Statement Of Health Status
Prepared By
Mayo Clinic At The Request Of Senator John McCain
Victor F.
Trastek, M.D., CEO, Mayo Clinic In
Arizona
:
We have been asked by Senator McCain to provide medical
information pertaining to his care at Mayo Clinic.
I would like to reiterate that patient privacy is integral
to Mayo's core value that the needs of the patient come first, and we are releasing
this information at the request of Senator McCain.
Also, to be clear about the issue of the timing of
the May 23rd press conference, the release of the Senator's medical information
is a combination of two factors: scheduling and making certain that the release
included the most recent medical information. The Senator had physician visits at
Mayo Clinic as recently as earlier this month. Consequently, the date of May 23rd
was the earliest possible time that could be scheduled following his last visit,
given the calendars of the campaign staff as well as his three Mayo Clinic physicians,
and also taking into consideration the minimum amount of time necessary to have
complete information regarding his most recent medical evaluations.
At Mayo Clinic, we practice medicine with a coordinated
team approach, with our physicians working closely together on behalf of the patients
we serve. The following three physicians
comprise the team that has been primarily responsible for caring for Senator McCain
over the past several years at Mayo Clinic:
-
Dr. John Eckstein is a physician in our Internal Medicine Division
and has been caring for Senator McCain for the past 16 years
-
Dr. Michael Hinni is a surgeon in our Otolaryngology/Head
and Neck Surgery Department. Dr. Hinni specializes in surgical oncology of the head
and neck. He performed Senator McCain's left lower temple melanoma surgery in August
2000.
-
Dr. Suzanne Connolly is a specialist in our Dermatology
department, with extensive clinical experience. She is Senator McCain's dermatologist.
John D.
Eckstein, M.D., Internal Medicine, Mayo Clinic:
(bio & photo:
http://www.mayoclinic.org/bio/10395679.html)
I will begin with a synopsis of the Senator's general
health, based on his most recent comprehensive evaluation in March 2008 and a subsequent
follow up visit and tests earlier this month. At the present time, Senator McCain
enjoys excellent health and displays extraordinary energy.
While it is impossible to predict any person's future health, today I can
find no medical reason or problems that would preclude Senator McCain from fulfilling
all the duties and obligations of President of the
United
States
.
Senator McCain has been a patient at Mayo Clinic since
1992. He had periodic comprehensive
physical examinations during the 1990's and annual examinations since August 2000.
In this review of Senator McCain's health status, the
issues we will address include the following:
1) Skin Cancer
2) Urologic History
3) Cardiovascular Fitness
4) Orthopedic Status and
5) Medications
1) Skin Cancer:
Regarding his past skin issues, the Senator has received
skin care at Mayo Clinic in
Arizona
since August, 2000. Four malignant melanomas were surgically removed in the past. Three of these were “in situ” melanomas,
meaning they were limited to the top layers of the skin and were not invasive. These three early melanomas – on his
left shoulder, left arm and left nasal sidewall, were removed in 1993, 2000 and
2002, respectively. A fourth melanoma
that was invasive was removed from his left lower temple in 2000.
Each melanoma was a new primary melanoma and did not
represent a recurrence of any previous melanoma.
There was and is no evidence of recurrence or metastasis—meaning spread—of the invasive melanoma nearly eight
years after surgery. Other less serious skin cancers have been removed over the
years without complication. These have been non-melanoma basal cell and squamous
cell cancers.
Many questions have been asked about the removal of
the invasive melanoma from Senator McCain's left lower temple in August 2000. Dr. Hinni, who performed the surgery,
will explain in detail the surgical procedure. To
summarize, we continue to find no evidence of metastasis or recurrence of the invasive
melanoma as we approach the eighth anniversary of that operation.
This was most recently confirmed with his comprehensive examination
and tests in March 2008 and with Dr. Connolly's skin examination on May 12, 2008. The prognosis for Senator McCain is
good because the time of greatest risk for recurrence of invasive melanoma is within
the first few years after the surgery.
Michael
L. Hinni, M.D., Otolaryngology/Head and Neck Surgery, Mayo Clinic:
(bio & photo:
http://www.mayoclinic.org/bio/10569677.html)
The following is a summary of the surgical procedure
that I performed on Senator McCain in 2000.
- In August 2000, following
a 27 month absence from care at Mayo Clinic, Senator McCain was diagnosed with a melanoma
that was 2.2 millimeters thick at its thickest part and was 2 centimeters across.
This melanoma was located on the left lower temple region of the face.
-
Prior to surgery, numerous tests were performed, including CT scans, an MRI scan
of the brain, liver tests that included LDH, and there was no evidence that the
cancer had spread.
-
A comprehensive surgical procedure was done that included sentinel lymph node biopsy,
removal of the cutaneous melanoma and key lymph nodes, and reconstruction of his
left temple region.
-
A 2 centimeter margin of normal skin
was removed around the 2 centimeter melanoma, resulting in a 6 centimeter by 6 centimeter
roughly circular wound on the left side of the Senator's face. The underlying
Parotid salivary gland was also removed to assure a clear deep margin, to protect
facial nerves from injury and to remove the sentinel and other lymph nodes that
were inside the Parotid gland. None
of Senator McCain's lymph nodes showed any evidence of metastatic disease.
-
The large incision was necessary to safely remove all cancer with an appropriate
margin, resulting in a wound requiring sizeable reconstruction. This explains
why the large incision was made—it was necessary so that a flap of skin and soft
tissue consistent with the color and texture of the Senator's facial skin could
be elevated and advanced/rotated into the wound.
-
To answer what appears to be numerous questions about the prominence of the Senator's
left jaw: this is a result of an absence of soft tissue on the face in front of
his ear that makes the masseter (the chewing muscle) over the jaw appear more prominent.
To be clear, the swelling is not due to any evidence of cancer.
Suzanne M.
Connolly, M.D., Dermatology, Mayo Clinic:
(bio & photo:
http://www.mayoclinic.org/bio/10222821.html)
I will summarize the skin issues associated with Senator
McCain's care at Mayo Clinic. First,
I'd like to provide some background on melanoma, because it is often misunderstood.
-
The current estimate is that 1 in 58 Americans will
develop malignant melanoma in their lifetime.
-
Melanoma is a potentially serious form of skin cancer
and its incidence continues to rise. In 2008, it is estimated that there will be
116,500 new cases of melanoma—more than 54,000 that are not invasive (in situ) and
more than 62,000 that are invasive.
-
Although the exact cause of melanoma is not known,
avoiding excessive exposure to ultraviolet light is the most effective prevention
for all skin cancers, including melanoma.
-
Risk factors for developing melanoma include
many moles that are benign or atypical, a previous melanoma, immunosuppressed state, fair skin
and light eyes, excessive exposure to ultraviolet light, and a family history of
melanoma.
In speaking specifically about Senator McCain, his
risk factors include light skin, light eyes and a history of excessive sun exposure.
Senator McCain has no known family history of melanoma. He has few moles and he
has no known history of atypical moles.
As far as his skin care at Mayo Clinic is concerned:
As Dr. Eckstein and Dr. Hinni stated above, there has
been no evidence of recurrence of the invasive melanoma on the left lower temple
that was removed in 2000. I would repeat
again that the period of greatest risk for metastatic disease from that melanoma
was within the first few years.
At the present time:
-
The Senator has no evidence of melanoma.
-
He continues to monitor his skin carefully.
-
He comes in for a skin examination every 3-4 months.
-
He not only practices good habits of sun safety but also advocates them publicly.
Dr. Eckstein:
I will touch on a few additional aspects of Senator
McCain's health.
2) Urologic History:
-
He has
small kidney stones in his right kidney and a number of small benign cysts in both
kidneys. Neither of these issues impacts his kidney function.
-
He had 4 bladder stones which were fragmented
with laser in August 2001 and at the same time some benign enlarged prostate tissue
was surgically removed. Since then,
he has normal urination and has not passed a kidney stone.
-
He takes medication to help prevent future kidney
stones.
3) Cardiovascular Fitness:
- He has
no evidence of heart or other cardiovascular disease.
He walked the
Grand Canyon
rim-to-rim in August 2006 without problems, and continues to hike whenever his schedule
permits.
-
His current stress echocardiogram is
normal at a high level of exercise.
-
There is no evidence of decreased blood
supply to any part of his heart muscle.
-
In the past he had slightly abnormal
lipids, and now takes medication.
4)
Orthopedic
Status:
- He was
a Navy pilot in
Vietnam
, and his plane was shot down in October of 1967.
He broke both arms and a leg after ejecting
from his plane. He was a prisoner of
war in
Hanoi
for 5.5 years.
-
As a POW, he was beaten and tortured
repeatedly, and suffered fractures of both shoulders.
Because he received no treatment for his fractures, all fractures healed
with significantly reduced range of motion of his shoulders, arms and right knee.
-
He does not complain of bone or joint
pain and does not take pain medication.
5) Medications:
Current medications are:
-
Simvastatin, which is a cholesterol lowering medicine
-
Hydrochlorothiazide, for kidney stone prevention and Amiloride to preserve potassium
in the blood stream
-
Aspirin, for blood clot prevention
-
Zyrtec, an anti-histamine as necessary for nasal allergies
-
Ambien CR, as necessary for sleep when traveling
-
A multiple vitamin tablet.
###
Useful Definitions:
-
Basal Cell Carcinoma - most common type of skin cancer which most
commonly develops on sun exposed skin. They are more common in fair skinned individuals
and tend to grow slowly. They have a very low likelihood of metastasizing (spreading
to other parts of the body) but can
be locally invasive. Treatment is associated
with a very high cure rate.
-
Squamous Cell Carcinoma- second
most common type of skin cancer which
is primarily found on sun exposed skin in fair-skinned people. This form of skin
cancer can metastasize (spread to other parts of the body), but early treatment
is associated with a very high cure rate (>95%).
-
Melanoma - a form of skin cancer
which develops from the melanocytes (pigment cells) in the skin.
It can be mixed shades of tan, brown, black but also pink, red or white.
If treated early, it is curable.
-
Actinic Keratosis - small, rough,
scaly spots are found on light exposed skin especially in fair skinned individuals
and represent cells damaged by sun exposure. They have potential to progress to
skin cancer of the squamous type. They can be treated by a number of topical approaches.
-
Seborrheic keratosis - benign
lesions that never turn into cancer.
Do not require treatment; they may be treated for cosmetic reasons or if they are
irritated.
-
Metastasis - The process by
which cancer spreads from the place at which it first arose as a
primary
tumor to distant
locations in the body.
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