PHOENIX -- Here's what medical marvel Hong-Chih Kuo, with four elbow operations already on his resume, thinks after also overcoming a mysterious case of the yips earlier this year to land back in a pennant race with the Dodgers. "I'm lucky," said the 28-year-old from Taiwan. "I'm lucky I can still pitch. There are people who don't have any chance to do this. A lot of guys get hurt in the Minor Leagues and never get here. I still get the opportunity, so it could be worse. So, yes, I am lucky. Lucky to still be pitching." As if there wasn't enough to worry about with Kuo's elbow, the sometimes tenuous linkage between body and mind disconnected early this year when Kuo, who was named MLB.com's Setup Man of the Year last year because he could throw in the mid-90s for strikes with a star-crossed left arm, couldn't hit the broad side of a bullpen gate, let alone a catcher's mitt, even though there was no loss of velocity.
The low point was May 1. Trying to warm up in the bullpen for an eighth-inning entry, Kuo couldn't throw a catchable pitch to Brad Ausmus. Some bounced 10 feet short of the catcher, others sailed wide to both sides. Two pitches cleared the gate entirely and bounced into the infield, stopping the game. After 15 throws, Kuo was shut down and Ronald Belisario took over. Kuo was disabled the next day with what was called an elbow "strain," and with his medical file, who's to say that every pitch he throws in some way isn't a strain after two Tommy John reconstructions and the two other cleanup procedures that have left his elbow an arthritic wreckage? "The architecture of the joint is never the same after that much surgery," explained athletic trainer Stan Conte. "It's like a tire out of alignment. Once the wear is uneven, nothing moves the same way. The stress on the elbow when everything is perfect is not good. His joint surface is not normal. Any time there's any issue, it's huge for him. I don't want to be overly dramatic, but since last year, it's not unfair to say he's one throw away. Any pitcher can say that because of the nature of the position. In his case, it's literally true and he's known it all this time and there's a huge mental stress, but he handles it." That's why Conte cautioned club officials during the offseason that Kuo "can't be counted on because of his history." Where all players can be considered "day to day," Conte said Kuo literally is "pitch to pitch." Kuo's daily therapy ritual -- exercises, hot/cold applications, ultrasound, stretching, etc. -- is off the charts, according to Conte. "It makes him the most persistent player I've ever seen," said Conte, with three decades as an athletic trainer. "I don't say that lightly. I've seen a lot of great players work hard. But that's why I call him, out of respect, 'the cockroach.' He just keeps coming back." After calming down the constant inflammation, Kuo headed to the club's Arizona training complex to get the arm and mind back in alignment, gradually regaining his command, graduating to a Minor League assignment in July and was reactivated July 27 after nearly three months on the shelf. He's pitched nine times since returning, allowing two runs on two hits in eight innings with 11 strikeouts, but also five walks, including two Wednesday and one with the bases loaded. That he can throw 96 mph with arthritis has Conte calling Kuo "an outlier." "Any of his surgeries could have ended someone else's career, but he's a special guy," he said. "It's a compliment to the organization that people saw something special here and never gave up on him. And he never quit." Kuo's biggest test, though, might have come before his appearance last Friday night and not during it. Kuo got the call to replace Chad Billingsley, who injured his hamstring. Replacing an injured pitcher, rather than warm up in the relative privacy of the bullpen, Kuo had to do it on the Dodger Stadium mound, in front of a sellout crowd. Manager Joe Torre said he was uneasy about the situation because with Kuo, there's no way to know what will happen. But for Torre, the situation called for Kuo. Teammates held their breath. "The demons he's had to fight off -- I don't know how he's done it," said Randy Wolf, who can appreciate Kuo's comeback, having returned from "Tommy John" and shoulder operations. "It's amazing, because the scariest things are the ones we create in our head and with him it snowballed into that. So when he warmed up Friday in front of 55,000 people when Bills got hurt, throwing strikes without knowing where the ball would go, that's a tough thing to do. "You see guys with the yips that never recover from it. For some reason, that's a problem that can stick with you. For Kuo, he battled back and conquered it. We are all so happy for him. Hong-Chih doesn't have quit in him." Kuo said he appreciates his teammates' support, as well as the tireless work of trainers in Los Angeles and Arizona who got him back on the mound. "Without them," Kuo said, "I can't even do anything." The feeling is mutual. "I don't think there's a time you won't see the training staff on the dugout rail when Kuo is pitching," said Conte. "It's not out of concern. It's out of respect. We know what he's been through and what he has to do every day to keep pitching. Teammates watch him do this every day. Anybody who doesn't respect what this man has gone through simply doesn't know."
Ken Gurnick is a reporter for MLB.com. This story was not subject to the approval of Major League Baseball or its clubs.