Medlen mentally prepared for 2nd major elbow surgery

Atlanta Braves starting pitcher Kris Medlen (54) warms up from the mound before the first inning in a spring exhibition baseball game against the Washington Nationals, Tuesday, March 4, 2014, in Kissimmee, Fla. (AP Photo/Alex Brandon) Braves pitcher Kris Medlen will have his injured elbow examined. (Alex Brandon / AP)

Atlanta Braves starting pitcher Kris Medlen (54) warms up from the mound before the first inning in a spring exhibition baseball game against the Washington Nationals, Tuesday, March 4, 2014, in Kissimmee, Fla. (AP Photo/Alex Brandon) Braves pitcher Kris Medlen will have his injured elbow examined. (Alex Brandon / AP)

LAKE BUENA VISTA, Fla. -- Braves pitcher Kris Medlen spent the past few days coming to grips with the reality that he's almost certainly going to need Tommy John surgery for the second time in five years, after tearing the ulnar collateral ligament in his pitching elbow in a game Sunday.

“Mentally preparing myself," Medlen said Wednesday. "It's something that I’ve felt before. I think I had all the answers to anybody’s questions in my head when I was walking off the mound. I never do that. When I did it before in 2010, the same thing kind of happened. Nothing’s … " (Here there was a long pause, as he fought back emotions.) "Nothing’s official, but I think I know and just go from there.”

Medlen has already undergone an MRI exam and other tests that indicate the ligament damage, and he expects to have Tommy John surgery and go through another lengthy rehabilitation process, which he believes will at least be a little easier now that he has a wife and 1-year-old son to help keep him occupied through the grind. The typical 12-month rehab can take a little longer after a second Tommy  John surgery.

Medlen will see Dr. James Andrews in the next few days before making a final decision about surgery. Andrews and other orthopedic surgeons have been at a convention in New Orleans that runs through the weekend.

He would join fellow Braves pitcher Jonny Venters in trying to be among the few pitchers to ever come back from two "TJ" surgeries and perform at a high level again in the majors. Andrews has previously placed the success rate at about 20 percent for pitchers to return to pre-surgery form after a second Tommy John surgery, and the percentage has been much better for relievers than for starters.

"I just told him everyone’s here for you," Venters said in the Braves clubhouse. "Just stay positive, make the best decision for you and your family. I think he’ll be fine. Obviously you don’t want to see something like that. But I just told him he’ll be OK, make a decision and go at it as hard as you can.”

Medlen, 28, paused several times and put his head down as he discussed the situation with reporters Wednesday morning at Champion Stadium, three days after he left a game against the Mets clutching his right elbow in pain. He said he actually felt the injury on a curveball he threw to Curtis Granderson on a ground out, but stayed in the game and threw two more pitches to Matt Clark, and felt searing pain after each, before hopping off the mound and heading to the dugout with the count 1-1.

He said cursed to himself after the Granderson pitch, almost in disbelief that he had probably torn the ligament again, like he did in 2010.

"It was more of a denial/frustration/anger thing," Medlen said. "I was already losing it on the way to the dugout. I couldn’t breathe. Just all that stuff … going through it one time, I told myself if I ever had to do it again I would quit. Stupid comments like that. I’m not going to quit, obviously. But the first  time I did it in 2010, I was telling myself there was no way I could will myself to do all this crap again."

Braves general manager Frank Wren sat next to Medlen when the pitcher spoke with reporters, and put a hand on his shoulder at one point when Medlen nearly broke down.

"From his perspective, he probably knew when he walked off the mound, based on how he felt," Wren said. "And over the last couple of days he’s had additional tests. Yesterday he had a stress X-ray, and that stress X-ray, it’s not definitive, but it did probably confirm what he was fearing. That there’s a high likelihood that he’s going to have to have a second Tommy John.

"And so that put him in a position where he wanted to come to you guys and be open and honest with where we are. It’s nothing official. It’s not definite yet. But I think over the next few days when he sees the doctor, that’s what we’re anticipating.”

The Braves are likely to lose one of their most popular team members for the entire season, and the pitcher they had planned to have start on opening day. They moved quickly to bolster their injury-plagued rotation by signing free agent Ervin Santana, an announcement that was made Wednesday morning in the pressbox at Champion Stadium about one hour before Medlen met with reporters in the dugout.

“It’s awful," Braves second baseman Dan Uggla said of Medlen's injury. "To have that happen once sucks bad enough, then to have it happen again as soon as it did … it just sucks. There’s no other way to say it. In here as a clubhouse, you’ve got your guys and you’re counting on leaning on these guys. Med is our ace; that’s our horse. When he goes down, that’s a big, big loss, man. The morale of the team is like, ‘Oh, my gosh, what’s going to happen now?’ To see the front office step up like they did and get Santana is a huge pick-me-up.

"We all love Medlen so much, and believe me, with the signing of Santana we haven’t forgotten anything that’s going on with Medlen. We’re all hurting for him."

Medlen is 24-12 with a 2.47 ERA in 44 games (43 starts) since moving from the bullpen to the starting rotation at the end of July 2012. His 2.40 ERA since the 2012 All-Star break is the second-best among major league pitchers with at least 250 innings, behind only Dodgers ace Clayton Kershaw.

Medlen has won three of the past eight NL Pitcher of the Month awards, while no other pitcher in either league has won more than one such award during that period.

“My teammates have been extremely supportive," Medlen said. "It definitely makes you feel better. But the reality has set in the past couple of days, and it’s more like, all right, let’s go, let’s get this taken care of. It’s not like a woe is me, or why me? I don’t even think like that. I wouldn’t be at this level if I ever thought that way.

“I feel like I carry the flag for the underdogs and the people who believe in themselves when no one else does. I’ve had a good support system coming up, and those are the people that I play for. I just want to do it for them.”