12.31.12

How Serious Is Hillary Clinton’s Blood Clot and Hospitalization?

Clinton was hospitalized to treat a ‘clot’ Sunday after a recent illness, fainting, and concussion. Dr. Kent Sepkowitz on what’s behind her spokesman’s terse announcement.

The mystery of what is ailing Hillary Clinton took an unsettling turn Sunday with the announcement that she was being hospitalized in New York City to treat a “clot” with blood thinners. As with the fainting and concussion announcement of a few weeks ago, the absence of information makes it very difficult—impossible, actually—to know whether Secretary Clinton is truly ill or simply in the midst of one of the routine bumps one receives known as middle age.

Here are the facts as carried by The Associated Press and parroted by the rest of the world: she is being treated for the clot, anatomic site unknown, “stemming from the concussion” of mid-December. The clot was discovered on a Sunday follow-up exam; right now she is receiving anticoagulants to prevent extension of the clot and will be in the hospital 48 hours. That’s all. It is noteworthy that she has received anticoagulants before, in 1998, after developing a clot behind her right knee, though the AP report does not mention the previous episode.

So, Kremlinologists, what do you think? Is Clinton faking a “diplomatic illness,” as suggested by John Bolton and echoed by other members on the incredulous right? Or is she mighty sick and maybe dying, and the Clinton misdirection machine is simply spewing out falsehoods to throw people like me off the scent? Or is she really being treated for a clot related to the concussion, and once again our desperate need to inflate all things Clinton into a psychodrama requires us to assume nothing is quite what it seems?

Unlike the relatively bland “concussion after fainting” pronouncement from earlier this month, this terse press release from her spokesman smells a little fishy. First it is odd that we are not told where the clot is—usually the clot, referred to as thrombophlebitis, occurs in the leg, a condition suffered by former president Richard Nixon after leaving the White House. The clot can be uncomfortable but is only dangerous and even life-threatening if it breaks free and travels downstream into the lung—a pulmonary embolus, in medical parlance. This is a condition that former vice president Dan Quayle developed soon after his term ended and that almost killed Serena Williams last year. Given that Clinton already has had this condition and those who have had one episode have a predilection to recurrence, the lack of a reminder of the 1998 clot from her press people seems a strange oversight.

Another problem with the “concussion then clot” story is this—the concussion, if indeed it came after a faint, should not directly predispose Clinton to a clot. Trauma to the leg or to the hips and pelvis might cause a clot, but we were not told of any leg injury. If there is no predisposing trauma—well, that might mean real trouble. “Trousseau’s sign” refers to a clot that forms in persons with cancer due to a tendency seen in many common cancers to readily form clots.

Alternatively, is it possible that the clot in question is one in the lining of the brain that can form after head trauma. She did have a concussion after some sort of impact to her head. Here, again, there is a presidential precedent. Ronald Reagan, soon after the end of his time in the hot seat, developed the condition called “subdural hematoma” after a horseback-riding accident. But anticoagulation is never given to persons with clots around the brain. They are either watched without intervention or surgically evacuated. So this possible explanation is out.

We are left with a story that is not easy to connect up with sparse information from the inside crowd, who could easily deflate speculation with two or three more measly facts. The National Enquirer has already declared Clinton to be suffering from a brain tumor, linking her observed weight gain, possibly from treatment for the putative cancer, and not-exactly-explained need to leave Obama’s cabinet to the grim diagnosis. Such a story no longer seems to me as implausible as it did after the faint and concussion reports.

Unlike politics, where truth can remain hidden forever, in medicine, sooner or later, the truth will out. Always.

Weakling that I am, I think I will give Clinton the benefit of the doubt one last time. Like so many, the thought of a life without the Clintons strikes me as more than a little sad, and so my judgment may be clouded.

But here goes: as someone with a history of clot, it may be that the bed rest she took after the concussion caused a clot recurrence. Bed rest is well known to do just that, which is why hospitals go to great lengths to prevent clot in bed-bound hospitalized patients by applying inflatable stockings to squeeze the calves intermittently or else by giving injections of blood thinner. And maybe her concussion was pretty bad, and she was dizzy and miserable and in bed a lot, and eventually the clot returned. And she or Sunday’s doctor spotted it, and she really only needs 48 hours in the hospital to smooth things out and be sent on her way.

Maybe. In the swirl of guesses and smart-guy insights, this much about her condition is certain—unlike politics, where truth can remain hidden forever, in medicine, sooner or later, the truth will out. Always.

Update:

A reader wrote suggesting an alternative diagnosis for Ms Clinton that is quite plausible: superior sagittal sinus thrombosis. This is a very rare condition that can occur after head trauma, something we assume Secretary Clinton sustained after her faint, given the claim of a concussion. The simplified version is this (Wiki also gives a nice explanation): the brain has a unique way of draining the blood pumped into it. Unlike the rest of the body, with its familar lattice-work of arteries and capillaries and veins, blood leaving the brain empties into a complex system of sinuses (completely unrelated to the sinuses that drip and congest in people with "sinus conditions") including the superior sagittal sinus, which eventually drains into the central venous sinus. Should thrombosis occur in this anatomic area, a patient might have headaches, dizziness, or even stroke-like symptoms. And the treatment is exactly what Secretary Clinton is receiving—blood thinners. That said, a 48-hour stay to tie together this complex a diagnosis and treatment seems remarkably swift, even for persons such as the Clintons for whom sophisticated home care could be arranged.