Did George W. Bush Really Need A Stent?

[deminks]

http://www.forbes.com/sites/larryhusten/2013/08/06/questions-about-president-george-w-bushs-stent/

(Updated) – Former President George W. Bush received a stent today at Texas Health Presbyterian Hospital. Here is the statement from Bush’s office:

“During President George W. Bush’s annual physical examination at the Cooper Clinic in Dallas yesterday, a blockage was discovered in an artery in his heart. At the recommendation of his doctors, President Bush agreed to have a stent placed to open the blockage. The procedure was performed successfully this morning, without complication, at Texas Health Presbyterian Hospital. President Bush is in high spirits, eager to return home tomorrow and resume his normal schedule on Thursday. He is grateful to the skilled medical professionals who have cared for him. He thanks his family, friends, and fellow citizens for their prayers and well wishes. And he encourages us all to get our regular check-ups.

As someone who has followed the intense debate and discussion that has occurred in the cardiology community in the last few years about precisely this sort of case, I’m wondering about a number of issues raised here:

Did Bush experience any symptoms as a result of his blockage? According to the official statement, the blockage was uncovered during a routine annual physical examination so it seems unlikely that Bush had severe or unstable symptomatic disease. It’s unclear how Bush progressed from a routine examination to a stent implantation in less than 24 hours. This would not be a usual occurrence for most people.

(snip)

2. It’s often been pointed out that celebrities and VIPs receive medical care that differs from what the rest of us receive. But it’s unclear whether celebrity care is really any better. Many people believe that the undue attention given to celebrities leads to inferior care. Right now there’s no way to know what side of this question Bush’s case illustrates.

(end snip)

I heard Nancy Snyderman raise similar questions on Morning Jerk this morning. She was asking if Bush was not symptomatic, why the emergent stent procedure? She said they found a narrowing, not a blocked artery.

Asside from Bush's own statement that he hoped we all had frequent checkups (which millions of us don't have access to, Chimpy, thanks for reminding us), this may also be sending the wrong message as well.

[Scuba]

1. I would have recommended a stake.

[Mr. David]

2. and a nice steak and fava beans..... with chianti

</End Hannibal Lecter mode>

[rurallib]

3. If you are lucky enough to have check ups

can you afford the treatment?

Well I can't afford either so maybe Mr. Bush can have my stent as well.

[tridim]

15. Annual check-ups are now free thanks to Obamacare.

You can't afford $0.00?

[rurallib]

16. I can't afford follow ups.

[tridim]

18. But you said you couldn't afford both.

Misinformation about the reality of Obamacare drives me up the wall.

I expect it on Faux, but not on DU.

[rurallib]

20. please if you do not know my finances do not argue with me

yes I know that there are free check ups, but the follow ups and prescriptions are not. I have a very high deductible which pretty much precludes medical care except emergencies.
Hopefully next year, Obamacare will make some insurance more affordable. If not I am about 13 months from medicare. I am trying my best to balance a precarious situation.
I fought like hell for single payer that never got a sniff. i cried the morning Joe Lieberman decided that maybe he could not actually support lowering the medicare age.

[tridim]

21. Just stop spreading falsehoods about the ACA.

It's embarrassing to DU.

Just put me on ignore if you don't want to talk about it. Have a good one.

[rurallib]

22. what falsehoods?

[Myrina]

5. .... to his brain, maybe .... but not his heart.

n/t

[Buns_of_Fire]

6. Perhaps, but not as much as he needs an enema. nt

[Arkansas Granny]

7. I'm not a physician, I don't know what W's physician found and I'm not going to second guess

his diagnosis or the treatment.

There is no doubt that W receives better medical care than millions of other people, but he's certainly not the only one who does. I wish we could all have that level of care, and we all deserve it, but I don't begrudge the people who have it for making use of it.

[CTyankee]

8. my husband had that narrowing but his cardiologist said "no stent needed."

He's on appropriate medication and doing very well, now 4 years later...

[B2G]

11. It depends on the extent of the blockage

If the artery is over 90% blocked, a stent is required. Less than that can sometimes be treated by surgically cleaning it out or meds.

[CTyankee]

14. well, he had both the surgical cleaning and is on regular meds. It's a lot of pill taking but

hubby's fine, exercising, eating a good diet, and having his one glass of red wine at night....

[B2G]

17. I'm glad he's doing well.

So is my mom, thanks to a routine physical and a great doctor.

[CTyankee]

19. My biggest worry with him is falling. He's had 2 spinal surgeries and has recovered very nicely

but must steady himself with a cane and needs the extra railings we put in the stairwell. Because he's on Coumadin, a fall resulting in a bad cut could be disastrous...

[B2G]

9. You don't have to have symptoms to have a severe blockage

and require a stent. I don't understand the contraversy.

[deminks]

10. Another link

http://www.ptca.org/voice/2013/08/06/george-w-bush-gets-angioplasty-and-stent-was-it-necessary-1448

[yellowcanine]

12. People sometimes have symptoms and don't know what they are.

They think it is a case of mild indigestion or a sore muscle, etc. but it is actually a vascular problem. I don't think it is particularly useful for people to try to diagnose medical problems on TV based on news reports. We were highly critical of Bill Frist for doing this in the Terry Schiavo case. Let's be consistent.

Yes, Presidents get good medical care. So what? They would regardless of what kind of medical insurance system we had in the United States. I don't see the case of an individual President as being particularly instructive, particularly since we don't know the actual details. Let's keep our focus on universal access to good medical care regardless of rank or income and not get distracted by celebrity medicine.

[B2G]

13. Yes. My mom had severe carotid blockage that was found

in a routine physical. She was completely asymptomatic.

They stented on side (VERY quickly) and cleaned out the other surgically. She's just fine now, but was essentially a time bomb.

Sometimes the topics on this site astound me.

[deminks]

23. Yet another link: Bloomberg: George Bush’s Stent Surgery Revives Debate on Heart Care

http://www.bloomberg.com/news/2013-08-06/former-president-s-stent-surgery-reopens-debate-on-heart-care.html

Former President George W. Bush’s decision to allow doctors to use a stent to clear a blocked heart artery, performed absent symptoms, is reviving a national debate on the best way to treat early cardiac concerns.

The discussions have been ongoing since 2007, when the trial known as Courage first found that less costly drug therapy averted heart attacks, hospitalizations and deaths just as well as stents in patients with chest pain. The results were confirmed two years later in a second large trial.

(snip)

Stents are lifesaving when patients are in the midst of a heart attack, said Chet Rihal, an interventional cardiologist at the Mayo Clinic in Rochester, Minnesota, who has studied use of the devices. They allow immediate and sustained blood flow that help a patient recover, he said.

For those who aren’t suffering a heart attack, the benefits are less clear, according to Rihal. While stents may be used in patients with clear chest pain, there’s no evidence that they prevent future heart attacks, he said.

Two large-scale clinical trials completed within the last seven years have shown that drug therapy works just as well as stents in preventing cardiac complications. The three major U.S. heart associations changed their guidelines in 2011 in an effort to reduce excess treatment. A review of eight studies published last year in JAMA Internal Medicine also found no differences.

(end snip)

[UTUSN]

24. It wasn't a stent. It was an upgrade to the microchip. n/t