American Idol alumni Michael Johns lost his life in Los Angeles, CA on August 1, 2014 at the age 35, due to a blood clot as a result of a twisted ankle. Johns had reportedly been taken to a doctor after complaining of pain in the ankle, and it was reported he was concerned it was a blood clot. The doctor, according to the friend who took Johns to the hospital, examined him and determined that he should go home. While it is not clear whether Johns was given any treatment or medications, in hindsight, he should have been aggressively treated or hospitalized.

Blood clots can form in the lower extremity from laying or sitting too long in one position, deep vein trauma, medications, old age, or obesity. When blood flow slows down in the veins, it can  clump together and form clots. These clots can break off and send pieces called emboli to the lungs and other organs which can lead to death. Typically the signs of clots, called Deep Vein Thrombosis (DVT), are pain in the leg, warmth, redness and swelling. When Johns arrived at the hospital with a painful, swollen and warm leg, with a history of recent trauma to the ankle, the choice for the doctors would either be an ultrasound or venography diagnostic test. The ultrasound uses sound waves to delineate the arterial and venous blood flow pattern and provide a graphic image of the results. However, if the doctors had suspicion of DVT, they should have immediately performed venography, the gold standard for diagnosing DVT. In venography, a dye is injected into the vein allowing the velocity of the blood flow to be visualized on a x-ray. A physician’s level of precise diagnosis of DVT improves when the physician suspects a high probability of DVT before diagnostic tests are even done.

There are other tests that measure the blood for a chemical byproduct released from dissolving clots, as well as Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) scans, which are crucial to determine the status of organs that may be affected by DVT. Particularly within the lungs where pulmonary embolism (PE), which is a deadly consequence of DVT, can occur. PE is the most likely reason why a blood clot killed American Idol alumni Michael Johns.

How could a blood clot have been prevented from killing singer Michael Johns? When he presented at the hospital with his symptoms, suspicions of the likelihood of DVT should have arisen. Doctors use a differential diagnosis matrix to determine the perimeters of the condition. The differential for a warm, swollen, painful leg associated with recent trauma includes–cellulitis (an infection), ruptured Baker’s cyst, and tumor. A doctor’s training incorporates a popular adage: “If you hear hoof beats, don’t think zebras!” This model prepares doctors to assign the common symptoms to the most likely cause. For instance, if you present to the doctor with a fever, runny nose, and malaise, you probably have a cold or the flu. However, though you may present with common symptoms, there is the chance that a more serious condition could exist. Here, the hoof beat model works well for the ninety-nine percent, but works poorly for the one percent who may have their diagnosis tragically delayed.

The answer to why a blood clot killed American Idol alumni Michael Johns may have been that the doctors saw a young man, who during physical activities suffered a twisted ankle, which is a common occurrence, especially in that age group. They heard hooves and treated him as though he only had an ankle injury, but perhaps they overlooked the zebras in the room.

By LC Loggins

Sources:

National Institute of Health–Deep Vein Thrombosis
Los Angeles Times–Michael Johns Dies at 35
National Institutes of Health–Blood Clots That Kill: Preventing DVT