Posted on 03/09/2005 11:47:23 PM PST by neverdem
The condition for which former President Bill Clinton will undergo elective surgery on Thursday is a complication that occurs in fewer than 1 percent of coronary bypass patients, his doctors said yesterday.
The complication, in which fluid and scar tissue compress and collapse a lobe of the left lung, is not expected to recur, the doctors said at a news conference at NewYork-Presbyterian/Columbia University Medical Center.
The doctors said they expected that Mr. Clinton "will resume his work without limitations" within a month. Doctors not involved in Mr. Clinton's care agreed that the complication was unusual and did not pose serious long-term problems. All the doctors interviewed expected him to recover fully and quickly.
One heart surgeon not associated with the case, Dr. Konstadinos Plestis of Montefiore Medical Center in the Bronx, said that irritation from even a small amount of fluid collecting in the chest after bypass surgery could lead to the formation of a layer of tissue that can cover the left lower lobe of the lung like a thick sock.
"That can squeeze the lung down," Dr. Plestis said.
The squeezing prevents the lung from inflating fully and causes shortness of breath, which Mr. Clinton had noticed. Mr. Clinton will undergo general anesthesia for what his doctors said is a low-risk procedure.
But when asked to specify the risk on a scale of 1 to 10, Dr. Joshua Sonnet, a chest surgeon who will perform Mr. Clinton's operation, did not give an answer. To free the lung, surgeons must peel off the thickened tissue in an operation that takes about two hours, Dr. Plestis said.
One of the first steps in the surgery, to give doctors room in which to work, is to collapse the lung, which is done with a special breathing tube that blocks air supply to one lung. Dr. Plestis said that to remove the thickened tissue, doctors normally try the least invasive method first, inserting a miniature video camera and surgical tools between the ribs through three small punctures in the chest.
If that approach does not provide enough access, they must make an incision in the chest, about three inches long, and spread the ribs. The open operation is usually faster than the one using the camera, but it is more painful.
In addition to the usual risks of surgery, like infection and bleeding, Mr. Clinton's operation can cause tiny injuries that let air leak out of the lungs. Dr. Plestis estimated the risk of leaks at 20 percent to 30 percent. The injuries heal, but patients are usually kept in the hospital until the leaks have stopped, he said.
Dr. William Follansbee, a cardiologist at the University of Pittsburgh, said that fluid and inflammation in the chest after bypass surgery could sometimes be cleared up with drugs, and that only a minority of patients needed surgery.
Dr. Follansbee said the problem did not mean the original surgery had been done improperly. Some people may be more prone to accumulate fluids and develop irritation and inflammation.
But once Mr. Clinton is treated, he said, there is no reason to believe the problem will recur. The operation can take one to three hours, depending on the complexity of the surgery.
Mr. Clinton first noticed symptoms from the complication about a month ago when he began getting winded more easily during his exercise program of walking six to seven miles a day over a hilly course near his home in Chappaqua, N.Y. Mr. Clinton also felt discomfort in his left chest.
The combination of the two problems as well as findings from examining his chest and X-rays led the doctors to recommend the surgery, called decortication, said Dr. Alan Schwartz, the chief of cardiology at NewYork-Presbyterian/Columbia.
CT scan X-rays showed a decrease of about 25 percent in Mr. Clinton's lung volume and a larger, but unspecified, decrease in lung function. There was no sign of infection; irritation of the pericardium, or covering of the heart; or pneumothorax, a different type of lung collapse than what he has, the doctors said.
Because Mr. Clinton passed an exercise stress test "with flying colors" - he scored in the 95th percentile for a 58-year-old man - the doctors considered the timing of the procedure elective. So they said he could safely travel to Indonesia on Feb. 19 with former President George Bush to tour South Asian nations devastated by the Dec. 26 tsunami.
If Mr. Clinton does not have the procedure, there would be a small risk that the collapsed area of the lung could become infected.
Dr. Craig R. Smith, the cardiac surgeon who led the team that performed Mr. Clinton's bypass operation on Sept. 6, estimated that fewer than 10 patients among the 6,000 on whom he has performed bypass operations have needed surgery for the complication that Mr. Clinton experienced.
Most patients develop fluid in the lungs after bypass and other chest surgery, but the body usually absorbs it in time without need for surgery. Sometimes diuretic and anti-inflammatory drugs help.
"What has happened here is the extremely unusual end result of an extremely common process," Dr. Smith said.
Dr. Smith said he was "quite sure" that he did not tell Mr. Clinton about the risk of this complication because it was so low.
FReepmail me if you want on or off my health and science ping list.
I'm glad I read this article, because I was really worried.
Inflammation can be nasty, but also can be controlled with diet. I don't think that Slick ever paid much attention to his diet until being on South Beach before his surgery, which did him a world of good. Could be he's back to his old rotten eating (and perhaps other) habits.
I do send up a prayer for his recovery. But there's a TEN OUNCE premie on another thread that is getting most of my prayers.
"Mr. Clinton will deservedly die a slow, horrible death."
Not nice. In fact, downright nasty.
Remember too, that should Bubba have an unforseen complication on the operating table, that the resulting State Funeral and the scene of a weeping, heartbroken Hillary Clinton will just about cement her status as the '08 nominee for the 'Rats.
I can hear Bill Clinton now, as he's rolled into the operating room, "I hope all you doctors are Democrats", and then thinking to himself "Say now, wait a minute..."
"Mr. Clinton will deservedly die a slow, horrible death."
Ouch! For those of you here who are Christians..Just a reminder..Luke 6:32-36.."If you love those who love you, what credit is that to you? Even 'sinners' love those who love them. And, if you do good to those who are good to you, what credit is that to you? Even 'sinners' do that. And, if you lend to those from whom you expect repayment, what credit is that to you? Even 'sinners' lend to 'sinners' expecting to be repaid in full. But, love your enemies, do good to them without expectation of getting anything back. Then your reward will be great, and you will be sons of the Most High, because he is kind to the ungrateful and the wicked. Be merciful, just as your Father is merciful."
I certainly have not achieved this admonition as a Christian but it is what we need to strive for. If an individual or a group is actively seeking to do harm to persons or our society, we are justified in stopping them if we can. However, the Clinton's now have a legacy which will not be changed and therein lies the consequences for them..I do not believe it serves us here to be this vicious today and I hope we can offer up sincere, personal and group prayers for this former President as he undergoes this surgery.
When this first came out, the MSM was saying this was no big deal, blah blah blah.
My wife has worked as a critical care nurse for 15 years, many of them in surgical intensive care, when she heard what it was, she said "Those people are full of crap. This is not minor stuff."
I certainly do not wish him ill as a patient. I would like to see him answer for many things he was responsible for as President, though, particularly the transfer of technology to China and campaign money from China.
I understand your anger at the damage Clinton has done to the country, but please, think before you write things like that.
One of the differences (besides, of course, reality) between FR and "the other site" is...civility.
Clinton was a weak man who was offered temptation in many ways, and sadly, for him and our country, could not resist the temptation. As much as I dislike what he has done, I pity him.
'Mr. Clinton will deservedly die a slow, horrible death.'
Wow. Are you really THAT mean & nasty? Sheesh!
I thought I read here on FR (during his first surgery) that it is more difficult to do surgery on those who have used drugs (like Clinton). Something about it's difficult to sew up these folks...something about the muscles. Can anybody throw some light on this please?
Thank you.
Wanna bet he is not itching to give an Affirmative Action doctor "an opportunity" to work on him?
Wanna bet he is not itching to give an Affirmative Action doctor "an opportunity" to work on him?
I agree with you but don't forget that if Bubba goes, so goes Hillary's prime political strategist, without whom her candidacy is meaningless.
President Reagan was and remains our shining star, but Clinton was and remains so heinous that he mobilised the conservative movement to fight and win. As such, we should be perversely thankful he came along.
Prayers for his recovery.
Regards, Ivan
I don't know about 'muscle problems'.
But I DO know that heavy drug or alcohol 'users' present difficulties for the anesthesiologist. The more you drink (or get high) the MORE anesthesia it takes to knock you out and keep you out. And if its a long operation this is a problem - a big problem.
In my 'younger days' I'd have a couple-three 'martinis' a day (after work). And when I had to go in for knee surgery and then back surgery, the anesthesiologist was NOT pleased with me. He explained the difficulties my drinking would cause him.
(I don't drink anymore)
IMO Clinton's cocaine use (alleged) was the reason his initial heart surgery was delayed for three days. They were waiting as long as possible for his body to purge the drugs in his system.
Thank you for your reply. I appreciate it.
You are very welcome :-)
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