Any issue with a person’s heart is tricky. Daniel Robert, 31, collapsed after a bullpen session last October just as he was preparing to leave Clearwater for the winter. If not for the immediate and skilled response of Phillies medical personnel, Robert would have died. It’s just that simple. Instead, he was revived, taken to a hospital and recovered. The collapse was caused by arrhythmia, a condition where your heart beats irregularly. The condition is worsened by any exertion, which a bullpen session would qualify as being.
Surgeons placed an implantable cardioverter defibrillator (ICD) in Robert’s chest. After continuing to recover and go about his life, he was given clearance to start throwing. From there he moved to throwing a bullpen session this past Sunday and all seemed to go well. When he was walking off the field he seemed to stagger and then collapsed. Again, Phillies medical personnel responded and knew exactly what to do. Reports vary on whether Robert lost consciousness, but he was on the ground for about five to seven minutes. Medical personnel then guided him as he walked to an ambulance and was taken to a hospital.
A personal friend who is a cardiology physician’s assistant (PA) gave me a quick less on in ICDs. Yes, you can exercise and go about your life just as you did before having one implanted. An ICD works by detecting the person’s heart rhythm and if it becomes irregular, delivers a shock to the heart. That shock will hopefully, bring the heart back into a normal rhythm. Sometimes, the shock is low enough that the person doesn’t even feel it. If that works, great. If not, a larger shock of between 30-40 joules is delivered. Patients sometimes describe that as an “internal kick.” It feels like lying on the ground while someone drops a fairly large hard cover book on your chest from shoulder height. That is probably what made Robert stumble and fall to the ground.
So, what caused the whole incident and will Robert return to the mound?
“The feeling of the shock can be overwhelming. If a person feels it for the first time, it might knock them to the ground,” said my friend, the cardiology PA. “It’s extremely rare that the ICD itself would have malfunctioned. What can be an issue is how the ICD is programmed. It has to be programmed in terms of detection thresholds and pacing rates, and they can be difficult to program correctly. More often, it’s possible that there is an underlying cardiac issue. In some people, their blood pressure can drop very rapidly after exercise, which the ICD can detect as an abnormality.”
In other words, only Robert and his doctors know what happened on Sunday. The Philadelphia Inquirer reported that a source close to Robert said the issue was with the settings on the device. The ICD sensed a shock was necessary, so it did what it was supposed to do and delivered a shock. Apparently, the device was recalibrated and Robert was sent on his way.
What happens now?
“Typically, after an incident like this the patient needs to take it easy for a few days. They can then start to build up their activity or exercise level until they are at their maximum level. Many times that’s done under a doctor’s supervision, or at least with medical professionals monitoring the person. Once everything, including medications, which could also have affected him, the person should be good-to-go,” said our PA. “Unless there is some serious underlying cardiac issue, he should be able to resume his career.”
That description fits with what manager Rob Thomson told reporters Monday afternoon. “He’s good. No activity for a bit, but he’s fine. He feels good.”
Robert turned in some strong numbers last season. He opened the season with Reading, but made just 10 appearances with a 1.54 ERA and 17 strikeouts in 11.2 innings. From there he went to Lehigh Valley and was eventually shuttled back-and-forth on the Pennsylvania Turnpike to and from Philadelphia. With the IronPigs, Robert made 18 relief appearances and posted a 3.38 ERA. In Philly, he made 15 appearances with a 4.15 ERA. Between the three stops, Robert was a combined 1-0, 2.67 in 28 outings that covered 30.1 innings. He struck out 36 while walking just nine hitters.
Robert actually became a free agent after last season, but opted to re-sign with the Phillies.
The Phillies will place Robert on the injured list with Lehigh Valley. When he is healthy and can work back into game shape, he will join the IronPigs. There is no timetable for his return.
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