Does American Opioid Epidemic Influence Care In Japan?


 

Japan Times Opioid Article

Japanese taboo regarding the use of strong painkillers is the key difference in athletic injury care when compared with other countries. Many wrestlers with chronic joint injuries would face a life struggling with a delicate balance between managing pain and avoiding addiction. The United States’ well publicized opioid epidemic serves as a cautionary tale in how readily available and easily prescribed narcotics can lead to serious long term battles with addiction. This may be why some foreign wrestlers are seeking care in their home countries. It is notoriously difficult to obtain a prescription for the medicine and strict penalties hinder the importation of these medicines.

This is a very serious issue for athletes, even those in high school and even middle school. With athletics comes injury and often, surgery. When an athlete reaches the professional ranks, they often have numerous procedures under their belt to go along with any trophies earned along the way. A distant relative of Tachiai had a long, successful professional career in one of America’s four major sports. He continues to battle with his own addiction to opioids, a result of treatment for a score of injuries and resulting surgeries.

Two years ago, the Tachiai blog flew to Japan to visit relatives for a few weeks, just as news of the Julie Hamp scandal broke. Mrs. Hamp was just named as one of Toyota’s executives and as a female, her ascension brought wide news coverage. However, that coverage paled in comparison to the coverage of her fall when she was caught importing opioids hidden in jewelry boxes.

On the flight to Narita, my wife turned white as a sheet as she watched the news on the in-flight entertainment system. In our luggage was a bottle of opioids, prescribed to yours truly shortly before our travels because of another bout with kidney stones. Bringing these medicines into the country illegally carries very stiff penalties: up to 10 years in prison and $250,000 in fines. For Mrs. Hamp, it cost her a job, her reputation, and several weeks in detention while her case played out.

My wife was terrified when we landed in Japan. I joked that, “at least we’re not in Taiwan, the airports there have big signs pronouncing in bold letters that you risk the death penalty for bringing drugs into that country.” She didn’t find me funny. It was also very interesting to see how her friends reacted when they heard her tell the story. The taboo is certainly real.

In the US, however, it is quite easy for doctors to turn to the morphine genie. When another pebble pops loose from one of my kidneys and begins to meander down to my bladder (the last one looked more like a shard of glass than a “stone”) holy crap that hurts. When I make it to the Emergency Room, I am inevitably treated with a morphine drip, a quick MRI scan to see where it is and how big, then I’m sent home with a prescription for opioids. Thankfully none of mine have been large enough to remove surgically. Perhaps that should be “unfortunately,” though, as it means I must let them find their way out, naturally.

My kidney woes crop up every couple of years so thankfully I don’t have to dance with the devil in the medicine cabinet because I don’t keep it around. I know it’s dangerous to have that stuff, especially with the kids around, so I rely on those IV drips at the hospital when I get the pain, which isn’t often. But athletes face this kind of treatment on a continual basis, particularly with chronic joint or muscle issues. If Terunofuji, Kotoshogiku, Aminishiki, and Osunaarashi were athletes in the United States, they would certainly be provided opioids on an almost continual basis. As a result, they would be in prime danger for opioid addiction. I believe this aversion to opioid treatment leads to many of the ongoing injury issues we witness basho after basho.

This is conjecture, but I believe the NSK feels that if the rules were loosened for rikishi, this would not only lead to addiction among wrestlers, it would bring yakuza back into the sport. With the door opened for sumo wrestlers to be routinely treated with opioid pain killers, inevitably some of those pills would trickle out of the stables and into the general population as athletes supplement their income.

Is a few days pain worth a couple of hundred dollars? This isn’t fantasy. This tradeoff is happening here in the US every day and my dad’s cousin is an example. And if the pills and pain can be traded, is it necessary to begin with? To me, this is where the danger of socialized medicine makes itself known, unnecessary tests and unnecessary treatment – including OTC and prescription medication – become rife when someone else is paying. It’s already an issue for deep-pocketed insurance companies and it becomes a bigger one for deep pocketed sovereign governments. (Ask the NHS.)

The first time I had a kidney stone, I was lucky enough to be at home. When the doctor handed me the oxycodone prescription, my dad (also a physician) reached over and plucked it out of my hands, ripped it up, and threw it away. “You won’t be needing that.” My dad’s a smart dude. I didn’t need it. I passed the stone later that day and it would be two years before my next stone. The risk of addiction and abuse is high, and so is the temptation to make a few bucks in the black market. Who’s to say a sekitori won’t start cutting his pills in half so he can trade the other half away?

According to the Japan Times, Americans consume 243.79mg of oxycodone per capita. Japanese consume the drug at the miniscule rate of 3.63mg per capita. Much of that treatment goes to cancer patients. But this article claims that even among cancer patients, there is a strong taboo when it comes to the use of opioids while in the US it is standard “palliative care” for terminal diseases.

(Note: I also wonder if this plays into the low birth rate as Japanese women do not seem to have the same access for epidurals…but I digress.)

Yokozuna Kisenosato May Join Summer Jungyo?


Kisenosato

Horrific If True

One thing to keep in mind, the Japanese sumo press sometimes is given to speculation, so take this one with a grain of salt. From Yahoo Japan comes a quote from the Tagonoura stable master. He states that injured Yokozuna Kisenosato my join the summer tour later during the month of August.

This could indicate that it has been decided to have him “heal naturally”, and that Kisenosato feels like he needs to be taking care of his Yokozuna duties. With Hakuho (fresh from a Mongolian golf course) the only Yokozuna on he tour, Kisenosato may have decided that he can put up with more suffering for the cause of sumo.

Readers should form their own opinion, but after 2 back to back kyujo tournaments, I would rather have a great Kisenosato in 2018 than a malfunctioning, one-armed Yokozuna at Aki. Hopefully, someone from the Sumo Kyokai and or the YDC will urge him to get medical repairs before engaging in more public displays of sumo.

Yokozuna Hakuho Enjoying Time In Mongolia


Following his yusho at the Nagoya basho, Yokozuna Hakuho has retired for a brief rest in his native Mongolia. Courtesy of twitter user azechiazechi, we have this nice video of the Boss sinking a putt in rather glorious fashion.

The summer Jungyo will start shortly, and Hakuho will be the only Yokozuna in attendance, as most of the rest of the upper champion ranks are out attempting to heal up from their various injuries and maladies.

This video begs the question: Have Hakuho and Yoshikaze ever faced each other on the golf course? I understand the man form Oita is an excellent shot.

Ozeki Terunofuji Facing Medical Challenge


Terunofuji

On the heels of reports of Harumafuji’s pending elbow surgery, there is also news about Ozeki Terunofuji. Terunofuji has suffered increasing problems with his knees, and underwent corrective surgery in June. It was likely too soon to place his newly repaired knees under competitive stress, but the Ozeki attempted to compete in Nagoya anyhow.

Now it is reported that the knee surgery did not provide relief, and he is weighing his options. One option, obviously, is to return to surgery and attempt additional corrections. The second is the Japanese favorite of letting it “heal naturally” and hoping for the best. If he returns to surgery, he is likely to be prevented from competing in the Aki basho. He is already carrying the probationary “kadoban” tag, and missing Aki would reduce his rank to Sekiwake, with a one time chance to reclaim his Ozeki rank with 10 wins. For the next 6 weeks, Terunofuji is sitting out the summer Jungyo tour along with stable mate Harumafuji.

This would represent a huge but dramatic gamble. A healthy Terunofuji is entirely capable of 10 wins or more, but if he is unable to regain full use of that knee, his career might be more or less finished anyhow. The crew at Tachiai deeply love that big kaiju, and sincerely hope that he is able to recover and excel once more.

Yokozuna Harumafuji Facing Elbow Surgery


Harumafuji

As pointed out by Tachiai reader Herouth, Yokozuna Harumafuji may need surgery on his left elbow. At Nagoya, Harumafuji competed with both elbows under two layers of bandages, and inner “black” bandage (which he prefers), and an outer white bandage which is required by the Sumo Kyokai.

From the Japan Times:

Yokozuna Harumafuji may require left elbow surgery, a move which would not only rule him out of the summer regional tour beginning this weekend, but also the Autumn Grand Sumo Tournament in September, his stablemaster said Thursday.

“He has inflammation in his left elbow and can’t extend it,” stablemaster Isegahama said.

Harumafuji is set to miss part of the regional tour but could join up (later on) “depending on how it heals,” Isegahama said.

Isegahama, however, also spoke about the possibility of an operation and said Harumafuji “would not make it in time” for the Autumn Basho starting on Sept. 10 in Tokyo should he have to go under the knife.

This is the second time that Harumafuji has sought medical intervention in an attempt to resolve problems with his elbow, the prior time being May of 2015. Like many sumo veterans, Yokozuna Harumafuji is suffering under the cumulative damage of years of competition with no chance to allow mechanical injuries to completely heal.

Aki Juryo banzuke forecast


The promotions from Makushita to Juryo have been announced, and four rikishi will be moving up: Kizenryu, Kataharima, Daiseido, and the yusho winner Yago. Using highly complex mathematical algorithms and hours of CPU time, I have determined that this means that four guys will also be dropping out of Juryo, losing their sekitori status and going back to doing stable chores. It’s not hard to see that based on the Nagoya results, these four will be Satoyama, Rikishin, Tobizaru, and Kitataiki.

When I posted my Makuuchi banzuke forecast for Nagoya, Josh asked if the same prediction system would work for Juryo. The answer is largely yes (see the caveats below), so here is that forecast for Aki.

  East West
J1 Aminishiki Tokushoryu
J2 Sokokurai Daiamami
J3 Azumaryu Kotoyuki
J4 Toyohibiki Kyokutaisei
J5 Ryuden Kyokushuho
J6 Yamaguchi Hidenoumi
J7 Homarefuji Amakaze
J8 Kotoeko Tsurugisho
J9 Meisei Gagamaru
J10 Chiyoo Osunaarashi
J11 Chiyootori Kataharima
J12 Yago Seiro
J13 Terutsuyoshi Abi
J14 Kizenryu Daiseido

In red are the Makuuchi guys dropping down to Juryo, while the guys coming up from Makushita are in green. I still don’t see the logic in the Kaisei/Gagamaru swap for Nagoya, and Gagamaru would likely have ended up in a better spot for Aki had he stayed in Juryo.

Now the aforementioned caveats. I don’t have a great sense for how to place the newly promoted sekitori relative to either each other or the holdovers. Comments welcome.

At the top, J4e Myogiryu and J4w Aminishiki have nearly identical cases for promotion with 10-5 records. They should both be promotable over Tokushoryu, and there isn’t a great case to be made for demoting anyone else to Juryo. I opted for the by-the-numbers scenario of promoting Myogiryu and leaving Aminishiki at J1e, where he can hopefully get his kachi koshi at Aki to essentially guarantee promotion. The NSK could leave them both in Juryo and keep Tokushoryu (or, less likely, Sokokurai) in Makuuchi. Alternatively, they could demote Endo or Okinoumi and bring them both up, though this would be harsh and seems unlikely.

Yokozuna Kisenosato To Miss Summer Jungyo


Kisenosato-Dohyo-Iri

As reported today in Nikkan-Gendai Jiji News, Yokozuna Kisenosato will sit out the summer sumo tour of northern Japan. The Jungyo (literally, making the rounds) is a daily traveling sumo show that takes a set of some 50 rikishi to medium sized cities across Japan to bring sumo closer to the fans and the public, and is responsible for driving and maintaining sumo’s popularity.

His absence should be view as part of the larger program to heal up the very popular Yokozuna, and may be a sign that he will or currently is undergoing expanded medical treatment for what could be a career ending injury to his left pectoral muscle.

Corrected: Thanks to Herouth for catching the wrong link. I need to sleep instead of wading through Kisenosato news.  The other article is more focused on his injuries. You can find it here.