It takes more than Ankylosing Spondylitis to Keep Guti Down

One of the very few good things about my beloved Seattle Mariners this year, besides Nelson Cruz crushing the ball, has been the call up of Franklin Gutierrez. Guti has been one of my favorite M’s over the years, and to see him struggle with his health concerns since 2011 has been really sad and disappointing. For a long time it was not clear what exactly was wrong with Guti, but the diagnosis of ankylosing spondylitis was especially discouraging.
GutiRemembering Franklin Gutierrez as arguably the best defensive center fielder, and according to my wife the most handsome, now destined to be facing a life of increasing immobility seemed terribly unexpected and unfair.
For Mariner’s fans who are unfamiliar with ankylosing spondylitis, sometimes called “AS”, is one of the autoimmune class of arthritic conditions. Unlike rheumatoid arthritis and systemic lupus erythematosis, which are more common in women, AS affects young men more often. than women. Gutierrez is demographically a typical person to be diagnosed with AS. It most often affects young men in their late teens to 20’s and typically presents with back and hip pain and stiffness. The word “ankylose” means according the, “the union or consolidation of two or more bones or other hard tissues into one.” Typically in AS the vertebra develop abnormal bony growths on the edges that grow to meet each other and they become fused into immobile joints. This leads to initially, pain and stiffness of the back, and progresses to loss of mobility. The ribs that attach to the thoracic vertebrae can become involved also leading to difficulty taking deep breaths. One of the simple tests done is to measure the chest circumference at full expiration and again at full inspiration. Usually a difference of several centimeters is noted, but with AS little or no change may be noted
Other joints classically involved in AS are the hips and knees. Joint replacement can be needed, especially in the hips, to reduce pain and improve function. Treatment is typically with therapy to try to prevent loss of mobility, anti-inflammatory medications called NSAID’s that help with pain and inflammation, and when needed biologic agents like tumor necrosis factor inhibitors like Humira, Enbrel and Remicade can sometimes help.

The cause of AS is unknown but it is more common in persons who have a gene named HLA-B27.  For unknown reasons people with the HLA-B27 gene are more prone to develop AS and some other autoimmune disorders, but many people with the gene never have any known problems.  It’s one of the mysteries of medicine.
Typically AS is slowly and steadily progressive and it remains to be seen how Franklin Gutierrez will fare. In the meantime I for one am rejoicing in seeing him play, and am happy that the Mariners have found a way to allow him to play in MLB while getting him the rest he needs to stay functional. M’s fans everywhere celebrated his pinch-hit grand salami, and his two home runs last night are a testament to his courage and hard work to get back after missing much of the last 4 seasons. Go M’s! Hooray for Guti.

The Mammograms or Not in Women 40-49 Controversy

As usual Dr. Kenny Lin, a former USPSTF member and prolific writer of “common sense” articles writes on how emotions rule rather than evidence and data when it comes to how people feel about breast cancer Check out his article: Countering the too neat narrative on screening mammography. Here are a couple of snippets for… Continue Reading

Personal Experience on a High Plant Based-Low Fat Diet

This post is unlike any I’ve put up over the years of  It is largely anecdote and not based on enough hard data that I will convince my physician friends.  Intrigued?  Read on. My son Brett has been on a journey with his diet and health over the last few years.  He has become… Continue Reading

USPSTF “Strong” Recommendations for Preventative Services.

This article is the second in a series on the USPSTF recommendations to health care providers and U.S. residents on recommendations for preventative care services.  The previous article listed 16 “D” recommendations, i.e. things you should not do in an attempt to prevent health problems.  In that article I selected the most relevant “D”: recommendations,… Continue Reading

SGR is History- Finally!

I started to write a post about the house and the senate finally coming up with a way to get rid of the regularly occurring threat to implement major Medicare payment decreases mandated by the SGR.  Last night, appropriately at nearly the last minute the Senate passed the house bill to repeal the SGR and… Continue Reading

You- Yes YOU Can Save a Life by Using an AED

This week Sound Family Medicine purchased a replacement AED (automated external defibrillator) for my clinic. I underwent a training session for use with the new device. It took about 1 minute. Open the container. Apply the pads. Turn on the machine. If it says to shock the patient make sure no one is touching the… Continue Reading

Bill Maher’s Illogical Thoughts on Vaccinations

I’m visiting my mother-in-law and so Friday night we watched Real Time with Bill Maher and I enjoyed watching satire of the news from the left side.  I recently visited my Dad and endured Fox Network’s Justice w/Judge Jeanine so Maher seemed like a Rhode’s Scholar in comparison to Ms. Pirro.  Much of what Mr. Maher… Continue Reading