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I have always wondered that if someone could make a minor change here and there to the timeline, how different being a Cub fan might be. Cub history is littered with so many momentary adverse events that with an occasional tweak, the one hundred year World Series drought would never have been an issue. With just a little help from Mr. Peabody and the Wayback Machine--voilà: Lee Smith throws a different pitch to Garvey, Leon Durham bends just a little lower to field that grounder or Alex Gonzalez actually turns that 8th inning double play.

Here’s a time-warped tale of modern day Orthopedics coming to the Cubs rescue! In order to tell the story of the World Series Shuffle, I went to one of my favorite TV programs of the 1990’s and discovered there were missing episodes in the archives.

QUANTUM LEAP – The Chicago Cubs Episode

The Cubs have a few nagging health problems as well as injuries this spring. Nothing critical. Just stuff like heart arrhythmia's treated with surgery.

 Mark DeRosa had ablation surgery to burn the short circuit in the electrical wiring of his heart. Now that he's got normal sinus rhythm, can dancing with the stars be far behind? Our 2nd baseman is back in Mesa and should resume baseball activities as soon as next monday.

Alfonso Soriano broke the tip (distal phalanx) of his right long finger catching during fly ball drills while coached to catch two-handed. Ouch that hurts. If this was a 16 inch softball league he'd be out there the next day (gnarly looking hands are the trademerk of us 16 inch softball players). Fortunately it's a hairline crack in the bone so it will be less sore in a week or two.

Update (from the Sun-Times):

(Soriano)... threw from the outfield in his first work since suffering the injury sunday and fared well. Next up is batting practice.

Aramis Ramires has a sore shoulder.  Not sore enough for an MRI. Expect him back soon and more importantly expect to see DeRosa at third soon too.

Update (from the Sun-Times):

...(A-Ram) had his scheduled spring debut pushed back to friday, but Piniella said it's not a concern and plans to have him in the lineup Friday and Saturday.

Michael Wuertz was held back a bit with a weak arm but he pitched a 1-2-3 inning with 2 K's yesterday looking solid. Last year Wuertz had a rough spring but was back on track once the season started, so it appears he's OK. 

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Cub near Hall of Fame 3rd baseman and radio broadcaster Ron Santo turns 68 today! Yes, he was born on Feb 25th, 1940 in Seattle, Washington. Rumor has it that he clicked his heels right after the delivery.

May all your wishes come true this season (and we all know what that main wish is).

...and remember to keep the "gamer" away from all those birthday cake candles.

Ernie Banks.jpgHappy 77th Birthday Mr. Cub.

My close encounter with Ernie was well after his hall of fame career was over. Take the "wayback machine" with me to May 19th, 1979. A group of my University of Chicago Med School classmates went with me to see a Cubs game that crisp May afternoon. Some of you might remember that unmemorable team...Buckner, Kingman, DeJesus, Ontiveros and Foote.

We sat behind home plate but about half way up the grandstands and the group had an entire row. About the 2nd inning one of my friends gets up and has this weird grin on his face as he moved down the row. Then out of the corner of my eye I noticed, coming up the aisle...Mr. Cub. That was cool enough, but he procedes to sit down next to me in the recently vacated seat from my friend. My classmates knew I was getting married in June and so I have to tell you that this was IMHO the worlds greatest batchelor party geeky me could have ever hoped for (although the Palomino Club in North Vegas would have been my 2nd choice). Ernie stayed there with me talking baseball for about 7 innings. Honest. I have a picture (that's me in the Cub hat) on my office wall to prove it. What does one talk about to his childhood hero? I don't remember much other than it was a very surreal experience. I do remember hearing him tell me his favorite number was 9 (not 14), as in 9 innings and 9 players on the field. Ernie philosophising Baseball Kaballah?

Ernie was still under the Cubs employ for PR functions in that era and my med school pals had set this up, hence the goofy grins when the group knew he was on the way up to us.

The Cubs were 3-hit and lost 3-0 that day to the Pirates. Jim Rooker over Mike Krukow. So much for surrealism.

To throw in my orthopedic two cents worth, Mr. Cub has had two total knee replacements (not by me, but I do know his orthopod) and they are working just fine. When the Ortho Academy meeting was in Chicago March 2006, Ernie was guest appearing in a promotion called "Champions for Patient Education" and was as bubbly as ever.

Drumroll...and You Tube tributes to good ol' #14. May you have many more very happy birthdays.

The newest addition to the Cubs pitching staff, 37 year old (38 on April 2nd) Jon Lieber is apparently ready to pitch. His tenure in Philadelphia ended abruptly last season in the 6th inning, on June 20th, while backing up home plate on a play in Cleveland. It was one rotten day for him already as he had given up 7 runs on 10 hits and was on the hook for his 6th loss. Initially, and at least for the first few days, it didn’t look like anything serious, probably just the run of the mill lateral ankle sprain.

This was the initial report from the Phillies mlb.com site:

June 21st: Ken Mandel, of Philadelphia.Phillies.MLB.com, reports Phillies SP Jon Lieber (ankle) injured his right ankle Wednesday, June 20, while backing up home plate. Lieber had the ankle checked out and it turned out to be largely a muscular injury. Because of off-days, the Phillies should be able to give him extra time to heal and he won't be needed until Friday, June 29, at the earliest.

Mirroring this information, Will Carroll, from Baseball Prospectus, in his Under the Knife column on 6/22/07 said:

The Phillies are also waiting to see how Jon Lieber responds after spraining his ankle in Wednesday's start. He limped off the field after rolling the ankle running to back up home plate after a hit. It didn't look serious, but we should know more by the time his bullpen session comes up this weekend.

Day three injury update:

June 23: Ken Mandel, of Philadelphia.Phillies.MLB.com, reports Phillies SP Jon Lieber (ankle) had his ankle wrapped Friday, June 22, however, he is still expected to make his next start Wednesday, June 27.

Now we know that this was no conventional ankle sprain.

Lieber apparently was having some problems with his foot starting the first week in March in spring training (per a C. Muskat interview this year). Older pitchers expect to have a lot of aches and pains. Apparently it wasn’t enough of a nuisance to get an MRI at the time. Still, it certainly could have been that Lieber's foot was giving him some soreness at the start of the season with the tendon having degeneration, inflammation or wear problems and it finally ruptured with the June 20th injury.

Looking at Lieber’s last 5 starts with the Phillies, four were awful, including three-10 hit outings each over 5 innings and one 13 hit outing over 6.2 innings. Nobody was blaming those outings on a inflamed foot tendon and it must not have been overly obvious as in the midst of that ugly string on June 9th, he did throw a beautiful complete game 3 hit shutout against the Royals.

With an acute injury in Cleveland and significant swelling, MRI imaging of the foot/ankle was obtained and it showed that the injury was something fairly uncommon. He had a rupture of the peroneus longus tendon, well below the outside of the ankle as the tendon goes toward the bottom of the foot.

Then, after the Phillies team orthopedist evaluation, came second opinions by sub-specialty trained foot and ankle orthopedic surgeons.

Finally, USA Today reported:

AP--Jon Lieber will undergo season-ending surgery on Friday (July 6th) to repair a ruptured tendon in his foot.

Lieber was 3-6 with a 4.73 ERA in 12 starts this season. He was the Phillies' opening-day starter in 2005 and '06, but will become a free agent after this season. "He pitched some good baseball for us," said Phillies manager Charlie Manuel. "If things had been a little bit different, he could've pitched better. He had the talent." Lieber will have the surgery at the Mercy Medical Center in Baltimore, the team said.

Jon Lieber had his peroneal tendon repair surgery on July 6th at Mercy Medical Center in Baltimore, The head of this center's foot and ankle department is Dr. Mark Myerson, who is one of the most renown foot and ankle surgeons and who apparently trained the Phillies local foot and ankle specialist (Dr. Steven Raiken). We are talking high end orthopedic sub-specialists here (their practices focus only on foot & ankle care). I'm not sure which surgeon did the tendon repair but it appears he was in very good hands.

More newswire stuff:

Philadelphia Phillies SP Jon Lieber (foot) had successful surgery, Friday, July 6, to reattach a tendon in his right foot, according to the Associated Press. He'll be in a walking boot for three to four weeks.

Sat, 14 Jul: Phillies | Lieber moved to 60-day disabled list

Tue, 7 Aug 2007: Phillies | Lieber cleared to begin rehab program

Finally, from C. Muskat, at the cubs.com site:

Lieber…finished his rehab in early October. Now, he said, everything is fine, and Lieber is back on his normal off season routine.

From my perspective as an orthopedic surgeon, this was an injury I had to do some literature review to learn more, as I haven’t seen an isolated peroneal longus rupture. I've read the chapter in Dr. Myerson's textbook. I’ve seen and treated many peroneal tendon subluxations (partial dislocations) where the two peroneal tendons (longus and brevis) slip around the injured or stretched retinaculum that supports these tendons just behind the ankle. That situation was the infamous “bloody sock” injury that Curt Schilling had back during the 2004 World Series. Schilling’s memorable treatment was very unconventional as the former Red Sox team physician, Dr. William Morgan, put stitches through the skin deep enough to stabilize the slipping tendons as a temporary measure to get him through the playoffs. In the offseason, he had more definitive reconstruction of the injury.

Here is a link to the anatomy of the outside of the ankle/foot.

The peroneus brevis tendon attaches to the base of the 5th metatarsal and is responsible for eversion (outward rotation) of the foot. The longus tendon goes under the foot and ultimately attaches to the undersurface of the 1st metatarsal. This stabilizes the 1st metatarsal and foot from rolling over in both push off and landing, so it’s function is very important in pitching from a mound.

Lieber’s injury was a bit lower down (distal) into the outside portion of the hind foot, well below the ankle. I could see why there might be a delay in diagnosis and confusion with a conventional ankle sprain which is a lateral ligament injury (ligaments between the fibula and talus/calcaneus and tibia). Lateral ankle sprains will look similar to this injury with lateral ankle and foot swelling and an X-Ray that doesn't show a fracture. For most ankle injuries, it’s conventional to get X-Rays to make sure there is no fracture. MRI’s are usually not ordered unless the ankle sprain is taking too long to heal. Most severe lateral ankle sprains take 2-6 weeks to heal. In Lieber’s case, the correct diagnosis was made very quickly. So getting the MRI early on meant Lieber’s swelling and tenderness initially didn’t match up to where a typical ankle sprain should have been tender. Score one for the Phillies athletic trainer and Orthopod showing excellent clinical decision making, a very fine job indeed!

In the case of a peroneal longus tendon rupture, there is a tunnel/groove in the outer hind foot, which involves the cuboid bone where the peroneal longus tendon passes and often there is a spur or small (sesmoid) bone that can lead to friction and subsequent tendon rupture. One of the larger published series I found on this had only 41 patients of which only 11 patients had isolated peroneal longus rupture as Lieber had. So it’s a pretty rare (or at least not commonly diagnosed) injury. In the days before MRI scans (the early 1980’s) this injury had virtually not been reported on in the ortho literature. Also, I couldn’t find any previously treated professional pitchers with this injury, but the orthopedic literature suggests athletic patients do well when the tendon rupture is surgically repaired.

Thus, if you see Derrick Lee backing up the catcher on throws from the outfield when Jon Lieber is pitching, you’ll be a bit more understanding. That is, unless Jon Lieber has already let in 7 runs by the 6th inning.

We’ve seen Cub ownership try to squeeze every little ounce of revenue from us whenever they can, but due to a tight schedule they’ve missed the big one. Now that the Wrigley field playing surface is being reconstructed by the Sodfather, Roger Bossard, they are moving all that historic dirt out and not selling it. The Sun-Times site even has a video (if you can stand waiting through the commercials) through the knothole gate in right field, Wrigleyville resident Ken Vangeloff said it looked like the Tribune was having a demolition derby or tractor pull, but the fan’s just didn’t show up. I could see them selling Urn’s of infield dirt… with a locker room/uniform number and card you can label:

#14 -- Uncle Fester

So my poor Uncle Fester’s ashes are getting a free ride in a dump truck outta his native Cook County. The Cubs are not selling it to fans. Per Shamus Toomey’s interview of Cubs VP, Mark McGuire in the Sun-Times:
“We have been accused of selling everything all of the time,” McGuire said. “But in this project, we didn’t want to do anything to impede” the tight schedule.
This is a bonus Sunday random notes edition of TCR. When Rob G. posted that he thought it would be spooky if Kerry Wood homers in tonight's ALCS final game, it got me thinking. The reality is that if manager Terry Francona brings in Josh Beckett to pitch 4 innings and shut down any Indian rally it will have haunting parallels to one of the more painful days of my life. My son, Ken, was in Boston's Fenway last night and since he's been in Cleveland for college, I've given him permission to root for the Tribe. He also attended the 2003 NLCS games 6 and 7 with me, therefore, he had explicit instructions not to reach for any catchable foul balls near the wall (unless he was sure it would reverse the timeline distortion Bartman had caused).
Cubs front office promotions include Oneri Fleita and Mark O'Neal. FLEITA WAS: director of player development and Latin American operations NOW IS: vice president of player personnel It's a new title, so what becomes of Oneri's old position? Is this a cost cutting move (24 fewer letters on his business card)? O'NEAL WAS: head athletic trainer NOW IS: director, athletic training I think it lets Mark O'Neal take care of the entire body now instead of only things above the neck (he was getting tired of working on Z punching people in the noggin). My congratulations to Mark O'Neal. Keeping the team healthy makes my life on TCR that much easier! CARL RICE WAS: director of information systems and special projects NOW IS: senior director of information systems and special projects Looks like our Cub computer whiz is either a year older so he got the elder statesman title or he took a course in Spanish, so now they get to call him señor. JAY BLUNK WAS: director of sales and marketing NOW IS: vice president of marketing and broadcasting The promotion includes getting a key to the executive washroom. His first action will be to get rid of the remaining Andy McPhail monogrammed hand towels.
Swiss born psychiatrist, Elisabeth Kübler-Ross, M.D., published her groundbreaking book on the five stages of grief in 1969. It's been a model for those who have to deal with grief, to understand why we react the way we do and therefore to adapt to what life has thrown our way with some insight. Here they are and feel free to post where you are at this point: Denial, Bargaining, Anger, Depression, Acceptance. Cubs fans will most definitively recognize many of the 5 stages over the decades and for the most senior of us remaining, over the century. Here are a few of my thoughts regarding the events surrounding some of our lasting experiences with grief.
If Eric Patterson had only known how much impact his tardiness would create in the 2007 playoff picture. When Corey's little brother was sent down to the AA Tennessee Smokies playoffs as the consequence of his reporting late to the ballpark, little did he realize he just might have Wally Pipped himself. In a quasi-punitive measure, Cubs GM Jim Hendry sent EPat out and recalled Sam Fuld.

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