Clay Buchholz forgoes pain meds

ST. PETERSBURG, Fla. -- When you start tearing the lining of your foodpipe, which is the bluntest way to describe what Boston Red Sox pitcher Clay Buchholz was dealing with when he was diagnosed with esophagitis, you do what you can to keep that from happening again.

In Buchholz's case, that means laying off the pain medication, which was a major contributor to the acid reflux that caused his esophagitis. Acid reflux describes the backflow of acid-containing fluid from the stomach to the esophagus, causing it to become inflamed and the membranes to tear.

"I haven't taken anything -- I'm not even taking Advil," Buchholz said after resuming pitching for the Red Sox on Saturday after an absence of 24 days.

It wasn't a triumphant return, Buchholz taking the loss in a 5-3 defeat to the Tampa Bay Rays in Tropicana Field, but his outing abounded with hugely positive signs. If he'd gotten report cards in high school like he did from the Inside Edge scouting service used by many clubs, he might have gone to Harvard instead of Angelina (Texas) Junior College.

Buchholz graded out to an A-plus in 10 different categories. They included first-pitch strike percentage, strike percentage of fastballs, finishing off hitters (two-strike at-bats that become outs), percentage of 1-2-3 innings, percentage of strikeouts in four pitches or less, and percentage of 2-and-0, 2-and-1 and 3-ball counts ending in outs.

"I felt good -- I definitely think the start in Pawtucket helped out, to get my feet wet again and face some hitters," said Buchholz, who had a short tune-up last Sunday for the PawSox. "I felt good, I felt rested -- I think that was the biggest thing. I felt everything was coming out of my hand pretty good."

Buchholz looked strong, his fastball averaging 92 mph and topping out at 95. He struck out eight, six on called third strikes, and did not walk a batter until the seventh, when he also hit a batter, those baserunners coming back to haunt him by coming around to score the go-ahead runs after he departed.

Otherwise, his command was impeccable, especially given the length of his layoff. He threw 12 of 13 first-pitch strikes to right-handed hitters, 8 of 12 to lefties. Left-handed hitters went 0-for-11 against him. The three hits by right-handed hitters were singles by Desmond Jennings and Jose Molina in the third, a run scoring on Sean Rodriguez's sacrifice fly, and a fourth-inning double by Jeff Keppinger, who came around to score on a sacrifice bunt and an error by shortstop Mike Aviles.

Buchholz had thrown just 79 pitches through the first six innings, aided by an eight-pitch sixth in which he struck out Carlos Pena and retired Ben Zobrist and B.J. Upton on first-pitch outs. Manager Bobby Valentine said he checked with Buchholz before sending him out for the seventh -- Buchholz told him he was definitely good to go.

Some consistency from Buchholz -- who was 8-2 with a team-worst 5.53 ERA in his first 14 starts -- would make a huge difference for the Sox in the second half. He appeared to be putting things together in his first three starts in June, when he gave up three earned runs in 24 innings and benefitted from a switch to the first-base side of the rubber suggested by pitching coach Bob McClure. But he was knocked around in his last start against the Marlins, giving up five runs on nine hits in six innings, before winding up in the hospital with a condition that (1) scared the hell out of him and (2) caused him to lose more weight than he could afford to lose.

One of the medications that Buchholz had been taking was Toradol, a nonsteroidal anti-inflammatory that is in the same family of drugs as an ibuprofen like Advil but can be injected, though it can be done so legally only by a physician. A number of major league baseball pitchers use Toradol, including at least three on the Red Sox, according to a baseball source.

"I haven't been taking Toradol the (entire) season," Buchholz said, "just a couple of starts here or there. I think the Anacin and Advil caused the acid reflux more than that did."

Buchholz also uses chewing tobacco, which is not cited as a cause of esophagitis but can exacerbate it, according to medical experts.

"That's definitely not what caused it," Buchholz said. "I think there were five or six things that factored into it."

But now he's healthy, throwing well, and back in the rotation. His record fell to a deceptive 8-3, but the way he was pitching in June, and all those A-pluses Saturday night, suggest he's capable of a good deal more.