Under The Knife: Manny's positive drug test, injury updates

The biggest issue I have with the MLB drug policy is that it leaves us wondering. Manny Ramirez tested positive for some substance on the banned list and walked away, leaving the substance unknown. The appeals process allows the accused player to have representatives watch the testing of the "B" sample, since collection and testing are the most often-used defenses. With no more easy alibis or excuses to use, Ramirez decided to walk away rather than accept the 100-game suspension. With the process over, MLB cannot release the name of the substance. Sources have told me that it was not hCG, the drug that Ramirez was suspended for in 2009. I'm also told that Ramirez's positive test came from one of his "accelerated" tests, rather than the standard spring training test that all players have to take. Once a player tests positive, he is placed in a program that requires both counseling and additional random testing. Knowing he was facing as many as 10 tests makes it much tougher -- or dumber -- for Ramirez to sneak some substance with a short detectable period through. Players that I've spoken with on the accelerated program say that it is truly random, with no clue when or where the testers might show up. One player last year told me he had two tests in the space of three days, since many athletes will use right after a drug test, thinking that they'll have a few weeks before the next test. (Yes, this suggests the timing might not be purely random, but instead is "trap testing", but we'll leave that discussion for another day.)

Also, let's take this opportunity to close the books on masking agents. Simply put, there is no such thing. A substance or technique to beat drug tests doesn't exist. You might as well call a unicorn or Sasquatch a masking agent if you're going to use it the same way many have in covering this story. The substance hCG, as Ramirez used in 2009, obviously does not mask results. It is used in concert with other drugs to create a desired effect. In most cases, it's used to keep the testicles from shrinking due to disuse by the endocrine system. (If Kim Bell is to be believed in her recent testimony, Barry Bonds wasn't using hCG.) Modern drug tests are exceptionally accurate and precise; they can't be fooled. However, it's that very precision that makes the cat-and-mouse game of doping possible. Dr. David Black of Aegis, one of the top drug testers in America and in charge of several pro programs such as NASCAR, told me that drug testing works like a mug book, like you'd see on Law and Order. The testing looks for a chemical profile the same way you or I would look for a particular face. If the face isn't there -- or if the profile isn't there -- it can't match. Even a small chemical change, like the one made in "the clear", defeats the testing process. It's not undetectable, but unknown. Once the testers -- or specifically, Dr. Don Catlin -- was given a sample of "the clear," it took a matter of days before there was a test. More accurately, there was a new profile added to the existing test.

If a player takes a substance, his only hope is that it clears the system before the next drug test. Some drugs, like Deca-Durabolin, a common anabolic steroid, can stay in the system for more than a year at detectable levels. Others take a week or so. Human Growth Hormone is detectable for less than 48 hours -- and that's with blood testing. Worse for the testers, players have moved on to other substances, ones that are both more effective and untestable. Use of insulin as an anabolic agent is probably the one most abused in American sports right now. It's cheap, very effective and essentially indistinguishable from the insulin naturally produced in the body.

The MLB policy is effective in reducing the number of players that experiment with the use of banned substances due to effective testing, a complete panel of banned substances, and powerful penalties. It's the most effective drug testing policy in sports, in my opinion, even more so than the Olympics. However, even the best policy is not going to net zero. Some will take the chance for economic reasons, some for ego, and some, like Manny Ramirez, will be inexplicable. Knowing the substance would go a long way in helping erase that and absent a suspension, understanding Manny in just this little way would be just.

Powered by my weekly video chats, on to the injuries:

The worry with any muscle strain is that it will recur. Team medical staff try to get a player back as quickly as possible without putting the player at risk of re-injury, a razor's edge that is difficult at best to judge. It's hard to say that the Nats did anything wrong, given the way that Zimmerman played over the first week. Unfortunately, Zimmerman managed to re-strain the abdominal muscle and will miss a few days. The Nats tend to be aggressive with injuries, though I'm curious whether the injury to Stephen Strasburg will adjust things. While they'll never acknowledge publicly that they're "playing for next year," fans can certainly see that, and I hope that the Nats can as well. Zimmerman shouldn't have much of an issue once he's back, assuming he's past another recurrence risk. He's a watch-and-see for daily leagues and a no-play for weekly leagues.

Apparently, Dunn is human. Instead of returning to the lineup 48 hours after an appendectomy, as he was reportedly trying to do on Thursday, he was just taking batting practice on Sunday. I'm beginning to wonder if Dunn, a prankster in the clubhouse, was joking with his talk of a quick return. Dunn is expected back this week, though Ozzie Guillen is being smart by holding him out until there's no discomfort. The batting practice went well and he showed power, so he might get a chance to beat Holliday's return time. Holliday was back in the Cardinals lineup on Sunday, just 10 days after his appendectomy. That saves five games off the DL.

Peavy went three innings at AA Birmingham on Friday. It's one time that "going to Birmingham" didn't include a visit to Dr. James Andrews for an injured pitcher, but then again, maybe the White Sox might have taken the opportunity for Peavy to visit Dr. Fleisig and check his biomechanics. Instead, Peavy just threw and things appeared to go well. The Sox have a very flexible calendar for Peavy's return, one that sources tell me is going to be based more on Peavy's responses than a normal five-day pitching rotation. The three innings of work included 71 pitches, a lack of efficiency that has to be a bit concerning. He'll throw again later this week and move on from there. If all goes well, he'll be back in the Sox rotation around the end of the month.

Sizemore is getting closer to Cleveland. I mean, Akron is geographically close, but I mean close as in getting back in the lineup. Sizemore has shown little issue with his knees since starting back into live games. The Indians have been very conservative with his return, largely because there's no comparison for a successful return. The Indians medical staff is led by Lonnie Soloff, who was responsible for Ken Griffey's multiple rehabs from leg injuries while in Cincinnati, and there's some overlap here. Sizemore played all nine innings on Saturday and is expected to do so Monday. He's had no real issues, so all that's left is playing back-to-back days, a series of games in a row, and then getting enough at bats. The Indians make it sound like the latter is the biggest issue, so seeing Sizemore back in Cleveland rather than just down the road in Akron or Columbus should happen in the next 10 days.

If you weren't paying attention, it might look like Wilson Valdes was a solid replacement for Utley over the first week. Valdez was OPSing .801 through Saturday, though much of that came in one 4-for-4 game with a pair of doubles. It's a reminder that it's possible for a lesser player to be an adequate or better replacement over the short term, but why losing a player like Utley for an extended period of time is so painful. Utley continues to progress slowly -- so much so that it doesn't appear like any progress. Jogging is the next step and that could come "any time now," according to one source closely following the rehab.

After seeing Nishioka break his leg on a similar play, it was hardly a reach to think that a takeout slide had done the same to Ramirez. Florida's start shortstop was in obvious pain, but he ended up with a deep bruise on his leg instead of a fracture. The difference is ... well, luck. Maybe Ramirez was hit just a little lower or with a little less force. Nishioka's fracture came low on the fibula, but not near the ankle. You can watch the video and see where Nick Swisher's leg hit him. Nishioka won't need surgery or even a cast; he'll be in a walking boot for a couple weeks while the swelling seeps out and the healing takes hold. Ramirez should be back once his pain and swelling is gone. He's just lucky it's only a few days rather than a few weeks.

Torres was a nice breakout story for the Giants last season. There's an argument that he was the best defensive player in baseball last season, but even the statistical die-hards will tell you that things like UZR don't have much value in one-year samples due to fluctuation. Scouts agreed with last year's numbers on Torres' defense, but also agreed with the new school stats guys that there was no real explanation for it. Add in a hot playoff run, and Torres was someone who was bound to be a bit overrated coming into 2011. An ADP of 229 and a positional ADP of 55 don't indicate that many overpaid, however, which is a good thing since he just went down with an Achilles strain. Torres strained the tendon, but did not rupture it, though he has not yet (as of my Sunday evening writing) had an MRI to determine the severity and location of the strain. Until we know that, it's impossible to put a solid ERD on Torres, but this definitely isn't good for a player who's value is based strongly on range and speed. Aaron Rowand will go back into CF for the Giants, though they'll have to look at long-term solutions if Torres will be out more than a few weeks.

The decline and fall of Kazmir might not seem so interesting to anyone but Angels fans, but it's a cautionary tale on several levels. First, is Kazmir's issue still one of mechanics? Two years ago, the Rays brought in Rick Peterson to work with Kazmir and seemed to have some short-term results. Is Kazmir's problem physical? He's had a series of injuries that could be a chain cascade, moving from elbow to shoulder to back. Is it an issue of concentration? Many have said that Kazmir never really focused on his pitching, relying on natural talent and movement. That almost always fades and that adjustment, from thrower to pitcher, gets a lot of guys, with only the great ones adjusting through it (or avoiding it altogether.) Added up, no one seems to know just what to do with Kazmir. A "change of scenery" trade didn't work last time, so I'm not sure that some suggestions for that would work any better this time. Then again, there are teams that can afford a gamble, like his hometown Astros, or a team with a serious scientific bent, like the Red Sox. His value is held down by teams wondering when his former teammate, James Shields, will come onto the trade market.

This isn't going to be so quick today, with lots of injuries ... Rajai Davis aggravated an existing ankle injury. He's day to day, but watch to see that he's stealing again, more than playing again ... Carlos Gonzalez is out with FLS (flu-like symptoms.) Why do teams not just say the flu? It's actually a matter of precision. Since a player is seldom diagnosed with influenza, the description of symptoms is smarter. Yes, it's occasionally used to hide things, but not often ... Todd Helton may have to go back to Denver for testing if his back issues don't clear up quickly. The Rockies are concerned, enough that their scouts have been asked for options ... Stephen Drew returned to the lineup, but the abdominal strain is still an issue. You'll have to watch Kirk Gibson's lineup card closely to use Drew in daily leagues. In weekly leagues, I hope you have another option ... Mike Stanton was back in the lineup as of Saturday and played again Sunday, a very good sign despite going 1 for 6 ... Johnny Cueto will throw a couple innings Monday at XST, then is scheduled for a rehab start on April 16 ... Domonic Brown is hitting off a tee and could begin hitting live pitching this week. That could put him back in Philly by May 1 ... Kelly Shoppach was pulled with knee soreness on Friday, but was back behind the plate Sunday. The Rays will have to keep splitting time with Shoppach and Jaso, but early season issues might mean the split will shift more to Jaso ... JJ Hardy has an oblique strain, one sources described to me as "a bad one in a bad place." He'll have an MRI, but is likely to miss a month or more ... Corey Hart is about ready to start a rehab assignment. He's made quick progress with his oblique strain over the last few days, leaving me to wonder what changed ... Kendrys Morales is running on a treadmill, but not on the basepaths. That's the next milestone for him ... Andrew Bailey is expected to throw off a mound on Monday. That will be a big test for him and help determine the next step in his rehab. The play of Brian Fuentes is allowing the A's to be conservative ... Erick Aybar goes to the DL in part because of his oblique strain and in part because the Angels need pitching after their 14 inning marathon. Playing a man down is smart until there's a situation like this ... Jason Isringhausen will be up for the Mets on Monday. He's both a cautionary tale about the use of young pitchers and someone you have to tip your cap to for continuing to come back ... I don't know if my interview made the final cut -- and it's about football -- but it's worth watching this week's Frontline anyway. It's focused on health and concussions in high school football, but there are lessons for all sports in there, including MLB.