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CDC84
07-18-2008, 11:09 AM
Gonzaga's Daye doesn't have ACL tear, will only miss 3 weeks
By Andy Katz
ESPN.com
(Archive)
Updated: July 17, 2008, 9:21 PM ET

All is good again at Gonzaga after star sophomore forward Austin Daye was told Thursday that he doesn't have a torn ACL that will require surgery and jeopardize his status for the upcoming season.

Daye was told by doctors at UCLA that he has a bone bruise and a minor, low-grade tear that won't require surgery. Instead, Daye and his parents Darren and Tamara said Thursday that he simply needs to rest the next three weeks.

Over the weekend, the first reading of an MRI produced a diagnosis that he had a torn ACL, would need surgery and could be gone for six to 12 months. The injury, which was first believed to be a tendon injury in his hamstring, occurred during drills at the Nike LeBron James Skills Academy on July 8 in Akron, Ohio.

Daye was told Thursday that he shouldn't have any problem playing for the Zags next season after strengthening his right knee this summer.

"It's been an emotional rollercoaster week," Daye said by phone Thursday. "Now I'm getting off the ride."

Daye said he was really sad when he was first told he would need surgery. He said he was even more down realizing that the Zags had a top 10 preseason ranking and high-profile nonconference schedule that included the loaded Orlando Old Spice Classic (which includes Michigan State and Georgetown), games against Connecticut in Seattle, Arizona in Phoenix and at Tennessee.

"I was really emotional," Daye said. "I just didn't want to miss so much time. We've got one of the best teams and schedules in the country. I wasn't expecting any of this when they first told me [in Akron] that it was my hamstring. Then the ACL came out of nowhere [from the first doctor in L.A.]. Then we met with two more doctors who gave me better news."

Daye said he hopes to be back to normal within three to four weeks. He said he plans on strengthening his knee prior to the season.

His mother said the initial diagnosis was "wrong." She said it was hard to get a grasp on so many differing opinions.

Tamara and Darren Daye got Austin with doctors from the L.A. Lakers and at UCLA for other opinions. They said the fact Austin ran through a terminal to catch a flight back from Akron indicated he couldn't have torn his ACL.

"It's all very good news now," said Darren Daye, a former NBA guard.

Austin Daye averaged 10.5 points and 4.7 rebounds for the Zags last season as a freshman. He is expected to team up with WCC player of the year point guard Jeremy Pargo, guards Matt Bouldin, Steven Gray and Micah Downs and center Josh Heytvelt to form the top scoring team in the WCC.

Gonzaga head coach Mark Few and associate head coach Leon Rice witnessed Daye fall to the court at Akron last week. They ran to his aid but then were relieved when told it was a hamstring. They were distraught at the first ACL news.

Few was unavailable for comment Thursday. But according to at least one member of the staff, the Zags were relieved to hear the latest news that Daye won't need surgery and should be ready to go for the season in the fall.

Andy Katz is a senior writer at ESPN.com.

gozagswoohoo
07-18-2008, 11:15 AM
"Few was unavailable for comment Thursday. But according to at least one member of the staff, the Zags were relieved to hear the latest news"

Were they?? Hmm... lol

zagco
07-18-2008, 04:48 PM
Zagco hopes that Austin plays video games all summer long. Just laying down, having some pizza and candy, with his buds, playing Halo or whatever. Nice and easy. It worked for Zagco when he was a college boy. :D

VinnyZag
07-18-2008, 04:56 PM
I know that a handful of medical professionals are valued members of this community. So with all due respect to them and their honored profession ...

Sheeesh. First it's a hamstring, then it's a torn ACL, then it's practically nothing. How is it he was told in the first place that it was a torn ACL, if he's going around telling the docs that he ran through the airport to catch a flight?

I feel bad that Daye had to go through this 'rollercoaster ride.'

My question is this: Is it unusual to have two such wildly divergent, and ultimately incorrect, diagnoses? And should we believe this diagnosis, or will we hear a week from now that it's something else entirely?

ZagNative
07-18-2008, 05:12 PM
My own personal take on this is that I'm going to try to keep my nose out of the family's and Austin's business for a while, especially not to question the decisions they're making based on the opinions of highly qualified medical professionals. I have no doubt that they want what's best for Austin and will do their utmost to see that he gets the best medical care possible and that they will share further with us what they feel appropriate, while protecting Austin's privacy. It would seem really unfair and presumptuous for me to go beyond that.

What I'm really trying to say is that I'm just not going to worry about it until I hear differently from the family.

thebigsmoove
07-18-2008, 05:29 PM
Thank God!!! My Life Has Meaning Again!

ZagsGoZags
07-18-2008, 06:00 PM
The only scenario that still threatens me is that the second opinion, after the first MRI, would still have some truth in it. His mom asked for a second and a third opinion, so that makes four opinions given by the medical experts: hamstring at the camp, ACL tear MRI and the next two. So, I am celebrating with everyone else, and trust the 2d opinion will turn out to be the least accurate of them all.

dim4sum
07-18-2008, 07:21 PM
Maybe if Nathan got second or third opinions on his supposed ACL, he would have had somewhat of a career with the Zags. Surgery is always a risk and rarely a panacea. Lately they've been recommending knee surgery to older folks and invariably the result is that they wind up going from annoying pain to unbearable pain. My father says, "Look at the old Celtics--did Russell ever get surgey?, did Cousey ever get surgery?, did KC Jones ever get surgery??

sullyzag66
07-18-2008, 07:28 PM
I know that a handful of medical professionals are valued members of this community. So with all due respect to them and their honored profession ...

Sheeesh. First it's a hamstring, then it's a torn ACL, then it's practically nothing. How is it he was told in the first place that it was a torn ACL, if he's going around telling the docs that he ran through the airport to catch a flight?

I feel bad that Daye had to go through this 'rollercoaster ride.'

My question is this: Is it unusual to have two such wildly divergent, and ultimately incorrect, diagnoses? And should we believe this diagnosis, or will we hear a week from now that it's something else entirely?
In this layman's experience medical diagnoses are often guesses; they're highly educated guesses, and finding a good diagnostician is more than half the battle.

Reborn
07-19-2008, 06:21 AM
Great news for everyone. I'm really happy for Austin and his family. The feeling of joy and happiness around their home right now must be intoxidating. Great news for all of us too. Keep up the good prayers for a successful rehab, and keep being positive.

:D :D

airdutton
07-19-2008, 11:27 AM
WOW... that would of been a heartbreaker. Hopefully this year we can keep EVERYONE healthy the whole year and we can get a good run at the Final Four.

MedZag
07-19-2008, 12:24 PM
I know that a handful of medical professionals are valued members of this community. So with all due respect to them and their honored profession ...

Sheeesh. First it's a hamstring, then it's a torn ACL, then it's practically nothing. How is it he was told in the first place that it was a torn ACL, if he's going around telling the docs that he ran through the airport to catch a flight?

I feel bad that Daye had to go through this 'rollercoaster ride.'

My question is this: Is it unusual to have two such wildly divergent, and ultimately incorrect, diagnoses? And should we believe this diagnosis, or will we hear a week from now that it's something else entirely?

Austin's injury was one of those borderline diagnoses that is really difficult to nail down due to a very common and ambiguous clinical picture. When a person really "pops" their ACL its typically very obvious to the clinician, but when you deal with meniscus tears, MCL tears, partial tears, the symptoms and mechanisms of injury that patients present with are often highly similar if not indistinguishable. That's where the MRI comes in. Unfortunately, while medical imaging has come a long way, the image that comes out the other side does not have a convenient little arrow on it stating "this is an ACL tear." Radiologists look for certain landmarks and features indicative of certain pathology, but ultimately it is all interpretation (albeit highly skilled interpretation). And that interpretation can be colored by the radiologist's own experience, familiarity with orthopaedic injuries, heck even where he or she was trained. Couple that with, while medical imaging has come a long way, resolution still isn't pristine, and further ambiguity is thrown in. This is where the second opinion comes in, as the more people that look at an image, the less likely individual biases play a part. This issue is continually being studied and new methods of achieving greater accuracy and consistency in diagnosis are always being developed.

Sully is right on that "diagnosis" is very much making an educated guess. As far as we've come with looking into and manipulating the human body, its very much like trying to look at the side of a barn with a telescope. You can see little bits and pieces at a time and you try to fit that into what the larger picture is. Diagnoses are like putting a jigsaw puzzle together fitting different "pieces" together such as patient's symptoms, history of illness, past medical history, family medical history, social history, physical exam findings, imaging findings, blood tests, etc. Different features of each aspect raise the probability of certain diagnoses, and ultimately clinicians go with the "most likely" diagnosis... the diagnosis with the highest probability. But different injuries or diseases don't always present as X, Y, and Z. Sometimes they present as X, Y, and K, or Y, Z, and G. Or another different injury or disease also presents as X, Y, and Z. This is where the experience and intuition of the clinician comes in, as well as attention to detail making sure no stone is unturned when attempting to hammer out the diagnosis.

The fact that two individual physicians agreed on the 3rd diagnosis raises its probability of being right greatly in my mind. The way I see it... the trainer at the camp (who I am not even sure is a physician) was working on just physical exam results to draw his conclusions... not the most desired way to look at and diagnose knee injuries. The physician who looked at the 1st MRI was likely looking at a "borderline" ACL tear... it could be there, it couldn't, and MRIs of partial ACL tears are particularly ambiguous (especially in adolescents). Finally, with the 2nd and 3rd opinions the Daye family garnered, the physicians had the opportunity to look at the whole history of the injury, how the injury was 1 week after, as well as look at two separate MRIs of the knee. This greatly helps in removing uncertainty in the diagnosis, and the fact that the two physicians reached the same conclusion means its highly likely its correct.

MDABE80
07-19-2008, 06:37 PM
History and Physicals made the DX Med. Imaging was confirmatory. Technologists sometimes over process and the images look like they have diagnostic value when they simply are misleading. We'll need hands on Drs for a long time. I know it sounds old fashioned but learn good physical exam when you hit the clinics. It will never fail you. #s 2 and 3 above were correct NOT because they agreed with each other......they both did good exams indpendently....then came technologically correct and processed imaging. I would never trust an image without a prior clinical exam that might generate a differential diagnosis.

Mom Tamara saved the day on this one. She was relentless........like good moms should be. Driving around Orange and LA Counties isn't fun anytime but it's worse when we're in the tourist season. She did it though because she had some direction and she wouldn't take an easy softer course of action.
Kudos to Tamara........Zag mom of the month!!!:)

MedZag
07-19-2008, 06:46 PM
#s 2 and 3 above were correct NOT because they agreed with each other......they both did good exams indpendently....then came technologically correct and processed imaging. I would never trust an image without a prior clinical exam that might generate a differential diagnosis.

Agreed, that's what I was getting at, though it may have come off the wrong way.

The fact that they each arrived at the same dx independently lends credence to it, not the fact that they necessarily "agreed" with each other.

MDABE80
07-19-2008, 08:34 PM
Bayesian models of pre and post test liklihood of the diagnostic accuracy of any test depend on the prevalence in a clinical situation. Me and by fellow trainees published this stuff in the New England Journal of Medicine in 1979.
Boy did we think WE were smart;) Best wishes Gr####oppah as BZ would say.
I hope you love the road as much as I have Med. It's all about your contributions.........he says while taking call.........:)

MedZag
07-19-2008, 08:52 PM
Bayesian models of pre and post test liklihood of the diagnostic accuracy of any test depend on the prevalence in a clinical situation. Me and by fellow trainees published this stuff in the New England Journal of Medicine in 1979.
Boy did we think WE were smart;) Best wishes Gr####oppah as BZ would say.
I hope you love the road as much as I have Med. It's all about your contributions.........he says while taking call.........:)

I knew there was a reason for the bevity of your posts, haha. Sent a 3 paragraph email to a physician the other day, got a 3 word response. Yeah, he was on call.

The first physical exam instructor I had, a fantastic internist here at OHSU, really hammered into our skulls pre-test/post-test probability (and sensitivity/specificity) the first month I was in med school. Hadn't even had epi yet and still didn't fully understand "prevalence" but he made sure we understood it all backwards and forwards, and it has definitely aided my clinical acumen as a result.

But yeah, a lot of pessimism in medicine these days, but so far it's been water off the duck's back for me. I still can't imagine myself doing anything else with my life.

Apologies to the leatherheads for the thread jack.

zagco
07-20-2008, 09:00 AM
Isn't there some kind of thing you could inject into the person that would light up/glow in MRIs that would really identify where the injury is at and therefore what it is?

Zagco is just thankful that the first doctor didn't order a "good bleeding" as the cure for Austin. :D

MDABE80
07-20-2008, 10:09 AM
"PET Imaging" is better Abe says to Zagco in the 3rd person;) Gadolinium imaging in MRI defines normal tissue but not detailed enough to generate the resolution needed to be accurate in determining edges on a troubled area.....tiny regions of damage are very hard to define.........Like in our boy's case. In big areas of damage....sure!

NONE of these imaging modalities give accurate information if the images aren't processed properly. Some can be very misleading . If Drs rely on the images without knowing the clinical picture...things go wrong. Tracers/image enhancers DO light up and some GLOW!!!...but the border zones that define normal/abnormal aren't easy. It's never just on/off ...normal/abnormal .

Sometimes the "biology of an injury" just won't allow the details needed to be sensitive and specific.

jesuitplaya
07-20-2008, 11:17 AM
He's tough, he'll get thru it, but the thing that worried me was he's so skinny he is probably more injury prone, good thing to hear he'll be back.

VinnyZag
07-20-2008, 11:29 AM
thanks for the responses, guys. I think we all have a better understanding now.

DrDrivel
07-21-2008, 03:40 AM
Two things:

First, blowing out an important ligament doesn't leave many options other than surgery. It's not like the ligament bits are going to search one another out and agree to settle their differences for the good of the knee. Someone with a lot of degrees needs to staple them together or at the very least apply a good bowline hitch.

Second, we're all pretty sure Austin's, what...? 14? 15? This is the peeeerfect time to get him started on a nice cocktail of Brian MacNamee's finest site-injection... uh... homeopathy. Nobody would ever see it coming AND he'd probably have essentially bionic knees until the tendons gave out entirely. That won't be until he's been well paid in the NBA, so I say we go for it.

LongIslandZagFan
07-21-2008, 06:28 AM
Maybe if Nathan got second or third opinions on his supposed ACL, he would have had somewhat of a career with the Zags. Surgery is always a risk and rarely a panacea. Lately they've been recommending knee surgery to older folks and invariably the result is that they wind up going from annoying pain to unbearable pain. My father says, "Look at the old Celtics--did Russell ever get surgey?, did Cousey ever get surgery?, did KC Jones ever get surgery??

If I remember right, there was no question at all as to the extent of the tear on Nathan's knee. It was nowhere near the borderline that Austin's was. Heck, as was stated in articles, he RAN for a plane which was one of the impetuses to have a second and third opinion.

CDC84
07-21-2008, 08:17 AM
When a player truly blows out an ACL, they go to floor and roll around in agony as if they've been hit by a bullet. At least that's what I've observed over the years. Anyone who saw Doudney go down for the count at Wazzu knew right away what was up. His season was over. As many of the articles related to Daye's injury have pointed out, he was walking around just fine soon after his injury. Guys like Doudney or Ammo with the Bobcats weren't exactly walking around like normal a few days after their injury.

MickMick
07-21-2008, 11:39 AM
CDC's comment reinforced what I was originally thinking...only from a different angle. I thought that Austin must be some kind of tough, tough warrior to withstand the pain.