Joshua Poytress: Life-Threatening Blood Clot
Surgery Restores Young Pitcher's Arm and Future
It was game three of the 2009 season for the Cape Cod League, the oldest amateur baseball league in the nation, when left-handed pitcher Joshua Poytress noticed his arm was swollen and discolored.
For two consecutive days prior to game three, Poytress had felt sharp pains in his scapula (shoulder blade). The 18-year-old California State University Fresno freshman - an elite player who had been drafted in the 16th round to the Houston Astros as a high school senior -- decided to rest his arm and wait for the pain to subside.
What Poytress believed to be a pinched nerve was actually a life-threatening blood clot. The condition also had the potential to threaten his promising baseball career. After seeking immediate medical attention at Cape Cod Hospital, Poytress was taken to Beth Israel Deaconess Medical Center, where physicians in the CardioVascular Institute diagnosed the pitcher with Thoracic Outlet Syndrome (TOS).
TOS is a group of disorders brought about when blood vessels or nerves in a person's thoracic outlet -- the space between the clavicle (collar bone) and first rib -- are compressed.
Poytress suffered from two forms of TOS, vascular and neurogenic. His first rib (located below the collar bone) was compressing an artery, causing the vascular form of TOS. In addition, a repetitious, over-the-head movement he had been making as a pitcher since the age of six was to blame for the neurogenic form of TOS.
Athletes including tennis, volleyball and baseball players such as Poytress, who make these repetitive moves, are often stricken with TOS.
At BIDMC's CardioVascular Institute, physicians deliver world-renowned medical and surgical care for heart and blood vessels and provide access to the most up-to-date treatments.
Marc Schermerhorn, MD, and his team, who has extensive experience and a strong record of excellence in treating all diseases and conditions affecting veins and arteries, needed to immediately dissolve Poytress's clots and remove his first rib.
When surgeons explained the necessary procedure to Poytress, he was okay with it so long as he would be able to play ball the following year.
In the first of Poytress's many surgeries, doctors dissolved the blood clots. The blood in Poytress's arteries, however, began to clot again. The pitcher then endured a 12-hour surgery in which his first rib was removed and scar tissue was released along the course of the vein.
"Because my vein had so much scar tissue, at the end of the 12-hour surgery, they had to leave a stent in the vein to keep it open while setting me up for the next surgery when they would replace the stent with a vein from my groin," Poytress explains.
The pitcher was in surgery again, this time for nine hours. During that time, surgeons had to repair the vein from within the chest out to the shoulder. Surgeons also had to go in and connect an artery and vein in Poytress's wrist to increase blood flow through the repaired subclavian vein in his thoracic outlet to prevent clotting. A patch of skin from his thigh was used to cover the artery and vein in his wrist.
In total, Poytress has had three major and five minor surgeries totaling more than 40 hours.
"I was really scared," Poytress says. "I tried to tell myself that I would get past it and took it one day at a time."
"I have done a lot of operations for people with TOS," Schermerhorn explains. "The difference is most people are not elite athletes."
Normally when a patient is diagnosed with TOS, surgeons remove the first rib and put in a stent in a procedure lasting six or seven hours.
"In someone who is an elite athlete we don't leave the stent in because it is prone to fracture," Schermerhorn says. "In all likelihood he would be told to live with it. This was a very difficult and long thing to take care of but I don't give up. One of the reasons we chose to do what we did is because he is young, incredibly healthy and strong."
Right Place, Best Surgeons
In more than a month at the CardioVascular Institute, Poytress got to really know the medical staff.
"The people at Beth Israel Deaconess Medical Center make things comfortable and are so personable," Poytress says. "The surgeries were all done really well and thoroughly explained by the doctors who are really knowledgeable."
Karyn Mazzei-Poytress, Poytress's mother said if it was going to happen, it happened at the best place.
"I believe it could have happened anywhere else but it manifested in Massachusetts and I think it was the timing of God that put him in the best place, with the best surgeons to handle what was happening with him."
Mazzei is thankful for the special people at BIDMC, especially the nurses on the Farr Five unit she still calls and e-mails today.
"You know when people are being nice and doing their job but Dr. Marc (Schermerhorn) and a handful of BIDMC nurses will be mine and Josh's friends for life," Mazzei adds.
Baseball is his life, says the CSUF Bulldogs pitcher, and anything that would prevent him from making it to the mound would be devastating.
"The doctors were saying I would be okay and they did the surgery in a way that would avoid messing with my throwing," Poytress explains. "I did not think my career was over, but I knew it took a little bit of a detour."
An all around athlete who played soccer, basketball and was his high school football team's quarterback, Poytress honed in on the art of pitching because he had the mental and emotional control that a pitcher needs, Mazzei says.
"Josh has always told me he was born to be a pitcher," Mazzei adds.
Despite his detour into BIDMC, the now 19-year old sophomore is back in the bullpen practicing for the Bulldogs' new baseball season and is throwing heat.
"The recovery he has made is phenomenal as we expected," Schermerhorn said. "I am looking forward to him playing in Cape Cod."
The Cape Cod Baseball League, which fosters careers of thousands of top baseball players from Hall of Famer Mickey Cochrane to Boston Red Sox catcher Jason Varitek and outfielder Jacoby Ellsbury, has invited Poytress back for another summer on the mound.
Not only does Poytress plan to return to the Cape to play ball, he also plans to reunite with the surgeons and nurses at the CVI who rallied around him.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted February 2010