MRIs and Service Time

What’s the deal with Dinelson?

As we discussed on Monday, Dinelson Lamet left his Sunday start with soreness in his right elbow. The Padres have since diagnosed Lamet with a flexor strain—a muscle issue—and ruled him out for April. At first blush, it’s great news. Anytime an elbow issue finds a pitcher, Tommy John surgery immediately jumps to mind. Flexor strain, then, is a pitcher’s best friend.

Still, like much of Padres Twitter, I can’t quite understand why the Padres haven’t given Lamet an MRI yet. Team doctors apparently diagnosed Lamet through some type of surface examination. That’s cool, I guess—I’m no fan of modern medicine myself, but I’m also not a major-league pitcher or someone who has to make decisions regarding the future of one. It seems like it’d be in the best interest of the Padres, Lamet, and everyone involved to order the MRI, just to double-check whether there could be structural damage in his ligament.

The lack of an MRI so far seems silly, but I like to believe that teams generally act rationally, particularly when confronted with something like this, something that could potentially hurt their on-field product—and, thus, their revenue stream. So . . . what’s the deal?

It almost certainly can’t be the price, right? I found an article from Time.com that lists the average cost of an MRI in the United States at $2,611, with prices ranging from $474 to $13,259. That’s a lot of dough for you and me, but not so much for a big-league baseball team. Even on the high end, it’s a drop in the bucket, particularly when we’re talking about the fate of the most valuable pitcher on the 40-man roster.

The theory: There’s nothing here. Even if you think the Padres are cheap, they aren’t this cheap.

MRIs aren’t dangerous, right? Of course not. According to Radiologyinfo.org, “an MRI examination causes no pain, and the electromagnetic fields produce no known tissue damage of any kind.” So long as you don’t have much metal in your body, you’re good.

Still curious, I dug a little deeper, which really just consists of typing “MRI side effects” and similar phrases into Google and poking around a bit. I didn’t quite find the deep underbelly of the MRI, but there are perhaps more potential health concerns than one would think. From Healthline.com:

That’s what Dr. Emanuel Kanal says about the Food and Drug Administration’s safety announcement last week on the risk of brain deposits from repeated use of certain contrast agents used during MRI tests.

The director of magnetic resonance services and professor of radiology and neuroradiology at the University of Pittsburgh Medical Center said it’s difficult to know the significance of the recent research, but he noted there are “several things [that] are perturbing.”

First, scientists didn’t expect to find a substance called gadolinium deposited in MRI patients’ brains.

In addition, he said, this effect isn’t seen equally among the various FDA-approved gadolinium-based contrast agents (GBCA) used in MRIs. “That’s the elephant in the room,” Kanal told Healthline.

There are other areas of concern, too, like damage to DNA and what I interpreted as a possible link to cancer. The findings seem muddled at this point, but it’s clear that MRIs could pose more of a threat to sound long-term health than once imagined. It’s not quite the same as a trip to the family dentist.

The theory: The Padres medical staff isn’t big on MRIs, going to them only as a last resort. The problem areas mentioned above seem to indicate precautions with having multiple MRIs. Lamet, just 25, could be in store for more tests if he has a long career, so perhaps the Padres are trying to avoid an early MRI if they’re reasonable sure he doesn’t need one.

MRIs also don’t provide a sure-fire solution to diagnose any malady, as they often return murky results (h/t Lostradamus):

An M.R.I. is unlike any other imaging tool we use,” Dr. Sangeorzan said. “It is a very sensitive tool, but it is not very specific. That’s the problem.” And scans almost always find something abnormal, although most abnormalities are of no consequence.

The theory: The Padres believe they know what’s wrong with Lamet’s elbow, and don’t want additional testing to blur the picture. An MRI on a pitcher’s throwing arm is bound to show some wear and tear, at least, which could force the Padres into making a difficult decision. If Lamet’s rest and rehab goes as planned, the Padres can assume that their initial diagnosis of the flexor strain was right, and that Lamet’s right arm is back to 100 percent—or as close to 100 percent as the arm of a pitcher can get. At worst, if all doesn’t go well, they could get the MRI done then and only lose a month or month and a half.

If those theories sound a bit stretched, well, they just might be. The idea here is that the Padres have to have some reason why they wouldn’t rush Lamet to the nearest MRI machine, and this is the best I’ve got. Maybe they’re onto something, or maybe they’re just incompetent when it comes to evaluating pitching injuries.

You make the call.

Lucchesi: Now or later?

How about now?

I listened to Kevin Acce on the Darren Smith show yesterday, and the sole reason for keeping Joey Lucchesi down for a few weeks, according to Acee, appears to be for service-time manipulation. This line of thinking just doesn’t make much sense.

I mean, sure, I get it. Keeping Lucchesi in the minors for roughly two weeks will earn the Padres an extra year of team control down the road. Forget the ethical dilemma there—and the idea that it’s dangerously close to breaking the rules—and remember that Lucchesi, a senior signing back in 2016, turns 25 in June. We’re talking about the difference between having him through his age-30 season or his age-31 season. In other words, small potatoes, especially for a pitcher who isn’t a slam-dunk, top-of-the-rotation stud. (Lucchesi could reach that level, but he projects as more of a mid-to-backend workhorse.)

The Padres didn’t play the service-time game with Manuel Margot in 2017, starting him in the majors on Opening Day, so it’d be surprising to see them start now, with Lucchesi, a less heralded prospect. Then again, maybe Acee’s just reading the situation wrong. It’s possible the Padres want to get Lucchesi more reps against minor-league competition. While he did pitch 139 innings last year, posting a 2.20 ERA and a 4.48 strikeout-to-walk ratio, he hasn’t yet throw a pitch in Triple-A.

Given his performance last year and in spring training, his age, and the gut-punch news about Lamet’s flexor strain (fingers crossed), it’d be nice to see Lucchesi right away. El Paso is a launching pad, anyway, and Lucchesi is the type of advanced arm who could skip that level altogether. If it doesn’t work out, it’s not the end of the world. The Padres could always send him back down, starting from scratch. But if Lucchesi’s good—and he just might be—he’s probably going to be good now. Starting him out in the majors would be a positive development all around, one that would avoid the grim world of service-time manipulation while giving Padres fans an early taste of the next wave.

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