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Denver decision looms for Clark

| Friday, Oct. 30, 2009

A sickle cell trait expert said Thursday that Ryan Clark should be OK if he plays in Denver on Nov. 9 -- provided that the Steelers free safety takes the necessary precautions.

"I think that means aggressive hydration and oxygen," said Dr. Mark Gladwin, director of vascular medicine and chief of the pulmonary, allergy and critical care medicine division at UPMC.

Clark met with doctors again yesterday as he weighs the risks of playing in the Steelers' game that follows their bye week.

The mile-high altitude in Denver caused Clark's blood to sickle in a game two years ago. The resulting deprivation of oxygen to several major organs triggered a harrowing ordeal that eventually led to Clark getting his spleen and gall bladder removed in separate operations -- and could have cost him his career or worse.

Clark, a fearless hitter, does not back down from anything on the football field. What the eighth-year veteran must decide is whether a game is worth exposing himself to more complications that could arise from playing in Denver.

"It's hard, period, because you work so hard in the offseason for these games," Clark said after the Steelers' 27-17 win over the Minnesota Vikings. "But at the same time, you don't want one game to cost you your career. Or your life."

Clark, who turned 30 earlier this month, and the Steelers have been gathering as much information as possible in advance of the nationally televised game in Denver.

Clark has started 24 of the Steelers' past 26 games at free safety. Whether he even suits up against the undefeated Broncos will come down to a number of factors, not the least of which is that he and his wife, Yonka, have three small children.

Those with sickle cell trait have a genetic disorder that can cause hemoglobin - they release oxygen to different parts of the body through red blood cells - to stick together.

Oxygen essentially prevents this from happening by acting as a diluting agent. The process of red blood cells passing through blood vessels can be compromised in places where the altitude is higher and the concentration of oxygen in the air is lower, Gladwin said.

Gladwin explained what happens is what is commonly known as the "water balloon analogy of sickle cell", when the hemoglobin in red blood cells crystallize.

"Think of a wet water balloon, and you know how when you squeeze it, it slips right out of your hands• You could squeeze a water balloon through a tube, it would just slip right through it," Gladwin said. "Now take that same water balloon and partially freeze it. There's chunks of ice in it. Now you couldn't squeeze it through a tube."

A similar thing happens when hemoglobin get stuck together, Gladwin said.

Clark experienced that in the Steelers' previous game in Denver. Wide receiver Santonio Holmes, who also has sickle cell trait, did not endure anything that extreme.

But, Holmes said, it was a struggle for him to get through the game.

"It hurt to play there," Holmes said. "I couldn't breathe, I was coughing. I went out before we even did team warm ups and came back in, and I was like 'I can't breathe.' But it was my singular focus just to go out and play ball."

Holmes, who caught six passes for 54 yards and a touchdown in the Oct. 21, 2007 game against the Broncos, has said he will play in Denver.

Gladwin said players with sickle cell trait can minimize their risks of playing in high-altitude places such as Denver by getting supplemental oxygen when they are on the sidelines.

Hydration, Gladwin said, is also crucial because those with sickle cell trait have a harder time retaining fluids.

The Steelers also could limit Clark's number of snaps by using him in a rotation at free safety with Tyrone Carter or Ryan Mundy. Coaches have not decided how they will handle Clark's situation.

Still, the dilemma Clark faces is not an easy one.

What adds to the difficulty of the looming decision for Clark and the Steelers: doctors didn't initially diagnose how serious his condition was after he returned from his last game in Denver. His spleen wasn't removed until November after he sought a second medical opinion, and his gall bladder didn't come out until December.

"I know he wants to play," said Joel Turner, Clark's agent. "There's not a shadow of a doubt about that. I just told Ryan: Whatever the doctors and he and Yonka decide, I'm behind him 1,000 percent."

Additional Information:

A tough call

Steelers safety Ryan Clark must decide whether it is too risky to play in Nov. 9 in Denver since he has sickle cell trait. The disorder, coupled with the high altitude in Denver, caused his blood to sickle when the Steelers played there in October 2007. Here are a couple of basics regarding sickle cell trait, according to the Sickle Cell Disease Association of America, Inc.

• There are about 2.5 million people in America with sickle-cell trait.

• If you have sickle-cell trait, you have inherited the gene for sickle-cell disease. Sickle-cell trait does not turn into sickle-cell disease. If someone has sickle-cell trait and his partner has sickle-cell trait, they may produce a child with sickle-cell disease.

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