Ask Dr. Mike: Jalen’s Hurt! What the Hell Is Going on With This Blood Clot Thing?

Left: Penn doctor, Michael Cirigliano aka Dr. Mike. Right: Philadelphia Eagles quarterback Jalen Hurts, who is out for the season due to blood clots.

     Listen to the interview edition here:

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained. And he’s been named a Philadelphia magazine Top Doc every year since 2008. Now, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at victor@phillymag.com.

Okay, Dr. Mike. Everybody is talking about Eagles quarterback Jalen Hurts and his blood clots, which have benched him for the season. We’re learning that he played in the Eagles-Jaguars game in London on October 11th while being treated for blood clots — and wasn’t allowed to sleep the night before the game, due to the doctors’ concerns. Can you shed some light on this?
This is how it played out: He played against the Rams the week before, on October 4th, and took a hard cleat-kick to his calf – a trauma to the body, in other words, which (short of having some kind of genetic predisposition) is the number one cause of blood clots. So he suffers a trauma. He starts complaining of pain. They do an ultrasound, and they find that it’s a “superficial clot” — the kind you monitor and treat, for pain, with Motrin. You keep an eye on it. And I think the reason they didn’t want him to sleep was because they didn’t want him in one stationary position where the clot could progress.

You’re my primary care doc. I’m a writer. If I banged my hand real hard and you discovered I had a superficial clot, would you advise me to take a few days off?
If it’s a superficial clot that isn’t close to the deep venous system, I would have you take Motrin and do some hot soaks to increase blood flow. And then in a week we’re going to get you a Doppler ultrasound [which measures the speed and direction of blood flow through the blood vessels] and see how everything looks.

If you had Jalen Hurts as your patient, would you suggest he go play a game with a blood clot — and after not sleeping at all the night before?
I’ve never told anyone they can’t sleep. But there’s also concern because travel was involved here — on a plane, where you’re seated for a long time, which is a risk when you’re dealing with a blood clot as Jalen Hurts was. I tell people who will be on a plane for a while to get up and move around (which gets your leg muscles working to pump blood back to your heart, which stops blood from pooling and forming clots). Was it the right thing tor him to do, to get on a plane with a blood clot? You know, maybe if he was in first class, where he was able to get up, or shift position sometimes, or lie flat, which keeps the blood moving. Whereas you and I, we might be in steerage, pressed up against two other people or up against the bulkhead and don’t, move, can’t move. That’s a risk factor.

Okay, so he had a blood clot in his calf, and now we’re learning he has blood clots in his lungs. If you have a blood clot in your calf, why would you have a blood clot in your lungs?
Well, they can propagate. They can move. And once they go into your deep venous system, you have to be on a blood thinner for at least three months to resolve them.

Is it possible that he would have played the London game with blood clots in his lungs and they wouldn’t have known about that?
Usually, when you have blood clots in the lungs, you’re short of breath. You’re not feeling well. And it can become dangerous in a very quick manner. If they had known he had blood clots in his lungs, there is no way anyone would have let him play. I think the way this went down is that he had the superficial clot because some knucklehead from the Rams cleated him. He got pain. They monitored him. And then it progressed. And now he has clots in his lungs, and that can be very serious and life-threatening.

Why life-threatening?
If you get a big enough clot, what we sometimes call a “saddle embolism,” you can die within minutes because it blocks blood flow. So if somebody has a blood clot in the deep veins in the legs, they automatically get treated with anticoagulation, because it can progress to blood clots in the lungs, also known as pulmonary emboli.

If you find that I have a blood clot in my lungs, are you’re sending me directly to the emergency room?
If you’re not on anticoagulation and I make a diagnosis that you have pulmonary emboli, yes. You need a CAT scan. I have had patients who had clots the size of Nebraska. They would have expired rather quickly if they didn’t undergo interventional radiology to suck it out or use clot busters to break it up.

How often do you see a patient with a blood clot?
Only about two times per year. Sometimes, it’s just because they had a long flight.

I’ve taken some very long flights. One from JFK to Dubai. Another from JFK to Tokyo, which was more than 14 hours. Are you telling me I could have gotten a blood clot just from the flight alone, even if I am a generally healthy person?
In the right setting, you better believe it. So he had two risk factors: First, he had trauma, and probably developed the clot at that time. And then he had a long flight.

How would I know if I have a blood clot?
If you have trauma and then swelling and pain and a redness and a hard spot, that’s when you need to call me.