Wednesday, January 20, 2010
by Matt Pitt ([email protected]
When Brock Lesnar pulled out of his title defense for health reasons in October, there was little alarm: These things happen in fight sport.
The initial reports on Lesnar's illness were unfathomable to those of us in medicine, though. A robust man in his early 30s laid low by a normally trivial disease of the elderly? Many of us suspected Dana White was indulging in some over-the-top hype.
Today, the truth came out. And, for once, White’s hyperbole was insufficient for the gravity of the situation.
Diverticulitis is an infection involving the colon, generally the extreme end portion known as the distal and sigmoid colon. The normal course of the disease involves low-grade fevers, loose bloody stools and abdominal pain followed shortly by relatively easy diagnosis, treatment with oral antibiotics and swift recovery. A previously healthy individual would certainly be laid up for a week or so, and a professional fighter might be unfit for high-level training for as long as a month. But Lesnar’s diverticulitis wasn’t diagnosed early, and he was absolutely right when he stated on “SportsCenter” that he very nearly died.
The complication Lesnar suffered was a bowel perforation, a pus-forming infection eroding through the wall of the colon. If the perforation is contained, medical treatment and percutaneous drainage generally result in full recovery. If the perforation is not contained, if large volumes of pus and stool spill into the abdominal cavity, then emergency surgery is the only hope for survival and death is an expected outcome. At best a patient could expect to lose all or part of his colon and be incapacitated for years. It appears, from what Lesnar explained on “SportsCenter,” that he was diagnosed on the razor-thin border between these two extremes.
If he had gone to surgery, all or part of the colon would have been removed. The healthy bowel would be diverted to a hole in the abdominal wall -- a “fistula” -- so stool could have been drained into a colostomy bag. After a period of recovery, taking many months, it’s possible the colostomy could be reversed -- allowing normal function of the bowel -- but the recovery from this second surgery would again require several months. If reversing the colostomy were not feasible, Lesnar would have been bound to wear a colostomy bag for life; training for MMA, much less competing, would have been impossible.
The question now is what are Lesnar’s hopes of recovery? Watching him on the “SportsCenter” set, he appeared leaner than his fighting physique. He admitted to losing 40 pounds. That is almost certainly not the easy water weight that fighters sweat off making weight. Immobilized in a hospital bed, fed intravenously, the majority of Lesnar’s weight loss would be primarily lean muscle mass. How long does it take to recover? It’s impossible to know. Lesnar claimed he’s recovered 30 pounds of muscle: His career will depend on whether he can also swiftly recover his explosive speed and tremendous strength.
Beyond the physical injuries he’s sustained, some mention should be made of the psychological injury endured by a sudden confrontation with one’s own death. As George St. Pierre can attest, a battle-ready mind is arguably the most crucial of a fighter’s tools. The somber-faced, soft-spoken, introspective and almost chastened Lesnar we saw on “SportsCenter” is someone very different from the triumphant warrior exulting over the body of his fallen foe at UFC 100. Can he fight as well?
With the physical and psychological injuries he’s sustained, can the Brock Lesnar of old ever return to the cage? The answer is beyond what medical science can predict, but I suspect we’ll all get our answer this summer.
Matt Pitt is a physician with degrees in biophysics and medicine. He is board-certified in emergency medicine and has post-graduate training in head injuries and multi-system trauma. To ask a question that could be answered in a future article, e-mail him at [email protected]