Rehabbing Angels pitcher frustrated, knows PEDs are off limits
BALTIMORE -- Ryan Madson is frustrated. He's 14 months removed from a Tommy John procedure that normally carries a 12-month recovery period, and he's still struggling to clear that final hurdle, now relegated to playing catch and confined to the small victories of simply not feeling soreness the next day.
The Angels right-handed reliever has fluctuated the intensity of his throwing sessions, presumably tried every rehab procedure available, been to four doctors -- one in New York, one in Arizona, the Angels' orthopedic consultant and the late Dr. Lewis Yocum, who performed his surgery -- and yet his right elbow soreness lingers.
Madson, 32 and very much in his prime, just wants to pitch again. And that got him thinking out loud on Tuesday, pondering something taboo, whether Human Growth Hormone -- an illegal and banned substance -- if allowed, could expedite his return to the mound and help him live up to his contract.
"If HGH were legal," Madson said, "just in the process of healing, under a doctor's recommendation, in the right dosage, while you're on the [disabled list], I don't think that's such a bad idea -- as long as it doesn't have any lasting side effects, negative side effects."
This is a question that has occurred to a number of athletes who were willing to break the law and do so at the risk of getting caught, at the more important risk of harming their bodies further and suffering from the stigma associated with attempting to gain an advantage from an illegal drug.
But Madson wants to make one thing perfectly clear.
"Right now," Madson said, "it's cheating. I've never done anything like that, and I won't."
Madson hasn't brought it to the attention of Major League Baseball or even mentioned it to Angels trainers because he knows it's illegal -- the U.S. Food and Drug Administration only allows it in rare instances -- and because, as he said, "I'm still believing that I can come back.
"But I will still believe, even if I get healthy without that," Madson added, "that it should be legal, in the right dosage, under supervision, with doctors, for the only purposes to help heal and get players back in the Major Leagues. Because people want to watch them, because of their talents, just to get them back on the field to play. That's it. I think it would be good for the game; I think it would be good for the fans. Fans want to see the best players play, and they want to see the players that they watch come back from injury and stay back. I think it would be a good thing."
Madson paused and explained that his curiosity starts and stops at HGH.
"Not steroids," he said. "Not steroids. No."
U.S. law allows doctors to prescribe FDA-approved HGH for only very limited reasons, like hormonal deficiencies that cause short stature, adult short bowel syndrome or muscle-wasting diseases associated with HIV/AIDS.
In short, nothing Madson -- or, realistically, any of his peers -- would fall under.
And then there's this, pointed out by MLB medical director Dr. Gary Green: "There are no studies -- zero studies -- showing any benefit from using growth hormone by itself to aid in recovery or post-surgical or post-injury type thing."
HGH is produced in the pituitary gland, but because its levels naturally decrease with age, many -- including some who have been suspended under MLB's Drug Policy -- take it as an anti-aging remedy. HGH carries fewer side effects than steroids, but those who take it can be prone to dangerously high cholesterol levels, an increased risk of diabetes and nerve, muscle or joint pain, as well as carpal tunnel syndrome.
There is an appeal process under the World Anti-Doping Agency, and that's the Therapeutic Use Exemption, which allows players to use a substance on the banned list if they can demonstrate that it's for therapeutic purposes, that there are no other alternatives and that said player would suffer significant adverse effects without it. That, however, applies more to Adderall, for example, for A.D.D. -- not to HGH.
There's an even tougher issue when it comes to using HGH in the Major Leagues, and that's determining how much is for recovery and how much is to gain an advantage.
"Putting aside the legalities of it, drug testing cannot distinguish between what's a low-level use for therapeutic use and what's a high level of growth hormone use," Green said. "There's no way to do that, so practically, there'd be no way to distinguish those uses."
Madson admittedly had not done a lot of homework on the matter. He was speaking from an honest and anguished place, the type of place peddlers of black-market meds target for customers.
Credit Madson this much: He's not whispering and hiding. He's hurting, grasping for hope that there's some safe way out there to find light in seemingly never-ending darkness. All that said, he is rehabbing the old-fashioned way, not violating the law of the land or of the industry that pays him millions of dollars.
Madson realizes this is an unpopular question to raise. He sees it as urgency, not necessarily desperation, and it's coming from a player wanting to explore anything, under the rules, so he can perform his job again. And it's not as though he is sure HGH would fix his problem.
"If a doctor would say, 'No, this wouldn't help the situation,' I wouldn't take it," Madson said.
Green repeatedly made it clear that HGH is not the answer.
"I've taken care of a lot of athletes," the doctor said, "and I understand that they're frustrated and they want to get back to play. That's why we have the field of sports medicine. There's also a lot of things that people will try that won't work."
Signed in November to a one-year contract with a base salary of $3.5 million and incentives that can reach $7 million, Madson was expected to be the Angels' closer by the early portion of this season.
He threw four bullpen sessions before Spring Training, then had a setback that kept him off the mound for 5 1/2 weeks. He climbed the ladder again, throwing to hitters on April 19, and he experienced unusual soreness again. The right-hander intensified his efforts, going so far as a rehab game for Class A Advanced Inland Empire on May 13, then came even more soreness.
Now, Madson's back to simply playing catch, trying, as he said, "to get the most out of every day without making it worse."
Madson wishes there were another way.
"I really want to pitch, really bad," Madson said. "The problem is, there isn't much to do, it seems like, other than let it heal. … I'm just looking for answers and trying to get back as soon as possible.
"I have a lot left -- my body, my age, mentality -- and I just can't get there."