Chris Bosh Diagnosed with Pulmonary Embolism

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Update (2/17/16): Chris Bosh was ruled out of the All-Star game with what was initially described as a calf strain. It was later determined, however, that a small deep vein thrombosis (blood clot) was found in Bosh’s calf, and that he is back on blood thinners.

The good news for Bosh is that this latest clot is reportedly small, was caught early, and has not traveled to his lungs. It is not life threatening, and should be relatively easy to bust.

The larger issue, however, could be what this latest clot means for Bosh’s long-term future. After his initial clot last year, Bosh had some testing done which suggested he was not deemed to be abnormally susceptible to blood clots. This latest clot certainly provides at least some degree of contraindicating evidence. If he is deemed to be at greater risk for blood clots, doctors may determine it to be advisable for him to remain on blood thinning medication indefinitely in order to avoid that possibility or they may advise against continuing the physical rigors and heavy travel associated with NBA play, in either case putting his career at risk.

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Miami Heat power forward Chris Bosh received sobering news on Saturday. He suffered a pulmonary embolism, which will cause him to miss the rest of the 2014-15 NBA season.

Bosh was hospitalized at South Miami Hospital on Thursday but, amid a conflicting diagnosis, underwent further testing on Friday. The diagnosis was confirmed today.

This is a serious and scary condition, but according to Heat head coach Erik Spoelstra, Bosh avoided a potential life-threatening situation.

“Bosh… is currently resting comfortably. Chris is OK, and his prognosis is good,” the Heat said in a news release.

40410_1A pulmonary embolism(1) occurs when a substance – most often a blood clot, as is the case for Bosh – that develops in a blood vessel elsewhere in the body travels through the bloodstream to an artery in the lung and forms an occlusion (blockage). The obstruction, which blocks blood flow through the lungs and puts pressure on the right ventricle of the heart, can be fatal.

It is rare to have a single pulmonary embolism. In most cases, as is the case for Bosh, multiple clots are involved.

Blood clotting is a normal process that occurs in the body to prevent bleeding and promote healing after an injury. The body forms blood clots when the platelets within the blood encounter a damaged blood vessel, and then breaks them down as the damaged tissue heals. However, clots can form unexpectedly, without notice, and have dangerous consequences. They can happen to anyone for a number of reasons.

Almost all blood clots that cause pulmonary embolisms are formed in a deep vein of the leg (itself called a deep vein thrombosis). A piece of the clot breaks off from the wall of the vessel in the leg, travels via the bloodstream up the body, through the right side of the heart, and lodges in an artery of the lung. 

Blood clots that originate in the deep veins can be caused by anything that prevents blood from circulating normally or clotting properly, including certain surgeries and medical conditions and treatments. Among the most common risk factors, however, are inactivity and immobilization. Air travel, particularly long flights, is a particular risk, as most people tend to remain in their seats without moving their legs while on airplanes. Bosh did travel overseas, from New York to Haiti, after the All-Star Game.

While it can be speculated that Bosh’s pulmonary embolism was caused by a deep vein thrombosis which itself was caused by immobilization of his legs during air travel, the official cause has not been made public.

Pulmonary embolisms are treated with anticoagulant drugs (blood thinners), which prevent further blood clots from forming as the body’s normal systems work to break up the existing clot(s). Blood thinners are typically continued for three to six months.

Strenuous physical activity, such as basketball, must be restricted after a pulmonary embolism for two primary reasons:

First, the body needs time to heal so as to prevent any further blood clots from forming.

Second, while on blood thinners, any physical contact can lead to severe internal bleeding (which itself can cause serious damage and even be life threatening).

Bosh will therefore not return to NBA play until the underlying cause of his pulmonary embolism is resolved, he is fully healthy, and he has no more need for blood thinners.

Though Bosh’s condition is far more likely in elderly or inactive people, it can happen to athletes as well. The news comes just days after former NBA player Jerome Kersey died when a blood clot traveled from his left calf to his lungs; he was 52. Last month, Brooklyn’s Mirza Teletovic was diagnosed with a pulmonary embolism and is expected to miss the remainder of the season. Cleveland’s Anderson Varejao missed the rest of the season in 2013 when he was diagnosed in January with a pulmonary embolism. In 2011, tennis star Serena Williams was diagnosed with a deep vein thrombosis that led to a pulmonary embolism after a cross-country flight from New York to Los Angeles; she missed six months.

The long-term prognosis for patients with pulmonary embolisms who have sought medical attention in a timely fashion is generally very good. After the period of anticoagulation, patients generally make a full recovery. There is no reason to suspect that Bosh will not make a complete recovery and be fully healthy in time for training camp next summer.

Concerns for Bosh’s health has tempered excitement throughout the city after Heat president Pat Riley traded for Phoenix Suns point guard Goran Dragic on Thursday afternoon. The Heat was poised to have a formidable starting lineup, in Dragic, Dwyane Wade, Luol Deng, Bosh and Hassan Whiteside. It figured to be as talented as any in the Eastern Conference, outside of perhaps the Cleveland Cavaliers. The Heat may have even been able to challenge for an NBA title, which previously seemed impossible after the departure of LeBron James last summer. Just hours later, the news of Bosh’s condition broke.

The Heat will not receive a disabled player exception for Bosh, as NBA teams are not allowed to apply for such exceptions after January 15. The team does retain its $2.65 million disabled player exception that it received when Josh McRoberts tore his right lateral meniscus in December, but figure to utilize only a small portion of it, if any.

The Heat is currently $1.0 million below the luxury tax threshold. If the Heat were to cross the luxury tax threshold, it would become the first team in NBA history to pay the “repeater tax,” which adds an extra $1 for every dollar a team is over the luxury tax threshold, over and above the incremental tax rates that would apply. The repeater tax is triggered when a team has paid the tax in four of the previous five seasons. Coming into this season, the Heat has paid the tax for each of the last three years.

The Heat can use up to $1.0 million of its disabled player exception and still remain below the tax threshold, potentially as a means to attract a free agent with a slightly higher salary than what teams which only have access to the prorated portion of the minimum salary could offer. The difference would be up to about $800K (the exact amount depends upon the date signed and the NBA tenure of the player). If the Heat does not utilize its disabled player exception by March 10, it will expire.

With Bosh injured, the Heat may look to bring back former Heat forward Michael Beasley, who is back from China after averaging 28.6 points (on 51.3 percent shooting), 10.4 rebounds, 5.2 assists and 1.9 steals per game in 37 games for the Shanghai Sharks. Beasley worked out for the Heat earlier today today at AmericanAirlines Arena. If signed, Beasley will surely command nothing more than a 10-day or prorated rest-of-season minimum salary contract.

The Heat roster currently stands at 14, after signing Henry (Bill) Walker to a 10-day contract earlier in the day.

Bosh, 30, who is in the first year of a five-year, $118.7 million contract he signed in July in the wake of James’ return home to Cleveland, ends his season averaging 21.1 points and 7.0 rebounds. He will wind up missing 38 regular season games, the most in a season during his career.

But all talk of basketball is secondary at this point. The main concern now focuses squarely on the health of Bosh, and the hope that he experiences a speedy and complete recovery, free from complications. Bosh is widely recognized as one of the NBA’s truly nice people – funny, insightful, smart and thoughtful. He will be greatly missed.

Get well, Chris. We wish you the absolute best.

Notes:
(1) A blood clot that forms in a blood vessel in one area of the body and travels to another area of the body is called an embolus. When an embolus lodges itself in a blood vessel, blocking the blood supply to a particular organ, the blockage is called an embolism. The term pulmonary refers to the lungs.

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