Hard to Swallow : Cody Smith Expected to Be Kansas State’s Quarterback, but a Rare Gastrointestinal Ailment Threw Him for a Loss

There was a familiarly awkward feeling when he was on the telephone, arranging to meet a reporter for an interview.

“You want to do it here or you want to meet for lunch?” he asked, inwardly cringing, waiting for delivery of the inevitable punch line.

“You want to go out and eat ?” the reporter blurted.

From the other end of the telephone line came an audible sigh.

“Don’t worry, I’ll be fine, I’ll be fine,” Cody Lee Smith said, sounding as if he was also trying to convince himself.

Smith has been dealing with the jokes for nearly a year, during which the 21-year-old quarterback had expected to battle blitzing linebackers for Kansas State, not take on the bizarre and unpredictable foe that sacked him.

Instead of plunging into college life in football-mad Manhattan, Kan., Smith is recovering at his parents’ home in Thousand Oaks, relearning how to swallow water so that he does not instantly expel it.

After losing 50 pounds, after throwing up as many as 35 times a day, after severe dehydration, after being told his problem was all in his head, after seeing more than a dozen doctors, Smith is grateful to at last know the name of his opponent and to have a game plan for dealing with it.

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“He’s just a great, great kid,” said Bill Fisk, football coach at Mt. San Antonio College in Walnut, where Smith threw for 4,700 yards in two years. “He’s got an NFL arm.”

Bill Snyder at Kansas State agreed. Smith was ranked second to Brigham Young’s Steve Sarkisian among available junior college quarterbacks and Snyder guessed Smith might remind a few people of departing senior Chad May, who had just been drafted by the Minnesota Vikings.

“We thought Cody would fit into our system quite well,” Snyder said the other day. “I liked a lot of the intrinsic things about Cody. He’s a good young man, a quality leader. I’m impressed with the way he puts a positive spin on everything.”

Smith’s positive outlook was sorely tested only days after he arrived at Kansas State to begin classes last January. At first, he had difficulty keeping his food down. Then, even water came right back up. Smith was vomiting so violently, so often, that he was hospitalized. He could see the football stadium from his hospital room.

After 10 days, Smith’s condition was diagnosed as gastroparesis, a weakening of the stomach muscles. He was prescribed drugs that would help his stomach muscles in contracting.

Unfortunately, Smith’s problem turned out to be exactly the opposite of what his first doctors diagnosed.

“The drugs they gave him were all wrong,” said his mother, Cristina. “It’s like giving Ex-Lax to a person with diarrhea.”

Besides not solving the problem, the drugs caused depression and mood swings. After months of that treatment, doctors came up with an alternative plan: change to an injectable form of the drug, using a smaller dose. Smith dutifully jabbed himself three times a day for three months.

Meanwhile, he was losing weight and battling the urge to vomit. Lesions developed on his esophagus because of the acidic bile he was vomiting.

“Can you imagine what it’s like to go to a restaurant or anyplace, and have to find the bathroom immediately? Your first priority?” he said. “I hated going out. I had no idea what was happening to me or why. I thought I was going to die and no one could tell me what was going on.”

By spring, Smith, who normally carried 240 pounds on his 6-foot-3 frame, had dropped to 191. Snyder sent Smith to another doctor in another town, then decided that Smith should take his spring break at home and stay awhile.

Back in L.A., Smith saw more doctors. Still there was no consensus about what ailed him.

Smith returned to school and the team’s trainers and doctors began a routine, weighing him each morning and taking his blood pressure. He ate little but carried a bottle of Gatorade, which his system seemed to tolerate.

But by the start of two-a-day drills in August, Smith was a mess.

“I was exhausted,” he said. “They had two guys around me all the time. One guy was a student trainer who did nothing but watch me. The other guy carried the Gatorade.

“I would throw a pass and I would be on my knees. It was frustrating because these [coaches] had brought me in as a big-time player and I was showing them nothing.”

Smith lost 10 pounds in two days and Snyder decided he had seen enough.

“Cody was having a terrible time,” Snyder said. “We could all see what he was going through. There was no question that we had to get him some help.”

Snyder sent his young quarterback to the Mayo Clinic in Rochester, Minn. Smith stayed nearly a month. At St. Mary’s Hospital, under the care of the country’s best gastroenterologists, Smith’s baffling condition was at last diagnosed correctly: rumination syndrome.

Rumination syndrome is as unpleasant as it is rare. The abdominal muscles react when food is swallowed, involuntarily contracting. The sometimes violent muscle contractions cause the food to be vomited almost as soon as it is ingested.

Keith Lindor, the gastroenterologist at the Mayo Clinic who eventually helped diagnose and treat Smith, said he might see two to five cases of rumination syndrome a year.

“It’s unusual, you certainly could say that,” Lindor said.

Although sometimes thought to be an eating disorder, rumination syndrome is not.

“Food doesn’t have much to do with it,” Lindor said. “That’s one of the clues. The food elicits the response. It’s not about eating. It’s an involuntary contraction. Once you disrupt the habit, you can begin to deal with it.”

Smith went into the hospital severely dehydrated and terribly underweight. Once those problems were stabilized, Lindor sent him to a psychologist to learn behavior modification techniques.

Smith, for whom statistics held great import in football, compiled his own statistics to chart the progress of the illness.

“The doctors would ask me, all the time, ‘How many times did you throw up today?’ It was a big question,” Smith said. “I eventually had to make a ruling: Every time I threw up counted as one. Each time something came up--not each time I had to go into the bathroom. I put up some pretty big numbers, so to speak.”

Lindor said that some patients with rumination syndrome do not survive the rapid weight and water loss. The illness may exist in some less severe forms, but there is scant information.

“This may be a disease that, when it’s first being recognized, only the most serious cases are coming out. It could be that there are many more cases,” he said.

Much of the medical literature suggests that rumination syndrome is a reaction to stress. Lindor said he wasn’t sure how Smith’s condition developed but said, “A lot of these habits are developed under stress for some reason.”

Smith worked with a psychologist to learn breathing techniques that use the diaphragm in such a way that vomiting is impossible because the muscles that would come into play during vomiting are already being used for deep breathing. The technique helps.

“It was a relief to learn that what I had had a name,” Smith said. “It may be stress related, I don’t know. But to me, football at a Division I level is not stress. Sitting here with an illness, not being able to play, that’s stress.”

He watched as Kansas State did well without him this season. The No. 10 team will play Colorado State in the Holiday Bowl on Dec. 29 in San Diego, where Smith will be reunited with his teammates for the first time in months.

He is still on some medication, but plans to return to school in January. He has been training daily and, pending the outcome of an NCAA review of his application for a medical redshirt year, Smith hopes to have two more years of eligibility.

“I know people think it’s weird, but it’s very real to me,” Smith said of his illness. “When you are young, you take your body for granted. I’ve learned not to do that. A lot of times, I thought I was very sick. But all I had to do at the Mayo Clinic was walk around the place and I saw little kids fighting just to live through the day. I gained perspective.

“There are still times I throw up, hell yes. [But] I’m getting there. I’m so much better, believe me. I miss my friends. I just want to get back and throw the pill, I’m tired of being here. I want my life back.”