Diarrhea

An electron micrograph of rotavirus, the cause of nearly 40% of hospitalizations from diarrhea in children under 5[1]
ICD-10	A09, K59.1
ICD-9	787.91
DiseasesDB	3742
eMedicine	ped/583
MeSH	D003967

Diarrhea (from the Greek διάρροια meaning "flowing through"^[2]), also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day.^[3] It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over^[4] and 1.5 million deaths in children under the age of 5.^[1] Oral rehydration solutions (ORS) with modest amounts of electrolytes and zinc tablets are the treatment of choice and have been estimated to have saved 50 million children in the past 25 years.^[1] ORS should be begun at early as possible. Vomiting does often occurs during the first hour or two of treatment with ORS, but this seldom prevents successful rehydration as most of the fluid is still absorbed. The World Health Organization (WHO) recommends that if a child vomits, to wait five or ten minutes and then start again more slowly. Homemade solutions recommended by WHO include salted drinks (e.g. salted rice water or a salted yoghurt drink) and vegetable or chicken soup with salt. If available, supplemental potassium, as well as supplemental zinc, can be added to or given with this homemade solution. It's also recommended that persons with diarrhea, if able, continue or resume eating as this speeds recovery of normal intestinal function and generally leads to diarrhea of shorter duration. Clean plain water can be one of several fluids given.^[5] There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. A homemade solution can be made by adding between one-half to one teaspoon of salt (about 2-3 grams) and six teaspoons sugar (about 18 grams) to one liter of water^[5][6]. If the person drinks solutions with too much sugar or too much salt, these can draw fluid from the body to the bowel, cause osmotic diarrhea, and make dehydration worse.^[5] In a WHO publication, it's stated that a homemade Oral rehydration solution (ORS) should approximately have the “taste of tears.”^[7]

Definition[link]

Types 5-7 on the Bristol Stool Chart indicate diarrhea

Diarrhea is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person.^[3]

Secretory[link]

Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions, especially chloride ions. Therefore, to maintain a charge balance in the lumen, sodium is carried with it, along with water. In this type of diarrhea intestinal fluid secretion is isotonic with plasma even during fasting.^[8] It continues even when there is no oral food intake.

Osmotic[link]

Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea.^[5] Osmotic diarrhea can also be the result of maldigestion (e.g., pancreatic disease or Coeliac disease), in which the nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. High-fructose foods that also have a high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea.^[8] In most of these cases, osmotic diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped.

Exudative[link]

Exudative diarrhea occurs with the presence of blood and pus in the stool. This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis, and other severe infections such as E. coli or other forms of food poisoning.^[8]

Motility-related[link]

Motility-related diarrhea is caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation^{[citation needed]}. Hyperthyroidism can produce hypermotility and lead to pseudodiarrhea and occasionally real diarrhea. Diarrhea can be treated with antimotility agents (such as loperamide). Hypermotility can be observed in people who have had portions of their bowel removed, allowing less total time for absorption of nutrients.

Inflammatory[link]

Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. Features of all three of the other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis.^{[citation needed]}

Dysentery[link]

Generally, if there is blood visible in the stools, it is not diarrhea, but dysentery. The blood is trace of an invasion of bowel tissue. Dysentery is a symptom of, among others, Shigella, Entamoeba histolytica, and Salmonella.

Differential diagnosis[link]

Diagram of the human gastrointestinal tract.

Diarrhea is most commonly due to viral gastroenteritis with rotavirus, which accounts for 40% of cases in children under five.^[1] (p. 17) In travelers however bacterial infections predominate.^[9] Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.

Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting the intestine. Common causes include ulcerative colitis, Crohn's disease, microscopic colitis, celiac disease, irritable bowel syndrome and bile acid malabsorption.

Infections[link]

There are many causes of infectious diarrhea, which include viruses, bacteria and parasites.^[10] Norovirus is the most common cause of viral diarrhea in adults,^[11] but rotavirus is the most common cause in children under five years old.^[12] Adenovirus types 40 and 41,^[13] and astroviruses cause a significant number of infections.^[14]

The bacterium Campylobacter is a common cause of bacterial diarrhea, but infections by Salmonellae, Shigellae and some strains of Escherichia coli (E.coli) are frequent.^[15]

In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridium difficile often causes severe diarrhea.^[16]

Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and treated with drugs such as metronidazole,^[17] and Entamoeba histolytica.^[18][19]

Other infectious agents such as parasites and bacterial toxins also occur.^[9] In sanitary living conditions where there is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening.^[20]

Malabsorption[link]

Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas.

Causes include:

• enzyme deficiencies or mucosal abnormality, as in food allergy and food intolerance, e.g. celiac disease (gluten intolerance), lactose intolerance (intolerance to milk sugar, common in non-Europeans), and fructose malabsorption.
• pernicious anemia, or impaired bowel function due to the inability to absorb vitamin B₁₂,
• loss of pancreatic secretions, which may be due to cystic fibrosis or pancreatitis,
• structural defects, like short bowel syndrome (surgically removed bowel) and radiation fibrosis, such as usually follows cancer treatment and other drugs, including agents used in chemotherapy; and
• certain drugs, like orlistat, which inhibits the absorption of fat.

Inflammatory bowel disease[link]

The two overlapping types here are of unknown origin:

• Ulcerative colitis is marked by chronic bloody diarrhea and inflammation mostly affects the distal colon near the rectum.
• Crohn's disease typically affects fairly well demarcated segments of bowel in the colon and often affects the end of the small bowel.

Irritable bowel syndrome[link]

Another possible cause of diarrhea is irritable bowel syndrome (IBS) which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation) for at least 3 days a week over the previous 3 months.^[21] Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements, and/or medications such as loperamide or codeine. About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test.^[22]

Other causes[link]

• Diarrhea can be caused by chronic ethanol ingestion.^[23]
• Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.
• Microscopic colitis, a type of inflammatory bowel disease where changes are only seen on histological examination of colonic biopsies.
• Bile salt malabsorption (primary bile acid diarrhea) where excessive bile acids in the colon produce a secretory diarrhea.
• Hormone-secreting tumors: some hormones (e.g., serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
• Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects; this condition is called toddler's diarrhea.

Pathophysiology[link]

Evolution[link]

According to two researchers, Nesse and Williams, diarrhea may function as an evolved expulsion defense mechanism. As a result, if it is stopped, there might be a delay in recovery.^[24] They cite in support of this argument research published in 1973 which found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent a defense mechanism".^[25]

Diagnostic approach[link]

The following types of diarrhea may indicate further investigation is needed:

• In infants
• Moderate or severe diarrhea in young children
• Associated with blood
• Continues for more than two days
• Associated non-cramping abdominal pain, fever, weight loss, etc.
• In travelers
• In food handlers, because of the potential to infect others;
• In institutions such as hospitals, child care centers, or geriatric and convalescent homes.

A severity score is used to aid diagnosis in children.^[26]

Prevention[link]

A rotavirus vaccine decrease the rates of diarrhea in a population.^[1] New vaccines against rotavirus, Shigella, ETEC, and cholera are under development, as well as other causes of infectious diarrhea.

Probiotics decrease the risk of diarrhea in those taking antibiotics.^[27] In institutions and in communities, interventions that promote hand washing lead to significant reductions in the incidence of diarrhea.^[28]

Management[link]

In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in severe cases, intravenously.^[1] Diet restrictions such as the BRAT diet are no longer recommended.^[29] Research does not support the limiting of milk to children as doing so has no effect on duration of diarrhea.^[30]

Medications such as loperamide (Imodium) and bismuth subsalicylate may be beneficial; however they may be contraindicated in certain situations.^[31]

Fluids[link]

To prevent dehydration and electrolyte loss, it is widely recommended a person begin drinking Oral Rehydration Solution (ORS) as soon as possible. This strategy adds modest amounts of sugar and salt to water. There are prepackaged ORS products available. A person can also use home products such as lightly salted soup and/or lightly salted water from the cooking of rice. Supplemental zinc and potassium are also helpful, but ORS should not be delayed in the case that these are not immediately available.^[5][32]

Oral Rehydration Solution (ORS) can be used to prevent dehydration and in many cases is quite literally a life saver. Standard home solutions such as salted rice water, salted yogurt drinks, vegetable and chicken soups with salt can be given. Home solutions such as water in which cereal has been cooked, unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices can have from half a teaspoon to full teaspoon of salt (from one-and-a-half to three grams) added per liter. Clean plain water can also be one of several fluids given.^[5] There are commercial solutions such as Pedialyte, and relief agencies such as UNICEF widely distribute packets of salts and sugar. A WHO publication for physicians recommends a homemade ORS consisting of one liter water with one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added^[5] (approximately the “taste of tears”^[7]). Rehydration Project recommends adding the same amount of sugar but only one-half a teaspoon of salt, stating that this more dilute approach is less risky with very little loss of effectiveness.^[6] Both agree that drinks with too much sugar or salt can make dehydration worse.^[5][6]

Appropriate amounts of supplemental zinc and potassium should be added if available. But the availability of these should not delay rehydration. As WHO points out, the most important thing is to begin preventing dehydration as early as possible.^[5] In another example of prompt ORS hopefully preventing dehydration, CDC recommends for the treatment of cholera continuing to give Oral Rehydration Solution during travel to medical treatment.^[32]

Vomiting often occurs during the first hour or two of treatment with ORS, especially if a child drinks the solution too quickly, but this seldom prevents successful rehydration since most of the fluid is still absorbed. WHO recommends that if a child vomits, to wait five or ten minutes and then start to give the solution again more slowly.^[5]

WHO recommends a child with diarrhea continue to be fed. Continued feeding speeds the recovery of normal intestinal function. In contrast, children whose food is restricted, have diarrhea of longer duration and recover intestinal function more slowly. A child should also continue to be breastfed.^[5] And in the example of the treatment of cholera, CDC also recommends that persons continue to eat and children continue to be breastfed.^[32]

Antibiotics[link]

While antibiotics are beneficial in certain types of acute diarrhea, they are usually not used except in specific situations.^[33][34] There are concerns that antibiotics may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli O157:H7.^[35] In resource poor countries, treatment with antibiotics may be beneficial.^[34] However, some bacteria are developing antibiotic resistance, particularly Shigella.^[36]

Antibiotics can also cause diarrhea, and antibiotic-associated diarrhea is the most common adverse effect of treatment with general antibiotics.

Bismuth compounds[link]

While bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers' diarrhea, they do not decrease the length of illness.^[37] These agents should only be used if bloody diarrhea is not present.^[38]

Anti motility agents[link]

Anti motility agents like loperamide are effective at reducing the duration of diarrhea.^[34]

Codeine is used in the treatment of diarrhea to slow down peristalsis and the passage of fecal material through the bowels - this means that more time is given for water to reabsorb back into the body, which gives a firmer stool, and also means that feces is passed less frequently.^[39]

Bile acid sequestrants[link]

Bile acid sequestrants such as cholestyramine, colestipol and colesevelam can be effective in chronic diarrhea due to bile acid malabsorption. Therapeutic trials of these drugs are indicated in chronic diarrhea if bile acid malabsorption cannot be diagnosed with a specific test, such as SeHCAT retention.

Alternative therapies[link]

Zinc supplementation benefits children suffering from diarrhea in developing countries, but only in infants over six months old. This supports the World Health Organisation guidelines for zinc, but not in the very young.^[40]

Probiotics reduce the duration of symptoms by one day and reduced the chances of symptoms lasting longer than four days by 60%.^[41] The probiotic lactobacillus can help prevent antibiotic associated diarrhea in adults but possibly not children.^[42] For those who with lactose intolerance, taking digestive enzymes containing lactase when consuming dairy products is recommended.

Epidemiology[link]

Disability-adjusted life year for diarrhea per 100,000 inhabitants in 2004.^[43]

  no data

  < 500

  500-1000

  1000-1500

  1500-2000

  2000-2500

  2500-3000

  3000-3500

  3500-4000

  4000-4500

  4500-5000

  5000-6000

  > 6000

World wide in 2004 approximately 2.5 billion cases of diarrhea occurred which results in 1.5 million deaths among children under the age of five.^[1] Greater than half of these were in Africa and South Asia.^[1] This is down from a death rate of 5 million per year two decades ago.^[1] Diarrhea remains the second leading cause of death (16%) after pneumonia (17%) in this age group.^[1]

See also[link]

• Brainerd diarrhea

References[link]

External links[link]

Find more about Diarrhea on Wikipedia's sister projects:
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• CDC Disease Info Travelers' Diarrhea

Dr. Christian Jessen
Christian Jessen at the British Academy Television Awards 2009
Born	Christian Spencer Jessen (1977-03-04) 4 March 1977 (age 35) Hammersmith, London, England[1]
Residence	London
Nationality	British
Ethnicity	Danish-English
Citizenship	British
Education	MBBS
Alma mater	University College London, London School of Hygiene & Tropical Medicine
Occupation	Doctor, presenter, writer
Years active	2000-present
Employer	Channel 4
Known for	Embarrassing Bodies
Home town	Hammersmith
Television	Embarrassing Bodies Doctor Doctor Supersize vs Superskinny
Title	Physician and Surgeon
Website
http://www.drchristianjessen.com

Christian Spencer Jessen (born 4 March 1977)^[2] is an English doctor and television presenter.

Television career[link]

He is best known for presenting Channel 4's Supersize vs Superskinny and Embarrassing Bodies alongside Pixie McKenna and Dawn Harper.^[3] As well as presenting medical programmes on television, he contributes regularly to newspapers and magazines such as The Evening Standard, The Daily Mail, The Daily Express, FHM, Attitude, Closer and Arena. Following his series Supersize vs Superskinny,^[4] Jessen wrote the accompanying book Supersize vs Superskinny: Take Control of Your Weight. He also has his own stand alone book based on the weird and wonderful medical questions he gets asked called "Can I Just Ask" published by Hay House.

Medical career[link]

Jessen studied medicine as an undergraduate at University College London, receiving his MBBS degrees in 2000.^[5] He holds an MSc degree in sexual health, and has a particular interest in HIV and malaria, which were the focus of his work for two years in Kenya and Uganda.^[5]

Alongside his television career, Jessen is a doctor in a clinic in London and has worked privately in the UK oil and gas industry - as well as for the Australian, New Zealand and Canadian immigration services.^[6] Jessen also provides occupational health for London Underground and Virgin Trains. Currently he works more in the field of sexual health and HIV.

Personal life[link]

Jessen was born to a Danish father and English mother, and is openly gay and in a long-term relationship.^[7][8]

He plays the oboe,^[6] and has an interest in antique bronzes; in 2010, he won a celebrity edition of the quiz show Antiques Master with this as his specialist subject.

He has also mentioned that he struggles with body dysmorphia issues.^[9]

Television appearances[link]

• Embarrassing Illnesses
  • Embarrassing Bodies
    • Embarrassing Teenage Bodies
    • Embarrassing Old Bodies
    • Embarrassing Bodies Kids
    • Embarrassing Bodies: Live from the Clinic
    • Embarrassing Fat Bodies
• Doctor, Doctor
• Finding God
• Harley Street
• Sex in Court
• Skinny Celebrities
• Supersize vs Superskinny
  • Supersize vs Superskinny Kids
• 8 Out of 10 Cats
• One Born at Christmas
• Loose Women
• The Ugly Face of Beauty
• Mongrels
• Celebrity Juice
• Sunday Brunch
• Would I Lie to You? (TV series)

References[link]

External links[link]

• Official website

Chan Ho Park 박찬호
Park during his tenure with the New York Yankees.
Hanwha Eagles — No. 61
Pitcher
Born: (1973-06-30) June 30, 1973 (age 38) Gongju, Republic of Korea
Bats: Right	Throws: Right
Professional debut
April 8, 1994 for the Los Angeles Dodgers
MLB statistics (through 2010 season)
Win–loss record	124–98
Earned run average	4.36
Strikeouts	1,715
Complete games	10
Shutouts	3
Teams
Los Angeles Dodgers (1994–2001) Texas Rangers (2002–2005) San Diego Padres (2005–2006) New York Mets (2007) Los Angeles Dodgers (2008) Philadelphia Phillies (2009) New York Yankees (2010) Pittsburgh Pirates (2010) Orix Buffaloes (2011) (NPB) Hanwha Eagles (2012–present) (KPB)
Career highlights and awards
All-Star selection (2001) Led NL in H/9 innings (2000)

Chan Ho Park (Korean: 박찬호, born June 30, 1973) is a South Korean professional baseball pitcher for the Hanwha Eagles of Korea Baseball Organization. He previously played for the Los Angeles Dodgers, Texas Rangers, San Diego Padres, New York Mets, Philadelphia Phillies, New York Yankees, and Pittsburgh Pirates of Major League Baseball. He was the first South Korean-born player in major league history. He is 6'1" (185 cm) tall and weighs 210 lbs (95 kg).^[1]

Early career in Korea[link]

As a high school player in South Korea, he won team Most Valuable Player honors three consecutive seasons at Kongju High School in Kongju, South Korea. He also was named the MVP at four national prep tournaments.

Park was a member of the 1992 and 1993 South Korea national baseball team. He posted a 2.76 ERA in helping South Korea earn the silver medal at the Asian Baseball Championship in 1993. He also competed in Summer Universiade in July 1993, and led his team to the silver medal.

Park was a sophomore at Hanyang University, Seoul in 1994 when he was signed by the Los Angeles Dodgers as an amateur free agent.

Professional career[link]

1994–2001: Los Angeles Dodgers[link]

Park made his professional debut for the Dodgers on April 8, 1994 against the Atlanta Braves as a reliever, working one inning (a game in which the Dodgers were no-hit by the Braves' Kent Mercker).

Park played in one additional game for the Dodgers that season and then spent the bulk of the season with the Class AA San Antonio Missions, finishing with a 5–7 record and a 3.55 ERA for the Missions in 20 starts with 100 strikeouts.

With the Albuquerque Dukes in 1995 he was fourth in the Pacific Coast League in strikeouts with 101, and averaged 8.26 strikeouts per 9 innings, the top mark among all Class AAA pitchers. He was selected by Baseball America as the 2nd best Dodgers prospect after the season with the best fastball in the PCL. He recorded his first Major League start on October 1 against the San Diego Padres after receiving a September call-up.

In 1996, his first full season with the Dodgers, he went 5–5 with a 3.64 ERA in 48 games (10 starts). He recorded his first win on April 6 against the Chicago Cubs.

Park had a breakout season in 1997 as he became a fulltime starter. He tied for the team lead in victories, while posting a 14–8 record and a 3.38 ERA in 32 appearances, 29 of them starts.

In 1998, he was 15–9 with a 3.71 ERA in 34 starts and struck out 191 batters in 220.2 innings. After the season, he led the South Korean national team to the gold medal in the Asian Games, beating Japan in the final match.

In 1999, he struggled on rotation with 13–11 with a 5.23 ERA. On April 23, 1999 he became the only pitcher in the history of baseball to allow two grand slams in the same inning and to the same player, Fernando Tatis of the St. Louis Cardinals. There are two more pitchers in the history of baseball who allowed two grand slams in the same game - Jack Morris, and more recently, Brandon Backe - but to different hitters in different innings. He also walked 100 batters in only 194 innings.

In 2000, he ranked second in strikeouts with 217, second in opposing batting average (.214), and lowest in allowed hits per nine innings.^[2] despite second in allowing bases on balls (124) in the National League. He finished the season 18–10 with a 3.27 ERA, the best totals of his entire career. He also tossed his first career complete game shutout on September 29, against the San Diego Padres. Park was also named the Dodgers opening day starter for the 2001 season and tossed the Dodgers first season opening shutout since 1981. He was 15–11 with a 3.50 ERA during the season and was selected to appear in the 2001 Major League Baseball All-Star Game, where he pitched one inning, allowed a home run to Cal Ripken, Jr. and was charged with the loss. Park gave up Barry Bonds' record-breaking 71st and 72nd homers on October 5 against the San Francisco Giants.

2002–2005: Texas Rangers[link]

Park was granted free agency after the season and was signed by the Texas Rangers in December of that year to a five year, $65 million contract, which was one of the largest contracts for a pitcher at that time. However, during his time with the Rangers, he was hampered by injuries and a home stadium that favors hitters at Rangers Ballpark in Arlington. In his first season with the Rangers, Park went 9–8 in 25 starts, with a 5.75 ERA. The following season, he only started seven times due to injuries, going 1–3 with a 7.58 ERA.

On July 29, 2005, he was traded by the Rangers to the San Diego Padres in exchange for Phil Nevin. Padres fans had hoped that Park could repeat his previous success by playing in pitcher-friendly Petco Park.

2005–2006: San Diego Padres[link]

In the 2005 season, his combined record was 12-8, despite a 5.74 ERA. In the 2006 season, Park was reunited with his former Texas Rangers teammate and friend Chris Young, who was traded to the Padres in exchange for Akinori Otsuka. Park started the season as a reliever but soon he became a starter. On July 31, he suffered from intestinal bleeding and was placed on the disabled list. Several of his teammates, including Jake Peavy, Woody Williams, Chris Young, and Alan Embree, offered to donate their blood, but Park graciously refused their offer, as they were vital members of the team. Park accepted blood transfusions, that came, in part, from Jake Peavy's wife Katie and Kelly Calabrese, Padres' team massage therapist. However, Park's recovery did not last long as he suffered from another episode of intestinal bleeding on August 21. He was hospitalized again, this time along with his wife Rie, who was about to deliver their first child.^[3] A very thorough medical examination revealed that Park was suffering from a congenital defect called Meckel's diverticulum. Park had a successful surgery and only six days later his wife delivered a healthy baby daughter at the same hospital.^[4]

The San Diego Padres advanced to the post-season and Park joined the post-season roster. On October 3, 2006, Park made his first career post-season appearance in Game 1 of the National League Division Series against the St. Louis Cardinals as a reliever. He also had career-high season batting average of .268 from 41 at bats.

2007: New York Mets & Houston Astros[link]

On February 8, 2007, the Yonhap News and New York Daily News reported that Park had signed a one-year, $3 million contract with the New York Mets and would report to the Mets' spring training facility in Port St. Lucie, Florida to compete for a starting rotation spot. The Mets sent him down to Triple-A New Orleans following his poor spring performance.^[5][6][7] On April 30, 2007, Park was called up from Triple-A New Orleans to start for the injured Orlando Hernández. In that sole game, he gave up 7 earned runs in 4 innings.^[8] On May 3, 2007, Park was sent back down to Triple-A New Orleans. He was designated for assignment on June 4, 2007.^{[citation needed]}

On June 12, 2007, he signed a minor league deal with the Houston Astros. Astros Manager Phil Garner said "Park will have a few starts at Triple-A Round Rock before the Astros decide whether to call him up." Park compiled a 2–10 record over 15 starts with Round Rock, failing to earn a spot on the Astros' 40-man roster.

2008: Return to the Dodgers[link]

Park with the Dodgers in 2008.

On November 8, 2007, Park accepted an offer from his original team, the Los Angeles Dodgers, to attend spring training as a non-roster invitee. On November 28, 2007, Park asked to be let go by the Dodgers to play for the Korean team. After pitching with no health issues for the Korean National team, the contract was finalized on December 6, 2007. Despite being considered a long shot for the fifth starter's role, Park pitched very well, but was ultimately passed over for right-hander Esteban Loaiza. He was eventually reassigned to the minor leagues on March 30, 2008. Faced with the problem of a fatigued and depleted pitching staff three games later, the Dodgers purchased Park's minor league contract on April 2, 2008.^[9]

On May 17, 2008, Park made his first start as a Dodger since 2001 against Los Angeles Angels of Anaheim. He allowed two runs (one earned run) in four innings with no decision. This game turned out to be a historic one as for the first time in MLB history, all three Dodgers pitchers who pitched in this game (Park, Hong-Chih Kuo, and Takashi Saito) were of Asian origin. The Dodgers won it 6–3.^[10]

On June 21, 2008, Park started against the Cleveland Indians at the Dodger Stadium^[11] and joined Kevin Brown, Al Leiter, Javier Vazquez, and Jamie Moyer as the only pitchers to start a game against all 30 Major League teams.^[12] In addition to making history, he had a decent outing, with 9 strikeouts in 5 innings pitched, although this was overshadowed when he gave up a solo home run to Cleveland Indians pitcher CC Sabathia.

After Takashi Saito's elbow injury, Park was moved back to the bullpen by manager Joe Torre. Jonathan Broxton was promoted to the closer role and Park and Hong-Chih Kuo to the setup man platoon.

2009: Philadelphia Phillies[link]

On January 6, Park signed a one-year, incentive-laden, $2.5 million contract with the Philadelphia Phillies.^[13] On March 31, Phillies GM Rubén Amaro, Jr. announced that Chan Ho Park had won the fifth starter job.^[14] However, with several poor starts (7 starts with a 7.29 ERA), Park was moved to the bullpen and was replaced in the rotation by J. A. Happ. The problem with Park as a starter was that he was sacrificing velocity and movement for the energy to go deeper in games. After moving to the pen, his four-seam fastball velocity returned to normal (94-96 MPH range), with movement on his two-seam fastball and slider. Park played a vital role in the Phillies' bullpen with a 2.52 ERA. After missing time with a hamstring injury, Park made his return to the Phillies in the playoffs. With the Phillies, he advanced to his first World Series, in which he pitched well, giving up no runs in Philadelphia's loss to the New York Yankees. He became a free agent after the season.

In December 2009 it was announced that Chan Ho Park was suing his former Dodger teammate Chad Kreuter in Los Angeles Superior Court, in which he claimed Kreuter breached repayment of a $460,000 promissory note issued in October 2005.^[15]

2010: New York Yankees and Pittsburgh Pirates[link]

On the cover of KoreAm, January 2010

On February 28, 2010, Park signed a one-year contract worth $1.2 million with $300,000 incentives with the New York Yankees.^[16][17] Chan Ho Park decided to play for the Yankees after denying an offer around $3 millions per year from the Philadelphia Phillies.^[18]

After struggling with a 5.60 ERA.,^[19] Park was designated for assignment on July 31, 2010. On August 4, 2010, Park was claimed off waivers by the Pittsburgh Pirates.^[20] On October 1, Park became the winningest Asian pitcher in MLB history. He became a free agent at the end of the season.^[21]

2011: Orix Buffaloes[link]

On December 20, 2010, Park signed one-year deal with the Orix Buffaloes of Nippon Professional Baseball for the 2011 season.^[22]

2012: Hanwha Eagles[link]

On November 24, 2011, Park signed one-year deal with the Hanwha Eagles of Korea Baseball Organization for the 2012 season.

On December 20, 2011 Park announced that he would guarantee a minimum of $355k (₩400 million) of his salary to fund the development of amateur baseball in South Korea. His contract bonus has potential earnings at up to $5,500,000 (₩6 billion) in which Park would donate 100% of this salary to fund efforts to build amateur baseball with youth in the country. ^[23]

World Baseball Classic[link]

Between the 2005 season and the 2006 season, Park represented South Korea in the World Baseball Classic. In the Asia Round games against Taiwan and Japan, Park made appearances as a closing pitcher, shutting out the opposing lineups. He made another appearance as a closer in the semifinal game against Mexico, in which he again shut out his opposing hitters. His performance made San Diego Padres' manager Bruce Bochy believe that Park can be used as an effective reliever as well as a starter. Park later said that Padres' closer Trevor Hoffman taught him how to focus in a relief situation. With his shutout performance in 10 innings and three saves, Korea finished the World Baseball Classic in third place and Park was selected to the WBC All-Star team along with his teammate Seung Yeop Lee and Team Korea's captain Lee Jong-beom.

Pitching Style[link]

In his prime, Chan Ho was essentially a power pitcher, his biggest weapon being a four-seam fastball in 95-98 mph range. Mixed with a two-seam fastball, a slider, a curveball, and a changeup, he had five consecutive seasons of 10+ wins with the Dodgers. Being a power pitcher, however, he constantly revealed control problems, especially early in the game. He got many strikeouts, yet also allowed many bases on balls and hit batsmen that contributed to his lower than average strikeout-walk ratio of less than 2. This hindered him from achieving low ERA (He never had league top 10 season ERA except his career best season 2000 of 3.27 that was just 7th in NL by playing in pitcher-friendly Dodger Stadium.) He was also a flyball-pitcher that benefited a lot from the huge Dodger Stadium outfield; however his style all added up and later backfired when he played in other teams. After unsuccessful seasons with Rangers, Padres, and Mets, he added a two-seam fastball learned from Orel Hershiser. Fox play by play announcer Matt Vasgersian once said about Park's two-seam fastball, "You can only see a two-seamer like that in Playstation 2".^[24] In his career in Philadelphia he also used a cutter and a sinker, learned from Kevin Brown. Park's 2008 comeback season was marked with a return to complete health for the first time in years, allowing him to combine his crafty veteran style with a renewed ability to pitch effective fastballs in mid-90 mph.

Family[link]

Park married socialite Ri-hye Park on November 29, 2005. Although her heritage is Korean, she grew up in Japan and went to culinary school in New York. She is publicly known as a semi-professional cook, writer and an only daughter of Japan's 76th richest man according to The Philadelphia Inquirer. In Spring 2009, Ri-hye released a best-selling cookbook in Korea from which the proceeds went to various children charities on behalf of the Chan Ho Park Dream Foundation. Park has two daughters (born 2006 and 2008).

See also[link]

Baseball portal

• List of Major League Baseball leaders in career wins
• List of Texas Rangers Opening Day starting pitchers
• MLB All-Time Hit Batsmen List
• List of baseball players who went directly to the major leagues

References[link]