Having fallen through the roof into the burning building onto his back and sustaining extensive burns to his knees and elbows as he tried to crawl to safety, burns that covered 10-15% of his body, and having crushed several vertebrae, Mark was hospitalized, he recollected, “for a week or two.” This was, of course, the end of his brief, but eventful, fire-fighting career.
But he continued to run with an ambulance crew in medical school. Sometimes they were lucky enough to be enlisted to stand by during big concerts at the Hershey Arena and he recalled with boyish excitement that he then got to see Black Croes and U2 up close.
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| "The Philadelphia Inquirer" 8/10/92 story on the U2 rehearsal at HersheyPark Stadium for the outside leg of their elaborate "Zoo TV" world tour) |
And as he worried that his hands might not hold up for a long surgical career, he decided on the specialty of Family Medicine. He said that he could still do small surgical procedures, he could deliver babies, and he could do inpatient and outpatient work. (For a while, consistent with his strong Catholic faith, he had toyed with the idea of doing missions for his life’s work.)
Family Medicine Residency and Fellowship
So he traveled about forty miles south from Hershey on Route 83 in 1994 to start his three-year Family Medicine residency at the York Hospital. He said that he enjoyed the demanding “really hard” program where he learned to survive on three hours of sleep. He found it to be especially “fun to do women’s health” and Mark admitted that this brought out his competitiveness; though he delivered a remarkable 75 babies while a resident, he had aimed for 100! (By the way, he met his ex-wife Tara in York and they were married in 1997.)
After he finished his residency, his deeply personal interest in the value of athletics and treating sports injuries led to a one-year fellowship in the relatively newly-established field of (non-surgical) sports medicine at Crozer-Keystone in Springfield, just outside of Philadelphia. As part of the training, the fellows covered the sad-sack Swarthmore football team (they had not won a single game in 12 years, though they had an 8-1 record in 1984), the Chester High School (where one of the athletes he was to examine was carrying a 9 mm handgun), and the Philadelphia Eagles and 76ers.
When he helped with pre-participation physicals for the Philly basketball team his simple task was to check for hernias, to ask the player to turn his head and cough.
A Different Version of AI
When Mark routinely told a rookie on the squad that he had to check his “family jewels,” his “privates,” the young man with a heavy sterling silver bike chain dangling around his neck was suspicious. He wanted to know that the doctor had no agenda other than clearing him to play. Dr. Lavallee tried to reassure him, but it was not enough.
Thinking that this doctor with a somewhat high-pitched voice could be bought off, the wary basketball player pulled out a wad of cash and slapped a fifty on the table. Then another. Reacting quickly (maybe too quickly), Mark quipped that he usually gets a tip after the exam. Anyway, there were no hernias. And Allen Iverson was allowed to play ball.
Helping a Fellow Athlete
Later that year, as a competitive weightlifter (Mark said he could squat 440 pounds and bench press 290 at 150 pounds bodyweight), he was working out at the huge Springfield Sportsplex when he had another unusual encounter.
He wanted to use the only set of 25-pound dumbbells but they were being hogged by a guy involved in a big tennis tournament at the modern facility (with ten courts). Mark asked if he could “work in” with him. The guy wearing white pants and a white shirt said okay, and as he watched Dr. Lavallee use the weights he asked Mark if he could get some pointers. Mark complied, of course, and Peter (that was the guy’s name) was appreciative. In fact, he asked Mark if they could work out again.
Later that evening, while watching the sports news with his wife, a tennis fan, Mark suddenly realized that the unassuming athlete he helped at the gym was, in fact, the No. 1-ranked men's tennis player in the world, Pete Sampras.
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| Pete Sampras stretching for a return (from Britannica) |
Mark's fellowship program director had a relationship with the Olympics and Dr. Lavallee spent two weeks at the Colorado Springs Olympic Training Center high-performance lab doing VO2 max testing. (This may have set the stage for his later deep and prolonged involvement with the Olympic weightlifting program.)
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| Olympic and Paralympic Training Center (from "visit Colorado Springs") |
Following his Primary Care Sports Medicine fellowship he looked around carefully for someplace where could use his new skills. He ended up in South Bend, Indiana. He was hired as the Director of Sports Medicine at Memorial Hospital in 1998 and Co-Director of the South Bend Notre Dame Sports Medicine Fellowship in 1999 as he managed to bring two traditionally disparate groups of physicians (surgeons and non-surgeons) together. In addition, he practiced family medicine (but without sleep-depriving obstetrics) and acted as the team physician for several high schools.
Mark also served as a volunteer physician and consultant for the University of Notre Dame from 1998 until 2013. And as an Assistant Clinical Professor at the Indiana School of Medicine, he began his academic career. He has written a variety of chapters for sports medicine texts, presented numerous case studies at professional meetings, and published original and review articles in peer-reviewed journals.
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| The Catholic University of Notre Dame (from Britannica) |
He developed a special interest and expertise in the use of musculoskeletal ultrasound at the bedside and helped write the definitive guidelines for the training of fellows in this important underused diagnostic (and therapeutic) technology.
And while in South Bend, Mark (though I cannot, for the life of me, see how he had the energy, much less the time) did even more. He began his long (and strictly volunteer) involvement with Olympic weightlifting (his first event was a minor Masters meet in Baton Rouge in 1998). He also started his first connective tissue or Ehlers-Danlos/Marfan’s clinic. And most importantly, he and his wife adopted two boys with special needs, Thomas (with EDS and born in Thailand in 1997 and adopted at age 5) and Sean (with severe cleft palate and born in China in 2001 and adopted at age 2).
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| Gold medal winner Sergio Alvarez from Cuba at the 2011 PanAm Games in Mexico (from gettyimages) |
Injury on Labor Day 2011
Moving ahead, throughout his career in medicine, Mark has stayed in touch with those he trained. And he visited one of them, Jerrad Zimmerman (head team physician for the "Fighting Illini" football team), in Champaign, Illinois, on Labor Day 2011. As he jumped off a dock at the former fellow’s pond he felt intense pain. It was as if he was “shot in the foot.”
He had ruptured his right Achilles tendon and he needed “major reconstructive surgery” on his ankle. This did not deter him, however, from making the 2011 XVI Pam AM Games in Guadalajara, Mexico, on crutches for his Olympic duties as a USOPC team physician. But he has poor healing due to his fragile connective tissue, and he developed a delayed wound infection (foreshadowing the dark events to come).
The Move Back to York
Well, after 15 productive years in the Midwest in the shadow of the Golden Dome an 11-hour drive away from family, and with a busy family of his own, and a sense of professional unease, there was a turning point. Mark and his wife decided to return to the Mid-Atlantic region to be closer to her family and his parents and two brothers.
So in 2013, Dr. Lavallee came back to the York Hospital as Director of the York Hospital Sports Medicine Fellowship and Associate Director of the Family Medicine Residency. And he continued his unpaid work with the Olympics and tended to the Ehlers-Danlos/Marfan population.
Sadly, his very physically active and socially and spiritually involved mother, Connie, died of cancer in early 2015. (His father later remarried and Mark said that the former Barbizon model that is his stepmother still “rocks a bikini” in her 80s.)
Before proceeding further with Mark’s story, a few comments regarding resistance training, one of his areas of special expertise.
The Many Benefits of Resistance Training
According to Dr. Lavallee (2013), weightlifting (as a paradigm of resistance exercise) “improves strength, bone density, flexibility, proprioception, explosiveness, and functional movement, and these benefits carry over to almost every other sport.” And he adds that “studies demonstrate that lifelong daily physical activity confers many health benefits, including a decrease in (artery-clogging) lipids, (better) cardiovascular fitness, (improved) bone health, (better) mental health, improved glycemic control, and (lower) blood pressure.”
As a result of the physical stress or resistance exercise, muscle fibers are stimulated to increase in size and configuration and may change in type (slow twitch vs. fast twitch). And adapting to increased loading, there are changes in the supporting connective tissues and tendons. Bone growth is stimulated as well.
And the nervous system plays a role, especially early on in training, by more effectively activating the called-upon muscle groups to contract (such as the biceps when bending the elbow) while allowing opposing muscles (the triceps) to relax. This coordinates and smooths out the effort, making it more efficient. So, with resistance work, there is more muscle with more strength and more power (they are two different things), more stability, and more grace.
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| Prima ballerina Misty Copeland demonstrating strength and gracefulness (photo by Henry Leutwyler) |
In addition (as if the above isn't enough), a consistent resistance training program may improve cognition and has been shown to slow the progressive decline seen in individuals with the syndrome of mild cognitive impairment, often a forerunner of Alzheimer's. Strength training releases several important hormones including the brain-derived neurotrophic factor (BDNF) that enhances the plasticity and growth of new neurons in the hippocampus, the earliest site of damage in Alzheimer’s.
And it has been repeatedly demonstrated that regular exercise, including weightlifting, can reduce anxiety and depression and improve sleep. The list of benefits goes on and on. (Quick, everybody to the gym!)
The Fellowship Program in York
As Dr. Lavallee ran the Sports Medicine fellowship program at WellSpan, with two fellows a year, he was on-call for Orthopedics and Family Medicine for a full year. He loved the chance to teach, and the first four or five years were “great” and he was “excited” to be involved in a “top-notch” training program.
But (like all things) stuff began to change. As the health system extended its reach geographically, individual physicians had less and less influence on decisions about their practice. And when Mark’s plan to develop a relationship with a local university had little support from his employer the contract went to a competing health system. He was disheartened but continued to strive to provide the best training for his sports medicine fellows.
The Scuba Incident
He still did international travel for Olympic sports (incidentally, in June 2022 he was the first non-athlete or non-coach to be inducted into the USA Weightlifting Hall of Fame) and in 2019 he was in Pattaya, Thailand (about two hours from Bangkok) for a weightlifting congress when he had yet another leg injury.
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| Peaceful view of Pattaya (from Tripadvisor) |
They had a day off and the weather was beautiful. Mark decided on an adventure; he would do a scuba dive to see the beautiful coral and the endangered hawkbill sea turtles, and to explore the popular HTMS Hardeep shipwreck (a Japanese steamship carrying fuel that was sunk by the British on June 1, 1945).
Visibility in the water was excellent and the small group of experienced divers easily “penetrated” the bombed vessel that had landed on its side about 27 meters below the surface. But entering the boiler room, then encountered a scary “man-sized grouper” and turned around. By the time they carefully backed their way out of the wreck (with the help of a guide string) the sea currents had picked up. “A monsoon rolled in,” said Dr. Lavallee.
He was the last man to get back onto the 28-ton tour boat and as a huge wave hit the bow he was thrown. Mark ruptured his weakened right patellar tendon and dislocated his kneecap. The sea was now 15 feet lower than the dock and he was hoisted from the boat head-down on a backboard (an oddly unpleasant experience, said Mark).
He was quickly taken to a well-equipped “destination hospital” in a pickup truck. He had a CT and MRI within ninety minutes and immediately underwent the urgently-needed surgery. He was hospitalized for two days. He wasn't allowed to leave without paying the entire bill so he put the $12,000 charge on a credit card. He then took a 20-hour flight home, and used neither his FMLA for time off nor the available Disability, thereby protecting his job. And (despite severe fatigue) Mark managed to see a full roster of patients the day after his return to York, less than a week following the surgery.
Changes at WellSpan
During his time with WellSpan, physicians came and went. When it was deemed by his superiors that he was, perhaps, too demanding as a teacher, they had changed his role to assistant director. In addition, they had put a hold on his research (though it was self-funded) and put him on “production” instead of a salary. So when he felt that he was treated unfairly after the above surgery (he had innocently asked one of his staff if she could give him a ride home since he couldn’t drive yet, and this was an unforgivable breach of protocol ) Dr. Lavallee decided to look elsewhere for the next phase of his medical journey.
So he took a position with the University of Pittsburgh Medical Center (UPMC) as the huge Western Pennsylvania health system moved into the local area to compete with WellSpan. As one of their regional medical directors, he initially oversaw 22 medical practices, tried to make them profitable, and worked to recruit physicians to the area (a difficult assignment, he said). After the first year, UPMC hired another physician to help out, so Mark had to manage only 11 practices and he was still able to do what he loved most; practicing non-operative sports medicine and helping patients live better with EDS.
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| The UPMC-Presbyterian Hospital in Pittsburgh (from UPMC) |
More Leg Trouble
But the saga with his poor legs would not end with the mishap on the Gulf of Siam. On July 3, 2021, Dr. Lavallee, one of his sons, and his son’s friend were at his father's property on Cape Cod looking forward to the holiday celebration the next day. However, Mark saw the dismal forecast and decided to return to York where the weather was to be more suitable for a summer outing. He was carrying a box of Doritos to the car when he tripped and fell. He instantly knew that he had ruptured his left patellar tendon.
He needed urgent surgery once again but wanted to get this done closer to home. His son, though he was an inexperienced driver, drove the eight hours from the Cape to Harrisburg. Mark had the tendon repair the next day.
By the third or fourth post-op day, moving around on crutches, he began to get short of breath and sweaty. He checked his pulse-ox and it was low. He worried that he might be having pulmonary emboli, dangerous blood clots to the lungs from his wounded leg.
When he was seen three days after the surgery the dressings were removed and everything seemed to be okay. But when Mark had chest pain and a falling oxygen saturation he was admitted to the York Hospital overnight. The chest CT showed no clots. But when the tech did an ultrasound behind the knee the usually stoic Dr. Lavallee “yelped” in pain. There were no thrombosed veins but something was clearly wrong. There was an infection, and when it was seen to be quickly getting worse an infectious disease specialist was called in.
Really Serious Leg Trouble (Again)
Dr. Punitha Arunkumar’s diagnosis of the rapidly-spreading process (advancing two or three inches in 40 minutes by then) was “necrotizing fasciitis.” The attending surgeon, Thomas DiPasquale, frankly told Mark that there was a 90% chance he would lose his leg above the knee and a 20% chance that he would succumb to the feared "flesh-eating" disease. So he needed surgery immediately. (Can a person hear such frightful predictions more than once in their lives?)
The next morning, with “huge chunks” of his leg missing, was “the most emotional time” of his entire life. He knew that if the bacteria spread to the core of the body severe widespread gangrene would occur and he could “awaken with no arms and no legs.” There were five more surgeries over eight days as more and more dead pieces of his leg were removed. He eventually had no quadriceps tendon, no patellar tendon, and only half of a patella.Mark asked to see the priest and he took communion, confession, and last rites “all at once.” As he prayed, he asked God what he was supposed to learn from enduring his dreadful experience. And he listened.
A sixth surgery was done a week later, this time to place an external fixator to keep his mangled leg from falling apart. Rebuilding the leg with muscle flaps and skin grafts was next. Hyperbaric oxygen, human growth hormone, and testosterone might help to regenerate tissues, he was told, and split-thickness skin grafting would be needed. But he would have to wait a month to get to Johns Hopkins where all of this could be done. He asked for inpatient rehabilitation while waiting to go to Baltimore, but his request was denied. So Mark went home.
The Burn Unit and Beyond
His son took care of him for a few weeks, and his cousin, a widow, stayed longer as he went to Hopkins in August 2021. The eight days in the burn unit during Covid-19 were difficult as he was fighting for his life and his leg; his cousin could not visit, his son was in college, Dr. Lavallee was divorced by then, and had just decided to break up with his girlfriend, and his engineer father who lived five miles from Hopkins stayed away. He was doing this alone.
He sometimes heard the soft moaning of the other patients suffering from burns of up to 90% of their body surface (almost always eventually fatal). Patients whose average stay was 18 months. Some of whom, his nurse quietly told him, were homeless individuals who were deliberately doused with gasoline and set ablaze by gang members as a very sick prank.
Mark needed extensive skin grafting, both using conventional surgical techniques and the proprietary ReCell system of taking his own cells, separating them, and then spraying the specific cell types that can grow new skin onto the affected area. This worked well and he left Hopkins after eight days. But he needed to finish a full ten-week course of IV antibiotics to be certain that the bacteria responsible for the terrible flesh-eating disease were completely gone.
Though his orthopedic surgeon had told Mark that he might not be able to walk after the devastating infection and the multiple surgical attempts to save his life Dr. Lavallee had other ideas. He would use his extensive knowledge of sports medicine and strength training to rehabilitate himself.
He did that and resumed his position with UPMC, managing practices and caring for his patients, especially those with various types of EDS and sports-related injuries.
And so Mark has continued to be able to join his family for their yearly get-togethers on Cape Cod. He surfs the waves on a boogie board, takes a bike ride, and goes on a swim (he loves the feeling of moving weightlessly through the cool water) before he cooks a nice dinner for everybody. And he enjoys being alive.
A Few Personal Thoughts
When first meeting Dr. Lavallee, you cannot avoid being struck by his scarred body with missing pieces. But you quickly feel his energy and spirit, and his need to help others, if given the chance. You sense his complete empathy and compassion for the suffering person in front of him. And that he will venture into the thorny wilderness to try to find what the patient needs. And that he’s not afraid of getting hurt as he explores the unknown. And that vulnerability and strength may coexist.
And Yet Another Major Surgery
(Shortly after the two lively and riveting interview sessions, Dr. Lavallee and several other regional UPMC managers were summarily relieved of their positions, so he’s looking to reinvent himself again. He also told me, by the way, about his long and complex surgery at UPMC Children's Hospital of Pittsburgh in early February 2023 to alleviate the cardiac failure caused by compression of his heart from the sunken-in chest wall, the severe pectus excavatum that was thought to be just a cosmetic issue when he was a youngster. And he said that he went back to the gym and the pool in no time at all after the operation. And that, with gratitude, he feels great.)
References and Readings:
1. Finoff, J., Lavallee, M., and Smith, J. "Musculoskeletal ultrasound education for sports medicine fellows: suggested/potential curriculum by the American Medical Society for Sports Medicine." British Journal of Sports Medicine 2010: 44; 1144-48.
2. Lavallee, M. and Mansfield, M. "Weightlifting training gives lifelong benefits." ACSM Health and Fitness Journal 2013: 17; 2 1-4.
3. Current, Austin. Science of Strength Training: Understand the Anatomy and Physiology to Transform Your Body. DK Publishing, New York, 2021. (A complete guide with phenomenal diagrams of each exercise, from beginner to expert.)
4. McCloud, J., Stokes, T., and Phillips, S.M., "Resistance exercise training as a primary countermeasure to age-related chronic disease." Frontiers Physiololgy 10; June 6, 2019. (Exhaustive review of lots of data eventually slightly favoring use of resistance activities over endurance training alone.)
By Anita Cherry 8/6/23
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| Painting by AC |