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Tue Aug 01 2006 18:05:22 ET

President George W. Bush
Summary of Medical History
August 1st, 2006

With a date of birth of July 6th, 1946, the President is 60 years old.

Past (and Interim) Medical History ???????????

� There is no past medical history of hypertension, diabetes, tuberculosis, sexually transmitted disease, or stroke.? The President benefits from a ?low? to ?very low? (favorable) coronary artery disease risk profile with a favorable family medical history, absence of modifiable risk factors;? superior fitness, favorable CAD markers (e.g. CRP, lipids) and functional studies (?stress echocardiogram?), and ?minimal/mild? coronary artery calcification noted on anatomic study (coronary artery computed tomography, 2004).

� Seborrheic keratosis.

� Actinic keratoses identified and treated with liquid nitrogen.

� Telangiectasias, nasal bridge, consistent with solar damage; treated 8/03.

� Vasovagal syncope, 1/02; solitary episode with identifiable precipitating event superimposed on longstanding, non-pathologic sinus bradycardia (consistent with a conditioned heart); evaluation 1/02, no sequelae, and no recurrence since 1/02.

� Adenomatous colonic polyps removed on screening colonoscopy.? Repeat colonoscopy in 6/02 was normal without polyps or mucosal abnormalities. Repeat exam anticipated in 2007.

� Mild high frequency hearing loss documented and stable on prior exams; speech frequencies excellent.? Currently no symptoms.

� History of seasonal allergic rhinitis; asymptomatic this spring with preventive seasonal use of nasal corticosteroid spray.

� The President has a history of activity-related injuries as noted below, which resolved without sequelae and do not impact his current duties. He continues a vigorous aerobic, weight training, and flexibility program.

? Musculoskeletal low back pain secondary to heavy lifting and tight ?hamstrings; fully evaluated in 1990; asymptomatic due to current exercise and flexibility program.

? Intermittent bilateral anterior knee pain, activity-related, with a left medial meniscal injury and subsequent surgical repair in 1997. Orthopedic and radiographic re-evaluation in 12/03 confirmed an old incomplete tear of the PCL of the right knee with resultant patello-femoral chondromalacia, post-traumatic degenerative changes, and asymptomatic medial meniscal damage, all most consistent with a remote athletic injury and physical activity. Symptoms resolved with quadriceps strengthening, cross-training (biking), and elimination of routine impact exercises (e.g. running) from his routine.

? Right calf running injury (strain/tear), 4/03, most consistent with overuse. Symptoms resolved.

? Minor abrasions and lacerations secondary to injuries sustained while biking, all healed without sequelae.

� Gastroesophageal reflux with well-defined triggers, 2005, without recurrence

� Vitreous floaters, infrequent, evaluated by retinologist 3/06; examination normal for age (non-pathologic age-related changes only).

� Mild hyperopic astigmatism/presbyopia, fully correctable. Uses reading glasses as-needed.

� Blood transfusions: none

Past Surgical History

� Appendectomy 1956
� Left medial menisectomy as above, 3/97


� The President takes a daily multi-vitamin. He does not routinely use prescription medications.


� The President?s immunizations are current for worldwide travel.

Social History

Tobacco: An occasional cigar Alcohol: None
Caffeine: Diet sodas and coffee
Exercise: The President exercises six times per week. Workouts include bicycling (15-20 miles, 15-18mph), treadmill (low impact ?hill-work?), elliptical trainer, free weight resistance training, and stretching.

Other: The President has not missed work due to illness since his last physical exam.

Physical Examination

Vital Statistics

Age: 60 years old

Height: 71.50 inches (without shoes)

Temperature: 97.5 degrees F (oral)

Weight: 196.0 # (last year 191.6#)

Body Composition: Body fat 16.8% (last year 15.65%; normal for age 16.5-20.5%; Cooper data)

Resting heart rate (seated): 46 bpm

Resting blood pressure (seated): 108/68

System-specific examination summary

ENT (ears, nose, throat): Nasolaryngoscopy and physical examination of the head, neck, and thyroid are normal. Thyroid function tests were normal.

Eyes: No ocular pathology was noted on ophthalmoscopic examination. Visual fields were normal. Distant visual acuity was 20/30 (r) and 20/25 (l) correctable to 20/20 in both eyes. Corrected near visual acuity was 20/20 in both eyes (the President uses reading glasses as needed).

Neurologic exam: Normal.

Pulmonary: Normal.

Gastrointestinal: Normal. Colonoscopy was last performed in June 2002. No recurrence of previously described symptoms consistent with occasional gastroesophageal reflux. Abdominal examination normal.

Cardiology: Physical examination of the circulatory system was normal. The resting EKG revealed sinus bradycardia consistent with previous exams and aerobic conditioning. Fasting lipid panel: total cholesterol: 174 (last year 178; ?desirable?<200); HDL: 60 (last year 56; >40); LDL: 101 (last year 100; ?optimal <100, ?desirable?/?near optimal <130); total cholesterol/HDL ratio 2.9 (last year 3.2); Triglycerides: 61 (last year 71; <150). hsCRP: 0.029 (range 0.0-0.5).? Homocysteine: 11.5 (range 7.6-20.8). Ankle-brachial index 1.27 (r), 1.25 (l) (normal 0.96 or greater).

The President underwent Balke protocol exercise treadmill testing (ETT) with echocardiogram. He exercised for a total of 26:02 minutes achieving a maximum heart rate of 179 bpm with a 1-minute recovery of 148 bpm (31 beat differential). No signs or symptoms of cardiovascular pathology were noted. Stress echocardiogram was normal. Screening ultrasound of the abdominal aorta was normal.

Dermatology: Lesions consistent with solar damage (e.g. telangiectasias) noted as in past. A small actinic keratosis was noted on left arm and treated with liquid nitrogen. Seborrheic keratoses also noted.

Musculoskeletal: General musculoskeletal exam was unremarkable.

Genitourinary System: Normal. PSA was 0.6 (normal < 4.0).


A standard battery of routine screening laboratory tests was performed and was unremarkable.


The President remains in excellent health and fit for duty. All data suggest that he will remain so for the duration of his Presidency.? Based on an overview of his examination and history the following clinical diagnoses are made:

1. The President remains in the ?superior? fitness category for men his age (greater than ninety-ninth percentile for 60-64 year-old men; Cooper).

� Low? to very low coronary artery disease risk profile. Coronary artery disease (CAD) "activity-marker" evaluation (including C-reactive protein, homocysteine, and lipids), and functional studies (exercise treadmill test) stratify the President to a low to very low coronary risk category. Continued ?therapeutic lifestyle measures (i.e. reduced intake of saturated fat and cholesterol, regular physical activity, and weight control) are appropriate.

� Sinus bradycardia, asymptomatic, non-pathologic, and consistent with a conditioned heart.

� History of vasovagal syncope without pathology, sequelae, or recurrence.

2. History of benign colonic adenomas with normal colonoscopy 6/02. Repeat colonoscopy currently indicated in 2007.

3. History of gastroesophageal reflux without recurrence.

4. Skin lesions consistent with solar damage. Actinic keratosis, treated with liquid nitrogen (note:? treatment may cause transient erythema). Recommend sun-protection measures (e.g. sunscreen, wide-brimmed hats, etc.).? Seborrehic keratoses--treatment not indicated nor requested.

4. Seasonal allergic rhinitis, well-controlled.

5. History of activity-related musculoskeletal injuries currently without symptoms or limitations.

6. History of mild high frequency hearing loss unchanged from previous examinations.

7. Vitreous floaters, infrequent, nonpathologic, normal for age.? Mild hyperopic astigmatism/presbyopia, fully correctable.


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