CLEVELAND -- After struggling with command for the entirety of his outing Monday afternoon, Royals starter Cole Ragans exited his start against the Guardians with a left calf/hamstring cramp.

Facing Guardians center fielder Lane Thomas to lead off the bottom of the fifth inning of Kansas City's 4-3 win in Game 1 of Monday’s doubleheader at Progressive Field, Ragans threw four consecutive balls to issue his fourth walk of the day. On the third pitch of that plate appearance, Ragans threw a cutter that sailed high to the backstop.

The fourth pitch was a changeup below the zone, and as Salvador Perez caught the ball, Ragans motioned slightly to the dugout.

Perez popped up and immediately called out head athletic trainer Kyle Turner, and Ragans left the game with Turner a few moments later. The Royals announced that Ragans exited with a cramp in his left calf/hamstring, but it’s unclear yet if it was something Ragans had been trying to pitch through or if it had happened just in the fifth inning.

The lefty starter battled his command and an inconsistent strike zone throughout Game 1 of Monday’s split doubleheader, needing 56 pitches to get through two innings and 73 through three. The Guardians scored both of their runs off Ragans (only one earned) in the second inning when he loaded the bases with a walk, a hit batter and a single before walking Steven Kwan to bring home a run. A passed ball led to the second run.

Ragans entered the fifth inning at 90 pitches, so manager Matt Quatraro already had James McArthur warming up in the bullpen.