A doctor on the American Gastroenterological Association Board of Directors said this week that he would tell Mike Tyson to postpone his fight with Jake Paul if he is treating an ulcer.
And so it happened.
“I don't know how you can continue to train so hard for this when you have an ulcer,” says Lawrence Kosinski, a Chicago-area gastroenterologist who practiced medicine for 40 years before retiring in 2019. “If you have an ulcer, you have to respect that.”
USA TODAY Sports interviewed seven physicians who specialize in gastroenterology, which the Mayo Clinic defines as “the prevention, diagnosis and treatment of gastrointestinal disease,” including the treatment of ulcers, which are wounds in the lining of the stomach, small intestine or esophagus, according to the Mayo Clinic.
None of the seven doctors treat the 57-year-old Tyson or are familiar with his condition, but several said Tyson would be at risk if he resumed training too soon for the fight against Paul.
Rama Behara, a Texas gastroenterologist who has treated college and professional athletes with ulcers, said he typically recommends three weeks of rest to allow wounds to heal.
“If left untreated, over time the ulcer can erode deeper into the stomach and sometimes cause a hole all the way through the stomach wall, which is called a perforation,” says Behara, of Baylor Scott & White Medical Center Centennial in Frisco, Texas, “so when that happens, it can require emergency surgery to fix.”
The medical incident involving Tyson occurred on Sunday during a flight from Miami to Los Angeles.
Kosinski said Tyson could need four to six weeks to fully heal and would face the risk of emergency surgery if the ulcer worsened and perforated the stomach wall. Two other gastroenterologists also said that training too hard without giving the ulcer time to heal could lead to bleeding and a perforation that would require emergency surgery.
What else are doctors saying about Mike Tyson?
Behara, the Texas gastroenterologist, said medical advice is important, but how athletes respond to it is another matter.
“It can be difficult to convince players to rest when they are in the middle of intense training,” he told USA Today Sports, “but overall we are taking a prudent approach of resting them for at least a few weeks, depending on the severity of the ulcer.”
Matthew Hoscheidt, a gastroenterologist at the Cleveland Clinic in Ohio, said that generally speaking, emergency surgery would be the “worst possible outcome” of resuming training too early, but he also said Tyson's case was difficult to evaluate because it was so unusual: a 57-year-old former champion training for a sanctioned professional boxing match against a 27-year-old boxer.
“It's unbelievable what this guy is doing,” Oscheidt said of Tyson. “This is uncharted territory.”
“It's very hard on the body. His training methods are ridiculous so it's definitely very stressful.”
Kosinski and other doctors said Tyson's symptoms suggest he may have a peptic ulcer, which is an injury to the lining of the stomach, small intestine or esophagus, according to the National Institutes of Health. Tyson's representatives would not specify what type of ulcer he has.
“Peptic ulcers often present with symptoms like abdominal pain or discomfort, nausea, vomiting, and indigestion,” says Christopher Kao, M.D., assistant professor of gastroenterology at the Icahn School of Medicine at Mount Sinai in New York. “As for dizziness, that's certainly possible, especially if the person having the attack is dehydrated.”
Mark Kennedy, a gastroenterologist at Aurora Healthcare in Sturtevant, Wisconsin, was one of four doctors who said he had no concerns about Tyson returning to training so soon as long as the ulcer wasn't bleeding.
“My guess is he'll be ready for the game in July, barring the worst of the bleeding, which is possible,” Kennedy said, adding: “Once they find the ulcer and they get the medication, it heals pretty quickly.”
“By rapidly, I mean you will feel better fairly quickly, within a few days. It may take up to three months for the ulcer to heal completely, but with treatment you can usually return to your normal life.”
Kyle Eliason, chief of gastroenterology at Intermountain McKay Dee Hospital in Ogden, Utah, said the size of the ulcer will determine how quickly Tyson can return to training.
“If it's just a small superficial ulcer, there's no anemia, there's no evidence that it's caused bleeding or anything like that, I probably wouldn't put any restrictions on him,” Eliason said.
Mike Tyson may face other problems with ulcers
At a May 13 press conference in New York to promote the fight, Tyson said he was “feeling great,” but added that his “body is in a (expletive) state right now” and that he was “really sore” early in his training.
The main causes of ulcers are bacterial infections and nonsteroidal anti-inflammatory drugs (NSAIDs), which include painkillers like Advil, Aleve, ibuprofen, etc. According to the Cleveland Clinic, people with ulcers should avoid alcohol and tobacco, and anything that increases stomach acidity can irritate the wound.
Sarah Umar of the Mayo Clinic was one of five gastroenterologists who suggested Tyson's use of nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain from training could have contributed to the ulcers, Umar said. Continued use of NSAIDs slows the healing of ulcers, but Tylenol can be used instead.
“For some people, Tylenol helps the pain a lot,” Umar told USA Today Sports, “but for others, it doesn't work because it doesn't have the anti-inflammatory properties that are so helpful for pain.”
“He'll probably be in a lot more pain,” Umar said of Tyson's possible return to training.
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