NYTimes-Hillary health report inadequite. Call for her docs to reveal more.
WASHINGTON — The disclosure last week that Hillary Clinton was beingtreated for pneumonia thrust the health of both of the major parties’ presidential candidates and their running mates to the center of the campaign, and led to the release of more detailed medical histories from the two candidates seeking what is widely regarded as the world’s most demanding job.
Mrs. Clinton, 68, the Democratic presidential nominee, who has had serious medical problems in recent years, released on Wednesday an update of a July 2015 letter from her doctor attesting to her overall good health and ability to serve a full four-year term as president. However, the doctor, Dr. Lisa Bardack of Mt. Kisco, N.Y., noted that Mrs. Clinton had developed two new medical conditions in 2016: a sinus and ear infection in the winter and pneumonia this month.
Dr. Bardack wrote that she had regularly examined Mrs. Clinton this year for routine care and that she had been closely monitoring her pneumonia, which is improving.
But doctors not connected with the candidate’s care say that the letters omit basic information like height and weight, and that a more detailed history of her blood clots and a 2012 concussion should be disclosed. Still, the information Mrs. Clinton has made public is more extensive than the details and assessments that Dr. Harold N. Bornstein, the doctor for Donald J. Trump, 70, the Republican presidential nominee, provided on Thursday, saying that Mr. Trump has had no serious illness and “is in excellent health.”
Here is an assessment of the medical history Mrs. Clinton has made public (and here is one of Mr. Trump’s).
Mrs. Clinton’s pneumonia affects her right lung’s middle lobe, according to Dr. Bardack, a location that suggests that it was caused by bacteria, commonly pneumococcus. Mrs. Clinton received two preventive vaccines against pneumococcal infection: Prevnar and Pneumovax. Neither is 100 percent protective against pneumococcal pneumonia. Dr. Bardack did not say whether her examination had led to identification of a specific bacterium, which often happens in cases of community-acquired pneumonia like Mrs. Clinton’s.
Mrs. Clinton has been treated with two antibiotics, first for a lingering cough and then for pneumonia. The first antibiotic, which was not identified, was prescribed short term on Sept. 2 after she experienced a low-grade fever for 24 hours, along with congestion and fatigue attributed to an upper respiratory tract infection related to her seasonal allergies. Then, when Mrs. Clinton’s pneumonia was diagnosed on Sept. 9, Dr. Bardack prescribed a 10-day course of a second antibiotic, Levaquin.
Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University, said the course of treatment suggested that Mrs. Clinton might have had the pneumonia for a longer period than initially thought. It also means that she needs a further follow-up examination and X-rays to make sure it continues to respond appropriately to antibiotic treatment and without complications.
Some crucial details were left out of Dr. Bardack’s statement, including whether Mrs. Clinton was short of breath and experiencing chest pain while breathing when the pneumonia was detected, which could indicate the severity of the pneumonia.
A wide variety of medical information can be important in judging the length of a recovery period, which varies among types and individuals. Some have “walking pneumonia,” which is a nonspecific phrase, and still go to work. Depending in part on the kind of pneumonia, others may need days to weeks of rest.
History of Blood Clots
Mrs. Clinton has experienced blood clots on three occasions, two of which developed in a leg vein: one in 1998 when she was first lady, and another in 2009 when she was secretary of state.
The first occurred during midterm congressional elections when she developed a swollen calf from phlebitis and a blood clot. Mrs. Clinton’s doctors advised that she be hospitalized, but she refused, citing the demands of the campaign. (Mrs. Clinton similarly declined to cancel events after being told she had pneumonia.) She received outpatient treatment without known complications. Mrs. Clinton has not released her medical records from her White House years.
In 2012, Mrs. Clinton experienced a stomach virus after foreign travel. She became dehydrated, fainted and fell at her home in Washington, striking her head in the process. She experienced a concussion and double vision, for which she wore Fresnel Prism glasses for a period. A follow-up magnetic resonance imaging scan at the time showed a clot in one of the two main veins that drain blood from the brain. Doctors prescribed Coumadin, an anticoagulant drug, or “blood thinner,” to prevent the clot from growing and becoming even more dangerous.
Other tests showed that Mrs. Clinton did not have an underlying disorder that increased her risk for developing blood clots, Dr. Bardack said. Nevertheless, as a precaution, she continues to take Coumadin (also known as warfarin) daily to prevent further clots. A number of dietary items and other factors can strongly influence Coumadin’s effects on the blood-clotting system. These are among the reasons such patients frequently have a blood test, known as an I.N.R., to monitor the dose.
Many patients have switched to newer drugs like Pradaxa, Xarelto and Eliquis that eliminate the need for blood tests and allow for easier clotting control. However, many doctors advise patients who have stable I.N.R. test results and have not developed complications to stay with Coumadin. Dr. Bardack said she and Mrs. Clinton’s hematologist had decided not to switch to a newer anticoagulant.
Mrs. Clinton takes no additional regular medication except for thyroid hormone, which tests show properly controls her underactive gland; Clarinex for allergies; and vitamin B-12 when she feels she needs it.
Recovery From Head Injury
Accounts of how long it took for Mrs. Clinton to recover from symptoms of the concussion are discordant. Dr. Bardack said they had resolved in two months. But former President Bill Clinton said his wife’s concussion had “required six months of very serious work to get over.”
Unspecified tests performed in 2013 showed “complete resolution of the effects of the concussion, as well as total dissolution” of the blood clot, Dr. Bardack wrote in 2015. On Thursday, she wrote that a CT scan of Mrs. Clinton’s brain in March 2016 showed no abnormalities. Mrs. Clinton has not released statements from a neurologist, neurosurgeon or other specialists involved in her care in Washington and New York.
Because Mrs. Clinton and Mr. Trump are in the age range of increased risk for Alzheimer’s and other forms of dementia, some experts have urged that they both take neuro-cognitive tests that can detect early clues to dementia.
While dementia can develop independent of head trauma, researchers are exploring whether a head injury might hasten development of dementia, as has been seen with former boxers and football players. Neither Mrs. Clinton nor Mr. Trump has said whether they have taken such neuropsychological tests. Dr. Bardack wrote that Mrs. Clinton “is in excellent mental condition.”
Arteriosclerosis, which underlies heart and blood vessel disease, runs in Mrs. Clinton’s family. Her father died in his 80s from a stroke; her mother lived into her 90s and died from congestive heart failure; and one of the candidate’s two brothers has premature heart disease, Dr. Bardack wrote in 2015.
Because of Mrs. Clinton’s family history, she underwent a full cardiac evaluation, which found no evidence of heart disease, according to Dr. Bardack. Her untreated blood pressure was 100/70 and her cholesterol and lipid levels were normal. Because her LDL (bad) cholesterol levels were 118 and 103, higher than the desirable level of below 100, some doctors have asked why she is not taking a statin drug.
But a cardiologist who ran Mrs. Clinton’s cholesterol and other lipid measurements through a standard algorithm developed by the American College of Cardiology and the American Heart Association found that statin therapy is not recommended. It also showed that her risk of a heart attack or stroke was less than 0.5 percent for each of the next 10 years for a person of her age. With a coronary calcium score of zero from a CT scan, another database, developed by the National Heart, Lung and Blood Institute and known as MESA (for multiethnic study of atherosclerosis), showed that her risk of a heart attack was less than 0.2 percent in each of the next 10 years.