As training camp starts we begin to see players who will succeed and players who will fail. Some will fail quickly and obviously not have the package to play in the NFL, at least for the Broncos. Others will be in those final cuts that are so heart wrenching to a player's dreams since very few will be picked up by another team. For all those who succeed there is one character trait that I think is underestimated and even under-appreciated.

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More than 40 years ago on November 18th 1978 the greatest American civilian loss of life prior to September 11, 2001 occurred in Jonestown, Guyana. The People's Temple was a cult order based on Communist principles and led by Jim Jones, a mentally disturbed, but charismatic Church and community leader who took a large group of Americans to an enclave in Guyana to escape media scrutiny. The real purpose was to prevent anyone from leaving after they had been admitted and isolate the members from friends and family.  Jim Jones was a sociopathic megalomaniac and false faith healer who preyed on the weak and disenfranchised. Once you were brought into the People's Temple you were kept from leaving by armed security forces. US representative Leo Ryan flew to Jonestown on personal fact finding mission after receiving complaints from families about the slave camp atmosphere reported there. He brought a camera crew and reporters. After 15 members begged to leave with him, Jones sent his gunmen to the airstrip and murdered Ryan and his crew and one of the members attempting to flee. Ryan is the only sitting congressman to be killed in the line of duty.

Recognizing that his time was running short, Jones had his crew prepare Kool-Aid laced with cyanide and convinced the members that drinking this was their way to eternal salvation. 279 children were among those who died. Those who refused to drink were either shot or given it intravenously. Jones himself died of a gunshot wound to the head, presumably from one of his aides. Including those at the airstrip, 918 people died in the worst mass murder suicide in US history. 33 people escaped through the jungle and walked 30 miles to safety.  For many of the dead there was apparently little resistance to drinking what must have become clear very quickly was a lethal poison.

From this comes the current colloquial meaning of drinking the Kool-Aid.

It means when we mindlessly adopt the dogma of a group or individual leaders without understanding the ramifications or repercussions. It presumes ignoring facts at hand to accept a philosophy without merit.

It is curious that the phrase now has such an innocent even lighthearted tone as people use it. I myself can't bring myself to use the phrase on MHR having such gruesome memories of its origin.  By the way, the powdered drink that was used wasn't actually the brand name Kool-Aid.

Both Demaryius Thomas and Eric Decker are recovering from foot injuries that probably affected their draft standing. Ryan Harris is recovering from a severe turf toe injury. I'm not even going to try and deal with Ryan Clady's injury in this post.  Well it turns out that a players feet turn out to be pretty important in their athletic performance. I thought I'd share some information about the marvels that are our feet after the jump.

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What we know of our universe convinces us that nature strives for balance. For every type of force or energy there is an equal opposition. Positrons are balanced by electrons, positive magnetic fields are balanced by negative magnetic fields, strong nuclear forces, gravity, vibration and entanglement are all affecting everything that happens. In the human realm there are positive thoughts and negative thoughts and by some extension,  there are people who have predominantly negative thoughts or positive ones by force of habit, circumstance or upbringing. Reading MHR recently has been a curious exercise for me as I usually refrain from judgment and try to see  facts and how they relate to my point of view.  It is necessary to have facts to make conclusions of merit. Emotions are certainly valid brain expressions and a distinct part of our innate humaness, but they obfuscate arguments and create ego preserving behaviors that are counterproductive to inquiry. The invective about various aspects of the Broncos from players to coaches to (gasp!) owner seems to have polarized MHR despite John Bena's appeal for tolerance and levelheadedness that has defined this site since its inception.

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We now have confirmed information that Ryan Harris actually dislocated his great toe, not two of his little ones. Here's why this should matter to you: there is a world of difference betweeen the outer toes and the great toe in terms of consequences of the injury and its recovery time. After the jump we'll discuss the dreaded Turf Toe and how we may expect Ryan Harris to perform after his recovery.

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In listening to McDaniels during press conferences I have glimpsed a trait of his coaching method that provides us with great insight into his thinking. He never dwells on the past game and seems entirely focused on the next challenge. I believe he has imbued the entire team with a Zen approach to performance that incorporates characteristics of martial arts training.

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I missed the DAL and NE games while I was in Europe where the football is played with a round ball, so I was excited to return home and catch up on MHR news and watch the games.  Like many of us at MHR I like to watch the games by focusing on things away from the ball the second time through. This week I decided to focus on our superlative LT Ryan Clady. It is my contention that he is already at his young age the best OT in the NFL.

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I was 17 years old playing in the Minnesota State Hockey Championships when I went into the corner after a puck and was boarded head first from behind into the endboards. I woke up in the locker room with a huge headache, sprained neck and nausea. I didn't know where I was, when it was, or anything that had happened. There is no film of the event, but my teammates and family have filled in what happened. For the next four months I struggled with daily activities. I had a headache every day and it frequently woke me at night. I couldn't focus in class and eventually was pulled out of school. Any exertion, even walking up a flight of stairs left me nauseated and dizzy. My vision was wrong, I would see double or things would look blurry. My personality changed. I had always been fearless, an adrenaline junkie, but I became fearful and tentative. I lost my short term memory and a black cloud of depression settled over me when I had been a incorrigibly happy and optimistic person.  Gradually I came back to myself, bit by bit and finally over the summer was able to start exercising again. My thinking came back on line, my headaches went away. I never had any neurologic testing or x-rays. My doctor seemed to think I was malingering to get out of school or summer practice. This was my worst of three concussions I suffered as a young man. Later in Medical School I learned a great deal about traumatic brain injuries and was fascinated by the science although little was known other than the structural changes at that time. If you haven't read the article in GQ referenced today by TSG, I recommend you do.

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The third team on the field at all times just happens to wear stripes. They are the officials who enforce and interpret the rules of the game. In rewatching games I have frequently tended to block out the officials as if they're not there, like some kind of visual disturbance causing a blind spot. This is clearly a mistake because the officials on the field play a huge part in the outcome in both major and subtle ways (Ed Hochuli anyone?)  For instance, most teams have a play which uses the umpire as a pick on passes across the middle to brush off the linebacker. It can be effective too. 

Since it's early in the year, I thought I'd review the roles of the team of officials in the game, understanding that this is probably boringly simplistic for our sophisticated readers at MHR.

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Chris Simms streak of bad luck with injuries continues as it is now being reported he has a high ankle sprain which will keep him out of action from 2-4 weeks. This is definitely bad for the for the Broncos depth on offense as he represented one of the better back up quarterbacks in the NFL and steadily pushed Kyle Orton to continue to improve. It is also bad for the development of Simms in this new complex offensive system which requires frequent repetitions to master. For Simms this is a bad injury and I would think the time he misses will be much closer to 4 weeks than two even if all goes well. 

There is a big difference between low ankle sprains and high ankle sprains in terms of severity and ability to repair and also the long term consequences.  A low ankle sprain involves tearing or straining tendons and ligaments that attach from the lower leg to the foot on either the inside or outside, sometimes both. These require immobilization to allow repair and when severe are just as bad as a fracture requiring up to six weeks of casting. The muscle atrophy that ensues makes disability last even longer. Fortunately, most low ankle sprains aren't so severe and can repair in as little as 10 days with proper treatment and no signs of muscle atrophy.

The high ankle sprain is a totally different injury and much more feared among medical personnel. It is the result of tearing the ligaments that hold the two bones of the lower leg together and stabilize lower leg and foot movement. It is extremely painful and requires complete immobilization from the knee down and no weight bearing whatsoever. Many require surgery to reattach the ligaments that have been torn although we haven't heard if that's the case with Simm's injury. The instability that results has a serious effect on mobility and chronic arthritis is a distinct possibility. Chronic pain in athletes from this injury is common. It is much more serious in positions like running back than it is in linemen because of the great stress placed when planting and changing direction.

We can only hope Simm's injury is not a complete avulsion of this ligament, but rather an incomplete tear which will heal faster and with less long term consequences.

What would you rather be -- underappreciated or over appreciated?  I should know better than to read prognosticators in the MSM, but it is a guilty pleasure at times. This off season has the Broncos relegated to incompetent hacks in the draft, quantity over quality in free agency (change for change sake) and a bumbling over-his-head rookie for a coach. The shock of Shanahan's firing left many of the Broncos Nation dismayed; the hiring of an offensive HC instead of a defensive HC was seen as a huge lack of understanding what our needs are for the coming year.  Then we have the whole drawn out drama of Cutler vs. McDaniels (and Bowlen) that makes us national buffoons in the eyes of the MSM.  The hidden agenda of Bus Cook never reaches prominence although it is commented on here and by Ross Tucker. The draft in particular causes apoplexy in some of the Broncos faithful when we pass on defense for Moreno at pick 12 and don't try to trade up for Sanchez. Other than a few sane voices at MHR fans sink into a morass of despondency and many can't see us winning 4 or 5 games with our schedule.

Watching McDaniels at the OTA's has given me a real sense of the level of preparation this man demands from his players.  Every little detail, such as footwork, trunk position, where your eyes are looking -- nothing seems too insignificant for this coach to emphasize as important. If you believe as I do that excellence begins with exhaustive preparation then how can you not be hopeful about the direction of this team? This isn't implying that previous coaches didn't prepare the players, but this level of intensity seems to be quite new.  The presence of leadership in practice seems different as well. Yesterday there was a story about Graham and how intensely he practices. The defense was calling for him to be shutdown because he was making play after play and the next time he came out the pass was disrupted by the DB to great cheers. Not to be outdone, Graham later caught a TD. Perfect practice leads to great performance in games. Giving your all in practice is a discipline great players have as part of their excellence. I think we're seeing this type of leadership on our team.

Would you rather fly under the radar or have expectations that create an unmanageable burden? I think we're in the perfect position to surprise the whole NFL with a team that plays hard, smart, and with intensity. What do you think?

Brandon Marshall's comment on his web site concerning his hip injury last year and how it was managed raised the topic in my mind of the dilemma faced by players and team physicians alike.  Being a team physician has tremendous prestige and is an effective marketing tool for many physician practices.  "We are the Broncos team orthopedic surgeons" certainly sounds nice if you're seeing a doctor for your tennis elbow.  Becoming a team physician is a very political process which has responsibilities on both sides. While it is commonly thought that physicians pay for the privilege, this is in fact not true at least in the NFL.  They are required to be available on game day and sometimes training camp to deal with issues, but they get great views of the game and get to travel with the team as a perquisite. Many people don't know that the majority of assessment and treatment is actually done by the training staff headed by Steve Antonopoulous. He is absolutely superb and considered one of the best in the business; his ability to diagnose and treat would be near that or surpass many physicians who aren't specialists. Players have access to excellent diagnostic testing with the finest facilities and specialty physicians when injured.  However, there is certainly distrust on the part of players who feel the team doctor, by virtue of being employed by the team, may not have alignment with the players immediate and long term health.  I have no doubt that team physicians have high ethical standards and apply the oath to their diagnosis and treatment as a rule.  However, there are a number of grey areas which require scrutiny.  The fine line between playing hurt when no permanent damage will ensue versus the possibility of further injury which may alter long term disability or cause permanent harm cannot always be delineated with certainty.  What if a player is encouraged to play with an injury which becomes further damaged to the point that surgery is required. He ends up not being ready for the next training camp and gets cut.  Perhaps resting the injury would have prevented surgery and prolonged his career.   

While lay people think there is a fairly standard way to approach injuries and surgery, this is in fact a misconception.  For many issues there is not a body of evidence establishing one best way to do things, so individual physician judgment and experience come into play.  For instance, you tear your ACL and require surgery to repair it. Fairly standard right?  There are actually a number of different approaches that can be used and vary significantly by physician. What's more, there frequently are not published data to support which is best. So whom do you trust?  There is obviously a great deal of mistrust between players and team physicians, so much so that the collective bargaining agreement calls for second opinions which are paid for by the team. I think this is an excellent idea and I strongly recommend players take advantage of it. As a physician myself, I ask my partners and other physicians in my specialty for second opinions all the time on difficult cases. None of us can afford the ego that expects us to know everything  -- or not benefit from a different opinion. This is good medicine.

Football is a violent sport which has increased in potential danger with the amazing training methods, sheer size of the players, and the incredible speed which large players possess in the modern game. Injuries are inevitable and exquisite medical care and protective equipment and training methods are essential for us to keep the  players healthy. The long term disabilities suffered by NFL players is a shameful legacy that cannot be allowed to continue for the overall viability of the sport. Young men who make choices not realizing the long term consequences to their later years need to have better choices.  It now seems that many NFL teams need a variety of medical specialists to deal with the plethora of conditions associated with being a professional athlete. Orthopedic surgery is obvious, but what about Internal Medicine to handle hypertension and endocrine issues (diabetes for example). The size of players on both lines now has sleep apnea as an epidemic in the NFL and yet many go undiagnosed, only to be faulted when they miss a snap count or jump offsides from being sleep deprived. Traumatic brain injuries are a serious concern in the NFL with many players suffering multiple concussions which can lead to premature ending of careers and long term cognitive impairment.

By its very nature, the NFL selects out for certain psychiatric conditions. Aggression and violence are characteristic of psychopathic and sociopathic character disorders as well as borderline personality disorders, many of which have never been diagnosed. Many of these players are well adjusted to ordinary life, but may deteriorate under the pressure of a professional sport lifestyle. Depression and bipolar disorder are certainly diagnoses present on nearly every NFL team including the coaching staff. Should every NFL team have a resident psychiatrist to help players deal with stress etc?

As long as self interest on the part of both physicians and the team has the potential for conflict with a player's best interest, second opinions and even third opinions should be expected. Outside ethical review of decisions may be in order to protect our players and keep the legacy of football one that we look upon with pride and honor as the loyal fans we are.

While reports of steroid use are ruining the reputation of iconic baseball players in the media (who hasn't used steroids?), it remains rare to hear of this in the NFL. The NFL and NFLPA combined to realize the danger the use of these substances posed to the intregrity of the game and instituted a strict policy to protect the game and its players. The serious nature of permanent harm to players physically and the competeitve nature of the game being altered by use of steroids was a wake up call to action. I am not so naive as to think there aren't players using performance enhancing drugs in the NFL, but the consequences are severe -- second offense and you are banned from the league. I think this keeps their use to minimum. I've heard rumors that sometimes players are tipped to when they'll be tested, but the long lasting effects are very hard now to mask.  While designer drugs will always keep unscrupulous athletes trying to stay ahead of the testing program, keeping samples to test later acts as some deterent.  Baseball let use get totally out of hand before responding to the public outcry. At least the NFL acted sooner to protect itself and its players.

As a scientist and physician I have been taught since I was quite young to think differently than most people. Some of it was my Jesuit training, some of it was my innate desire to dig deeper, ask another question, ask "why ?" more frequently. I was never satisfied with answers some of my teachers gave as I thought they were superficial or lacking in insight that would allow me to understand more fully. 

There is a concept in science called critical thinking.  Simply it means that you start with a hypothesis, such as, heavier objects fall faster that lighter ones in the absence of wind or other resistance, and then do everything you can to prove it wrong.  So you go to the top of the Tower of Pisa with two different weights and drop them simultaneously with an observer on the ground. When both balls strike the ground simultaneously over and over you have a new insight.  This then requires a new explanation and a new equation to explain what you previously didn't know, but thought you did. 

Unfortunately, most people think with what is termed Confirmational Bias.  This is a flaw in thinking that starts with a premise, for instance, - a franchise quarterback is one with a strong arm, mobility, intelligence and a good agent, and then looks only for facts which support that conclusion. Facts which oppose this conclusion are discounted, ridiculed, or attacked in every way possible to avoid moving off the original premise. 

In fan posts and comments it's amusing to see how this plays out sometimes. It is really difficult to change someone's mind if they come into this forum with a strong confirmational bias that won't let them see facts in opposition to their belief.

Of course where I see confirmational bias the most is in MSM. Here it seems to be what you say today is all that matters. You are not very often held accountable for what you wrote about the draft last year or what player you thought would be a bust. It is so interesting to see how many UDFA become outstanding football players. we have our own Rod Smith, there's James Harrison, Tony Romo and many others.  MSM could use a lesson in critical thinking to keep digging deeper, ask the next question, and be open to the possibilty that you don't have all the information.

I know I don't have all the answers. When I am taking care of my critically ill patients I'm always reassessing, asking myself what have I missed? - what else could I be doing? what's going to go wrong next? It requires me to be in the moment, very present and open to the possibilities.

We all bring a point of view based on our backround and biases. It's like we all have  a window that we see the world through. Some of our windows are cloudy, some rose colored, some very narrow.  What I love about being part of MHR is that it keeps making my window larger and larger as I read fanposts and comments.

Thanks everybody for giving me a big picture window to look through at my Broncos! 

Oh help me, please Doctor, there's a hole where there once was a heart. Our draft has confused and tormented me till everything looks so dark. Mike Evans gives our draft a D,  Sandy says he has to pee,  Clayton has apoplexy,  the Sporting News thinks we're sexy. What's a good Bronco Fan to do? I've slit both wrists more than once and punched my mirror twice; I've stuck my eyeballs to ESPN looking for advice. Is there no hope in Broncoland following such a draft?  HT tells me not to worry, the others are all just  daft.  I just need to wait a few months and cool my football fervor.  I'm guess I'm lucky Tiger's back to play on the Tour.  My wife says the garage needs cleaning, my dog thinks I watch too much TV.  I've decided that Moreno is our stud RB to be. Ayers is sure a lot bigger than me and I hope he can run real fast. So many Bronco fans think our new Head Coach won't last.  Somewhere I think it will all be OK, I just realized that it's not even May!

McDaniels has vision for this team that he has expressed in many different ways, verbally, by his choice of coach to retain or dump, by the new coaches he's brought in, by the players he's acquired in FA and the players he's jettisoned.  Having played on successful teams I understand the magic that comes together when you have the right chemistry and everyone is following the same vision. I also was on a team that had incredible talent, but a divisive selfish locker room and we did poorly because of the lack of common purpose. I believe McD when he says he is assembling a certain type of player. One that is of admirable character. One that is a good athlete in many areas. One that has a tremendous sense of competition. One that has drive to work hard and be accomplished.  It seems to me that yesterdays picks fit this vision, although at first glance they may seem confusing or even counterintuitive. I think maybe we're seeing the tangible evidence of a big picture approach to building a franchise that has a specific identity. Maybe even one that will be consistent Champions! Looking forward to todays picks.

A telling statement by Josh McDaniels after the mini-camp finished was that he now knew what he needed to look for in the draft based on vulnerabilities he saw in practice.  Could he mean the defensive front seven? I would be surprised to see an offensive player taken in the first four Denver picks except the unlikely possibility of Moreno if he's available. 

Where the best GM's make their mark is generally not in the first round. These picks are too unpredictable and end up saddling the team with high cost against the moneycap. Real value lies in the 2nd through 4th rounds, especially the second where players of equal or greater value can be obtained. You see as many pro-bowl and HOF players from the second round as you do the first with the bonus that they're much cheaper. This is the core of the long term team nucleus that allows a franchise to stay at a competitive level year after year. Our Broncos were put at a competitive disadvantage with poor drafts from 2004-2007. A bad first round selection is doubly bad because it wastes money and the administration generally keeps the player at least a year too long because they don't want to admit failure. This keeps another player from making the roster. I know this is obvious to all of you.

This draft will really indicate how McDaniels and Xander plan to build the team. The reality is that they need to have two starters who are real playmakers on the defensive front seven come out of this draft. What a daunting chore! I believe much can be learned from a players body of work rather than the combine. We all know of players who defy the statistical norm but have a knack for the game. I also think that character cannot be overlooked. A young man suddenly earning mind numbing amounts of money and then traveling to big cities has opportunities for trouble that they could never foresee or be prepared to handle. I don't envy Xander and McDaniels job this weekend. I really hope they are well prepared to launch our Broncos into another era of excellence. Good Luck Guys!

Red Flags about Cutler

As a physician I think there are some serious questions about Jay Cutler's use of alcohol given his type 1 diabetes. The Chicago media seem to be downplaying its significance, but at least some consideration about this behavior led to the Broncos trading him.  After 25 years of following sports, when you hear the same rumor multiple times it's because it likely has some merit. I believe Cutler has an alcohol abuse problem which when combined with his diabetes makes his long term health a liability.