Treatment:    #10 of 12 of Taxol

Companions:  none

Time:            3:40 p.m.

I was just having a discussion with Erin about how it's better to live life in the moment rather than wait for the other shoe to drop.  If there's anything I've learned from this experience with Karla, it is to live in the moment and appreciate every moment that I am given to enjoy.  I have been cognizant of the known risks associated with the journey I'm on, but I haven't dwelled on them.  I mean, there is just too much right now to experience, enjoy, and be thankful for.  That all said, it was actually slightly refreshing to discuss some questionable news today with Dr. Otero (who filled in for Dr. Pinder today while she's on vacation for the next couple weeks).  It was a nice reminder that although I have been doing my best to live a superhuman life, I really am human.

I may have shared earlier that although the Taxol is generally easier on my body than that crazy Adriamycin/Cytoxin crap, some people on Taxol experience peripheral neuropathy (nerve damage).  Most people recover from initial peripheral neuropathy if caught early enough and dealt with, but for some people this condition will be permanent.  At its worst, people have difficulty walking because they can't feel their feet and they have grip issues with their hands because they have lost strength.  During every chemo treatment, the first question my doctor asks me is whether I have experienced any tingling or numbness in my hands/fingers or feet/toes.  It's one of the most dangerous side effects of the Taxol because it's potentially permanent. 

Unfortunately, I had to tell Dr. Otero today that I started feeling some tingling in my feet last night.  While I was trying to get to sleep last night, I thought perhaps that I ran more than I should have last week or my hike that day was super harsh on my feet.  Then when I woke up today and the tingling sensation was still present, I realized that it was probably the Taxol finally catching up with me. 

As a result, Dr. Otero decreased my dosage of Taxol by a 1/4.  He assured me that decreasing my dosage today would not affect my prognosis because I'm so close to the end of treatment.  However, he also warned that if the tingling/numbness continues or gets worse, the doctors may have to decrease my dosage even more, stop me all together (I would then miss my last two chemo treatments), or switch me over to another chemo drug.  I'm still feeling a bit of tingling in my feet, so I'm taking it easy today and hoping that the tingling subsides.

I did find a medical abstract that made me giggle about today's news.  Check it at: http://www.springerlink.com/content/b7288x7h8r837j27/.  Apparently, being vertically-challenged may have been one of the reasons why it took so long for me to experience any of this nerve damage crap!  Something to be thankful for, right?  Jesus, I never thought I'd be thankful for being a midget.

Then to end today's chemo treatment, the nurse who was giving me my Goserelin shot (to protect my ovaries during chemo) gave me a local anesthetic (Lidocaine) but totally missed the area where the Lidocaine was given.  Diane, my usual nurse, was on vacation today, so I had a different nurse.  I was confused by what was going on and the pain I felt (I mean, what the hell happened to the Lidocaine?), so like an idiot it took me a while to say something to my nurse, who was very slowly shoving that large needle into my side.  I ended up just riding out the pain until the dang Goserelin shot was done.  Very shitty.  Thankfully, although I've dropped some weight, I still have a bit of a muffin top around my waist, so the "stabbing" wasn't fatal.  I guess today is the day for unexpected blessings, as I never thought I'd be thankful for my muffin top!

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We have had excellent results with our original dental gels video so we are providing additional footage. Thanks for all your interest in our compounding pharmacy!

Stevens Pharmacy
Costa Mesa CA

I'll post my experience as soon as I'm done, and I may even twitter about it when I come up for air, so to speak. (If you're not already twittering, visit www.twitter.com and start tweeting--it's fun and it's challenging to restrict yourself to a 140-character report at any given moment.) 

I'm looking forward to visiting Earleen's new studio and seeing how the process may have changed in the past couple of years. I'm hoping my new motto will be "no pain with lidocaine!"

Stomatitis may be caused by infection, systemic disease, a physical or chemical irritant, or an allergic reaction; many cases are idiopathic. Because the normal flow of saliva protects the mucosa against many insults, xerostomia predisposes the mouth to stomatitis of any cause.

Viral causes are most common, but bacteria and fungi are sometimes involved. Oral infections can be clinically significant in immunocompromised patients. Primary herpes simplex infection produces multiple vesicular lesions on the intraoral mucosa on both keratinized and nonkeratinized surfaces and always includes the gingiva. These lesions rapidly ulcerate. Clinical manifestation occurs most often in children. Subsequent reactivations (secondary herpes simplex, “cold sore”), however, usually appear on the lip at the vermilion border and, rarely, on the hard palate.

Primary varicella zoster infection (chickenpox) often produces vesicles on the oral mucosa. Reactivation (shingles) produces similar lesions in the distribution of a nerve root; if the trigeminal nerve is involved, unilateral oral ulcers may result.

Many other viruses are involved. Coxsackievirus can produce hand-foot-and-mouth disease in young children, with both cutaneous and intraoral lesions, or herpangina, with isolated oral ulcers. Other infections include Epstein-Barr virus, influenza, cytomegalovirus, and HIV.

Acute necrotizing ulcerative gingivitis is a nonspecific, mainly fusospirochetal bacterial infection producing inflammation and punched-out ulcers on the dental papillae and marginal gingivae. A severe variant, termed noma (gangrenous stomatitis), can produce full-thickness tissue destruction (sometimes involving the lips or cheek), typically in a debilitated patient. It begins as a gingival, buccal, or palatal (midline lethal granuloma) ulcer that becomes necrotic and spreads rapidly. Tissue sloughing may occur.

Sexually transmitted diseases can produce stomatitis. Gonorrhea very rarely produces burning ulcers and erythema of the gingiva and tongue as well as the more common pharyngitis. Primary syphilis chancres may appear in the mouth, and about 20% of patients with secondary syphilis develop painless, shallow oral mucosal ulcers (mucous patch), typically with a yellow or gray base and slight surrounding erythema. Tertiary syphilis may produce oral gummas or a generalized glossitis and mucosal atrophy. The site of a gumma is the only time that squamous cell carcinoma will develop on the dorsum of the tongue.

Rare bacterial causes include Mycobacterium tuberculosis , inoculated by sputum from the lungs. Cervicofacial bacterial actinomycosis (lumpy jaw) may resemble a fungal infection and may contain pathognomonic yellow (sulfur) granules in purulent exudate.

Candida albicans and related species, which are normal oral flora, can overgrow in people who have taken antibiotics or corticosteroids or who are debilitated, such as patients with AIDS. Overgrowth may produce a pseudomembrane with a cheesy substance on friable mucosa. The chronic erythematous and erosive forms are more common but are also more difficult to recognize. Oral and perioral lesions occur infrequently in blastomycosis, histoplasmosis, coccidioidomycosis, cryptococcosis (mainly in debilitated patients), and mucormycosis (particularly in people with diabetes).

Behçet's syndrome, Stevens-Johnson syndrome, and inflammatory bowel disease can produce bullous or ulcerative oral mucosal lesions. Pemphigoid and pemphigus vulgaris cause oral vesicles and ulcers. Sprue (gluten-sensitive enteropathy) may produce oral ulcers. Hemorrhagic oral lesions may occur in erythema multiforme, scurvy, leukemia, thrombocytopenic purpura, and platelet disorders. Unprovoked bleeding, xerostomia, and an ammonia-like odor accompany uremia. The mucocutaneous lymph node syndrome (Kawasaki disease) affects children, causing erythema of the lips and oral mucosa. Stomatitis may result from hypovitaminosis (particularly B vitamins or vitamin C), iron-deficiency anemia with dysphagia (as in Plummer-Vinson syndrome), or agranulocytosis. Pellagra produces a smooth, fiery red tongue; painful mouth; and mucosal ulcers.

Cyclic neutropenia is a rare condition probably caused by a defect in neutrophil maturation, resulting in regular, cyclic bouts of neutropenia (< 500/μL) with fever, malaise, lymphadenopathy, and oral ulcers. It usually presents in childhood.

Physical irritation is frequently involved. Cheek biting, mouth breathing, jagged teeth, orthodontic appliances, ill-fitting dentures, and nursing bottles with nipples that are hard or too long may cause stomatitis. Other contributors are excessive use of alcohol, tobacco, hot foods, and spices.

Drugs and chemicals may be sensitizing (typically resulting in a type IV hypersensitivity reaction) or directly irritating (ie, triggering inflammatory mediator release without involvement of memory T cells or IgE). Common substances include ingredients in toothpaste, mouthwash, candy, gum (especially if made from chicle), dyes, lipstick, and, rarely, dental materials. Stomatitis also may result from occupational exposure to dyes, heavy metals, acid fumes, or metal or mineral dust. Many drugs are implicated in stomatitis. The most common are cytotoxic cancer chemotherapy drugs, and gold salts. Nicorandil (K channel blocker), iodides, barbiturates, and NSAIDs are rare causes. Some foods, especially highly acidic ones, may produce oral ulcers.

Patients with acute stomatitis and no symptoms, signs, or risk factors for systemic illness probably require no testing. If stomatitis is recurrent, viral and bacterial cultures, CBC, serum iron, ferritin, vitamin B₁₂, folate, zinc, and endomysial antibody (for sprue) are obtained. Biopsy at the periphery of normal and abnormal tissue can be done for persistent lesions that do not have an obvious etiology. Systematically eliminating foods from the diet can be useful, as can changing brands of toothpaste or mouthwash. Underlying disorders are treated. Meticulous oral hygiene (using a soft toothbrush) may help prevent secondary infection. A soft diet that does not include acidic or salty foods is followed.

Numerous topical treatments, alone or in combination, are used to ease symptoms. These treatments include anesthetics, protective coatings, corticosteroids, antibiotics, antihistamines, and physical measures such as cautery. For topical anesthesia, 5 mL of 2% viscous lidocaine is diluted in 10 mL water and used as a rinse and then expectorated q 3 h. A carboxymethylcellulose paste with or without 1% triamcinolone  qid reduces irritation of painful local lesions.

Other topical drugs include sucralfate and aluminum-magnesium liquid antacids; 30 mL of these drugs may be used alone but are often mixed with 2% viscous lidocaine  5 mL and diphenhydramine (an antihistamine with mild local anesthetic properties) and, often, kaolin, 12.5 mg to rinse and expectorate. Some physicians add tetracycline or nystatin suspension. If an infectious etiology is unlikely, fluocinonide gel may be applied to each ulcer. Amlexanox 5% paste can be applied qid (¹⁄₄ on tip of finger, wiped across ulcer).

Chemical or physical cautery can ease pain. Silver nitrate sticks are not as effective as low-power (2- to 3-watt), defocused, pulsed-mode CO₂ laser treatments, after which pain relief is immediate and lesions tend not to recur locally.

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Upon a prescription order, we can compound:

lip balms for viral lesions

topical muscle relaxants/analgesics

topical anesthetics

non-staining antibacterial rinses

oral sedation in lollipops and freezer pops

lollipops for oral thrush

mouth rinses for aphthous ulcers or chemotherapy-induced stomatitis

mouth rinse to stop oral bleeding during dental procedures for patients who take anticoagulants

dry socket preparations

"mucosal bandages" to cover ulcerated, infected, or tender mucosa

lozenges that help to prevent gagging

and many more unique preparations and novel delivery systems.

Medications are manufactured in a limited number of strengths and dosage forms that will satisfy the needs of most patients due to stability concerns, and the cost of stocking and distributing numerous formulations of each drug.

Using pharmaceutical grade chemicals and specialized equipment not found in most pharmacies, we can compound medications in doses and dosage forms that are not commercially available. We want to optimize the care of every patient. Just let us know what you need!

Charles T. Bonner, Rph.

Compounding
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Compounding Problem Solving
Adrenal Fatigue/Thyroid Hormones
Overview
Andropause
Overview
Testosterone

Steven's Dentistry Compounds

Here are some of our compounded products that are popular for use in the office by dentists and dental hygienists.

Profound Gel and Profound Lite Gel
Profound Gel is an topical anesthetic gel made from a powerful combination of tetracaine, lidocaine, and prilocaine.

It allows for gingival recontouring and other soft tissue procedures with little or no need for local anesthesia. If a patient were to be given local anesthesia via injection, the patient would experience no burn or sting.

With Profound, you can nearly eliminate the need for lower blocks, which are not patient-friendly, and achieve instant pulpal anesthesia without any tongue or cheek numbness. We also compound Profound Light, which is half the strength and provides good anesthesia for deep cleanings and other work the dental hygienist might do but has less risk of sloughing. It is dispensed in 30g and 45g tubes.

Info & Articles PDF (3 MB)
Safety Data PDF (4.6 MB)
http://www.stevensrx.com/files/dentistry/profound_cyclone_order.pdf
Profound in Health Updates

Profound Light Applications

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Dr. Mike Ditolla writes :

" I now use the (Profound) Light exclusively for pre-injection numbing. It is plenty strong to numb tissue prior to a needle puncture. For everything else I use the regular Profound Gel. For example, I use Profound for all palatal anesthesia. Palatal (roof of the mouth) anesthesia hurts like hell!! SO whether I am packing retraction cord, extracting a tooth, or doing laser recontouring of the palatal tissue, its all with (Profound) Regular."

Profound

Profound Gel is a great gel that provides pulpal anesthesia. The gel contains prilocaine, lidocaine and tetracaine (10%/10%/4%) in a loose running mint flavored green gel.

We compound Profound gel in 30g or 45g quantities. The gel should be applied for no longer than 3 minutes to prevent possibility of sloughing- leave on the site for about 2 &1/2 minutes, then rinse thoroughly. We also compound Profound Light which is half the strength and provides good anesthesia for deep cleanings and other work the dental hygienist might do but has less risk of sloughing.

Profound Gel / Profound Light

We ship nationwide via UPS or FedEx

Profpet

Profpet is similar to Profound gel, but contains thickener and 2% phenylephrine to prevent bleeding. It is dispensed in 30g and 45g tubes.

Depblu

Depblu is similar to Profound gel, but contains sweetener, thickener, and 2% phenylephrine to prevent bleeding. It is dispensed in 30g and 45g tubes.

Cyclone

Cyclone is a topical anesthetic in the form of a rinse that patients can swish around for one minute to anesthetize gingival and palatal tissues. It is fantastic for hygiene patients who needs some anesthesia but don't want local infiltrations or blocks. It also works well for needle-phobic, sensitive hygiene patients, and for patients who gag during impressions. It is dispensed in 480mL and 960mL bottles.

Topical Therapy for Pain and Infection

The options to help patients with oral and perioral pain problems such as neuropathies, burning mouth syndrome, neuromas and neuralgias. Vehicle-carrier agents and bases have been developed that can penetrate the mucosa and cutaneous tissues and transport the active medication to the treatment site. Dentists have been using topical agents with increasing frequency as part of the therapeutic protocol for orofacial painful neuropathy.

Several topical intraoral medications are used in the treatment of oral ulcerations and infections, including antifungals; nonsteroidal anti-inflammatory drugs (NSAIDs); and corticosteroids.

Because of their rapid onset and low side-effect profile, topical medications offer a distinct advantage over systemic administration for orofacial disorders.

Medicated lollipops, lozenges, and adhering powders are ideal for keeping an antibiotic or antifungal in contact with an infected area in the mouth.

Topical Anesthetics—Combinations of your Choice

Update on Burning Mouth Syndrome

Burning mouth syndrome (BMS), also referred to as glossopyrosis or glossodynia (when the burning occurs on the tongue only) is usually described as oral burning pain, sometimes with dysesthetic qualities similar to those present in other neuropathic pain conditions.

Therapy for Temporo-Mandibular Joint Disorder (TMJ)

Transdermal application of NSAIDs such as ketoprofen results in significantly higher tissue levels beneath the site of application than are achieved with oral administration. Additionally, side effects such as gastrointestinal irritation are avoided.

Transdermal Anti-Emetics

Topical application of anti-emetics in a gel formulation provides a rapid onset and offers an effective alternative to oral administration. Oral surgeons have found this formulation to be particularly useful.

Periodontal Therapy

Compounding allows countless active ingredients to be incorporated into customized mouthwashes, gels, troches, etc.

For example, to treat periodontal disease, antibiotics can be formulated as a mouthwash, or added to an oral adhesive paste or a plasticized gel that will maintain the contact between the tissue and medication for a prolonged period of time.

"Miracle Mouthwashes"

Compounding dental mouthwashes or rinses may offer numerous advantages over commercially available dosage forms.

Elixirs, syrups, and suspensions often contain preservatives such as alcohol which can cause reactions or gastrointestinal irritation, or sugar which makes the preparation undesirable for prolonged use in the mouth or for diabetic patients.

A customized preparation without unnecessary excipients - i.e., a sugar-free, dye-free, lactose-free, and preservative-free dosage form - can eliminate concerns of palatability, alcohol content, and dyes which may stain exposed mucosa.

Various preparations are also available to treat burning mouth syndrome and anesthetic/analgesic and antibiotic/anti-infective mouthwashes are commonly requested.

Examples of Compounded Medications

We are dedicated to meeting the unique needs of dental patients, and we welcome your questions and medication problems. Our compounding professionals are problem-solving specialists!

Examples of Customized Medications for Dental Care

Anti-Viral Lip Balms
Ketamine/Ketoprofen/Gabapentin gel
Ketoprofen/Cyclobenzaprine topical gel
Lidocaine/Prilocaine gel in plasticized base
Mucosal Bandages
Oxytetracycline/Hydrocortisone Suspension
Peruvian Balsam/Eugenol
Sucralfate Oral Adhesive Paste
Tranexamic Acid Mouthwash
Triple-Anesthetic gel - benzocaine/lidocaine/tetracaine ("BLT")
All formulations are customized per prescription to meet the unique needs of each patient. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.

Submitted by Stevens Pharmacy Compounding Pharmacy To The World
Courtesy of Instant Response Video

Our compounding pharmacy videos

ESPN is reporting that Brian McNamee may NOT receive immunity for the testimony he will be providing in Washington. McNamee had actually received immunity about a year ago when speaking with federal prosecutors (a separate case). 

That same testimony, testimony which featured Clemens, Pettitte, etc., was then employed by the creators (Mitchell & Co.) of the Mitchell Report. I guess McNamee will have to find another reason to talk now. Maybe the taped phone conversation produced by Roger Clemens was enough incentive ("what do you want me to do!?!").

Okay, that's too much seriousness already for this blog, so let's take that story in a different direction.  What might be the side-effects of making your butt numb?  Ponder that for a minute... then see if you believe Clemens' story...

She doesn't think she can offer much intervention, but she has given me the team's number and apparently I can contact her for a chat or advice at any time. She is ringing the CMHT to see what is going on with the psych support I am getting there and is drafting a letter to send to my CPN. It all sounds quite optimistic really. She thinks at some point in the future I would benefit from long-term therapy but realises that I'm not in the right frame of mind at present. She's also given me the number for the mental health adviser at uni and thinks that uni counselling is a good idea.

She also twigged that I cut myself recently. 4am this morning to be precise after taking one and half zopiclone and two zolpidem and still being wide awake from half midnight to half four this morning. It was quite bad as well and she suggested I went to A&E, I obviously didn't look too happy about the idea so she came with me. 9 stitches in one of the cuts and 7 in the other bad one and steri-strips on the third. It was quite sweet as I was seen by a trainee nurse practitioner who went off to get a colleague as she "couldn't suture" and so a fully qualified nurse practitioner came in and sutured the worst one and then offered to let her suture the other one (she had been on a course but never sutured a person). I agreed and so she did her first ever suturing on me - and it's dead neat!

The biopsy was bloody painful. More local anaesthetic and a large needle straight into my bone. However, they did give me some nice sedative drugs and kept me in for a couple of hours to sleep them off afterwards. I should get the results by the end of the week. Quite scared about it but trying to stay optimistic.

Ruth

Tellingly enough, Clemens did not really answer the question when someone asked him why he let McNamee inject him, and he said that McNamee provided his injections. So basically, we can see the defense he’s carving out for himself: He thought B12 just meant B12 while McNamee, taking a cue from accepted baseball insider lingo, thought that B12 meant steroids. So there you go. We’re right back where we started, and this pissing contest is just getting started.

I do believe that Clemens did offer some form of an explanation as to why he allowed McNamee to inject him (he reportedly thought McNamee had a medical degree), although, one can debate the nature of the response, especially in terms of its legitimacy and believability. Either way, RAB brings up a good point about B-12 being "insider speak" within the steroid culture that had seemingly consumed much of baseball.

Vitamin B-12, which is not a steroid, had actually become a codeword for steroids, as described by Jose Canseco in his book "Juiced." Canseco can be credited for bring this insider terminology (in baseball) to the external world. Here's an excerpt from his first book (p. 211) which speaks on the word and its use in clubhouses.

It was so open, the trainers would jokingly call the steroid injections “B12 shots,” and soon the players had picked up on that little code name, too. You’d hear them saying it out loud in front of each other: “I need to go in and get a B12 shot,” a player would say, and everyone would laugh. (Of course, that was the kind of joke you really only made around other steroid users, because obviously they were in the same boat as you. What were they going to do, tell on you? Not hardly.)

So, according to Canseco, B-12 was coded language for steroids, or a steroid injection. Now, we all know that Roger Clemens has openly stated that Brian McNamee did, in fact, inject him with Vitamin B-12. Could this have been a mix-up or could this eventually be portrayed as a mix-up in the way that RAB predicts? I heard Seth Everret (from MLB.com), discussing the Clemens' situation directly after the conference, and he made a similar comment. Maybe this whole thing was a misunderstanding between the athlete and his trainer. Maybe Roger Clemens asked for a B-12 shot, thinking he'd get a vitamin supplement, and McNamee gave him what he thought Clemens wanted-- steroids.

Well, this still seems unlikely. In his book "Juiced," Jose Canseco, who is no vision of truth and morality yet has been right in the past, also stated that, not only was B-12 a codeword for steroids and steroid injections, but Roger Clemens actually knew of this association between the phrases.

It was the pitchers that kept the “B12” joke going. For example, I’ve never seen Roger Clemens do steroids, and he never told me that he did. But we’ve talked about what steroids could do for you, in which combinations, and I’ve heard him use the phrase “B12 shot” with respect to others.

A lot of pitchers did steroids to keep up with hitters. If everyone else was getting stronger and faster, then you wanted to get stronger and faster, too. If you were a pitcher, and the hitters were all getting stronger, that made your job that much more difficult. Roger used to talk about that a lot. (Canseco, p. 211-212).

This contradicts the "I didn't know that B-12 meant steroids" argument that some may think Clemens will pursue. If he does pursue this route, people will constantly challenge him and use these quotes by Canseco to say that he is lying. If he was doing steroids, he can't really venture down this path because its clearly not foolproof.

Also, this quote from Canseco's book even questions what Clemens said in his press conference. In the conference, he mentioned that he rarely discussed steroids (to other players) and only talked about when it was in the news or "in passing."

Peter Abraham (and his friend) offers another suggestion as to what my occur.

Is it possible McNamee injected Roger Clemens with steroids but told him they were painkillers or B-12? McNamee was a nobody until he started training Clemens. Might he have been so desperate to keep his job that he resorted to steroids to give Clemens a false sense of accomplishment?

This conclusion would allow Clemens to be painted as a victim, providing him with an affordable way out of a tremendously difficult situation, while maintaining some form of dignity and respectability. Of course, the only way this would work for him is if McNamee comes forward and states that this is what actually occurred.

To tell you the truth, I still don't see why McNamee would lie. Yes he's trying to beat out jail-time by offering names, BUT, judging from that phone conversation, he obviously loves Roger Clemens (seriously), so why offer his name if it isn't legitimate? Plus, he had to tell the truth in order to stay out of prison. He could have avoided this whole mess by simply not saying anything about Clemens if it wasn't true. Doesn't that seem like a scenario McNamee would have welcomed? After listening to that phone call, if Clemens didn't take steroids, it seems as though McNamee would go to bat for him.

Was McNamee coerced into divulging falsified information? It makes more sense for him to tell the truth so he can take care of his sick son (who he spoke of during the phone conversation) and not got to jail. McNamee was simply all over the place in that phone conversation. One minute he was saying he'd go to jail for Roger, the next, he's saying he needs to stay out to help his kids. The whole thing just doesn't make much sense. They probably both knew it could be recorded, so they both provided guarded responses.

After the press conference, McNamee's first "interview" since the Mitchell Report was released via Sports Illustrated and Jon Heyman. In the reaction-piece (which was completed before the Clemens Conference), McNamee basically states that he still likes Clemens (it's actually becoming a little creepy) as an athlete and a person. However, he still says that his Mitchell Report allegations were true and have always been factual.

Here's a bit of the article. The context features McNamee watching Clemens' 60 Minutes interview and reacting openly to what is said.

He stops to hear Clemens acknowledge that McNamee did, in fact, inject him -- only with the anesthetic lidocaine and B-12 vitamins rather than with HGH and anabolic steroids. "That's news to me," McNamee says. But the edge is gone now. He explains that such shots are administered through the arm and not the butt and implores Wallace to ask the pitcher where he got such prescription drugs. Wallace does not.

McNamee even goes on to say that he wouldn't be surprised if Clemens actually did not know that Andy was taking steroids, which actually hurts his credibility, since everyone basically assumed that Andy and Roger were doing these things together. Also, McNamee continues, stating that Roger Clemens should not be denied a spot in the HOF even in light of his supposed steroid use. He essentially says that Clemens is merely a part of the steroid culture that has engulfed the baseball community and was not one an abuser of performance enhancing drugs. Apparently, he was just another member of the community, engaging in normative behavior.

"And Roger was in no way an abuser of steroids. He never took them through our tough winter workouts. And he never took them in spring training, when the days are longest. He took them in late July, August, and never for more than four to six weeks max ... it wasn't that frequent."

Now this is interesting. I don't have the Mitchell Report directly in front of me, so I'm not sure if it has these exact dates in the report. Either way, if McNamee injected Clemens around 16 times (combined) during the months of July (late July) and August in 1998, 2000 and 2001, let's look at some numbers (briefly). The following splits seem to fall within the time-line presented by McNamee (give or take a start).

• In 1998, Roger Clemens' splits (first and second half) were the following:
• 1st half -- 18 GS...9-6 RECORD...119 IP...3.55 ERA...96 H...47 ER...120 K
• 2nd half -- 15 GS...11-0 RECORD...115.2 IP...1.71 ERA...73 H...22 ER...151 K
• In 2000, Roger Clemens' splits (first and second half) were the following:
• 1st half -- 16 GS...6-6 RECORD...95.2 IP...4.33 ERA...94 H...46 ER...90 K
• 2nd half -- 16 GS...7-2 RECORD...108.2 IP...3.15 ERA...90 H...38 ER...98 K
• In 2001, Roger Clemens' splits (first and seond half) were the following:
• 1st half -- 18 GS...12-1 RECORD...124.1 IP...3.55 ERA...115 H...49 ER...122 K
• 2nd half -- 15 GS...8-2 RECORD...96 IP...3.47 ERA...90 H...37 ER...91 K

I'm not sure what to believe as I view the numbers. You can see some better numbers in the second halves, although 1998 seems to present the most extreme case while the disparities between the halves begin to fade over time. However, when compared to 1998, Clemens pitched similarly in 1997 (except his numbers in the 2nd half were slightly lower in terms of quality). In 1999, when Clemens was having his first year in pinstripes, his numbers were pretty low in comparison to these presented here, but this was largely due to his terrible statistics away from Yankees Stadium (his 1st and 2nd half splits are fairly similar). Also, in terms of monthly statistics, according to Baseball Reference, in 1998, Clemens' best numbers were in July and August. The same can be said for 2000. This is almost the case in 2001, except June was Clemens' best month (but July and August are 2nd and 3rd).

All of this is rather unconvincing. I mean, we can look at the statistics all day and break them down even further, but none of it provides us with anything conclusive. Maybe we'll just have to wait for that stupid "smoking gun" that we've all been talking about, or maybe even another weird phone call between two ex-friends. What do you think?

Today is the big day for Roger Clemens. He will finally get his shot at softening public opinion as it relates to the Mitchell Report's allegations (e.g. steroid use), while explaining himself to the viewers. Here are some final bits that we should all keep in mind as the interview airs today on CBS.

• Clemens knew of the report's allegations before the report was even released (in fact, he had the chance to discuss the issues before its release). Clemens and his lawyers chose to withstand the fallout from the report, and have had ample time to prepare their public relations strategy.
• Tyler Kepners of the Times wonders exactly how the relationship between Clemens and Andy Pettitte will be influenced by the allegations. He also wonders how their situation might play out before Congress, especially after Pettitte has confirmed Brian McNamee's assertions while Clemens rejected them entirely.
• Believe it or not, Brian McNamee and Roger Clemens spoke via phone on Friday (the 60 Minutes interview had already been taped by then), and Newsday is reporting that the conversation was extremely "emotional."
• McNamee could possibly sue Roger Clemens for defamation if Clemens explicitly refers to McNamee as a liar (in relation to the Mitchell Report's findings) while on 60 Minutes. Clemens has already stated that McNamee was "mistaken," and had injected him, not with steroids or HGH, but with Vitamin B-12 and Lidocaine.
• Finally, Clemens will most likely attempt to disprove McNamee's statements by attacking his credibility, so be on the lookout for McNamee references that may portray him in a negative light (e.g. the "rape" situation, etc.).

I'm sure we'll know some more later today. Stay tuned.

Roger Clemens says he was injected with "Lidocaine and B-12" and not steroids or human growth hormone by former trainer Brian McNamee, according to a portion of an interview with CBS' "60 Minutes" released Thursday.

"Lidocaine and [vitamin] B-12. It's for my joints, and B-12 I still take today," Clemens told Mike Wallace in the interview, which is scheduled to be shown Sunday night. It is Clemens' first interview since the release of the Mitchell report in December.

I really don't know what to make of Roger Clemens and these statements. He's essentially confirming that he was injected by Brian McNamee, but he's also simultaneously (and cleverly) denying the steroid and HGH injections, stating that they were actually Lidocaine (an anesthetic) and B-12.

This is similar to the route that Rafael Palmeiro took when he tested positive for steroids a few years ago (which didn't work at all). Palmeiro claimed that the positive test was the result of a failed B-12 shot, thanks to a dirty vial provided by teammate Miguel Tejada. Obviously, the severity of Palmeiro's situation was a bit further along due to a conclusive test, however, it's still similar in that B-12 (along with Lidocaine) is now the fallback injection.

I guess this could work for Clemens. McNamee was a personal trainer for Clemens and was employed by the Yankees for a time, so, choosing this man to inject him with vitamins and a local anesthetic actually makes some sense. That's clearly what Clemens is going for.

He's not outwardly stating that McNamee never injected him with anything. Instead, he's merely saying that he injected him with legal substances. Now, it's up to McNamee to go the extra mile and physically prove that Clemens did receive steroid injections (if he chooses to), which is essentially impossible if there's no smoking gun (e.g. syringe, positive test, package slip, a check, e-mail, etc.).

McNamee's legal team is still holding their ground, saying that they will sue Clemens (after the full 60 Minutes interview is aired) if he defames their client. I'm still wondering how they'll prove this, but Richard Emery who specializes in legal matters pertaining to defamation, offered the following:

"There is a ton of evidence that the Mitchell report failed to explore that will corroborate Brian, and so it would be foolhardy for Clemens or Hardin to allow Clemens to trash Brian.''

You know, they've already stated that they don't have anything substantial (physical evidence) that they can use to support McNamee. However, I wonder if this is just some sort of ploy that they're using.

What "evidence" are they talking about? If there's a ton of it out there, that's what everyone is waiting to see and that's what's going to ultimately effect this situation (if there actually is any evidence).

It'll be interesting to see Clemens answer some questions this weekend. This whole thing seems like it may just become a game of "he said, she said," predicated upon secondary sources and no real evidence. If this is the case, Clemens may just "win," as he'll prolong our decisions about his career, just long enough so that the matter will eventually die out (after everyone becomes tired of it).