Dr. James Andrews couldn’t believe it when he heard the combined pitch count racked up by two Louisiana high school pitchers in a game last month.

The number? Try 347.

“Wow,” said Andrews, who is arguably the world’s most famous and best orthopedic surgeon. “I have a hard time believing two pitchers were allowed to do that. Are you sure that number is for only two pitchers?”

Yes, doc. Just check the box score.

Jesuit School (New Orleans) senior ace Emerson Gibbs threw a whopping 193 pitches in an 18-inning, 2-1 victory over Archbishop Rummel (Metairie, La.) senior star Mitch Sewald, who threw 154 pitches. Gibbs threw 15 innings, while Sewald tallied his high pitch count in 10 frames.

“It’s ludicrous and it’s not safe judgment,” Andrews said. “That is just way too many pitches. That shouldn’t happen anywhere in any league.”

Well, it did happen again.

Two weeks later, another young pitcher was piling up the pitch count in Massachusetts. Barnstable (Mass.) senior ace Willie Nastasi threw 155 pitches in a nine-inning, complete-game victory over Taunton (Mass.).

Nastasi, who struck out 16 in the game, said he doesn’t regret the high pitch count but does agree that 155 is a little too steep for his comfort.

“Looking back, yes it probably was too many pitches and I won’t do it again,” said Nastasi, who is signed to play for UConn next season. “But I also look back at that game and remember that I stayed strong throughout the whole game. I really felt great and had no fatigue.”

All three pitchers drew national attention because of their high pitch counts, and it once again raised the question of when enough is enough when it comes to pitch counts at the youth and high school levels.

Andrews has an answer.

“High school pitchers should not throw more than 90 pitches in a game and they should have to take at least five days rest before they pitch again anywhere,” he said. “No way should they throw more than 100. The elbow isn’t ready for that workload.

“I understand coaches are under a lot of pressure to win. But coaches need to know your No. 1 priority is the health and safety of your young pitchers and baseball players. Your job is to deliver them to the next level without injury.”

All three coaches of the above-mentioned pitchers have caught heat from national media and scouts for the way they handled the pitch count.

Jesuit coach Joey Latino said looking back he would have changed the way he used Gibbs.

“I can’t defend the number,” he said. “It’s something I am going to have to deal with for a while. It’s hard to explain to someone who wasn’t there.”

Gibbs, however, saw no reason why he should have been pulled from the game because of a pitch count.

“I was feeling good the whole game and my velocity stayed the same,” said Gibbs, a Tulane recruit. “I didn’t think it was a big deal.”

Andrews disagrees.

Based on numerous studies he has been involved in, Andrews said most shoulder and arm surgeries in youth, college and professional baseball are related to fatigue in the arm. And high pitch counts are a big factor in the fatigue.

“Pitching too much in one game, one week or one season is a very high risk factor,” he said. “The problem is the injuries don’t always show up when they pitch too many pitches at age 15. When you see a pitcher at age 22 start developing a problem, you go look at their history and most times you find out they threw too much as a teen.”

None of the parents involved with the three pitchers complained to the coach or school district, but Sewald’s father did raise an eyebrow when he watched his son continue to pitch.

“We were shocked he kept pitching,” Chris Sewald said. “[Mitch] knows he probably shouldn’t do it again. He was caught up in the moment. His coach did ask him and he kept saying he was fine. He wanted to stay in.”

All three pitchers felt no pain beyond the usual soreness. And they all continued to pitch this season.

“I felt fine the whole time before and after,” Nastasi said. “But I will say, if I was tired and if I felt like my arm was getting tired I think I am smart enough to know to take myself out. That just wasn’t the case that game.”

His coach, Joe DeMartino, agreed.

“He didn’t look like he was pressing, and in my mind he was looking really strong as the game went on,” he said. “I was confident in my decision. And I still am.”

DeMartino said he always kept Nastasi’s health a concern during the game and repeatedly asked his young pitcher if he was OK to continue.

“It’s a tough call,” he said. “Any coach who has been in my position knows the feeling. But I know what Willie is capable of and I know he works hard and has great mechanics. The key in all this is a coach should know what their pitcher can and cannot do. I can tell when a pitcher is getting tired. I would have had no problem pulling him if I felt he wasn’t good to go.”

Good mechanics or not, Andrews still thinks every high school league in the country should have pitch-count rules.

“Why do we have red lights and stop signs?” Andrews said. “Because we have to have them. Nobody likes them. I hate red lights. But they make you safe. Someone has to police these young kids to get them out of the operating room.”