When Dr. Lisa Bardack[*] was asked to become Hillary Clinton’s personal physician in 2001, it had to have been a crowning moment in the career of the Mt. Kisco internist. Dr. Bardack could have anticipated little downside. She already had the responsibility — and legal obligation under HIPAA — to protect the privacy of her patient. She and her staff would have to be especially scrupulous in the case of a senator with presidential ambitions, but this should not have posed a serious problem.
Unfortunately, Hillary Clinton corrupts everyone who serves her. And this year Bardack encountered difficulties she could not have foreseen in 2001:
1. Clinton developed serious medical issues.
2. The candidate was being videoed, not only during campaign stops, speeches, townhalls, and the rare press conference, but before and after events — by individuals with cell phones who were under no obligation to obey orders given to servile journalists to turn off their cameras.
3. The internet not only permitted the mass distribution of these videos and photos, but it enabled those who were curious to check Bardack’s reports against information available on reputable medical sites. It also enabled skeptical physicians to share their doubts with hundreds of thousands of readers.
In July 2015, the Clinton campaign asked Bardack to give the candidate a clean bill of health. She was to disclose, selectively, some of her patient’s medical history. But the letter was not widely analyzed until after the disturbing September 11 video by Zdenek Gazda, the Zapruder of 2016. It was no longer possible to dismiss those asking questions about Hillary’s health as right-wing conspiracy theorists, and the campaign now requested a second letter from Dr. Bardack explaining the event. The physician duly issued a report on September 14. Now her real problems began.
Let’s take a look at the two letters and some of questions doctors have asked about the diagnoses and treatment.
Bardack’s summary revealed a couple of major health problems that had not been previously disclosed. We had been told that Clinton suffered an elbow fracture in 2009 and a concussion in 2012. The fact that a woman in her mid-60s would fall twice ought perhaps to have raised some red flags. In particular, unless you’re being tackled or attacked, a concussion can usually be avoided by the body’s reflexes. Arms are extended to break the fall.
But now the public learned that some time in 2009 and in December 2012, the month of the concussion, Clinton had suffered blood clots.
She already had a history of clotting. Running for the Presidential nomination in the fall of 2007, Hillary gave an extended interview on her 60th birthday in which she disclosed that she’d had a life-threatening medical emergency in 1998. The crisis had been kept a secret not only from the public, but from her staff, who were told she had a sprained ankle. Clinton’s foot had swollen and she was in great pain. A White House doctor told her to rush to Bethesda Naval Hospital, where the diagnosis of a blood clot was made. “That was scary,” Hillary said, “because you have to treat it immediately — you don’t want to take the risk that it will break lose and travel to your brain, or your heart or your lungs. That was the most significant health scare I’ve ever had.” Clinton assured the reporter that she was no longer on blood thinners. This was probably the last time Hillary spoke candidly about her health.
What Clinton had was a deep vein thrombosis, or venous thromboembolism (VTE). The blood clot is usually in the leg, and in Hillary’s case, it was behind the right knee.
Now Dr. Bardack revealed that Hillary had had two others. The first, in 2009, was another VTE, but the second was still more serious. It was a right transverse cerebral venous sinus thrombosis (CVST). This is a clot in one of the two channels between layers of the dura, the membrane enclosing the brain, which receive blood and cerebrospinal fluid. A clot here means that blood flow out of the brain is impeded, and there is the potential for a hemorrhage if there’s leakage into the cerebral tissues. The Johns Hopkins Health Library refers to it as a rare form of stroke affecting only five in one million individuals. It’s treated with anti-seizure medicines as well as anticoagulants, and the complications range from impaired speech, difficulty moving parts of the body, and vision problems to death.
There were two problems in the 2015 letter relating to the clot:
1) Clinton, her physician wrote, “began anticoagulation therapy to dissolve the clot.” But this is not something anticoagulants do. Two of these drugs are mentioned by Bardack: Lovenox, which was discontinued in 1998, and Coumadin (warfarin).
Bristol-Myers-Squibb, its manufacturer, says explicitly that the medication doesn’t dissolve clots:
COUMADIN has no direct effect on an established thrombus, nor does it reverse ischemic tissue damage.
Every doctor prescribing Coumadin knows this. Because of patient expectations, all reputable medical sites, like the NIH’s PubMed, repeat the warning.
There are thrombolytic (clot-dissolving) drugs, injected by catheter or infused through an i.v., but none are mentioned by Bardack. In any case, the embolisms for which thrombolytic agents are indicated don’t correspond to Clinton’s, and these drugs are never referred to as anticoagulants.
2. A second problem comes with the duration of the symptoms. Bardack says that these lasted for less than two months. But according to Bill Clinton, his wife’s injury “required six months of very serious work to get over.”
Of course it could be that the four addition months of symptoms were the result not of the concussion, but the CVST. However, it would not be easy to differentiate these symptoms. One is instinctively disinclined to take the former President’s word on anything, but there’d be no reason for him to exaggerate the length of time it took his wife to recover.
In any case, what the public was told was an elbow fracture (Hillary sported a State Department sling) and a concussion (she was jokingly presented with a football helmet by her minions) coincided with problems much more ominous.
3. A third issue in the 2015 letter is Bardack’s final evaluation of her patient. Twice she calls Clinton “a healthy female” and concludes that “she is in excellent physical condition and fit to serve as President of the United States.”
While Bardack could hardly have been expected to write otherwise, the truth is that anyone who is on lifelong Coumadin is not in excellent physical condition. As is well known, warfarin was developed as a rat poison, and increases significantly the risk of
intercranial intracranial bleeding. A recent ten-year study of 32,000 veterans found that nearly one-third developed intercranial intracranial bleeds while on warfarin. The vets were over 75, but the high figure was still very disturbing, though probably not surprising to most physicians.
Dr. Milton Wolf, a board-certified radiologist, writes, “Coumadin carries a substantial risk for patients, particularly those with fall risk. Spontaneous hemorrhage common, intracranial and elsewhere. I see it commonly, including life-threatening brain bleeds. Normal, healthy patients are NEVER, NEVER prescribed Coumadin.” There are safer anticoagulants. “Coumadin is typically given to those who can’t afford the newer drugs or reserved for cases that are refractory to the safer drugs.” Wolf speculates that Clinton probably has a hypercoagulable blood disorder. Coumadin would otherwise be given only to patients with chronic atrial fibrillation (like the vets) or with prosthetic heart valves, both of which can cause hypercoagulation.
The interactions with warfarin are also sobering. In addition to avoiding both NSAIDs and acetaminophen, users are advised not to use, or to use with caution, antibiotics, anti-fungal medications, anti-depressants, and seizure medication — carbamazepine (Carbatrol, Equetro, Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin).
Whether or not Hillary has been put at risk by seizure medications, the whole world now knows about her propensity to fall. The airplane and podium stumbles and her being helped up a short flight of steps had gone viral long before the 9/11 collapse. And we know nothing about the falls that have occurred off-camera, except for the one that gave her a concussion. Family friends have told Ed Klein these falls are frequent. And head trauma is the number one concern for patients on Coumadin.
4. Still another disclosure in Bardack’s July 2015 letter raised eyebrows. In addition to taking Coumadin for the rest of her life, Hillary will also be on Armour thyroid until she dies. Unlike CVST, hypothyroidism, an underactive thyroid gland, is common. In fact, the most frequently prescribed drug in the U.S. (though not the most lucrative) is Synthroid, synthetic levothyroidoxine, the major hormone the gland produces.
Armour thyroid is an extract of desiccated pig’s thyroid. The therapy dates to the 19th century, and the American Association of Clinical Endocrinologists recommends that it not be used. But a case can be made for natural thyroid therapy, and one recent study found that more patients prefer it, though there was no difference in the control of symptoms. These include memory problems and difficulty thinking clearly. A physician who is one of the most vocal advocates of natural thyroid switched to a different brand of natural thyroid after Armour changed the tablet formula in 2009.
1. Bardack disclosed that Clinton was given a brain scan for an ear infection after she had “experienced significant improvement in her symptoms.” The physician of a patient “in excellent health” would not normally order a CT scan for an ear infection that was being successfully treated by antibiotics and a myringotomy tube. Bardack’s caution, however commendable, suggests she was worried about some underlying problem.
2. Bardack then discusses Hillary’s pneumonia. When an upper respiratory infection persisted for a week after Clinton had been prescribed antibiotics and allergy medicine, Bardack, on Sept. 9, ordered “a non-contrast chest CT scan, including a CTA calcium score.”
According to Dr. Wolf, a CTA (a CT angiogram) scan always requires a contrast. On the other hand, a CT calcium score study must always be non-contrast, otherwise “the coronary calcifications would be masked by the contrast in the arteries.” The radiologist concluded that “Hillary’s doctor just claimed Hillary got a perfect score on a test that does not exist.”
It’s likely that Bardack misstated what she’d ordered — though one would think she would be extraordinarily careful in a letter that would be read by millions. A coronary calcium scoring CT does not use contrast, while a CTA requires it. A simple thoracic CT, which is what Hillary must have received, may or may not be done with contrast.
3. Then there’s the finding from the scan: “a small right middle-lobe pneumonia,” further described as “a mild non-contagious bacterial pneumonia.”
Doctors immediately questioned this diagnosis. There is no such thing as a non-contagious pneumonia, tweeted Dr. Wolf. How did Hillary pick it up? What about all the reports the campaign circulated about staffers who’d come down with pneumonia, including manager Robbie Mook?
While bacterial pneumonia is not as contagious as viral pneumonia, there is no test to determine whether or not a patient is contagious. A doctor defending Bardack listed three types of bacterial pneumonia not likely to be contagious. The only one that Hillary could possibly have had was aspiration pneumonia.
The dubious adjective “non-contagious” may have been dictated to Bardack by Clinton. The problem, obviously, was that after her collapse, the candidate went directly to her daughter’s apartment, where she presumably exposed her grandchildren to pneumonia, then, 90 minutes later, bounced out of the building, exulting that it was a beautiful day in New York, and embraced a little girl, exposing her, too, to the infection.