00:00The breaking news this morning in the NFL, Jalen Hurts is out for the rest of the season.
00:06That blood clot issue that was first discovered in London last week prior to the Eagles' loss to the Jags
00:14has apparently now gone to his lungs.
00:18The prognosis is good, but he's done for the season as they deal with a serious health issue.
00:25Joining me right now is Dr. Barry Telesnick.
00:29Dr. Telesnick is a friend of mine.
00:31He's my doctor.
00:33He knows how fascinated I am with all of this conversation.
00:36He'd rather talk about the Wizards.
00:39They open up on Wednesday night.
00:40He was the former and still works with the Wizards a lot team doctor and one of the leading cardiologists
00:47in town.
00:47So tell me about this blood clot issue that has now gone to his lungs.
00:54Hi, Kevin.
00:56Hello.
00:58It's an evolving story.
01:00And like anything in the press, sometimes there is conflicting information.
01:06So first of all, he was apparently diagnosed with what's called a superficial phlebitis,
01:12a superficial inflammation of the veins in his legs, which generally is a more benign condition that's treated with heat,
01:23elevation and aspirin and is usually not threatening and a superficial phlebitis does not go to the lungs, causing an
01:33embolism.
01:33So an embolism is a sort of a traveling clot that would start in the legs of thrombus or in
01:41the legs that travels to the lungs.
01:43And that is usually, that originates from a deep venous thrombosis.
01:50So either he was initially misdiagnosed or he had a superficial clot in one of the superficial veins that propagated
01:59into a deep vein and then broke apart and went up to the lungs.
02:04So in essence, his pulmonary emboli was caused by deep venous thrombosis.
02:11Now, deep venous thrombosis can be a very life-threatening situation if you have a very, very large clot and
02:21it travels up into the lungs and can cause death.
02:26Many people just have smaller micro or smaller emboli that could go to either lungs or one lung and that
02:35could be treated and people could do well.
02:38And from the reports, it sounds like it will be the situation with Jalen Hurts.
02:44The reason that he got this situation is still not clear.
02:54Often the setup for developing clots in the leg, deep venous clots, is prolonged bed rest.
03:01We often see it in the hospital after people have had surgical procedures and have been in prolonged bed rest.
03:08That's why after a major orthopedic surgery today, almost all hospitals have an early ambulation protocol to get people up
03:18and keep the circulation going.
03:20He was on that long flight, remember, over to London before that game.
03:25There should be a doctor, Kevin, because prolonged flights, prolonged car rides,
03:33where you are sedentary, can also be a setup for development of clots in the legs.
03:40So that certainly could have been the situation.
03:43Or if you've had recent or previous trauma that caused some clot to develop in the legs.
03:50And as we're both aware, football is a rough game.
03:54Well, he got cleated the game before against the Rams in his calf.
03:59That could have clearly been an initial setup.
04:06Because I would think, you know, listen, thousands and thousands of people take transcontinental flights every day.
04:15And no one develops, or a small percentage of people develop clots in their legs.
04:21And he's an otherwise healthy, younger person without any pre-existing conditions.
04:29Kevin, as far as him being out for the rest of the season, that's because this condition is treated with
04:36systemic anticoagulation.
04:38And you cannot play a contact physical violent sport, such as football, being on a blood thinner.
04:45So that cancels the season, because usually the standard just for blood clots in the legs alone is usually three
04:55months of systemic anticoagulation,
04:57a minimum of three months of systemic anticoagulation, which can go up to six months.
05:03I am making an assumption here that the overwhelming likelihood is that this clot in the leg was provoked, provoked
05:13by trauma, provoked by a long flight, or a combination thereof.
05:18Because we divide clots in the legs, or DVT, into those that are provoked or those which are unprovoked.
05:27An unprovoked clot that develops in the leg is, in essence, a clot with which there is no clear-cut
05:36discernible cause for.
05:38In those people, anticoagulation is given for a longer period of time.
05:44And usually after, say, six months of therapy, patients will see a hematologist to see if they have any underlying
05:53blood condition that would necessitate a protracted or long-term anticoagulation.
06:04That's something that is determined in the future.
06:08I would suspect that if he had previous leg trauma, then the long flight, that this was most likely a
06:19provoked deep venous thrombosis that then went to his lungs.
06:23All right.
06:24So, yeah, I want to, so a couple things.
06:28Number one, most importantly, the prognosis for his current condition, as long as he's not going to play a contact
06:34sport, is pretty good, right?
06:36Absolutely, yes.
06:37Okay.
06:38Secondly, I want to go back to London.
06:42Like, Tom Pellisaro, longtime NFL reporter, tweeted out about an hour ago,
06:48after initially being diagnosed with a superficial blood clot in London, doctors told him not to sleep as a precaution.
06:56So he had been awake for roughly 36 hours when he started against the Jags, throwing for 220 yards and
07:04a touchdown.
07:04So my first question in a two-parter is, one, why would he be awake and they want him to
07:11be awake for 36 hours?
07:12I would assume movement.
07:13Two, is do you think that there was any risk from afar, obviously you didn't see it, but a superficial
07:21blood clot, having him stay awake for 36 hours,
07:25do you think he should have been playing in an NFL game?
07:29I wouldn't have played him if he had superficial phlebitis.
07:33The diagnosis for superficial versus deep can be made with an ultrasound examination of the venous system that you could
07:43see if there is deep venous thrombosis present or not.
07:46As I initially said, we've had patients we've seen over the years who have superficial phlebitis,
07:53and we usually treat them with rest, you know, leg elevation, sometimes lump soaks, and aspirin.
08:02And they do fine because there is no threat for, in terms of pulmonary embolism,
08:10from a superficial thrombosis, unless it's, you know, very significant and the clot sort of grows and propagates into a
08:18deeper vein,
08:20which is a less common circumstance.
08:24Having him walk around for 36 straight hours is a little bit perplexing to me personally.
08:31Usually, usually getting people up and ambulating is done to prevent deep venous clots,
08:40usually after surgical procedures where we don't want people with prolonged bed rest.
08:46I think, you know, their approach may be different than the approach that I or someone here would have,
08:53but in terms of playing, it probably would have been more prudent for them not to play.
09:00I mean, that's the part that's fascinating to me.
09:04Like, he ended up playing after being awake for 36 hours and having, they did do the ultrasound,
09:09which revealed this superficial blood clot in his leg,
09:15and they deemed it to be not serious enough to keep him from playing in that game
09:20after they kept him awake for 36 hours.
09:23That's kind of crazy.
09:24I think everybody that has had any sort of exposure to any of this stuff understands
09:29once he goes on the blood thinner, you can't box, you can't play football, you can't play hockey,
09:36you can't play any sports where contact and a potential injury, physical injury,
09:41that would create either internal bleeding or external bleeding, right?
09:45That would be the risk.
09:46Right.
09:46Well, you cannot play a contact sport on systemic anticoagulation.
09:51That's been seen, you know, across multiple sports with athletes who've developed clots in their legs
10:02or arms or wherever systemic anticoagulation is necessary.
10:10Kind of a crazy story.
10:12Don't you think that he played that game in London?
10:14Yeah, it is crazy.
10:15To me, it's just crazy enough to play after 36 hours regardless, but that's a different issue.
10:21Right.
10:22All right.
10:23Wizards over-unders, 34-and-a-half games, 34-and-a-half wins.
10:27Are you going over or under?
10:28I'm going over this year.
10:30If AD stays healthy and the team stays healthy in general,
10:36I've been to both their preseason games of Will Dawkins and Mike Owing have done a great job
10:42of putting a really good athletic team together.
10:47I'm very optimistic this year.
10:50I'm generally not an optimistic person.
10:55When it comes to your patience, you are, but when it comes to the NBA team here, not so much.
11:01Listen, Kevin, you know I've sat through a lot of very poor seasons,
11:06but I think these guys have done a bang-up job.
11:08They look great.
11:09They look deep, and I think the players that she'll be fighting for playing time.
11:15But the thing that you started off...
11:17Go ahead, finish.
11:18I think they're deep, and I think they're the right combination.
11:23And they're young, and they're athletic.
11:25And I am optimistic.
11:28But you started off with the same thing that I start off whenever I'm asked
11:33or talk about the Wizards' upcoming season.
11:36If Anthony Davis stays healthy, I think they'll fly over 34.5 wins.
11:43But that's a big if, because he just hasn't been able to win that.
11:47Right.
11:47He doesn't have the track record.
11:49But isn't it the same in every sport?
11:52I mean, we've talked about this all the time.
11:53I think it was I once heard Tom Brady speak about football just being a game of attrition.
11:59Yep.
11:59And when it comes to playoff time, just who's healthy?
12:03All right.
12:04Well, thank you for diverting my attention from talking about the third-string center,
12:08which you always make fun of me of doing.
12:11Well, but when you used to come into the office, we'd start off with medicine.
12:14We'd end up in sports, right?
12:16Yes.
12:17We didn't talk much about medicine.
12:19I will talk to you later.
12:20Thanks for doing this.
12:21You're welcome.
12:22Thanks for having me, Kevin.
12:23Bye-bye.
12:23Dr. Barry Telesnick, everybody.
12:26Yeah, the whole setup before the game in London is, I mean, really an interesting conversation.
12:33I wonder whether or not the Eagles put him in any kind of physical health jeopardy by
12:41playing him after, according to Tom Pellisaro, he was up for 36 consecutive hours heading into
12:47that game.
12:48I believe in the name or not the game.
12:48It's just a half game later.
12:48I mean, we're right.
