As a podium talk at the annual meeting of the American Venous Forum (VENOUS 2020; 3–6 March, Amelia Island, USA), it represented a bit of an outlier. It was, the presenter admitted, the only non-scientific talk on the programme. But the speaker was no mere upstart, the particular session not an ordinary rundown of figures.
Venous disease was indeed on the menu—but on this occasion through the prism of golf. The man at the helm was Thomas O’Donnell (Tufts School of Medicine, Boston, USA) the erstwhile AVF president.
O’Donnell was speaking during the conference’s Sumner Session: “The wisdom and experience of the past presidents of the AVF” with a talk entitled “Venous disease and famous golfers”—the Floridian backdrop of Amelia Island being conducive to the topic at hand.
The presentation was a walk through the history of both the game and venous treatment over the years, but what O’Donnell also delivered was an example of fortitude and, ultimately, wellness. Vascular surgeon burnout and associated problems, of course, are omnipresent, backed up by studies highlighting the pressures doctors operate under, the individuals who succumb and the financial consequences of these pressures.
Why this topic? O’Donnell mused. What is it doctors do outside of their professional functions? So: “Are sports and hobbies beneficial to MD, doctor health?” O’Donnell pondered. “Yes, I think they are—for mental and physical reasons.”
The passionate sportsman outlined some of the duels with colleagues he has enjoyed on the tennis court and golf course down the years, before turning to the core of his talk: a motley crew of Bobby Jones, Ben Hogan and Casey Martin, each of whom had different forms of venous disease. “The purpose of the remainder of the talk,” O’Donnell told the audience, “is to talk about three forms of venous disease affecting three top golfers and focus on the medical problem to see how the disease and its morbidity influenced their game and life.”
First up, Bobby Jones. “He was the consummate amateur; he never became a professional. He was emblematic of the Grand Slam, winning the four major titles as an amateur, all in one year—1930,” he explained. Before, at the age of 28, O’Donnell added, “he said, ‘I have had enough,’ and retired.”
But what Jones also possessed, O’Donnell continued, was an “odd” approach to his health. He suffered from a nervous disposition, spending his nights smoking and drinking whisky heavily in order to relax. “During a major tournament, he would usually lose between 12 and 18 pounds, and occasionally had fits of vomiting—like some of the residents going in to do their first case,” O’Donnell joked. “What a lot of people do not know is Jones had some very bad varicose veins. They were crippling.”
In the 1920s, aged just 18, he had had four operations on the condition, and at that time most likely underwent the Keller invagination procedure, which, O’Donnell said, probably accounts for his morbidity and the number of times he was operated on.
Jones was educated, O’Donnell went on. He attended Harvard College, though he could neither get on the institution’s golf team owing to his status as a golfer nor take on the manager’s role, instead ending up as assistant manager to get his Harvard letter. Much later on, by now in his 40s, Jones was part of the Normandy landings during World War II, despite the presence of the varicose veins that had undercut his golfing journey and having been declared 4F—or unfit for military service.
O’Donnell then moved onto Ben Hogan, one of the all-time greats who won all four major tournaments in the pro game. But the native Texan was almost cut down in his prime when in 1949 he was involved in a road traffic accident.
“Ben was with his wife driving to a golf tournament when a greyhound bus pulled out and hit his car,” O’Donnell began. “He was told he would never walk again. The reason he survived is he saw the bus coming and threw himself onto the lap of his wife— either that or the engine would have gone right through him.
“His injuries were a double fracture to the pelvis, a fractured collar bone, and then two days prior to planned discharge, he had severe chest pain. The chest X-rays showed typical findings of PE [pulmonary embolism]. He was treated with heparin, standard treatment at the time, but then had a recurrent PE manifested by tachycardia and a drop in blood flow.”
The titan of PE at the time was summoned to the hospital in El Paso, Texas, where Hogan was being treated. The surgeon in question was Alton Ochsner, MD, who made it out west from New Orleans amid difficult weather on a specially reserved military aircraft to treat Hogan.
“When he finished, Hogan had typical post-thrombotic syndrome,” explained O’Donnell. “Despite this, he went on to play at the U.S. Open 16 months later.” Needless to say, Hogan won the tournament.
Lastly, O’Donnell turned to the less familiar Casey Martin, a three-time All-Pac 10 and member of Stanford University’s NCAA Championship team in 1994.
“He had Klippel-Trenaunay-Weber Syndrome but it was a little different in that its major involvement was of the bones. His doctor said, ‘His bones look like Swiss cheese,’” O’Donnell said. “Because of the pain and his disability, he was unable to walk. So, he sued the PGA under the American Disabilities Act, saying ‘You must accommodate this disability, I have got to use a golf cart.’ The Supreme Court ruled in favor of Martin, despite Jack Nicklaus and Arnold Palmer saying you shouldn’t be able to use a cart.”
As O’Donnell pointed out, Martin did not go on to win many golf tournaments, but he did contribute to golf by going on to coach an NCAA team at the University of Oregon.
All of which is to say: Each confronted great difficulty to succeed in their game of choice. “We have three golfers, all with different manifestations of venous disease; all caused disability but it was amazing how they all overcame it.”