Kelechi osemele injury situation - very bad look for the Jets (update: Cut)

[BuffaloRebound]

Easy to criticize the Jets because they’re the Jets.  But this guy is getting paid $10m per year.  Football is his profession.  I think most of us would play through pain for $10m per year.  

[NoHuddleKelly12]

19 hours ago, Warcodered said:

Is this not the face of a man you can trust?

 

I reject your insinuation good sir! 

[Saxum]

At my previous job we did secure signing applications for prescriptions and we were cautioned extremely about releasing HIPAA information being told that it was a federal offense.

 

Ironically one of my coworkers was an ex-Jet player who did quite well for himself post brief NFL mostly practice squad career.

Edited October 19, 2019 by Limeaid
correction

[Hapless Bills Fan]

6 hours ago, Mr. WEO said:

 

So his choices are keep just showing up for practice and still not play and collect all the money and wait until after the season the have the surgery (he will no longer be a Jet), or show up for practice, book the surgery and if they still cut him he can file a grievance.  If his case is as legit as he says it is, he should easily win his arbitration.

 

I don't think that's quite it.  A player under contract is not allowed to decide to stop playing and have surgery and effectively put himself on season ending IR.  That would violate his contract as I understand it, and he really wouldn't have grounds for a grievance.  The grievance would be on the side of the Jets if he does that.

 

 

15 hours ago, Mr. WEO said:

Why doesn't he just go ahead and have the surgery?

 

14 hours ago, Hapless Bills Fan said:

Contract

 

14 hours ago, Mr. WEO said:

What does it say? [I respond with links - Hap]

 

2 hours ago, Mr. WEO said:

What part of that have the Jets violated?

 

The question was "why doesn't Osemele go ahead and have the surgery" [Answer: because NFL players contracts under the CBA do not allow players under contract to do that - the team doctor and/or the second opinion have to indicate it is necessary]

 

The question was not "what part of that have the Jets violated".

[Hapless Bills Fan]

2 hours ago, BuffaloRebound said:

Easy to criticize the Jets because they’re the Jets.  But this guy is getting paid $10m per year.  Football is his profession.  I think most of us would play through pain for $10m per year.  

 

I would expect it depends upon the degree of the pain and the degree to which it is impacting his performance.  I have had degrees of pain I would play through for a fraction of that $$.  I have had degrees of pain OHSWEETJESUSMAKEITSTOP I don't think I could keep going with for any amount of $$.  Maybe if the alternative were being crisped in a fire.

The question I have is why the Jets want to keep a player in uniform who they feel has been ineffective (they benched him) and who asserts that he is in such pain that Toradol doesn't allow him to play effectively.  Get him off your roster and replace him with someone who might be effective and wants to play.

 

2 hours ago, Mr. WEO said:

Isn't the player the one who brought this public?  What has the Jets org said publically?

 

Officially, the Jets have said they will fine him for conduct detrimental if he does not practice Saturday.

Unofficially, stuff like this is leaking out: " After putting Osemele through a series of MRIs, sources said, Jets team doctors determined, via overwhelming evidence of the MRIs, that his shoulder injury was not new, but rather an existing one from his time with the Raiders. Team doctors cleared Osemele to return to practice, informing him surgery could wait until after the year. Osemele refused and requested a second opinion. After seeing another specialist, however, Osemele received the same diagnosis. He could play. Surgery could wait. "

 

EIther the Jets have rogue employees who are without their employer's knowledge and buy-in releasing potentially HIPAA protected medical information about a player (in which case they best get on it and shut it down), or the Jets are the source.

 

What I'm unclear on, and perhaps you could shed some light, is how the MRI would be unambiguous that the injury is preexisting and has not been aggravated or worsened this season.

[Doc]

So much for the big upgrade to the Jets' OL he was supposed to bring.

[BringBackOrton]

2 hours ago, Mr. WEO said:

 

Agreed.

 

Toradol has become the standard of care for intra-and post op pain control specifically to avoid narcotics.  Like any NSAID (even your Motrin over the counter) it can (rarely) lead to gastric ulcers and even more rarely renal dysfunction---both of which would be typically acute, not years later after use.  I don't recall any recent reports of players suffering bleeding ulcer or kidney failure after Toradol use.  Those would be rare.

 

The issue is that the nature of the job entails the player to incur at least some injury acutely or chronically---or at least some degree of chronic pain during the season at least.  The choices for the player are (in addition to standard PT and trainer treatments): narcotics, anti-inflammatories (NSAIDS and/or cortisone) or nothing else.  The latter choice puts their ability to play, and thus their livelihood at risk.  So they make a choice, just as many people in this country make a choice to use whatever substances (NSAIDS, narcotics, steroids, stimulants) allow them to continue to work.

 

 

Isn't the player the one who brought this public?  What has the Jets org said publically?

 

Others have quoted "insiders" who are defending the Jets decision--in fact, they say both the team Dr and the second opinion have cleared him to play.

I think Richie said he was experiencing kidney failure at one point but with factors of dehydration, transient multifactorial AKI’s are the more likely explanation, that are misinterpreted as “kidney failure” by football players without a medical background.

11 minutes ago, Doc said:

So much for the big upgrade to the Jets' OL he was supposed to bring.

Well he was traded for a fifth round pick for a reason. Not sure he was touted as the “answer.”

[Doc]

16 minutes ago, BringBackOrton said:

Well he was traded for a fifth round pick for a reason. Not sure he was touted as the “answer.”

 

More than a few pundits and posters thought he'd be a major upgrade for them.

[OldTimeAFLGuy]

18 hours ago, BringBackFergy said:

I wonder why Jalen Ramsey wasn’t allowed to have back surgery?? Tom Coughlin is a meaner!!!!

 

 

..because Oral Roberts healed him......."throw away your crutches and walk!".......SMH....fraud...........

[Putin]

19 hours ago, YoloinOhio said:

 

I remember Ronnie Lott cut off his pinky to keep playing 

Edited October 19, 2019 by Putin

[YoloinOhio]

55 minutes ago, Doc said:

So much for the big upgrade to the Jets' OL he was supposed to bring.

He wasn’t good with the raiders. The jets thought he would somehow revert back to his ravens days. In retrospect a 5th was too much to give up. 

[Mr. WEO]

2 hours ago, Hapless Bills Fan said:

 

I don't think that's quite it.  A player under contract is not allowed to decide to stop playing and have surgery and effectively put himself on season ending IR.  That would violate his contract as I understand it, and he really wouldn't have grounds for a grievance.  The grievance would be on the side of the Jets if he does that.

 

 

 

 

 

 

The question was "why doesn't Osemele go ahead and have the surgery" [Answer: because NFL players contracts under the CBA do not allow players under contract to do that - the team doctor and/or the second opinion have to indicate it is necessary]

 

The question was not "what part of that have the Jets violated".

 

His grievance clearly would be based on his claim that a doctor has told him surgery is indicated now and that the other 2 doctors are wrong (team and second opinion).  It would be based on his inability to play without surgery so he would claim it was in the best interest of the preservation of his career to have the surgery now.  
 

The grievance would be to challenge the violation of the contract.  The violation would not be the basis of a denial...otherwise the grievance mechanism would serve no purpose.

 

Again,  what part of the contract or rules have  the Jets violated?

2 hours ago, Hapless Bills Fan said:

 

I would expect it depends upon the degree of the pain and the degree to which it is impacting his performance.  I have had degrees of pain I would play through for a fraction of that $$.  I have had degrees of pain OHSWEETJESUSMAKEITSTOP I don't think I could keep going with for any amount of $$.  Maybe if the alternative were being crisped in a fire.

The question I have is why the Jets want to keep a player in uniform who they feel has been ineffective (they benched him) and who asserts that he is in such pain that Toradol doesn't allow him to play effectively.  Get him off your roster and replace him with someone who might be effective and wants to play.

 

 

Officially, the Jets have said they will fine him for conduct detrimental if he does not practice Saturday.

Unofficially, stuff like this is leaking out: " After putting Osemele through a series of MRIs, sources said, Jets team doctors determined, via overwhelming evidence of the MRIs, that his shoulder injury was not new, but rather an existing one from his time with the Raiders. Team doctors cleared Osemele to return to practice, informing him surgery could wait until after the year. Osemele refused and requested a second opinion. After seeing another specialist, however, Osemele received the same diagnosis. He could play. Surgery could wait. "

 

EIther the Jets have rogue employees who are without their employer's knowledge and buy-in releasing potentially HIPAA protected medical information about a player (in which case they best get on it and shut it down), or the Jets are the source.

 

What I'm unclear on, and perhaps you could shed some light, is how the MRI would be unambiguous that the injury is preexisting and has not been aggravated or worsened this season.

The Jets are responding to the public claims this guy is making

1 hour ago, BringBackOrton said:

I think Richie said he was experiencing kidney failure at one point but with factors of dehydration, transient multifactorial AKI’s are the more likely explanation, that are misinterpreted as “kidney failure” by football players without a medical background.

Well he was traded for a fifth round pick for a reason. Not sure he was touted as the “answer.”

He made all that up.  

[Hapless Bills Fan]

5 hours ago, BringBackOrton said:

So you’re partially right here.

 

Toradol isn’t used for chronic pain but the definition of NFL pain isn’t entirely chronic. 

 

GI side effects of toradol can be avoided with GI prophylaxis.

 

I don’t have experience on the field but using Toradol once a week may also be preventative of its side effects. Most regimens of Toradol acutely is every 6 hours for 1-5 days. And it needs to be stopped after 5. Getting a single shot at 11 am on Sunday is a lot less.

 

Also, Toradol and corticosteroids are not contradinicated to use together. You are at increased risk of GI side effects but that’s it. 

 

OK now do I get to say "you're partially right here" *g*?  I take your point that the NFL usage doesn't meet the definition of "chronic pain" used by clinicians.  I don't want to divert this thread into "J. Clin Pharm" but there are some assumptions here, and I'm not sure they're correct.

 

For example, not sure it's a good assumption that NFL players are only using NSAIDs 1x a week.  They have to sleep after games and get through practices and workouts.  They may well be using oral NSAIDS during the week, then a Toradol injection on game day.  Yes, studies have shown that proton pump inhibitors and misoprostol protect against GI ulcers and erosions.  Some studies have shown a 24x relative risk increase for GI ulcers using toradol vs. other NSAIDs!  Yes, 1x a week toradol may carry lower risk for GI ulcers, erosions, and perforations - but has the impact of concurrent NSAID use along with regular, recurrent use of 1x week Toradol (a form of "chronic use") been studied?  Are these athletes receiving anti-ulcer co-therapy, or the an assumption being made that 1x per week mitigates risk?  Is that assumption supported by collated data?  Are athletes being asked, or self-reporting, use of OTC NSAIDs? 
 

I'll leave the stuff about whether GI side effects are really the only increased risk for concurrent toradol and corticosteroids.

 

My point would be, if athletes really want to play through pain (for whatever reason) and are asking physicians and trainers to help them do it - it's their choice.  But there's something very uncomfortable to me about the idea that an employer can know an employee has an injury, know that the injury requires injections of a powerful NSAID with known side effects to control pain enough for OTJ function (or maybe not enough, per Osemele's agent), and basically in some form coerce them into taking that route when the employee wants to treat the injury.  That seems unethical to me.

 

And I dislike credential waiving, but because it's occurred before that some folks know "Mr. WEO" is a physician, I will put out that I have a PhD in Biochemistry and worked at the School of Medicine and later at the Pharma company where COX-2 selective NSAIDS were developed.  So I do know something about the clinical pharmacology of this stuff, though I haven't kept current with it for the last 5 years or so.

 

33 minutes ago, Mr. WEO said:

His grievance clearly would be based on his claim that a doctor has told him surgery is indicated now and that the other 2 doctors are wrong (team and second opinion).  It would be based on his inability to play without surgery so he would claim it was in the best interest of the preservation of his career to have the surgery now. 

 

You're making the assumption that the leaked story from "unnamed source" is correct and the story from Osemele's agent (that the second opinion doctor said the timing of surgery depends upon symptoms, and Osemele's symptoms merit surgery now) is incorrect.

 

Unless you've actually got gouge from the two physicians in question, I'm not sure that's a good assumption.

 

 

[BringBackOrton]

22 minutes ago, Hapless Bills Fan said:

 

OK now do I get to say "you're partially right here" *g*?  I take your point that the NFL usage doesn't meet the definition of "chronic pain" used by clinicians.  I don't want to divert this thread into "J. Clin Pharm" but there are some assumptions here, and I'm not sure they're correct.

 

For example, not sure it's a good assumption that NFL players are only using NSAIDs 1x a week.  They have to sleep after games and get through practices and workouts.  They may well be using oral NSAIDS during the week, then a Toradol injection on game day.  Yes, studies have shown that proton pump inhibitors and misoprostol protect against GI ulcers and erosions.  Some studies have shown a 24x relative risk increase for GI ulcers using toradol vs. other NSAIDs!  Yes, 1x a week toradol may carry lower risk for GI ulcers, erosions, and perforations - but has the impact of concurrent NSAID use along with regular, recurrent use of 1x week Toradol (a form of "chronic use") been studied?  Are these athletes receiving anti-ulcer co-therapy, or the an assumption being made that 1x per week mitigates risk?  Is that assumption supported by collated data?  Are athletes being asked, or self-reporting, use of OTC NSAIDs? 
 

I'll leave the stuff about whether GI side effects are really the only increased risk for concurrent toradol and corticosteroids.

 

My point would be, if athletes really want to play through pain (for whatever reason) and are asking physicians and trainers to help them do it - it's their choice.  But there's something very uncomfortable to me about the idea that an employer can know an employee has an injury, know that the injury requires injections of a powerful NSAID with known side effects to control pain enough for OTJ function (or maybe not enough, per Osemele's agent), and basically in some form coerce them into taking that route when the employee wants to treat the injury.  That seems unethical to me.

 

And I dislike credential waiving, but because it's occurred before that some folks know "Mr. WEO" is a physician, I will put out that I have a PhD in Biochemistry and worked at the School of Medicine and later at the Pharma company where COX-2 selective NSAIDS were developed.  So I do know something about the clinical pharmacology of this stuff, though I haven't kept current with it for the last 5 years or so.

 

 

You're making the assumption that the leaked story from "unnamed source" is correct and the story from Osemele's agent (that the second opinion doctor said the timing of surgery depends upon symptoms, and Osemele's symptoms merit surgery now) is incorrect.

 

Unless you've actually got gouge from the two physicians in question, I'm not sure that's a good assumption.

 

 

I’m also a physician.

 

I’m not sure “assuming” there’s chronic OTC NSAID use at home is valid. The greivance is about the Toradol use on the sideline. AFAIK, Osmele isn’t complaining they are making him take ibuprofen at home. We can just as easily assume that isn’t the case, as there’s no evidence.

 

Those studies on Toradol usage and their increased risk of GI side effects vs other NSAIDs are almost certainly not based on one time use. And I think we can BOTH assume physicians are not going to these players’ homes to inject them on Monday.

 

I have no idea if 1x usage weekly has been studied, but I’d imagine with the focus on performance in the NFL also warrants lab monitoring. If I was slapping a player with Toradol every week, I’d check a creatinine a couple times. Ditto for GI prophylaxis if NSAID use was chronic. AFAIK, there isn’t a malpractice claim concurrent with this issue.

 

In regards to ethics, we get into sticky situations when it is in a performance standard industry. Is it industry standard to use Toradol for pain control so the players can perform? Is their reasonable suspicion that Osmele does not require immediate surgery based on the facts we’ve been presented?

 

Obviously I err on the side of anonymity. And this is a huge reason why I don’t do Worker Comp or medical grievances or work for any kind of company. My purview is the best treatment for the patient, regardless of employment status or work concerns or what their employer thinks. Some physicians do forensic medicine, many times in psychiatry for example, to give statements that the patient’s story or symptomatology is inconsistent with the illness they are claiming. Again, that stuff ain’t for me.

Edited October 19, 2019 by BringBackOrton

[Mr. WEO]

23 minutes ago, Hapless Bills Fan said:

 

OK now do I get to say "you're partially right here" *g*?  I take your point that the NFL usage doesn't meet the definition of "chronic pain" used by clinicians.  I don't want to divert this thread into "J. Clin Pharm" but there are some assumptions here, and I'm not sure they're correct.

 

For example, not sure it's a good assumption that NFL players are only using NSAIDs 1x a week.  They have to sleep after games and get through practices and workouts.  They may well be using oral NSAIDS during the week, then a Toradol injection on game day.  Yes, studies have shown that proton pump inhibitors and misoprostol protect against GI ulcers and erosions.  Some studies have shown a 24x relative risk increase for GI ulcers using toradol vs. other NSAIDs!  Yes, 1x a week toradol may carry lower risk for GI ulcers, erosions, and perforations - but has the impact of concurrent NSAID use along with regular, recurrent use of 1x week Toradol (a form of "chronic use") been studied?  Are these athletes receiving anti-ulcer co-therapy, or the an assumption being made that 1x per week mitigates risk?  Is that assumption supported by collated data?  Are athletes being asked, or self-reporting, use of OTC NSAIDs? 
 

I'll leave the stuff about whether GI side effects are really the only increased risk for concurrent toradol and corticosteroids.

 

My point would be, if athletes really want to play through pain (for whatever reason) and are asking physicians and trainers to help them do it - it's their choice.  But there's something very uncomfortable to me about the idea that an employer can know an employee has an injury, know that the injury requires injections of a powerful NSAID with known side effects to control pain enough for OTJ function (or maybe not enough, per Osemele's agent), and basically in some form coerce them into taking that route when the employee wants to treat the injury.  That seems unethical to me.

 

And I dislike credential waiving, but because it's occurred before that some folks know "Mr. WEO" is a physician, I will put out that I have a PhD in Biochemistry and worked at the School of Medicine and later at the Pharma company where COX-2 selective NSAIDS were developed.  So I do know something about the clinical pharmacology of this stuff, though I haven't kept current with it for the last 5 years or so.

 

 

You're making the assumption that the leaked story from "unnamed source" is correct and the story from Osemele's agent (that the second opinion doctor said the timing of surgery depends upon symptoms, and Osemele's symptoms merit surgery now) is incorrect.

 

Unless you've actually got gouge from the two physicians in question, I'm not sure that's a good assumption.

 

 

 

No, I'm challenging that the Jets have made all this public when that's not the case.  

5 minutes ago, BringBackOrton said:

I’m also a physician.

 

I’m not sure “assuming” there’s chronic OTC NSAID use at home is valid. The greivance is about the Toradol use on the sideline. AFAIK, Osmele isn’t complaining they are making him take ibuprofen at home. We can just as easily assume that isn’t the case, as there’s no evidence.

 

Those studies on Toradol usage and their increased risk of GI side effects vs other NSAIDs are almost certainly not based on one time use. And I think we can BOTH assume physicians are not going to these players’ homes to inject them on Monday.

 

I have no idea if 1x usage weekly has been studied, but I’d imagine with the focus on performance in the NFL also warrants lab monitoring. If I was slapping a player with Toradol every week, I’d check a creatinine a couple times.

 

In regards to ethics, we get into sticky situations when it is in a performance standard industry. Is it industry standard to use Toradol for pain control so the players can perform? Is their reasonable suspicion that Osmele does not require immediate surgery based on the facts we’ve been presented?

 

Obviously I err on the side of anonymity. And this is a huge reason why I don’t do Worker Comp or medical grievances or work for any kind of company. My purview is the best treatment for the patient, regardless of employment status or work concerns or what their employer thinks. Some physicians do forensic medicine, many times in psychiatry for example, to give statements that the patient’s story or symptomatology is inconsistent with the illness they are claiming. Again, that stuff ain’t for me.

 

Workman's comp work is the worst. I left the NYS rolls so I never have to deal with all that.  it's nuts--filled with decisions made almost always on subjective info only.  It's a dirty business.

[YoloinOhio]

 

[Rochesterfan]

I find this stuff to be fascinating.  I only think it is a bad look for the Jets because the player specifically got the info released to look that way.  
 

In reality - it does not seem the Jets are wrong in this - they diagnosed the issue and through either interview or pre-trade means - assessed that the damage was there prior to the trade and that he played through it before and earlier this year.  The player wanted a second opinion and the Jets allowed it and the second doctor agreed with the first.

 

The player in being benched (partially due to the injury perhaps or maybe he because he is not that good) decided he was done with the team and went out and found additional doctors that gave him the opinion he wanted - which if I remember from previous cases is against the CBA and his contract without the approval of the team.  
 

I understand the pain and frustration- especially at being benched and wanting to get this cleaned up to be ready as a FA, but my guess is if the Jets were winning or he was still starting - he hums a different tune here.  
 

This smacks of a player frustrated with his role and results and a team looking more at the small picture rather than the big picture.  The team could take the high road as the player is not part of the long term plans and let this get done, but they have chosen to fight it and although I do not think they are wrong - I think they lose more than they can win.  Sometimes it is just better to look at the big picture and say - ok let’s put you on IR and get you cleaned up and let’s poach a PS player that maybe is not as good, but has a future. 
 

I see similar issues with the Bengals and Cordy and Jacksonville and Ramsey.

 

 

[NoSaint]

4 hours ago, Hapless Bills Fan said:

 

I don't think that's quite it.  A player under contract is not allowed to decide to stop playing and have surgery and effectively put himself on season ending IR.  That would violate his contract as I understand it, and he really wouldn't have grounds for a grievance.  The grievance would be on the side of the Jets if he does that.

 

 

 

 

 

 

The question was "why doesn't Osemele go ahead and have the surgery" [Answer: because NFL players contracts under the CBA do not allow players under contract to do that - the team doctor and/or the second opinion have to indicate it is necessary]

 

The question was not "what part of that have the Jets violated".

define necessary though- as that’s the part I’ve always wondered. 

[Hapless Bills Fan]

21 minutes ago, Rochesterfan said:

I find this stuff to be fascinating.  I only think it is a bad look for the Jets because the player specifically got the info released to look that way.  
 

In reality - it does not seem the Jets are wrong in this - they diagnosed the issue and through either interview or pre-trade means - assessed that the damage was there prior to the trade and that he played through it before and earlier this year.  The player wanted a second opinion and the Jets allowed it and the second doctor agreed with the first.

 

The player in being benched (partially due to the injury perhaps or maybe he because he is not that good) decided he was done with the team and went out and found additional doctors that gave him the opinion he wanted - which if I remember from previous cases is against the CBA and his contract without the approval of the team.  
 

I understand the pain and frustration- especially at being benched and wanting to get this cleaned up to be ready as a FA, but my guess is if the Jets were winning or he was still starting - he hums a different tune here.  
 

This smacks of a player frustrated with his role and results and a team looking more at the small picture rather than the big picture.  The team could take the high road as the player is not part of the long term plans and let this get done, but they have chosen to fight it and although I do not think they are wrong - I think they lose more than they can win.  Sometimes it is just better to look at the big picture and say - ok let’s put you on IR and get you cleaned up and let’s poach a PS player that maybe is not as good, but has a future.

 

Ironically just as you point out it could be a bad look for the Jets because the player got info released to look that way - the reality you describe is heavily influenced by what "sources" (probably the Jets) have released - the bit about the team doctor and 2nd opinion doctor saying he could play through it, and that there has been no change or worsening of the injury.

 

In reality, just as the player got info released that paints the Jets in a bad light, they responded with the above info that paints the player in a bad light.

 

The player's agent says it's untrue that both opinions say surgery can wait.  None of us know what the MRI really shows.

 

Someone knows the truth of what's going on here, but none of us do.  I agree completely with your last couple sentences, though.  The Jets can win the $$ battle here, and lose the war in terms of unnecessary distraction, possibly feelings in the locker room if Osemele was well liked, and bad PR to FA.

Update:  Osemele did not practice and was fined

https://profootballtalk.nbcsports.com/2019/10/19/jets-fine-kelechi-osemele-for-failing-to-practice-saturday/

[Rochesterfan]

2 minutes ago, Hapless Bills Fan said:

 

I don't know if you can see this, but ironically just as you point out it could be a bad look for the Jets because the player got info released to look that way - the reality you describe is heavily influenced by what "sources" (probably the Jets) have released - the bit about the team doctor and 2nd opinion doctor saying he could play through it, and that there has been no change or worsening of the injury.

 

In reality, just as the player got info released that paints the Jets in a bad light, they responded with the above info that paints the player in a bad light.

 

The player's agent says it's untrue that both opinions say surgery can wait.

 

Someone knows the truth of what's going on here, but none of us do.  I agree completely with your last couple sentences, though.

 

This in my opinion is always a bad look for the team.