Something Is Rotten In Denmark
Yesterday, I posted about the strange announcement concerning Bill Clinton's new "medical" problem.
We're told that he has a pleural effusion (see yesterday's post to explain what this is) that needs decortication to fix.
There are a lot of problems with this diagnosis and the chronology given by the Clinton's press pushers.
But first let's talk about the dramatic change in Bill Clinton's appearance.
Downhill in a Hurry
Have you noticed that the chubby, robust Bill Clinton has, of late, been looking quite wan and acting more like Jimmy Carter? Do you think this is because Clinton is still recuperating from his bypass?
Here's what Bill looked like not so long ago, during his presidency.
Remember how crazy everyone got because of the abrupt change in Viktor Yushchenko's appearance over the course of six months? Well this is PRETTY CLOSE, wouldn't you say?
I know that a lot of people ascribe this dramatic withering to Bill Clinton's bypass, but, I'll tell you, I've seen a LOT of bypass patients over the years, and I would say that most of them bounce back to normal after 1-2 months, and ESPECIALLY if they are previously healthy 58 year-old men with uncomplicated surgery and hospitalization.
Yeah, I know, Clinton saw the light and went on the South Beach Diet and stopped eating Twinkies...but isn't good diet and exercise supposed to make you look YOUNGER and BETTER?
If this is the result, maybe we should be sending Clinton cartons of Yodels!
But I believe there is much MORE to this story. because as perplexed as I have been, personally, about the rapid deterioration of Bill Clinton's appearance, I have been loath to propose a more ominous diagnosis than "post-bypass, post-South Beach Diet inanition"...until some new SIGN arose to lead me to the diagnosis.
Now we have that sign.
An Improbable Diagnosis and a Radical Treatment = A Bad Sign
NPR interviewed one of the MD's from Columbia Presbyterian yesterday who said that they only discovered Clinton's pleural effusion one month ago when the former president began to experience shortness of breath while running up hills. Hmmmm...personally, my 10 year-old SON gets short of breath running up hills, but we'll pass on that for a minute.
With the onset of this symptom it was discovered that Clinton had a left-sided pleural effusion. That was ONE month ago and FIVE months after Clinton's coronary bypass.
This effusion has caused pleural stiffness and resultant lung collapse in the left lower lobe. As I explained yesterday, medically, pleural stiffness only occurs when the pleural effusion is COMPLICATED with blood, infection, or tumor.
Problems with this Scenario
Complicated pleural effusions occur shortly after surgery. Why? Because it is hard to be BLEEDING or INFECTED for five months and have it go unnoticed. There really is no reason that can easily be blamed on Clinton's bypass for him to develop a complex (bloody or infected) pleural effusion FIVE MONTHS LATER.
Why are they rushing Clinton to the OR to do a relatively risky (general anesthesia) decortication procedure? The algorithm for stubborn pleural effusions calls for CONSERVATIVE THERAPY with decortication a LAST DITCH EFFORT when all else fails. This just doesn't make sense in the context of the story...unless
The doctors are worried...
I work in a cardiac hospital. I've seen 1,000 patients a year undergo coronary artery bypass surgery and there are two things I can tell you:
1. Most people bounce back incredibly quickly -- especially 58 year-old previously healthy males -- and are themselves again in a month or two at the most
2. I have NEVER seen or heard of someone suddenly developing a complex pleural effusion six months after the surgery.
Pants On Fire
I DON'T THINK SO!
Does Clinton have cancer...or AIDS?
Why is he so skinny and listless?
And why are they rushing him in for this surgical pleural resection instead of doing everything in their power to fix it without surgery and general anesthesia (which is what I would insist upon if it were MY pleura)?
They may be trying to make a diagnosis.They may be very worried and need to rush to a diagnosis because...
Maybe they are taking him to surgery to get a piece of that pleura to look at in pathology, under the microscope, because... they suspect that this pleural problem is much more than an unlucky by-product of cardiac surgery (done at one of the best places in the world for that particular surgery).
Maybe they are looking for metastatic melanoma.
Or Kaposi's Sarcoma.
Maybe they should let us know a little more before this catches fire on that tinder pile that is the Internet...
ADDENDUM: For those of you who remember the late, great heartthrob, Rock Hudson -- whose diagnosis of AIDS seemed to spur the world into finally recognizing and admitting to the prevalence of the disease-- here are his "before and after" AIDS diagnosis images, reminding me of Bill Clinton:
Responding to some friendly fire that creitisized my Clinton photos as being too far apart in time, I offer you the following comparison from his book cover of last November, to his photograph from one month ago:
Here is his face on last year's book
Everyone I talk to agrees that the change is dramatic given the time span over which it has occured.