rohrenbach: I will use anti-inflammatories. You know, it is a safe medicine and as long as it used in the appropriate doses at the appropriate times and the appropriate intervals it is a safe medicine. But, we use, on an initial injury, we use RICE - rest, ice, compression, and elevation - and then we supplement for pain control with Tylenol or ibuprofen or Aleve and they are safe medicines. They work well, and it really helps with the pain control of an acute injury.
Health Matters: We are out of time. We are going to talk right into the Aquasox pregame show. Dr. Rohrenbach, fantastic. You've got to come back on with us.