|
|||
|
|||
|
 |
|
|
DAVIS CUP - USA vs AUSTRALIAJuly 18, 1999Dr. David AltchekBOSTON, MASSACHUSETTS Q. Can you just go through with us the examination you did on Todd Martin and what led to the determination that he was not fit to play? DR. ALTCHEK: Sure. I guess to answer that question correctly it is important that you and I are working on the same concept, same definitions. Heat illness and its components are not necessarily diagnosed by specific physical examination findings when they relate to activity, athletic activity, and the ability to compete. I think it is very important that we all understand what we are talking about here. We are not talking about life and death heat illness. We are talking about heat exhaustion that makes you unfit to compete at your normal level. That is what we are dealing with with Todd. So there were no physical examination findings like elevated core temperature, abnormal electrolytes or anything like that, or urine specific gravity changes. This was simply a sense of the player that he couldn't compete and a visual observation that after 15 minutes of practice, he lost his bearings and had to be helped off the court. Q. That is not the standard for having an injury replacement? Standard is not just can he compete in his normal leave but is he injured -- DR. ALTCHEK: You are asking me what an injury is? Q. No, Davis Cup definition of why somebody can be removed has to be if you look at the rule, the person has to be injured, not merely not playing up to their normal level. But they have to actually be injured, unable to play. DR. ALTCHEK: Unable to play. That is the key. Q. Right. I think the difference here is whether or not someone is just a little bit hindered like the guy has a blister on his finger; he might not be injured but he is obviously not able to play to his normal level. At what point-- DR. ALTCHEK: There is a level of subjectivity here, there is no question about it. But I think the key issue then is I didn't feel that in the condition he was in he could compete so what did we do? We I.V. hydrated him before the match. That is not standard procedure. We do not in general I.V. hydrate athletes prior to competition. That seemed to make an enormous difference in his level of functioning. I don't recommend that we do things in that fashion. Q. Did you have any discussion with the neutral doctor and any - I mean, medical diagnosis is in essence different, and was kind of critical whether he can compete or not, was -- did you get a satisfactory understanding of why he ruled the way he did? DR. ALTCHEK: No. Q. Weren't you concerned about that? I mean, seemed like it would be a natural topic of, hey, wait a minute, I think this, you think that? DR. ALTCHEK: Well, let me give you the facts so you will be able to understand the position I was in. We had the discussion and there seemed to be an agreement that Todd was not fit to compete. I went out to make a phone call and came back into the locker room and it was 20 of 12 and I was told - he has to compete. At that point there was no time for any further discussion. I wasn't told by the doctor. I was told by Todd and I had to deal with the situation which in this case was I.V. hydration. Q. I don't want to put words in your mouth, are you saying that the neutral doctor flip-flopped; you left the room thinking one thing -- DR. ALTCHEK: I left the room thinking that. Whether he flip-flopped is not something that I can confirm. Q. When you left he had agreed with you that Todd couldn't play? DR. ALTCHEK: He seemed to agree. Q. Before he was hydrated, when he first said he was unable to compete and at the level, did you feel like it was -- he was ill enough so that his health might be in serious danger? DR. ALTCHEK: Well, serious danger, you know, again there is a level of subjectivity there. We would never let it get to that point. Heated illness can get to that point obviously. We were not going to come close to that. Q. At that point if there was a difference between yound you and the doctor if you told him not play -- DR. ALTCHEK: It wouldn't have been an issue, he just wouldn't have played. Q. How close did it come to you guys essentially stopping him, did you feel like obviously Gully was talking to but were you at a point not overruling but say, you know, I think maybe I am stepping in; I am really worried about you jeopardizing your health, endangering yourself? DR. ALTCHEK: During the match? Q. Yes. DR. ALTCHEK: During the match I was kind of a different opinion than everybody at the beginning. I thought he looked fine. From a physiological -- my physiologic observation of him he was okay. I wasn't worried at all. Q. After the I.V.? DR. ALTCHEK: Yeah, I was astonished, quite honestly, nobody has a lot of experience with pre-participation I.V. hydration. So this was new ground for me. I was astonished by what effect it seemed to have. Q. To hydrate them, in other words-- DR. ALTCHEK: I think to cool his core. I think we weren't dealing really with dehydration. We were dealing with an elevated core temperature that really hadn't come down properly from the days before, because again what I was saying to you is 15 minutes of a light practice and he was losing his normal coherence. Q. What about electrolytes, things like that, those levels? DR. ALTCHEK: I don't think that was an issue. I really don't. Q. After the match Friday (inaudible)-- DR. ALTCHEK: Oral hydration, all of his vital signs were sign, urine specific gravity was fine so there were no signs of dehydration. Q. Talking about being in that room, Dr. Paul seemed to agree, can you take us through in a little more detail, examination lasting about? DR. ALTCHEK: This was a discussion, not an examination. Q. Was this after the observation of Todd, when you and the other doctor were having this discussion? DR. ALTCHEK: Yeah, this was -- in other words, we had reached what we felt like was our own internal judgment on this situation and then this was our presentation to the neutral doctor with the Australian doctor present who happens to be, I think, an American. But anyway -- Q. What was his opinion? DR. ALTCHEK: He didn't state his opinion. He just asked several questions. Q. Were you present for the exam? DR. ALTCHEK: For this discussion, yeah. It wasn't an examination. Q. What type of questions was Dr. Paul asking? Was it simply -- DR. ALTCHEK: I was just mainly listening. He asked Todd how are you feeling; do you feel like you can go out there and function and Todd said no. In the current state I am in, I don't think I can function. Q. That was the extent of the exam? DR. ALTCHEK: Yeah, that was the examination. Again that is the subjective part of this issue of heat illness. Q. He asked him do you think you can go, Todd says, no. You leave the room. Make a phone call you come back; everything has changed? DR. ALTCHEK: Exactly. Q. How long was that phone call? DR. ALTCHEK: Two minutes. Q. Did the neutral doctor ever say to you, I agree, but he shouldn't go? DR. ALTCHEK: He seemed to. He nodded in an agreement. Q. Can you say what he did say that left that impression? DR. ALTCHEK: He said, well, okay, you know, those kind of nodding of his head. Put it this way, I guess what I should say, clearly, he did not disagree to me in my presence. There was no verbal disagreement. Q. Okay, he could be just acknowledging what Todd is saying? DR. ALTCHEK: You are right. So that is what I am saying. He never said to me, using a formal sentence: It is okay for Todd Martin to compete. It is not okay for Todd Martin to compete. He just seemed to -- Q. What did he say -- did you see the man again? DR. ALTCHEK: I did. Q. What did you say? DR. ALTCHEK: I said to him, I think that if this kind of situation ever comes up, we should have a discussion about it first with you explaining to me your findings, your reasons for reaching a conclusion before you tell, you know, the next level of bureaucracy so that we are doing it on a medical level at least first. Q. So he went to the referee before he went to you? DR. ALTCHEK: I don't know. You have to ask him that. I don't know. Q. You came back -- DR. ALTCHEK: When I came back out, it was done. Todd either had to play or we had to default. Q. And the doctor told you that -- the neutral doctor told that to you? DR. ALTCHEK: He didn't tell me anything. Q. Todd told you? DR. ALTCHEK: Todd Martin told me that. Q. Let us go back. When did you next see Paul? DR. ALTCHEK: On the bench. Q. How much time later? DR. ALTCHEK: During the match. But at the beginning of the match I wasn't focused on Dr. Paul. I was just focused on whether or not -- I mean, as you might have observed, Todd Martin's mother came up to me, I don't know if you saw what she said to me. She was very upset, concerned about Todd's -- as you were asking the question, concerned about Todd's well being, and I was responsible for it. So I was obviously paying attention to that. And not to Dr. Paul. Q. Then how much time later did you talk to him? DR. ALTCHEK: It wasn't until things were clearly under control, calm. Q. Second set? DR. ALTCHEK: Yeah, I just turned to him said -- Q. What did he say? DR. ALTCHEK: Nothing. Q. Is there a reason for letting him play more to the fact that this doesn't go to an injury or illness; did he say in some way, you know, that it is -- he should be able to play or he can't play -- DR. ALTCHEK: Well, do you remember what happened in the US Open to that Japanese player where he was left cramping on the court on national TV? It is a very controversial subject, the whole subject of heat illness because there is a subjective part of it. Written into tennis is this issue of lack of conditioning, loss of conditioning, as you were trying to point out which doesn't fall under an injury. But I don't think we are really -- we have really got it clearly defined and we were clearly in subjective area. I am the medical director of the ATP Tour so I am pretty comfortable with these issues, I deal with it all the time. I just made a judgment based on what I feel was in the best interest of this athlete which is what I do for a living. Q. Do you feel like if you hadn't made a phone call stayed there, it might not have gone that way? DR. ALTCHEK: No. Because it wasn't like it was any discussion with us. Q. Was there ever any -- this might be a bit out of left field -- ever any pressure put on you to rule that the way you did? DR. ALTCHEK: No, not at all. Not at all. I am being totally up front with you. This was my athlete saying, look -- I observed my athlete almost passing out after 15 minutes of practice. Then and I look at him, I say, Todd, how do you feel. He says, I can't play. As a doctor what are you going to do say to him, oh, you can play. You will be okay? Q. That is what Dr. Paul did? DR. ALTCHEK: Well -- Q. How long after the practice did -- after Todd came on the court did Dr. Paul see him, he had taken a shower? DR. ALTCHEK: Yeah, that is a very good question. Dr. Paul was at a disadvantage because he did not see Todd right after his practice. He saw him about a half hour later after he had taken a cold shower; after he had drunk fluids and was much more coherent. Q. When you saw him Dr. Paul at that discussion, did you look at him and say at that moment not 30 minutes earlier or --(inaudible) -- DR. ALTCHEK: I am sorry, which moment? Q. When you were in that discussion with Dr. Paul and Dr. Paul was asking the questions and getting the answers. As you were seeing this exchange, did you look at Todd and think at that moment Todd can play? DR. ALTCHEK: You mean was I guessing what Dr. Paul was thinking? Q. No. Dr. Paul was asking these questions. And he was getting the answers for his judgment. You earlier said Todd can't play. At the moment Dr. Paul was seeing him, as he Dr. Paul was getting his information, what was your assessment of Todd's ability to play at that moment? DR. ALTCHEK: Well, Todd stated his case pretty clearly. He said, I don't think I can play. That is what he said. Wasn't anymore complicated than that. That was the issue. Q. You came -- I mean, you must have heard coming in that there was some talk about wanting Sampras to play maybe? DR. ALTCHEK: Sure. Q. Were you anticipating this at all today that you would be called on to make a diagnosis? DR. ALTCHEK: No, not at all. Because that, you know, no. That was not -- that was not an issue at all. Pete, as you know, Pete was called like as an emergency; was not happy obviously. He was not prepared to play. Had not eaten his normal breakfast, nothing, we were not at all prepared for this event. It caught me totally by surprise. Q. Is it your general philosophy that if an athlete tells you they can't do something, then that is the way it is? DR. ALTCHEK: In general, yes. I mean, there, is always this issue of malingering and stuff like that but when you are dealing with athletes that you know, it is just like when you are dealing with patients their instincts are important and when you start denying their instincts you are on very dangerous territory. Everybody with experience knows that. With experienced athletes like Todd Martin, when he looks at you and says, Doc, I don't think I can compete. You got to take that really seriously. Q. Why did you not treat him right away with the I.V. if you really wanted him to play, why was it only after they forced Todd to play that you decided to do the I.V.? Why didn't you try to help him when he was -- before you went to the next step of saying Todd can't play? DR. ALTCHEK: Well, you have to understand the timing here. We had to make a decision about whether or not we thought he was fit to play. That would have meant sticking an I.V. in his arm and bringing him to the other doctor at the same time. Q. Why couldn't you have alerted Sampras, start warming up in an emergency we are going to treat Todd. Was that discussed? DR. ALTCHEK: Because it is -- I don't know if you are privy to what was going on. It is not all in our control what happens. We have to present him to the neutral doctor who has to decide whether or not he can play. I think when you present him with an I.V. in his arm, if he wants to examine him, whatever, you can't. Q. Did he have I.V. in his arm? DR. ALTCHEK: No. Q. Any treatment after the match? DR. ALTCHEK: No. Q. How amazing was it -- can you give us a medical explanation on just how all of a sudden a condition -- he can go out and play five sets? DR. ALTCHEK: That is what I am trying to say. We are all on new ground here. This pre-participation I.V., cooled I.V. fluid is not something we normally do. We did that in this situation. Nobody in the world has a lot of experience with that. It seemed to have a remarkable effect. That is only way I can explain it. Q. Once Todd was out there, did you feel he was at risk at all beyond normal -- DR. ALTCHEK: No. No. Q. I know you don't want to be overly critical, but this is a doctor who looked at somebody who is telling him they can't play. You are a doctor with experience in this field specifically. Are you just astonished, disappointed that this doctor would not take your opinion and the players word or instinct-- DR. ALTCHEK: You know, I think I guess he would have to answer that question. In terms of my own feelings about it, the only thing I feel is that I like to discuss things between -- as colleagues between one another so we could understand why he made that call. I still don't understand it. Q. What is his specialty? DR. ALTCHEK: I don't know. Q. Hospital affiliation? DR. ALTCHEK: I don't know. End of FastScripts…. |
|
||||||||||||||||||||
|
||||||||||||||||||||||||
|
About ASAP Sports •
FastScripts Archive •
Recent Interviews •
Captioning •
Upcoming Events •
Contact Us
FastScripts | Events Covered | Our Clients | Other Services | ASAP in the News | Site Map | Job Opportunities | Links |
|
ASAP Sports, Inc. | T: 1.212 385 0297
|