William Clinton

President #42.

Lived: 1946·date.		Served: 1993·2001.

Timeline:

<== 2008
|<== 1776

Maladies = tonsillectomy · GE reflux · rectal bleeding · strained knee ligament · cardiac risk · height & weight · hearing aids · vocal cords · allergic rhinitis · refused anthrax vaccine · counseling · torn knee tendon · cyst removed · nose lesion removed · basal cell carcinoma · acne rosacea · coronary bypass · decortication surgery ·· Odds & Ends ·· Resources

Maladies and Conditions

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tonsillectomy	Bill Clinton had a tonsillectomy in 1952, at age 6 [3a].
GE reflux	Clinton "has been troubled by gastrointestinal symptoms which have been attributed to reflux esophagitis." These symptoms included "bouts of heartburn" [3b]. Treatment included elimination of certain foods (e.g. caffeine), antacid medication, and sleeping on a wedge [3c]. As Clinton prepared to leave office, his medical regimen was simplified because afterwards "he will be in charge of taking his own medications" [More]. Comment: The condition has several other names, including gastroesophageal reflux, GE reflux, and GERD.
rectal bleeding	Clinton underwent colonoscopy in 1984 because of rectal bleeding. It showed "no evidence of significant pathology including polyps or tumorous growths" [3d].
strained knee ligament	Left knee ligament strain in 1984 [3b].
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 [More]. In September 2004 Clinton needed urgent coronary bypass surgery (see below).
height & weight	Clinton is 6 feet 2 inches tall, or perhaps 6 feet 2.5 inches tall [12]. From 1992 to 2001 his weight varied from 236 to 214 pounds [More]. The lower height and a weight of 226 gives him a body mass index of 29.1 kg/m/m -- overweight, but not quite obese. After leaving office, Clinton was on the South Beach diet for an unknown time, and did lose weight [13] -- and then needed a bypass operation.
hearing aids	bilateral
vocal cords	For a year before the 1992 election, an otolaryngologist managed the frequent hoarseness Clinton would get from voice overuse. Nasal allergies and reflux esophagitis were felt to contribute to the problem [3f].
allergic rhinitis	Before his election, at least, Clinton was taking Hismanal (astemizole) for "environmental allergies." Consequences of his allergic rhinitis included: "sinus congestion, nasal drainage, and occasional swelling of the temporal area." A sinus window was surgically constructed in 1979 [3b]. An allergist evaluated him in autumn 1991 and reported [3f]: He [Clinton] has a history of nasal congestion, swelling of his eyes, and difficulty breathing through his nose. His nasal congestion was so severe in the spring of 1991 that he had difficulty running. There is no history of wheezing, asthma, or severe allergic reaction. His signs and symptoms are worse in the fall. He is noted to be a nonsmoker. Skin testing showed moderate reactions to house dust, mold spores, cat dander, weed pollen, grass pollen, beef, and milk. Allergy injections were prescribed, and he tolerated them well. By 1992 "he was on the usual maintenance dose and was taking his injections every two weeks, depending on symptoms" [3b]. Clinton continued to have allergy symptoms while President.
refused anthrax vaccine	The day after the U.S. military announced it would vaccinate its members against anthrax in 1997, President Clinton said he did not plan to be vaccinated [6]. Editorial: Dr. Zebra is a little bitter over this failure of leadership. Clinton's refusal lent credence to the crackpots and conspiracy theorists who used anthrax vaccination to sow suspicion and discontent in the military. (To his credit, Secretary of Defense Cohen was immunized.)
counseling	"In 1992, when Bill Clinton was running for President, up came the question of psychiatric history. No, was the reply; he had received counselling for some stressful family matters, but no psychiatric treatment. After revelations of Clinton's White House escapades, he announced a self-prescribed treatment course: periodic meetings with three clergymen to obtain guidance for his return to marital rectitude" [8]. Mrs. Clinton has commented that, beginning after August 1998, "We spent a lot of time in counseling, and I found it very helpful" [7].
torn knee tendon	At the home of golfer Greg Norman in March 1997, Clinton caught his heel on a step and tore 50% of his right quadriceps tendon. (The tendon connects the kneecap to the quadriceps muscle of the thigh.) Clinton heard the tear as a "very loud pop." He underwent a two-hour operation under regional anesthesia to repair the tendon, followed by weeks with a knee brace and crutches [4]. Had the operation required general anesthesia, Clinton had planned to transfer Presidential authority to Vice President Gore under terms of the 25th Amendment [5]. Clinton was awake during the entire operation and "was alert most of the time" [4].
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. [More]
nose lesion removed	A precancerous growth on the skin of Clinton's nose was removed in 1996 with liquid nitrogen.
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. [More]
acne rosacea	At his 2001 physical, this was described as "well controlled" [More].
coronary bypass	On Sept. 2, 2004, Clinton was evaluated at Northern Westchester Hospital in New York for chest pain and shortness of breath. Results were normal, and Clinton went home. The next day, further evaluation at the Westchester Medical Center (probably a cardiac angiogram) led to the recommendation for urgent four-vessel coronary bypass grafting [13]. [More] Clinton ultimately underwent successful bypass. Comment: Apparently Clinton had unstable angina, not a heart attack. Dr. Zebra has not, however, seen this explicitly mentioned in published reports. Angina (a type of chest discomfort) occurs when heart muscle is starved for oxygen. This starvation may or may not cause part of the starved muscle to die. By contrast, a heart attack ("myocardial infarction") has occurred when part of the heart muscle has died, however small. Blood tests are the best way to distinguish angina from a heart attack.
decortication surgery	On March 10, 2005 Clinton had an elective operation to correct a complication of his coronary bypass. Called "decortication," the operation removed part of the lining around the lower lobe of the left lung, the lining having become much thicker than usual as a result of the irritation caused by the bypass [2]. He tolerated the operation well [1].

Odds & Ends

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Of their first days in the White House, Mrs. Clinton has written [15]:
I knew I would never get used to the Secret Service agent posted outside our bedroom door. This was standard operating procedure for past Presidents, and the Secret Service was adament, at first, about keeping it that way.
"What if the President has a heart attack in the middle of the night?" one agent asked me when I suggested he station himself downstairs instead of with us on the second floor.
"He's 46 years old and in great health," I said. "He's not going to have a heart attack!"
Comment: I made some guesses about President Clinton's cardiac risk factors at age 46 and used the Framingham equation [17] to estimate his cumulative risk of a heart attack as 0.08 (i.e. 8%) over the following 10 years. Assuming heart attacks occur uniformly throughout the day (a false assumption), his risk of a nocturnal heart attack is about 0.027. Dividing by the number of nights in 10 years, the average per-night risk is 0.000007.
Family medical history: Mother had breast cancer. Father died in drowning accident. Mother's father died of emphysema (age 57). Father's mother died of stroke (age 62) [3g].
Clinton's mother had no eyebrows. According to her autobiography, she had to draw them in [10].

Resources

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Disclosure: Doctor Zebra gets a few pennies if you click & buy from Amazon.

Books (ranked by Amazon.com sales)		More


My Life Bill Clinton	Better Than Sex (Gonzo Papers, Vol 4) Hunter S. Thompson	Blinded by the Right: The Conscience of an Ex-Conservative David Brock

DVDs (ranked by Amazon.com sales)		More


Commanding Heights - The Battle for the World Economy	The Hunting of the President	Greatest Speeches of All Time, Vol. 2

Resources used by Dr. Zebra

Associated Press. Clinton 'glad to be home' after second operation. Washington Post. March 15, 2005; page A3.
Accessed from Washingtonpost.com
Brown, David. Clinton to undergo follow-up chest surgery. Washington Post. March 9, 2005; page A2.
Accessed from Washingtonpost.com
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. ISBN 0-89950-956-8 @ Amazon [a] pp. 297, 298 [b] p. 298 [c] p. 300 [d] pp. 298-299 [e] pp. 298, 299 [f] p. 299 [g] p. 297
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.
(CNN). Clinton should recover fully from knee surgery. CNN.com. March 14, 1997.
http://www.cnn.com/HEALTH/9703/14/nfm/knee/
(CNN). White House doctors: the President's shadow. CNN.com. September 24, 2004.
http://www.cnn.com/2004/HEALTH/09/23/wh.doctors/
Findlay, S. Clinton sees little anthrax threat to civilians. USA Today. December 17, 1997.
Gibbs, Nancy. Interview: "I had to ask myself whether I would stay married". Time. June 16, 2003, pages 28-29.
Greenberg, DS. Hale to the chief. Lancet. 1999;353:1894.
Grundy SM, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004; 110: 227-239.
http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04.htm
Kelly, Virginia. Leading with My Heart. NY: Simon & Schuster, 1994. ISBN 0671888005 @ Amazon
This was reported by a reader. I have not checked the reference myself.
King J, Henry E. Bill Clinton to undergo bypass surgery. CNN. cnn.com on September 3, 2004 at 2:59pm EDT.
http://www.cnn.com/2004/ALLPOLITICS/09/03/clinton.tests/index.html
Mathews J. The shrinking field. Washington Post. August 3, 1999. Page C1.
Accessed through washingtonpost.com: http://www.washingtonpost.com/wp-srv/politics/campaigns/wh2000/stories/tall080399.htm
Milbank, D. Bill Clinton to undergo heart bypass surgery. Washington Post. washingtonpost.com on September 3, 2004 at 3:25pm.
http://www.washingtonpost.com/wp-dyn/articles/A59226-2004Sep3.html
O'Keefe JH, et al. Optimal low-density lipoprotein is 50 to 70 mg/dl. Journal of the American College of Cardiology. 2004; 43: 2142-2146.
Time Magazine Staff. Hillary unbound. Time. June 16, 2003; page 28.
This magazine article is an excerpt of Mrs. Clinton's book Living History.
Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ [British Medical Journal]. 2003; 326: 1419.
Web page: http://www.doctorzebra.com/madcow/details.html
Another fascinating web page from Dr. Zebra!
White House. Press release. Office of the Press Secretary. January 12, 2001.
http://clinton5.nara.gov/library/hot_briefings/January_12_2001.html
The William Clinton web page at the White House.
(12 matches when checked in November 2003)

Alternate index terms: Medical history of President Clinton, Medical history of President William J. Clinton, Medical history of President William Jefferson Clinton, Medical history of William Jefferson Blythe, Medical history of Bill Clinton.

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