We still don’t really know what was going on with Darryn Peterson last season.
A few days before the NBA pre-draft combine in Chicago, an article from ESPN ran that included an exclusive interview with Peterson, in which he seemingly explains that he now has all the answers for what made the season at Kansas so weird.
That strange season is probably the most discussed topic when it comes to this year’s NBA draft. Ongoing and mysterious cramping issues and other injuries, along with Peterson asking to be subbed out of games and playing restricted minutes, created a lot of questions about his health.
But even after hearing from Peterson himself — through the ESPN interview and at the combine — and speaking with multiple physicians about the topic, there are more questions than answers about what the cause was for the mysterious ailments and behavior during his lone collegiate season in Lawrence.
Peterson is expected to be among the top two picks in this year’s draft, along with AJ Dybantsa. With the Utah Jazz owning the No. 2 overall pick, understanding the strengths and weaknesses of both players is critical.
Peterson missed 11 games with the Jayhawks, asked to be subbed out a number of times, and played fewer than 25 minutes in seven games due to a number of injuries, including what he described as cramping that was sometimes so severe it was debilitating.
In the ESPN interview, Peterson said creatine supplements were the cause of the cramping, including an extreme, full-body cramping episode that ended up with Peterson in an ambulance and ultimately at the hospital.
“I’d never taken it before (going to college),” Peterson told ESPN. “But after the season I took two weeks off and they did tests which showed my baseline level was already high. So, they said when I dosed (a process of increasing a dose over time to create maximum benefit at the beginning of taking a supplement), it must’ve made the levels unsafe.”
This quote introduces the first issue, according to a number of medical professionals, because most are unaware of any kind of blood test that measures creatine levels.
Dr. Brian Schulz, a sports medicine specialist and orthopedic surgeon at Cedars-Sinai Orthopaedics in Los Angeles, who is also the team physician for the Los Angeles Angels and the Anaheim Ducks, is completely familiar with the use of creatine and how athletes use it as a supplement, but was at a loss when read the above quote and asked about a test that could measure creatine levels.
“Yeah, I’ve never heard of that,” Schulz said in an interview with the Deseret News.
And he isn’t alone. Dr. David Cutler, a board-certified family medicine specialist at Providence Saint John’s Health Center in Santa Monica, agreed.
“There isn’t a blood test that I know of that measures creatine, so that doesn’t make sense to me,” Cutler told the Deseret News. “And most of the studies that I’m familiar with don’t really show statistically more or less cramping with creatine than not taking creatine at recommended levels. Does that either exclude creatine as a possible cause, or support creatine as a potential improving factor in relieving cramps? I don’t think so.”
At the combine, Peterson said that he wasn’t taking anything different from the other players on the Kansas basketball team and that it was only what was provided to him in protein shakes by Kansas staff before or after lifting sessions. It was nothing out of the ordinary.
But, even with that information, as we work through Peterson’s quote from the ESPN interview, doctors continue to struggle to understand Peterson when he says that, after testing, it was discovered that his “baseline level” was high.
“I don’t know what that means,” Cutler said. “Baseline levels of what?”
Creatine, creatinine and creatine kinase
The “what” is really, really important here, so we need to go over some terms.
• Creatine is a naturally occurring compound produced by your liver, kidneys and pancreas that is primarily stored in muscles. But creatine is more widely known as a dietary supplement that usually comes in powder form that is mixed into a drink. And again, importantly, creatine is not something that is measured through a comprehensive metabolic blood panel, or any other commonly known blood tests.
There are two other terms that physicians think Peterson might have meant to say.
• Creatinine is a waste product that comes from digesting protein, the normal breakdown of muscle tissue, and can also be a byproduct after creatine is broken down in the body. After being filtered out of the blood, through the kidneys, creatinine exits the body in urine. Creatinine is measurable through blood and urine testing.
• Creatine kinase is an enzyme that naturally exists in the heart and muscles. It is released into the blood when there is damage to a muscle. It is also something that can be measured through a blood test.
It’s completely possible that Peterson had been told that his creatinine levels were high, and since creatinine is a byproduct of creatine, discontinuing use of creatine would make sense. It would also be incredibly understandable to hear creatine kinase and associate it with creatine supplements. But we don’t know if either of those are what Peterson meant, or if there was something else that was tested.
But, why was Peterson’s issue not resolved until after the basketball season, when the cramping episode that landed him in the hospital happened all the way back in September of last year and then cramping issues continued to plague Peterson throughout the season?
If someone was admitted to a hospital with full-body cramps after intense workouts, which is what Peterson reported, most medical providers would go through the same thought process and procedures.
First, hydrate through intravenous fluids, which is what Peterson said happened. Then, there would be blood work.
“You would do a metabolic panel and you’d want to check their kidney function and their electrolyte levels,” Schulz said. “You would want to question them as to if they are taking any supplements or medications or things that could dehydrate them or mess up their electrolyte status.”
Heightened levels of creatinine would immediately lead to more questions about kidney function and electrolyte production, which would then prompt even more testing.
“If you’re severely dehydrated and cramping, you would have higher creatinine, if your kidneys were damaged because you were in rhabdo, your creatinine would go up,” Schulz said. “I don’t think there’s really any evidence out there that creatine itself damages the kidneys, but in a situation where the kidneys aren’t functioning correctly, they (other doctors) might be worried about being able to excrete it, which could be why it (supplementing) was stopped.”
A full-body cramping episode would also have a doctor worried about a condition called rhabdomyolysis (commonly known as rhabdo), which is the rapid breakdown of muscle tissue that leads to the release of toxic muscle components into the bloodstream, which can then damage kidneys. One of the components released into the blood during a rhabdo episode is creatine kinase, which would show up on a blood test along with heightened creatinine.
“That would be a pretty easy diagnosis,” Cutler said.
Timeline vs. diagnosis
But Peterson did not say that his “baseline level” was high immediately following the full-body cramping event last year, or after continued cramping events throughout the season. He said that his “baseline level” was high after weeks away from taking any supplement and from in-game action. And there were reports of cramping during games when he was in high school, and he was even seen eating mustard packets to try and fight cramping during a high school game.
If his levels of creatinine or creatine kinase are high, away from strenuous activity and supplements, it could mean that there is an underlying issue. It could mean that there are kidney function issues, or a degenerative muscle condition. But there’s also a chance of a not scary answer to all of this that doesn’t mean there is long-term damage.
“Muscle cramps in athletes engaging in strenuous activity are just so common,” Cutler said. “Certainly there are exogenous factors that may be contributing to those cramps, whether that be supplements they’re taking, or prescription drugs that they’re taking, or any preexisting conditions before they walked onto the athletic field that could be causing those cramps. But more often than not, it’s the athletic activity itself which is causing the cramps.”
Peterson described the full-body cramping experience as a “traumatic experience” and said that he was fearful anytime he would feel anything out of the ordinary.
A number of doctors said that after hearing this story, including Peterson saying he feared for his life after the day that he ended up in the hospital, it sounded more like a case of PTSD after a scary event (possibly just severe dehydration, without any underlying condition), than it sounded like a case of recurring cramping.
“I thought I was going to die on the training table that day,” Peterson told ESPN, later adding that he was worried it would happen again. “Whenever I felt anything like that come on, my initial thought was that it might get to that again. ... And I can’t let that happen and be embarrassed and have that on TV and all that. It kind of put me in a tizzy because I didn’t know what was causing it.”
But if this is a case of dehydration or another easily explainable reason for the cramping followed by a completely understandable struggle to deal with a traumatic experience, and if Kansas was giving safe and normal doses of supplements to its athletes, then what was it that was discovered and diagnosed after the season?
