Bill Clinton: Results of 2001 Physical Examination


GE reflux
 
Clinton "has been troubled by gastrointestinal symptoms which have been attributed to reflux esophagitis." These symptoms included "bouts of heartburn" 1a. Treatment included elimination of certain foods (e.g. caffeine), antacid medication, and sleeping on a wedge 1b. As Clinton prepared to leave office, his medical regimen was simplified because afterwards "he will be in charge of taking his own medications" SEE BELOW.

Comment: The condition has several other names, including gastroesophageal reflux, GE reflux, and GERD.



cardiac risk
 
Clinton's cholesterol level, and, more generally, his overall cardiovascular risk, were a concern as early as 1992. Details are summarized on an accessory web page, where Dr. Zebra does some rather unattractive ranting, but it's in the good cause of getting more people to take statin medications... MORE.

In sum, Clinton had five exercise tolerance tests while President; it was felt at his last Presidential physical examination (in 2001) that another such test was unwarranted. He started taking simvastatin (Zocor) at that time, because of elevated cholesterol levels, as discussed in a press conference SEE BELOW.

In September 2004 Clinton needed urgent coronary bypass surgery (see below).



cyst removed
 
A benign cyst was removed from Clinton's chest in 1995. Comment: Based on comments after Clinton's 2001 physical examination, this seems to have been a sebaceous cyst. SEE BELOW


nose lesion removed
 
A precancerous growth on the skin of Clinton's nose was removed in 1996 with liquid nitrogen. Comment: Based on comments after Clinton's 2001 physical examination, this seems to have been an actinic keratosis SEE BELOW.


basal cell carcinoma
 
Biopsy of a lesion on Clinton's back, discovered during a routine physical examination on January 12, 2001, disclosed basal cell carcinoma. It was removed in January 2001, to little fanfare. SEE BELOW


acne rosacea
 
At his 2001 physical, this was described as "well controlled" SEE BELOW.

More...
A press release 2, reprinted below, was issued after Clinton underwent a routine physical examination on January 12, 2001. Issues addressed included:
  • Height and weight
  • Cholesterol and other lipid levels; simvastatin
  • Allergies
  • Skin: rosacea and possible basal cell carcinoma
  • Eye evaluation (normal)
  • Cardiovascular evaluation
  • Diet
  • Exercise

THE WHITE HOUSE

Office of the Press Secretary
______________________________________________________________
For Immediate Release January 12, 2001


PRESS BRIEFING BY
DR. CONNIE MARIANO
ON THE PRESIDENT'S ANNUAL MEDICAL CHECK-UP

Bethesda Naval Hospital
Bethesda, Maryland


3:50 P.M. EST


MR. SIEWERT: Welcome back to Bethesda Naval Hospital for
President Clinton's seventh visit here. This includes six physical
examinations, as well as one hospitalization for tendon repair in 1997.

Let me begin by saying thank you very much to Admiral Martin, the
Commander of the Bethesda Naval Hospital, and Bethesda's Public Affairs
Office, including Commander Ed Austin, Kevin Sforza, and their team, for
taking care of all the press today. Most of all, we want to thank the
doctors, the nurses, the corpsmen and all the staff who participated in
today's visit.

The President is very grateful, as he told you on his way out,
for the outstanding care he has received here over the years at Bethesda
Naval Hospital. There was a very moving military tribute to him as he left
upstairs, and he appreciated it very much.

Today's exam took about three hours to complete. The highlights
of those findings are being released to you now on paper, and we'll make
those available back at the White House, as well. Admiral Connie Mariano,
the President's personal physician, will go over the key features of
today's visit. The President is very appreciative for the work she and her
team have done at the White House, a grueling schedule that the President
put them through, and they've always been there to take care of him through
good times and bad.

After her report we'll go off camera and we'll have five or ten
minutes of questions, and then we'll be done. Before I begin, let me just
say, the President told us before he left that he's looking forward to
getting back to civilian life where he might have a slightly more regular
schedule, be able to exercise a little more regularly, take up running
again and get himself in tip-top physical shape. But as for his shape
today, it's very good, and I'll let Dr. Connie Mariano run you through
that.

Thanks.

DR. MARIANO: Thank you, Jake. Good afternoon.

President Clinton underwent his final exam today; he passed.
This was his sixth physical exam on the President and, as in the past,
President Clinton was evaluated by a panel of medical experts who are all
board-certified in their specialties. I'd like to briefly name each one of
them now and as I name them, if they could step forward to be acknowledged.

Our first member of the board is Dr. James Suen, Professor and
Chairman of the Department of Otolaryngology at the University of Arkansas;
Dr. David Leonard, from Bethesda Department of ENT; Captain Richard
Morrissey, the Chairman of Bethesda Department of Cardiology; Captain James
Butler, the Chairman of Bethesda Department of Gastroenterology; Dr. David
Corbett, the retired Chairman of Bethesda Department of Dermatology, and
now in private practice; Commander Francis McGuigan, a orthopedic surgeon
from Bethesda Department of Surgery; Captain Robert Kellogg, the Chairman
of Bethesda Department of Physical Therapy; Dr. Talal N'souli, Associate
Professor of Allergy and Immunology at Georgetown University Hospital;
Captain Paul Christenson, Chairman of Bethesda Department of Urology;
Commander Craig Williams, the Navy Specialty Advisor for Podiatry; and
Captain Sushil Jain, the head of Bethesda Department of Optometry.

Thank you, Doctors.

With the President's consent, I have released a report
summarizing the medical findings from today. I would like to go over
briefly that report and, again, the details are to be released very shortly
with my report. Let's start off with vital statistics.

Our 54-year-old President weighed in at 214 pounds, on his 6'2"
frame, and this weight is actually unchanged from last year's physical. It
falls within the normal range of 190 to 220 for a man of his height.
Highlights from his blood tests include a total cholesterol that
is elevated this year, to 233 -- 233. The triglyceride was 52; the HDL was
46. But the physicians were concerned about the elevated LDL or unhealthy
cholesterol of 177, with a ratio of 5.1. The cholesterol and LDL values,
again, we noted are elevated over last year's results and we recommended in
addition to diet and exercise, we have started the President on medications
to lower his cholesterol.

The President's chronic allergies were also evaluated today and,
as you know, he has been receiving allergy shots every seven to 10 days
since he's been coming to the White House. His allergist has recommended
obtaining repeat skin testing in the future if he should discontinue those
allergy shots.

The President's recurrent bouts of hoarseness were well
controlled over this last year. He has had not very many episodes have
been noted. His vocal cords were visualized and they were found unchanged
from previous exams. The only thing we've done with his medications
regarding his gastro-esophageal reflux disease, made them a more simplified
regimen because after January 20th, he will be in charge of taking his own
medications.

During the dermatology evaluation, the President's acne rosacea
appeared very well controlled. He did not have any actinic skin lesions
that he had had in the past so he did not require any liquid nitrogen
treatments. But the dermatologist did not a small, suspicious skin lesion
on the President's back and that lesion was biopsied. The results should
be available within a week and we will definitely inform you of those
results when they do come in.

The President's eye examination consisted of the updating of his
reading glass prescription and the total eye exam was found to be normal,
including a checkup for glaucoma.

And then, finally, with no history of coronary heart disease and
five previous normal exercise treadmill tests, we elected not to perform
another treadmill test, we elected not to perform another treadmill test
again today. The President did undergo a routine ultrasound of his heart,
and this was compared to his baseline ultrasound performed in 1994, and
that was -- to moderate any questions.

Thank you.

MR. SIEWERT: This portion, I think, of the briefing will be off
camera.

Q Doctor, can you talk a little bit about -- (inaudible) --
can you tell us what that means --

DR. MARIANO: I'm going to ask Dr. David Corbett, the President's
dermatologist, to comment, because he noted the lesion and performed the
biopsy.

Dr. Corbett?

DR. CORBETT: The President had a small flat spot on his back
that was a little pearly, looked like a -- very suspicious for a basal cell
skin cancer, a basal cell carcinoma, the most common type of skin cancer.
It's a little locally-growing type of skin cancer, not a threat to his
health or anything, a very small spot, if it turns out to be that.

Q And you will find out next week --

DR. CORBETT: Correct. We took tissue to biopsy that. It goes
to the pathologist where it's processed. They'll look at it under the
microscope and tell us for sure whether it was or not.

Q Was it something that he could see or --

DR. CORBETT: No, it was nothing that he had noticed.

Q If it is found to be cancerous, what will be --

DR. CORBETT: If this turns out to be a little superficial basal
cell, there are superficially destructive methods that treat these very
easily, and it should be no problem at all.

Q Is there anything other than a superficial basal cell --
could it be something different than that?

DR. CORBETT: Oh, it could be a little benign, inflammatory
lesion or something. But the only way you know for sure is to biopsy these
spots, and that's the reason you take tissue for biopsy.

Q Have you been with the President in the past year?

DR. CORBETT: Yes.

Q So this was the first time it was discovered --

DR. CORBETT: That's correct. He's had sun-damaged spots before,
but this is the first time he's had a little spot that's been suspicious,
actually, for a skin cancer.

Q And what do you consider at this point the extent of his --

DR. CORBETT: No, he's had previous cysts, but those are totally
different. The little cysts are totally benign lesions and are very
common, as well.

Q How common is this in people of his age --

DR. CORBETT: Basal cell skin cancer again is the most common
type of skin cancer. Probably at least 800,000 to a million cases of basal
cell in the United States every year. It's the locally growing type; it's
not the type that spreads and goes other places. It just grows very
slowly, locally.

Q Dr. Mariano, could you describe the President's --
(inaudible) -- any overall recommendations given to him as he was leaving?

DR. MARIANO: Well, you know, the President, he wants to always
study for his exams, and passed them with flying colors. I think today
he's been undergoing a lot of busy activity and travel, so he was I don't
think in the top shape he wanted to be in. But medically, as a physician,
he passed -- he had a fairly normal exam, except for the things we noted,
such as the skin lesion and the elevated cholesterol. But those are things
that are very easily managed on an out-patient basis.

Also we gave him things to look at in the future for him to work
on, such as diet, such as exercise. And I think he should do very well
with that, with a new lifestyle for him.

Q (Inaudible.)

DR. MARIANO: Let me ask a cardiologist, Dr. Morrissey, he can
discuss a little bit more about the medicine.

DR. MORRISSEY: We'd like to emphasize, first of all, that
throughout the entire time, Dr. Mariano has made sure that the President
has been on a good diet program, as well as a regular aerobic exercise
activity. So those are the fundamentals that we have to continue to
stress, and the President plans on continuing to stress that therapy.

But in the studying of his LDL, which was 134 on our last
evaluation, today it was 177. As Dr. Mariano mentioned, that's the
unhealthy cholesterol occurring on a patient that's very active and
following a diet. It was time to initiate drug therapy. So we'll have him
on one of the HMG -- inhibitors. We'll start a normal dose regiment, and
we will do follow-up laboratory tests on him in approximately one month.

Q (Inaudible.)

DR. MARIANO: September 25, 1999. This is the 2000 exam and the
departure exam.

Q (Inaudible.)

DR. MARIANO: There is a Department of the Navy instruction or an
agreement since 1967-68 that authorizes former Presidents and First Ladies,
or widows of former Presidents to receive Navy medical care. So the
President is eligible to come here for his medical care and benefits,
should he seek that. And he's aware of that.

Q In 1990 -- (inaudible) -- he had a test for HIV. Did he
have that again today?

DR. MARIANO: No, he didn't. That test in 1990 for HIV was an
insurance physical, and that was negative. But, no, he's not been offered
that. He declined, he didn't feel it was indicated.

Q Back in 1996, the President released a part of his medical
records. Is there any plans of maybe releasing his full medical records?

DR. MARIANO: No. In fact, no other President has released their
entire records. What we have done in the last eight years is released
summaries of our physical findings and then made those part of the record.
So, in essence, that's in the records, the things we released.

I know we've released biopsies of the sebaceous cyst in the past
that he has had, we've done that as well. But having served President Bush
in the final years of his presidency, I'm pretty certain in talking to all
my predecessors that no one has released their records in entirety.

Q Back to the cholesterol, what would have caused that? Was
it demands, the stress of the presidency that helped increase the
cholesterol level?

DR. MARIANO: You know, the President is aware, he acknowledges
that it's a combination of not the right type of diet, food that's on the
road and long hours, and also not enough exercise. As you can recall, when
he first came in as President, he used to run on a regular basis, and you
don't seem him doing that anymore, he's not running as often as he wants to
with the demands of his office. So, definitely, the demands of the office
and the travel and all the things he does leave him very little time to
focus on the exercise he wants to engage in.

Q Doctor, the President said that his knee was fine. He told
us that outside. I wonder, the kind of exercise that you'd like him to do
more of, that would mean his knee is fine to do those kinds of workouts?

DR. MARIANO: Right. The orthopedic surgeon and physical
therapist essentially blessed him and considered that he's totally
recovered from that surgery and he is free to do StairMaster, running. In
fact, I think he started running early -- right after his surgery. And
actually -- let me have Dr. Kellogg comment. He was with us to help with
the rehab of the President and his knee. So, Dr. Bob Kellogg.

DR. KELLOGG: The President's knee is looking just absolutely
picture-perfect. He has been cleared really for the last two years to
return to all activities that he's wanted to do. He has certainly
expressed a strong interest to getting back out on the road and resuming
his jogging plans. And there are really no limitations that he faces.
He's been very active, working out regularly in the White House gym, but
around the demands of his road schedule and that sort of thing.

Q I want to ask a question about the cholesterol because the
ratio of 5.1, what is exactly -- what does that mean? And the other item,
you said that LDL is elevated from 134 to 177. I understand that, because
that's the dangerous cholesterol. What about the 52 for triglycerides? Is
that a normal --

DR. MORRISSEY: Those are all good numbers that you're looking
at. And you want to look at not only the total cholesterol, but all the
subcomponents of cholesterol and also understanding what the triglyceride
level is. So when the lab test was ordered today, it looked at all those
various sub segments and that's what we like to look at.

And the two things to focus in on here, knowing that the
triglyceride level was normal, is looking at what his HDL cholesterol was
and his LDL cholesterol. And the ratio kind of looks at what the HDL and
the LDL look like. And the nice way to remember that is the HDL is high
density lipoprotein and you want to get that as high as you can. And the
way to bring up that HDL is pick your parents well, because genes are very
effective for that. And then also good exercise and a moderate alcohol
consumption sometimes can cause an elevation in the HDL.

Q Is the HDL -- 52?

DR. MORRISSEY: It was 46. His HDL was 46, which is a normal
HDL. Now, if he had a low HDL, 35 or less, we would consider that an
additional risk factor. But since the President's HDL is normal, we're
happy with that. We do recommend, as we said, good diet and exercise, but
we're also going to go after the LDL, the LDL being the poor cholesterol,
and we're going to drive that down with diet, exercise and the medication.
And our goal would be to bring that as far down as we can.

Q Can I just mention one more thing about the cholesterol?
Are there any brand-name drugs that we might understand better than the --

DR. MORRISSEY: The medicine that we chose was Zocor simvastatin,
the medication that is on the military formulary, and we use it for our
active duty independents, and it's a very effective medicine. As I
mentioned earlier, we will monitor liver function in a one-month time frame
to make sure no adverse side effects.

Q And one more thing. What sort of recommendations did you
give the President as far as diet --

DR. MORRISSEY: I know that recently, there's -- the
Department of Agriculture put out a comparison of the different diets out
there. We still go with the American Heart Association type diet and go
with the low cholesterol, low fat diet. The President's chefs and the
entire medical team has made sure that when possible, he gets a
low-cholesterol, low-fat diet. So that's our goal in that.

Q He isn't eating cupcakes by himself -- (laughter) -- what
should he be eating?

DR. MORRISSEY: There's been dietary instructions and, of
course, we can supplement that to make sure there's enough education
material provided to the new cooks for his meals.

MR. SIEWERT: If you'd like to get him a steamer, Mark, that
would be fine. Steam some vegetables. (Laughter.) Probably not the diet
he had yesterday, in New Hampshire.

I think that's it. Thank you all. Unless anyone had any
pressing questions. Do you have one more?

Q A question for Dr. Mariano. With the President leaving
office in a week, from a personal and/or professional standpoint, do you
care to describe how it has been to be the President's chief physician?
(Laughter.)

DR. MARIANO: You know, he is an amazing man. I have known him
eight years and he's a good patient. He has a good heart, he's a good
person, and it has been a privilege and an honor serving him. And I know
that today, when he left here, he was very touched by seeing all the staff
here at the hospital, because he really is impressed by military medicine.
I didn't get to hear what he said about the hospital, but he is truly a
great fan of military medicine and what they've done for his medical care
and the dedication.

Again, it has been a great honor serving him and serving at the
White House. Thanks.

MR. SIEWERT: That's a wrap. Thank you very much.

END 4:10 P.M. EST
Cited Sources
  1. Bumgarner, John R. The Health of the Presidents: The 41 United States Presidents Through 1993 from a Physician's Point of View. Jefferson, NC: MacFarland & Company, 1994.
        
    a  p.298  b  p.300

    Comment: Devotes one chapter to each President, through Clinton. Written for the layperson, well-referenced, with areas of speculation clearly identified, Dr. Zebra depends heavily on this book. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book casting a physician's eye on that experience.

  2. White House. Press release. Office of the Press Secretary. January 12, 2001.
        

    Comment: http://clinton5.nara.gov/library/hot_briefings/January_12_2001.html


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