McCain's Health Records

The Washington Post's Michael Shear passes along the following pool report.

Read it after the jump.

Pool Report

John McCain Medical Records

Reviewed at the Copperwynd Resort and Club in Fountain Hills, Arizona May 23, 2008, 7:30 am PT to 10:30 am PT By Michael D. Shear The Washington Post





LOGISTICS:

About 20 reporters-- including CNN's Dr. Sanjay Gupta and NBC's Dr. Nancy Snyderman -- were allowed to enter a room at the resort in the back of the Alchemy restaurant. We were allowed in at 7:30 and given three hours to review the records and take notes. Most reporters used computers to take notes from the three stacks of documents that were provided to each of them. The main stack, labeled "Records from Mayo Clinic, Scottsdale, Arizona, 2000-present" were the main documents and are summarized below. The other two stacks were backup documents, including handwritten notes, lab results and insurance documents. In all it was 1,173 pages, in addition to 1,500 pages distributed the last time he ran for president.



The backup stacks included the statement of financial responsibility, assignment of benefits and authorization to release information, forwarded documents from the attending physician of the U.S. Congress, including lab results, clinical notes, pathology reports. Insurance details, doctor's orders and anesthesia reports. The documents went into great detail about his operations to remove melanomas and colon polyps.

Some notes handwritten; others are electronic.



It was a cloudy day of about 56 degrees and we were given fruit, bagels and some muffins, along with some nicely sculpted mounds of cream cheese. No one ate anything, as far as I could tell.



Below is an overview, followed by some specifics from each of the doctor's appointments in the records.





OVERVIEW:

The records document the health of Sen. McCain (referred to in some documents by a pseudonym which the campaign requested not be released) as tracked by doctors at the Mayo Clinic. The records document the following major issues that he has faced over the last eight years:

cancer (melanomas on his left face, his left arm and his nose); dizziness that was diagnosed as vertigo; blood in the urine, which was diagnosed as caused by an enlarge prostate and bladder/kidney stones; high cholesterol, which appears to be successfully treated with medicine; some pain in his shoulder, hand and knee joints diagnosed as degenerative arthritis; evidence of polyps and diverticulosis in th colon, and some other minor medical ailments along the way.



The cancer diagnosis and the following checkups dominate the medical records. Following the surgery to remove the cancer from the left side of his face and neck, he was seen every three or four months by Dr.

Suzanne Connolly at the Mayo Clinic. In addition, he was seen annually by Dr. John Eckstein for a complete phyiscal. The rest of the records show visits for tests (such as echocardiograms or a colonoscopy.)



The initial cancer was diagnosed as a "malignant melanoma 2.2 mm in thickness and was HMB-45 and S-100 positive." It was removed in a 5- hour surgery that also removed lymph nodes, which were declared free of cancer after the surgery. The surgery left him with a scar that over the years swelled up, causing him discomfort and concern about his looks. He underwent one smaller surgery in the year after to try and reduce the scar and he for a time used a face-mask to try to reduce the scarring. The cancer on his left arm was a much less involved surgery that appears to have gone without much comment in the years since.



Since the surgery, McCain's doctors appear to have been very aggressive in looking for other possible occurrences. In each of the cancer checks, Dr. Connolly reported using liquid nitrogen to "destroy" minor growths on various parts of McCain's body. In some cases, those were sent for biopsy, and most of them came back as either benign or as the very curable basal cell or squamous cell cancer.



In late 2001, a spot on the left side of his nose came back as a malignant melanoma. He had surgery to remove it in early 2002.

Following the surgery, doctors performed some nasal reconstruction.



Other than the nose spot, the records indicate no recurrence or spread of the cancer to other parts of his body. CT scans of his abdomen repeatedly show no indication of cancer.



Sen. McCain reported dizziness on several occasions in 2000 and 2001, saying that it happened when he woke up and moved his head quickly. It was diagnosed as vertigo. They manually tried to maneuver his head to relieve the symptoms, which have seemed to diminish in the last several years.



The blood in the urine was diagnosed as problems related to a "very large" prostate and bladder stones. He had a "resection" of the prostate to surgically reduce its size. That surgery appeared to have largely solved the problem, though scans later indicated kidney stones. Doctors encouraged him to increase the amount of water he drinks and to decrease the amount of sodium in his diet.



His cholesterol was recorded as being high in 2003 (cholesterol of 226 hdl 35, ldl 139, triglycerides 260) and he was put on Vytorin, a medicine which worked in reducing his cholesterol in subsequent checks. He was taken off that medicine earlier this year because of reports of an increased risk of heart disease. He was put on simvastatin, a different medicine, that did not reduce the cholesterol by as much but was deemed "acceptable."



He had two colonoscopies, one in 2000 and another in 2008. Both discovered some evidence of diverticulosis. The one in 2008 discovered polyps, which were removed but found to be non-cancerous.



The doctors noted overall that McCain appears to be very healthy, with a lot of energy. They noted several times that he was pleasant and cooperative. They noted that he smoked two packs of cigarettes a day for 25 years before quitting in 1980, but check x-rays and echocardiograms noted no serious heart disease. In both echocardiograms, he went for between 9 and 10 minutes on the treadmill. "Senator McCain is a very pleasant, healthy-appearing man,"

his doctor, John Eckstein, noted several times.



My favorite line from the records, for those of you who want a light moment in your stories: From Dr. Suzanne Connolly, his oncologist:

"Buttocks unremarkable except for some very light tan freckling."



NOTE: A more detailed pool report by my colleague, David Brown, on the cancer surgery and its specifics will come as soon as possible. But I wanted to get everyone this as soon as possible.





VISITS:



aug 15, 2000 -- dignosis: "malignant melanoma with focal superficial invasion (0.23 mm thickness) overlying a dermal scar."

from thompas v. colby md..





8/18/2000

Mayo Clinic

Dr. John Eckstein (Senator McCain's principle physician)



McCain reported dizzyness. McCain reported "mild positional rolling sensation with rapid turning of his head when he gets out of bed in the morning."



Did hearing tests, lab tests, MRI of brain.



"These studies were normal except for mild-moderate high frequency hearing loss"



Cancer:



Melanoma on left temple and left upper arm Temple one: 2.2 MM thick



8/17/2000 -- scans of the chest, abdomen and pelvis come back clear "I see nthing to suggest abdominal or pelvic metastases," said Dr.

Nelson on the radiology report.





8/18/2000 -- from the dematopathology biopsy: "A basaloid nest of epithelial cells is present in teh superficial dermis and is focally connected to the epidermis. There is peripheral palisading, and the dodule is sparated fr the dermis by a cleft. Focal pigment is present within the tumor. The examined edges of the pbiopsy specimen dp not appear to be involved."





Surgical report, 8/19/2000



"The patient recovered rapidly in the recovery room and was promptly removed to his room.



Final diagnosis: one lymph node negative for tumor left neck dissection: 33 lymph nodes negative for tumor.





11/7/2000:

melanoma follow up

dr. suzanne connolly



Mood pleasant. looks well. not tanned"

"no clinical evidence of recurrence."

chest x-ray and ldh norma



11/8/2000 -- colonoscopy

history of polyps. (previous one may 1997.

coloscopy clear.





11/8/2000 -- biopsy of left lower leg -- turned out to be squamous cell carcinoma



3/9/2001



"for the scar on the left temple, suggested cosmetic coverup. we have given him samples of products we have available today."





4/19/2001 --- "scar revision" to make the scar look better





8/17/2001 --

Comprehensive checkup

john eckstein



"Since then there have been no known recurrence of the melanoma"



"I urged him to watch his saturated fat intake to make sure that he gets regular exercise and that he not gain weight."



melanoma followup:



michael hinni -- surgeon

"delightful gentleman"

"nmalignant melanoma, no evidence of recurrence"





edema (swelling) of his reconstruction



From Dr. Hinni: "This is quite subtle; however, I do think that for him, as he is often in the public eye, it is a cause for some concern and I am quite sensitive to that."



"He is not interested in considering other therapies or operations to correct this, being relatively pleased with how things have gone and states quite openly that he is quite pleased with this Institution and describes it as a wonderful place."





Complaints of bleeding in urine:

"He has intermittent bleeding on and off since then. It got worse when he was up at Lake Powell on a jet ski."

scheduled a ressection of the "very large" prostate



8/29/2001 -- resection of the prostate operation



1/17/2002

general skin check

growth below left eye, spot on nose



"no clinical evidence of recurrence of past melanoma"

biopsy for nose and growth below left eye



1/17/2002 -- returns with vertigo.

symptoms last "very briefly"





chest x-ray -- chest is negative.



1/25/2002

lesion under the eye is benign



nose: it has been interpreted as malignant melanoma in situ.





2/5/2002

"he underwent surgical resection of a nasal lesion.





5/29/2002

cancer checkup

suzanne connolly





on left shoulder:



"There appears to be a subtle increase in pigment from the midportion of that scar superiorly. We have taken a Polaroid photograph of this area. Will wish to biopsy this too."





11/6/2002: Concerns about swelling of the scar on his face



"He does note that he has some fluctuating fullness along the left jaw line. this seems to be more prominent with exercise or with exposure to increased heat."



"Remainder of exam unremarkable save for photodamage."





1/3/2003

having a problem with his left great toe fungal infection of the toe





4/4/2003

cancer checkup.

suzanne connolly



"aware of a few rough patches on the hands."



offered option of reconstruction for the scar.

"patient will consider further."





8-28-2003

comprehensive exam

john eckstein





"He feels well most of the time. he gets about five to six hours of sleep each night and does not have sleep attacks during the day. he exercises by walking a gread deal when in washington dc and also on hiking vaction."





8/28/2003

cancer check, suzanne connolly

rough patches on hands, etc

"he is doing an excellent job of photoprotection. continue with his good habits."



12/6/2003 - facial lymphedema

swelling of scar continues to bother patient.



"In today's session, patient was educated in, instructed in, and demonstrated self massage."



Full facial mask: a mask was designed to put pressure on the scar and lessen the swelling.



"Patient is to wear the garment at night since he will not be able to do that during the day due to the nature of his work."'





12/16/2003/

cancer check

suzanne connolly



"i do not see any worrisome lesions."





12/120/2003

cholesterol of 226

hdl 35, ldl 139, triglycerides 260



"because of the low hdl cholesterol and elevated triglycerides, i believe lipid-lowering medication is indicated."





1/5/2004

check of lesions on upper lip/nasal sidewall not anything worrisome





3/17/2004

cancer check

suzanne connolly



"no clinical evidence of recurrence of past melanomas."





7/27/2004

check of a small growth on abdomen.

discussion of the scar

suzanne connolly



"he has used the compression device for the facial scar but he has not used it routinely. It makes sleeping difficult. He does feel that there has been some softening of the scar.



"no clinical evidence of recurrence of past melanomas"





from connolly: "Phone call to patient . advised regarding path pignmented actinic keratosis/lentigo. no evidence for skin cancer.

Great news!"





11/2/2004

cancer check

suzanne connolly



growth on his neck

he would like me to check it

suspect it is a "neuroma, and indeed, this is a ball-like structure that is painful with firm compression."





2/25/2005

cancer check

suzanne connolly





one small leision on the right breast. "best to remove to confirm the nature of this lesion."

-- pathology returns as benign





3/25/2005

comprehensive exam

john eckstein



height: 175.3 CM, weight: 78.93 KG, BMI: 25.68



stress echo cardiogram

9 minutes, 16 seconds -- "exercise echocardiogram negative for myocardial ischemia."



started on vytorin 10/10





8/29/2005

cancer check

suzanne connolly



"Cooperative, looks well, not tanned."



small scar biopsied on the left scapula

squamous cell





11/28/2005

cancer check

suzanne connolly





1/19/2006

cytoscopy



1/20/2006

traveling extensively over the last several weeks -- develped concentrated, dark-colored urine.

blood





it sounds like an episode of urinary track infection





2/21/2006

comprehensive exam

john eckstein



cholestrerol better: 153, HDL: 39, LDL 88, tryglicerides: 131



pain in the shoulders, knee

takes no pain medication





2/21/2006

cancer check

suzanne connolly



"no clinical evidence of recurrence of past malignant melanomas"



ARTHRITIS



scan of hands

mild digenerative changes at the dip jints, thumb ip joints, long and little finger mcp joings and thumb cmc joints.



shoulders:

severe degenerative changes at the glenohumeral joint.





6/1/2006

cancer check

suzanne connolly



"continues to have some intermittent swelling of the left jaw area.

This tends to occur especially if he has been up for prolonged periods of time I understand."



no worrisome lesions.





11/17/2006

cancer check

suzanne connolly



"He feels well. Has hiked the Grand Canyon rim to rim in 3 days this august. energy level is good. with the hike, he lost 10 pounds and has not regained it, but he has had no further weight lost."



"doing a very good job of photoprotection."



"he requests a flu shot today. will arrange to have that given."



"no clinical evidence of recurrence of past malignant melanomas"





1/8/2007

saw spot on forehead.

suzanne connolly



"Almost flesh-toned papule, not quite 4 mm in size. ... I do not see any worrisome features."





4/10/2007

comprehensive exam

john eckstein



"Over the years, he has had numerous non-melanoma basal cell and squamous cell cancers excised from various locations. There has been no recurrent melanoma or metastatic disease. His chest x-rays and liver function tests have always been normal."



current cholesterol: 155

hdl: 34, ldl: 83, tryglycerides: 190



4/10/2007

cancer check

suzanne connolly



"no clinical evidence of recurrence of his past melanomas"





4/20/2007

biopsy of left lateral canthal site

returns: "no skin cancer identified."





8/31/2007

cancer check

suzanne connolly



"actinic keratoses: treated 6 with liquid nitrogen ioncluding that on the left upper back, left midforearm, the one on the right dorsum nose and the very few on the upper forehead. all should resolve."





2/6/2008

cancer check

suzanne connolly



"He has felt well. he has been very busy with his campaign."



"Feels well. He has been very active with campaigning and has lost a few pounds he feels because of that. Energy level is excellent."



right upper shin: biopsy by shave techniue of a portion for diagnosis.

await path before determining appropriate treatment of remnant



squamous cell carcinoma in situ





3/10/2008

comprehensive exam

john eckstein





"His weight decreaed from 169 to 163 pounds in the past year and attributes this to his long days and frenetic pace."



alcohol: very infrequent. two drinks per month



blood pressure: 134/84





cholesterol: 151

hdl: 35, ldl: 90, triglycerides: 128

still on vitorin



"he needs to force fluids and decrease his diatary sodium."

because of bladder stone





3/10/2008

radiology of abdoment. CT scan



"no evidence of metastatic melanoma in the chest, abdomen, or pelvis.

metabolically and clinically active stone disease in the right kidney



echo cardiogram

exercised on a "bruce protocol" for 10:0 achieving 145% FAC







3/29/2008

thyroid sonography

ultrasound of a small, superficial palpable nodule in the left periauricular region...

(a small neuroma)



4/1/2008

colonoscopy report



"the colonoscopy showed extensive diverticulosis throughout the colon and a total of 6 colon polyps ranging in size from .3 cm to .6 cm. The polyps were removed from the ascending and transverse colon. All polyps proved to be tubular adenomas without high-grade dysplasia."





Take off of vytorin

switch to simvastatin 20 mg daily in view of the recent ENHANCE study as reported in the NEJM and presented at the American College of Cardiology meeting.





5/12/2008

cancer check

suzanne connolly



no new lesions.



cholesterol 192

hdl: 42, ldl: 123, triglycerides: 135

"These are slightly higher than in march because i switched him from Vytorin 10/10 to simvastatin 20 mg daily. These numbers are acceptable and I will leave him on simvastatin 20 mg."



Presented by

Marc Ambinder is an Atlantic contributing editor. He is also a senior contributor at Defense One, a contributing editor at GQ, and a regular contributor at The Week.

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