Sunday, June 22, 2008

Bill Clinton - Pump Head

When I attended my daughter’s graduation from the University of Michigan last year, there was great excitement among the audience. It was just about the pride of seeing your son or daughter on their university commencement day. It was also about the fact that former president Bill Clinton was going to give the commencement address. Not a bad gig for the husband of the woman was fighting for the presidential nomination in this battleground state (remember this was when, not now).

A great applause greeted his step to the podium. Then he began to speak. The sentiments and ideas about going out into the world and making a contribution toward a better world were fairly stock commencement sentiments nicely worded.

Surprisingly, though, they weren’t nicely said. Clinton hesitated, paused over phrases, stammered. I was wondering where was the fluidity of speech, the eloquence of man known as a great campaigner and speaker. I recalled his State of the Union speeches. He didn’t sound like this then.

And this past year, as the campaign continued, there was a whole series of remarks that seemed out of context and personal attacks against former friends and supporters that didn’t ring right.

As reported by Melinda Beck in the Wall Street Journal, aides to Bill Clinton last week denied speculation that the former president's intemperate remarks on the campaign trail were due to mild cognitive damage from his quadruple-bypass surgery in 2004.

"This theory is false and is flatly rejected by President Clinton's doctors, who say he is in excellent shape...." the statement said.

But the condition dubbed "pump head" or "bypass brain" is well known to doctors but few warn patients about it.

Symptoms include short-term memory loss, slowed responses, trouble concentrating and emotional instability. As noted by Beck, in the New England Journal of Medicine in 2001, researchers at Duke University Medical Center tested 261 patients before and after bypass surgery and found that 53% of them had significant cognitive decline when they were discharged -- and 42% still suffered from it five years later.

One explanation is that when a patient's blood is pumped through a heart-lung machine during bypass, tiny air bubbles, fat globules and other particles may enter the bloodstream. The pump can also damage platelets, which form clumps, and clamping the aorta loosens bits of plaque. That debris can travel to the brain and clog tiny capillaries, forming microscopic strokes.

So we may fix the heart, but, at the same, endanger the head. Surgery is always a risk, and it helps to really understand all the complications that occur.

The best answer lies in the prevention of coronary artery disease (CAD). There are approximately 30 million people in the US and top five EU countries who suffer from CAD. And, although, mortality rates are declining due to better therapies, it still remains one of the leading causes of death in the developed countries.

Lifestyle change and the use of drug therapies like statins clearly help, and, by aggressively managing against those initial symptoms of trouble and family history, patients can defer what used to be inevitable.

It is clearly better now to prime the heart pump into good long-term health than pay the consequences later. Yet while many patients think the surgery is a great fix (which it is), there are still many other risks that affect not just the heart but also the brain. There is no bypass there.