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Rupe gets blockage treatment

Rays RHP had blood clot in his arm, but it's not considered life- or career-threatening.

By MARC TOPKIN

© St. Petersburg Times, published September 8, 2000

CLEVELAND -- His right arm feeling heavy and stiff, Devil Rays pitcher Ryan Rupe knew something wasn't right through his first three innings Wednesday. But he had no idea what was wrong, a blood clot that would land him in the intensive-care unit of a Cleveland hospital and in all likelihood end his season.

It was team trainer Jamie Reed who noticed the swelling and a slight coolness in Rupe's hand, and then a vein in Rupe's biceps so engorged with blood it resembled "a garden hose."

Rupe was taken to the hospital, where doctors found a clot that had formed in a vein in his biceps along with a slight blockage stemming from a previous vascular problem. The 25-year-old was treated with the blood-thinner Coumadin and had a successful procedure Thursday to clear the blockage.

He is likely to remain hospitalized until Saturday and most likely won't pitch again this season, though his career is not believed to be in jeopardy.

"With the procedures they have, pitchers can come back pretty quickly, but with the combination of everything I would question whether he's going to be able to come back this year," manager Larry Rothschild said.

Reed said it would be "a far reach" to say Rupe's condition was life-threatening, but there certainly was the potential for serious complications had the clot not been detected.

"The doctors said there was a possibility of it going into his lungs and that would not have been a good situation," Rothschild said. "I give Jamie credit because you just don't know what can happen with those things. For an injury that's very uncommon, he did a heck of a job diagnosing it pretty quickly."

Rupe has had previous circulation problems. In 1997, he developed a blood clot and an impingement in the same vein in his right arm, a condition called thoracic outlet syndrome, and had surgery to have part of his top right rib removed to improve the blood flow.

Doctors told him at the time there was a chance he would never pitch again, but with the blood clot dissolved and the surgery a success, Rupe was back on the mound nine months later for Texas A&M.

The Rays took him in the sixth round of the 1998 draft and he moved quickly to the major leagues in May 1999, apparently with no hint of the past trouble.

But though the surgery was done to improve Rupe's circulation, Reed said it can also lead to further problems. "It's not really a complication, but a possible by-product from it," Reed said. "Guys who had that surgery are susceptible to having some circulation problems, but it's more uncommon than common."

Rupe had no pain, but his fatigue in the fourth and fifth innings of recent starts may have been a subtle warning. But even after telling Reed of his discomfort Wednesday, Rupe wanted to stay in the game.

"He's had a little history with this going back years and years, so he wasn't overly concerned about it," Reed said. "He kind of downplayed it, which is kind of his nature since he's battled through injuries throughout his career. But this was beyond normal, beyond his normal."

Reed summoned the Indians' team physician, Louis Keppler, who quickly decided Rupe should go the hospital. Rupe, who will be treated for an undetermined period with mild blood thinners, is expected to fly back to St. Petersburg after being released Saturday and will be examined by Dr. Larry Williams, the team vascular specialist.

Reed said the clot, which doctors said appeared to be new, formed just above the previous blockage on one of the two main veins that carry blood back to the heart.

"He had good blood flow down but it wasn't returning as fast as it should and that's why his arm felt kind of heavy and tired," Reed said.

Blood clots are not uncommon among baseball players. The Devil Rays' Mike DiFelice and Roberto Hernandez have had surgery to alleviate clots, and ex-Devil Ray Mark Guthrie had a similar condition.

Even with two clots in three years, Rupe should be able to resume his career without limitations, Reed said.

"You just make yourself a little more aware of the symptoms," Reed said. "The clot is a byproduct of the narrowing of that vein. So, ideally, if they open up that vein you get a much better return flow and it wouldn't clot."

The Rays, who haven't had much go right during a dismal season, felt fortunate Rupe's condition was diagnosed when it was. "We were kind of lucky, huh?" catcher John Flaherty said.

"It could have been a lot worse with Ryan," Rothschild said. "If you get down to the truth of it, sometimes you don't know how good it is when things are bad. Had this turned into something worse everything would be in much better perspective today, and thank God that's not the case."

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