CSI MEDBLOGS: DOES BILL CLINTON HAVE AIDS OR CANCER?

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.

Here's what he looks like now.

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

FIRST:

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.

SECOND:

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

So... are they telling us the whole story?

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)?

Why?

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 lymphoma.

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:

______________________________________________________________________

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ADDENDUM #2

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

  And here he is recently...

Everyone I talk to agrees that the change is dramatic given the time span over which it has occured.

CBBMD

Comments

[cardioNP]

I agree that something is "off" here. I too have seen many patients post CABG. If they have an immediate post op effusion that persists after hospital discharge they usually report DOE or orthopnea at their follow-up visit. A little lasix for 1-2 weeks helps the usual volume overload in the 1 mo post op period, and by 2 months they are fine. If the effusion persists, then CT surgery or pulm will do thoracentesis. So, if Clinton did not develop his DOE while running until 5 months after surgery, something is strange. As you suggested, either they have omitted telling us that they have exhausted conservative measures, or something else is going on. Would love to know what the cytology on the plueral fluid shows.

[Joe P.]

The intrigue is interesting, but I wish the best for Bill. He's quite an entertaining character.

[Cathie]

Being a medical editor, I think there is something that is not being said in the press either and that being "malignant mesothelioma" which would account for the rapid decline in Bill's appearance. Decortication and pleurectomy are the gold standard of treatment for mesothelioma.

[Jackie]

Cathie

When I heard what was going on with Bill, my first thought was Meso. My husband presented with exact symptoms before his decortication and resulting diagnosis of Meso. If that is what is going on with Bill - where would he have been exposed?

[Anderson Miller]

I don't care what he has and you shouldn't either what you are the study is to pray that Mr. Clinton recuperate in a timely fashion (hurry and get better Mr. Clinton This was Anderson from the Miller family which lives in Brooklyn but i am originally from La Republica De Trinidad y Tobago West Indies). This should not be public if he doesn't want to stress it and I believe he should not stress his much of his pains or disabilities with the media which mostly twist the truth to gain publicity, because this should be a family affair to know and as far as i can witness right now some people are not treating him as such.

[E. Nonee Moose]

Does Clinton have cancer...or AIDS?

I have to congratulate you... this has to be the most oblique smear effort ever directed at Bill Clinton. A true work of art! You are a master at your craft!

[Ampersand]

I've checked a bunch of medical sites, and all of them say that a 3 month recovery time is normal.

www.stmichaelshospital.com/content/programs/cardiac/treatment/bypass.asp

www.americanheart.org/presenter.jhtml?identifier=4484 ("a full recovery may take a few months or more")

www.healthatoz.com/healthatoz/Atoz/ency/coronary_artery_bypass_graft_surgery.jsp
("Full recovery from coronary artery bypass graft surgery takes three to four months")

hcd2.bupa.co.uk/fact_sheets/html/con_art_bypass.html

www.edwards.com/PatientsAndFamilies/MyHeart/ClinicalProcedures/CoronaryBypassCareAfterSurgery.aspx
("Full recovery from coronary artery bypass surgery may take several months")

That's just a handful of many examples available. It may be true that many healthy patients bounce back quicker, but there appears to be nothing odd about taking longer to bounce back.

[ddb]

I agree that his look doesn't fit his diagnosis.
And I have thought something was amiss since the
day of the news flash that he was to have "heart surgery".

Along the line of HIV, etc.

Have you noted HIV is the focus of his right now?

My person impression was that his appearance was from a possible assisination attempt on him, like the other man whose face got messed up. Especially since the day before Teresa Heinz Kerry had collapsed at a lecturn at a private home in Kansas, and he was quickly put in the hospital the next day - and then later was have Hillary passing out at the podium also.

But anyway, here is what I read on Clinton and his HIV focus lately:

Pangaea Partners with Clinton Foundation on Countrywide AIDS Treatment Programs

Former President Bill Clinton has made the global fight against AIDS a priority of the Clinton Foundation.


The William Jefferson Clinton Foundation has tapped the Pangaea Global AIDS Foundation as its treatment partner in Rwanda and the Bahamas as part of a bold, new plan to help government health services rapidly develop countrywide HIV/AIDS treatment programs. The partnership will focus on establishing local capacity to provide comprehensive HIV treatment and care, including the use of HIV antiretroviral drugs (ARVs), as well as to support the greater integration of treatment and care services with the countries' overall HIV prevention efforts.

continued

http://www.pgaf.org/newsletter/issue01/clinton_partnership.html

[Andrea]

Bill Clinton is an ex-president of the United States. He is even still referred to as President Clinton (as are all ex-presidents). Therefore, his health is a public concern. It is ridiculous to presume otherwise. That said, I noticed his failing health last spring from film clips of the opening of his library (when this 'chat' happened, but I was unaware of it then). Last night (Jan. 1, 2006), he was being interviewed by Dan Rather about a number of subjects, including his work with AIDS patients. Though I think speculation about the specifics of his diagnosis are dangerous and fruitless, I do think he is terminally ill. One of his telling comments last night was, "I don't know how long I have in this life" (or something roughly similar) Well, none of us do, but they slow, hesitant way he said that told me all I need to know.

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[deon]

On talking with former President Bill Clinton about his foundation's work to lower the cost of AIDS treatments in developing countries. The Clinton Foundation announced it had negotiated cheaper long-term drugs and faster AIDS tests.

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Former President Clinton checked into a New York hospital early this morning for what is described as "a low-risk operation to remove fluid and scar tissue

[online backgammon]

I don't care what he has and you shouldn't either what you are the study is to pray that Mr. Clinton recuperate in a timely fashion (hurry and get better Mr. Clinton This was Anderson from the Miller family

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[fio]

I agree that something is "off" here.

[sam]

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