Tuesday, May 25, 2010

Blocking the Plate

In the baseball world Ryan Westmoreland is what’s known as a five-tooler. He has all the fundamentals that make a great player. He can hit for average, hit for power, field, throw and run the bases with near flawless execution. He is a lanky outfielder with vast potential and upside.

In the fifth round of the 2008 baseball draft, the Rhode Island native was selected by the Boston Red Sox. Shortly after he was drafted it was found that Westmoreland had a torn labrum in his shoulder which required surgery. During his first season of professional ball in 2009, Westmoreland broke his collarbone smashing into an outfield wall while making a catch, and again surgery was required.

Despite the injuries he was named the number one prospect in the Boston Red Sox farm system by Baseball America entering the 2010 season. During an interview with the publication he was asked what the organization wanted him to work on in the off-season. Westmoreland answered, “I am doing everything I can to stay healthy for the upcoming season.” Neither he, nor the team, could foresee that his prior injuries would be the least of his health concerns, as a potentially fatal diagnosis derailed his current path to stardom.

Going into Spring Training the Red Sox faithful were eager to catch a glimpse of the future and the 19-year-old Westmoreland was raring to get on the field. One week in, he was forced to leave the team’s minor league camp to seek treatment for reoccurring headaches. The next day he was diagnosed with a cavernous malformation of the brain. Urgent treatment was required and after visiting with specialists Westmoreland had brain surgery on March 16th.

A cavernous malformation (also known as cerebral cavernous malformation (CCM), cavernous haemangioma and cavernoma) occurs when a cluster of abnormal, thin-walled blood vessels of varied sizes permeate the tissue. The vessels occur in the brain or on the spinal cord and can affect the nerves and slowly leak stagnant blood causing complications. The cavernous malformation may lead to significant bleeding or hemorrhage into the brain tissue. According to the American Association of Neurological Surgeons, 1 in 200 people suffer from some form of cavernous malformation.

Unfortunately many patients with cavernous malformations can by asymptomatic. Indirect symptoms lead to their diagnosis, as was the case with Westmoreland. These symptoms include weakness, numbness, difficulty in speaking, difficulty in seeing, unsteadiness and loss of coordination. Eventually it could lead to continued hemorrhaging, advanced neurologic deterioration, intractable epilepsy, paralysis and even death if not detected and treated.

Another issue is that the malformations typically hemorrhage in small amounts with bleeding episodes separated by months or years. Therefore a hemorrhage may occur with increasing symptoms followed by gradual improvement as the blood is partially absorbed. Diagnosis can only be made through an MRI on the brain itself, so it is often only detected by accident. This was the case for Westmoreland, who had a malformation on his brain stem which did have an episode of bleeding. According to Dr. Joseph Maroon, the vice chairman of the Department of Neurosurgery at the University of Pittsburgh Medical Center, “Any further bleeding would cause severe neurological damage.”

Just a few short years ago Westmoreland was a typical student at Portsmouth High School in Rhode Island. He was the star of his baseball team, earning numerous awards including the 2007 Rhode Island High School Baseball Player of the Year as well as both the 2007 and 2008 Cox Sports Television Baseball Scholar/Athlete of the Year. He dominated at the plate, in the outfield and even on the mound where he went 7-0 with a 0.45 ERA and a perfect game in his senior season. Baseball America had Westmoreland listed as the 113th best amateur prospect heading into the 2008 draft.

Living just an hour away from Fenway Park, Ryan was a typical, New England-raised Red Sox-diehard. So when they came knocking at the 172nd overall pick, Westmoreland passed up a full scholarship to play baseball at Vanderbilt and decided to pursue his professional baseball career. Ryan signed on the draft deadline day. Had he not, he would have retained his ability to pursue his college eligibility and the Red Sox would lose his rights. This earned him a $2,000,000 signing bonus, the third highest in team history.

Because of his late signing, he ended up playing one more summer of amateur ball with the Bayside Yankees in New York City. In November of 2008, Westmoreland underwent surgery for a tear in the cartilage near the top of his shoulder socket where the bicep tendon attaches to the shoulder. At the start of the 2009 season, Westmoreland was not fully healed, so he had to wait until July to make his professional debut. He kicked off his career with the short-season, Single-A level Lowell Spinners, mainly as a designated hitter.

He instantly proved himself at the plate and earned NY-Penn League All-Star honors. He would spend most of this summer as the club's designated hitter, but by mid-August he was itching to roam the outfield. On August 28th Westmoreland ran full speed into the left-centerfield wall making a spectacular catch and leaving a hole in the plywood wall at LeLacheur Park. He would be diagnosed with a fractured clavicle, was shut down for the remainder of the season and another surgery was in store for the young prospect.

Despite the injury, Westmoreland managed to put up big numbers for a first year player. He hit for an average of .296 with 15 doubles, 3 triples, 7 home runs, 35 runs batted in, 19 stolen bases and a .401 on-base percentage in only 60 games. He was gaining momentum within the organization and rising up the depth charts. Red Sox director of player development Mike Hazen went so far as to say that, “We would never assume players would walk into professional baseball and do what he did in all aspects of the game. He was very impressive."

He was also rising up the charts of the top prospect prognosticators as well. Two Baseball America writers listed him in their Top 25 prospects in all of baseball. Keith Law of ESPN Scouts Inc. had Westmoreland as the 32nd best in the minors and MLB Fanhouse had him at number 39 overall. The sky was the limit for Westmoreland and the Red Sox were willing to take the time to get him healthy and into big league shape.

The start of the 2010 season meant big things for Westmoreland. It would be his first opportunity to play a full professional season and he was charged up to prove to everyone that he was worthy of all the praise. In a Baseball America interview Westmoreland stated, “I don't know where they are going to put me but wherever I am I want to play to my potential.” At the end of February he packed up his gear and headed to Fort Myers, Florida for Spring Training.

Shortly after arriving Westmoreland did not feel right. He kept experiencing headaches that became more and more intense. He initially thought nothing of it until he started experiencing a tingling sensation in his head which eventually led to a numb feeling along his scalp. He traveled back to Boston and went to Mass General Hospital for a battery of tests. An MRI determined that the cavernous malformation on his brain stem was causing the symptoms. After a series of consultations, three specialists determined that surgery would be necessary. “It's very unusual to find these abnormalities in the brain stem," stated Dr. Joseph Moroon, "It is potentially life-threatening, as is any brain surgery."

Westmoreland traveled to Arizona to have the surgery, which was performed at the Barrow Neurological Institute in Phoenix. Dr. Robert Spetzler, who is renowned as one of the foremost experts in the field, performed the five hour surgery on Westmoreland’s brain. All of Red Sox Nation familiar with his situation had to hold their breath, since it typically takes a few days to determine what, if any, neurological damage may have occurred. A week after his surgery he was released from intensive care and began physical and occupational therapy in the hospital’s neuro-rehab unit.

Ryan would then be transported from Arizona back to Boston at the beginning of April, to undergo further therapy at Spaulding Rehabilitation Hospital. On April 4th the Red Sox faithful received their first glimpse of Westmoreland since his surgery when he showed up at Opening Day seated in the Red Sox luxury box at Fenway Park. A little more than three weeks later he was released from Spaulding and returned home. He continues to undergo occupational and physical therapy as an outpatient there.

There have been other, similar high-profile malformation cases in the sporting world. Houston Astros manager Larry Dierker experienced a seizure and collapsed in the dugout during a game in 1999. He underwent surgery two days later and returned to the team four weeks after that. He would go on to lead the Astros to a division title that season.

Olympic gold medal winning track-and-field star Florence Griffith Joyner suffocated to death in her sleep after suffering a severe epileptic seizure in 1998. Coroners determined that this was brought on by a cavernous angioma which was never diagnosed, despite dealing with seizures in the past. Griffith Joyner was three months shy of her 39th birthday.

In 2004, world renowned bicyclist Alberto Contador suffered a seizure and fell during a race. The then 21-year-old found that he too had a cavernous angioma and underwent successful surgery. He would go on to win the 2007 and 2009 Tour de France and become the first Spainiard to win all three Grand Tours of road cycling.

In recent years the Boston Red Sox organization has endured major health scares from some of its top talent. In 2008, prospect Anthony Rizzo was diagnosed with Hodgkin's Lymphoma, halting his season. After undergoing chemo-therapy, he was declared cancer-free in November of 2009 and was recently promoted to the AA level Portland Sea Dogs after only 29 games with Single-A Salem.

And who could forgetwhen Jon Lester was diagnosed with cancer (anaplastic large cell lymphoma) in 2006? Less than one year later Lester was the winning pitcher in the clinching game of the 2007 World Series and in 2008 he hurled the 18th no-hitter in Boston Red Sox history. Throughout it all, the organization has stood by their players and supported them to the fullest, much in the same way that they are doing with Westmoreland. They are hopeful for similar results in improved health as well.

Westmoreland’s progress has been closely guarded and his agents released a statement saying, “We greatly appreciate the privacy that we have had to this point. This privacy has allowed Ryan to focus entirely on his rehabilitation and we believe this has helped him make significant progress in a short period of time. The next few weeks are very important to Ryan’s recovery. We prefer to maintain this level of privacy until Ryan is further along in the rehabilitation process.”

Westmoreland has made another trip to Fenway on April 18th and the NESN cameras showed him smiling and enjoying the game with his friends around him. He is showing obvious progress and the organization is upbeat about the strides he is making. A Red Sox official made it a point to convey that "he's a fantastic kid. Very professional, very intelligent, well-spoken, a good worker -- everything you'd want in a kid." At this point, there is no way to know if he will ever play baseball again, but for the time being everyone is just happy to see this “fantastic kid” enjoying life again.

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