{"id":106328,"date":"2016-09-12T12:05:11","date_gmt":"2016-09-12T20:05:11","guid":{"rendered":"http:\/\/lukeford.net\/blog\/?p=106328"},"modified":"2016-09-12T12:05:11","modified_gmt":"2016-09-12T20:05:11","slug":"what-happened-to-hillary-2","status":"publish","type":"post","link":"https:\/\/lukeford.net\/blog\/?p=106328","title":{"rendered":"What Happened To Hillary?"},"content":{"rendered":"

An internist writes to Rod Dreher<\/a>:<\/p>\n

The most likely diagnosis \u2013 in my mind \u2013 an acute cardiac arrhythmia \u2013 either ventricular tachycardia \u2013 or more likely atrial fibrillation with a rapid ventricular response. A FIB with RVR is very very commonly associated with people feeling flushed or overheated \u2013 for quite extended periods of time \u2013 dizziness and nausea are also possible. When they exert themselves \u2013 it is not unusual at all for them to have complete syncope like she appeared to do today. If not afib with RVR \u2013 it is possible there could have been some other supraventricular tachycardia \u2013 there are several different types.<\/p>\n

(A side note \u2013 this is NOT without precedent in modern American presidential history \u2013 If you will recall the incident where George H W Bush stood up and vomited all over the Prime Minister of Japan at a state dinner. That incident was precipitated by exactly this \u2013 AFIB with RVR.)<\/p>\n

Why am I gravely concerned about this diagnosis?<\/p>\n

In my experience as a physician \u2013 this can happen at any time \u2013 however \u2013 it typically and often happens at times of great stress. Cardiac arrhthymias can be very easy to control \u2013 or very difficult to control. However \u2013 this has often meant \u201cretirement\u201d for my business executive patients down the years \u2013 the syncopal events can simply happen at very inopportune times and cause all kinds of havoc for the person and his\/her company. This is NOT the type of thing that I would want my President to have during a very stressful time.<\/p>\n

My fear is that it is fully known what is wrong with her \u2013 and this is being hidden from the American public.<\/p>\n

By the way \u2013 the diagnosis of \u201cpneumonia\u201d being put forth by her physician \u2013 Dr. Bardack \u2013 is just simply imbecile. A patient who would have this kind of event with pneumonia \u2013 would NOT be up and walking around an hour later. If this type of thing happens during pneumonia or any other infection, the patient is almost always suffering from sepsis \u2013 and not up and walking. Again \u2013 this is imbecile. Third year medical students know better than this.<\/p>\n

By the way \u2013 as an internist \u2013 I have been very very concerned about the reporting of the physicians covering Trump and Clinton. There is something clearly mentally wrong with Trump\u2019s personal physician. I am not sure what is wrong with that guy \u2013 but something clearly ails him. The scrutiny there was deserved and as of yet has not been answered even remotely by the Trump campaign. For the life of me \u2013 I do not know why there has not been equal attention on Dr. Bardack \u2013 Mrs. Clinton\u2019s physician. It has been known for a few weeks to internists in America connected to social media THAT Dr. BARDACK IS NOT BOARD-CERTIFIED by the American Board of Internal Medicine. If you look at the website for the American Board of Internal Medicine \u2013 and look her up \u2013 abim.org \u2013 you will find that SHE IS NOT BOARD-CERTIFIED. Why would Mrs. Clinton release a medical statement from a non-Board Certified physician? I have been puzzled by the fact that the national press has made such a deal about the failings of Trump\u2019s physician (rightly so) \u2013 but chirping crickets about the obvious board issues with Dr. Bardack. Any ideas about that?<\/p>\n

I have no doubt that Mrs. Clinton may have been diagnosed with pneumonia on Friday. That is entirely possible. 70 year olds have pneumonia all the time. My point is that pneumonia in and of itself \u2013 WOULD NEVER make someone do what happened today. I am fully aware of walking pneumonia \u2013 and indeed \u2013 by definition \u2013 it is \u201cwalking\u201d. It is a type of pneumonia caused by very specific organism(s) that are much different than those types that will put you in the hospital. The point being \u2013 walking pneumonia will produce ill symptoms \u2013 often a cough and overall malaise \u2013 but will never ever cause a syncope like episode. Pneumonia or reaction to antibiotics simply do not produce what happened today in the absence of many other grave symptoms \u2013 and believe me people would not be walking through a parking lot with these symptoms.<\/p>\n

I want to clarify the cardiac arrhythmia issue as well. AFIB with RVR is but one of many types of rhythm problems that could be going on \u2013 it is by far the most common therefore the most likely. This is what happens when people have afib: the atria \u2013 the top chambers of the heart \u2013 are beating in total chaos. Normally \u2013 your AV node protects the bottom part \u2013 ventricles \u2013 or pumping chambers from being exposed to the chaos. You can go for long times months even years without any problems at all. However, ever so often the AV node fails in its protection \u2013 the chaos from above is transported to the ventricles below and suddenly the bottom of the heart is beating 150, 160 whatever. Just think how you feel after 15 minutes on a treadmill. Running hard. Heart rate of 150 \u2013 light-headed and short of breath. Now imagine that you get off the treadmill \u2013 and your heart just keeps right on going at 150. In about 10 minutes you will begin to feel very bad. This is manifested in different ways by different people. Shortness of breath is very common. The feeling of being flushed or hot is very common. Nausea and vomiting are very very common. But your heart will not slow down. After several minutes of this \u2013 even the most simple exertion like walking \u2013 can lead to such low blood pressure that you will have syncope (pass out). That is why AFIB with RVR is so high on the differential diagnosis of the tape I saw today.<\/p>\n

Something else of concern that has been running through my mind since I saw that tape is yet another diagnosis that I neglected to put in the initial discussion. This is EXACTLY how people will react if they have an implantable defibrillator and it fires. This would be the same as having the big paddles put on you in the ER \u2013 and shocked. Over the past 20 years or so \u2013 we have been putting \u201cpaddles\u201d directly into patients chest that fire and shock them whenever the computer that is attached to them perceives there is a problem. These patients would already have a diagnosis of a cardiac rhythm problem. One of two things in my experience happens. 1) The rhythm problem comes out of nowhere \u2013 and the patient is shocked. They would seem to drop to the ground instantly 2) Often, the rhythm problem is lurking for several minutes before the shock occurs. It all depends on the diagnosis and the settings of the device. But the patient will often feel very very weak and tired, dizzy, hot and light-headed in the seconds\/minutes before the device fires. When it does fire however \u2013 most of the time \u2013 the patient goes down temporarily \u2013 just like Mrs. Clinton did today.<\/p>\n

Will someone ask her please if she has a defibrillator in her chest? This may or may not be so \u2013 but do you want someone who can be shocked like that in charge of the country in a crisis?<\/p>\n

I want to for personal reasons address concerns about my ethics in some of the above comments.<\/p>\n

I agree \u2013 no diagnosis should ever be made without the patient being right in front of you. And many of the tapes and videos used in the past month about Mrs. Clinton\u2019s health have been \u201cout there\u201d. I am not making a diagnosis on her \u2013 I am offering up medical facts about what could have caused something like this to occur. Common things occur commonly. This video today is clearly not from the lunatic fringe like some of the others I have seen this past few weeks. I am gravely concerned about this after what I saw today \u2013 and I wholeheartedly believe the voters need to know the whole story \u2013 whatever that may be \u2013 and what the campaign is telling and putting forth makes little sense medically speaking. As is so often in politics \u2013 it is the lies and confusion put forward to cover things up \u2013 that gets people in trouble.<\/p>\n

I like most of America am absolutely dismayed with the choices we have this year for President. This video today did not help decrease my concern about this election.<\/p>\n

Another question I have \u2013 and about this I need to be perfectly clear. Had I seen that video on any of my patients \u2013 and believe me \u2013 having things caught on video is actually very common in medicine today \u2013 my very very first reaction would be GET THAT PATIENT TO THE ER \u2013 I AM MEETING YOU THERE. Why on earth was Mrs. Clinton not rushed to the hospital???? \u2014 That issue alone brings up all sorts of concerning thoughts in my mind..<\/p>\n

And about her personal physician \u2013 Dr. Raback. In my haste \u2013 to get the previous comment done \u2013 and typing quickly \u2013 I did not fully convey her status with the Board of Internal Medicine. (This is really in the deep woods) If you care to do some research about this issue \u2013 Board Certification and its maintenance is HIGHLY CONTROVERSIAL among internists now. (Please see drwes.blogspot.com for full details). She is listed as CERTIFIED \u2013 but NOT PARTICIPATING in MAINTENANCE. That means that she has made the decision not to maintain her certification. She passed her initial exams and was certified at some point in the past \u2013 but is not participating in maintaining this going forward. At some point \u2013 this will put her at great risk of being dropped from insurance panels, etc. This is a huge thorn in the side of the internal medicine community at this point. The whole thing is a total mess. It is an example of government regulation gone horribly awry. But the fact of the matter is that she is not participating in her continued certification \u2013 There are those in internal medicine who would think that to be not a good thing.<\/p>\n","protected":false},"excerpt":{"rendered":"

An internist writes to Rod Dreher: The most likely diagnosis \u2013 in my mind \u2013 an acute cardiac arrhythmia \u2013 either ventricular tachycardia \u2013 or more likely atrial fibrillation with a rapid ventricular response. A FIB with RVR is very … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[185],"tags":[],"class_list":["post-106328","post","type-post","status-publish","format-standard","hentry","category-hillary-clinton"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/106328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=106328"}],"version-history":[{"count":1,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/106328\/revisions"}],"predecessor-version":[{"id":106329,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=\/wp\/v2\/posts\/106328\/revisions\/106329"}],"wp:attachment":[{"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=106328"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=106328"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lukeford.net\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=106328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}