Stamkos close to game shape, but still has no timetable for return

TAMPA, Fla. -- The question was a simple one: Will you be ready for Game 2?

"I wish," Tampa Bay Lightning captain Steven Stamkos said Thursday.

Stamkos, 26, had surgery on April 4 to remove a blood clot near his collarbone, known as vascular thoracic outlet syndrome. The original prognosis was that Stamkos would miss one to three months, but he's been skating for "a little bit" now and he's motivated to return to the lineup, especially after his team lost Game 1 of the Eastern Conference second-round series to the New York Islanders 5-3 on Wednesday night at Amalie Arena.

Stamkos has skated with the team the last three days while wearing a red no-contact sweater. He said he's close to being in game shape but he has no idea when he'll be able to play. He called it a waiting game and said there's no timetable for his return.

"It could be weeks. It could be months," Stamkos said. "That's the tough part."

Dr. Karl Illig, director of vascular surgery at the University of South Florida, performed the surgery on Stamkos. Dr. Dean Donahue, a thoracic surgeon at Massachusetts General Hospital in Boston, does not know the specifics of Stamkos' surgery or rehab, but he has operated on other professional hockey and baseball players. He also collaborated on a textbook with Illig.

Donahue believes if there's any athlete who can return to game action sooner than expected, it's a hockey player.

"I'm always amazed at how incredibly tough hockey players are and the amount of pain they can tolerate," Donahue said. "I see some tough guys who can gut it, out but [hockey players] are almost inhuman in terms of what they can tolerate. The risk of damaging a blood vessel or a nerve would be my main concern."

It's amazing to think Stamkos is on the ice and could be close to returning just weeks after having a rib removed and the muscles cut around the area where the clot formed.

"I'm always amazed at how incredibly tough hockey players are and the amount of pain they can tolerate. I see some tough guys who can gut it, out but [hockey players] are almost inhuman in terms of what they can tolerate." Vascular surgeon Dr. Dean Donahue

"The typical return for an athlete to full participation is about three months, as a general rule," Donahue said. "Now, without going into specifics, I've been involved in [treating] players on a [Boston] team who were involved in a late-season, championship-level performance and wanted to bend the rules of what we would normally do and were willing to understand the risks they were taking. They wouldn't have done anything life-threatening but were willing to bend the rules a little bit.

"Hockey players are different than every other athlete I've ever dealt with, so I wouldn't say it's mandatory [Stamkos] would miss three months. But that's certainly the standard approach for this operation."

Skating is not an issue as long as there is no contact. But Stamkos is also on blood thinners. Most people who have the surgery need to remain on blood thinners for a varying amount of time. The typical person spends between three to six months on the medication, according to Donahue.

"If a patient is on blood thinners, he could not participate in any contact activity, because the risk of bleeding, major bleeding, would be so high I wouldn't allow it," Donahue said.

The amount of time a player needs to be off blood thinners before he can play depends on which medication he is taking. "It it could take up to 10 days off [the blood thinners before he can] play hockey depending on what he's on," Donahue said.

This type of procedure is uncommon in hockey players. However, Stamkos' Lightning teammate Andrei Vasilevskiy had the same surgery earlier this season, and Boston Bruins defenseman Adam McQuaid underwent the procedure during the offseason in 2012. Vasilevskiy returned in two months. Because of the lockout-shortened 48-game season in 2013, McQuaid was able to fully rehab after his surgery.

Donahue explained that the area between the neck and shoulder, and under the collarbone, is complex. He said there are different reasons why a person could experience narrowing in that space.

"If you're anatomically prone to narrowing there, and then whatever activity you participate in can accelerate the process. Any overhead athlete, or throwing athlete, such as swimmers, baseball players, tennis, volleyball are the most common athletes. It's less common in hockey players," Donahue said.

If Stamkos is able to return sooner than expected, it won't be a life-threatening situation, according to Donahue.

"I've had players tell me: 'I know the risks. I understand what I'm putting myself through. I've worked my whole life for this and I'm willing to accept these risks,'" he said. "As long as you don't think they are life-threatening but you've done your job and really explained what the risks are, and a player is willing to accept that risk and the team is willing to go along with it, then they'll play.

"I've seen players do things that I would never advise anybody to do, but if you're playing for a championship and you're two games away, you're going to take risks that otherwise you probably wouldn't do during the regular season or any other time. He may have already decided, 'Yes, I'm at risk of developing another blood clot and I should be on blood thinners but I've worked my whole life for this and I want to participate in this and I'm going to accept the risks.' It's an individual's decision."

It's been a frustrating few weeks for Stamkos. It's not like he's sidelined with a broken leg, as he was for most of the 2013-14 season after he broke his right tibia when he crashed into a goalpost in November 2013. He said he feels good but has to wait and see.

"That's the frustrating part. When you're hurt with a broken hand or broken leg, you can't get out there and play because your body can't function properly," he said. "My body feels pretty good. Just doing some extra skating, getting the legs and the lungs back, that stuff will take time. But [feeling good and not being able to play] is the frustrating part, for sure."