By Michael D. Shear and David Brown
Washington Post Staff Writers
Saturday, May 24, 2008
FOUNTAIN HILLS, Ariz., May 23 -- As he sought the presidency twice over the last decade, Sen. John McCain has been the object of unusually aggressive medical care by a large team of doctors, who on Friday released thousands of pages of records that document he has been cancer-free for almost eight years.
The extraordinary release of what the campaign described as "every single piece of paper" in McCain's medical records for the last eight years is an attempt to confront concerns about the 71-year-old Arizona senator's fitness to serve as president and questions about his age. He would be the oldest president ever elected to a first term.
"Senator McCain wanted to be very transparent," said Nick Muzin, a Washington doctor who is serving as a medical adviser to the campaign. "He wanted to dispel any notions that he is in any way unfit to be president. There are no surprises in the medical records."
The campaign also made available three of McCain's doctors at Mayo Clinic Scottsdale, the Arizona campus of the famous hospital with its headquarters in Rochester, Minn.
The records detail the five-hour operation in August 2000 to remove the most severe of McCain's four cases of melanoma, efforts to reduce the facial puffiness the surgery produced, and the strategy of dermatological hypervigilance that followed.
Melanoma is a form of skin cancer that is rapidly fatal if it spreads to distant organs, such as the lungs and brain. Physicians now examine the senator's skin every three or four months. He has had more than a dozen patches of abnormal skin cut out or chemically destroyed this decade.
McCain's doctors have also paid meticulous attention to complaints unrelated to his skin. He has been treated for kidney and bladder stones, undergone surgery for an enlarged prostate and been evaluated several times for dizziness originating in the inner ear. He has also had four colonoscopies, two exercise stress tests and innumerable CAT scans and blood analyses.
The records, numbered at 1,173 pieces of paper by a McCain campaign official, shed light on why the 2000 surgery was more extensive than what is normally done for melanoma that has not spread beyond the deepest layers of skin.
In a meeting attended by McCain, his wife, Cindy, and an unidentified "physician friend," Mayo Clinic ear, nose and throat surgeon Michael L. Hinni described how he was going to remove a large oval piece of tissue from the left side of the senator's face. He told them "it seems feasible to use this incision to remove all of the lymph nodes in his neck that are at risk, as he is going to incur the morbidity [damage] of the incision" anyway.
A "sentinel" lymph node -- located by injecting the melanoma with blue dye before surgery -- proved to be cancer-free. Nevertheless, a total of 38 lymph nodes, along with a portion of the parotid salivary gland, were removed.
The large opening in McCain's face was filled with a flap of skin that was cut from behind his ear.
The records suggest that McCain was concerned about his appearance after the surgery, complaining several times the scar was "thick" and visible and that his face appeared swollen. He underwent a minor operation to minimize the scar and later wore a face mask designed to put pressure on the scar to help it heal.
"Patient is to wear the garment at night since he will not be able to do that during the day due to the nature of his work," a doctor wrote. The records show that McCain rarely wore the mask because he was unable to sleep with it on.
In addition to his battles with cancer, McCain has been treated for slightly elevated cholesterol, arthritis and noncancerous polyps in the colon. The doctors described his various ailments as minor and said they should not interfere with his ability to serve as president.
"I want to say emphatically: Senator McCain enjoys excellent heath and displays extraordinary energy," said John Eckstein, his personal physician of 16 years at Mayo. "There is no medical reason or problem that would preclude Senator McCain from fulfilling all of the duties and obligations as president of the United States."
McCain reported dizziness in 2000, described by a physician as "mild positional rolling sensation with rapid turning of his head when he gets out of bed in the morning." This was diagnosed as "benign positional vertigo" and was treated by teaching McCain to move his head so as to relieve the sensation.
Doctors said tests of his heart showed no sign of cardiac disease that would increase the risk of a heart attack. The records indicate that during two stress tests for his heart, he was able to exercise on a treadmill for 10 minutes.
"He feels well. Has hiked the Grand Canyon rim to rim in 3 days this August," one of his doctors, Suzanne Connolly, wrote in November 2006. "Energy level is good."
Doctors detected bladder stones in 2001 and shattered them with a laser while also performing surgery to reduce the size of his prostate. He continues to have four kidney stones and takes medicine to reduce the likelihood of future ones, his doctors said Friday.
Doctors said they discovered and removed noncancerous polyps from McCain's colon during a routine screening in 2008. He continues to be mildly bothered by degenerative arthritis in his shoulders, hands and knees, in part because of abuse at the hands of his Vietnamese captors.
McCain is taking several medications, including simvastatin for high cholesterol, low-dose aspirin, hydrochlorothiazide to reduce the stone-forming calcium in his urine, and amiloride to counteract the loss of potassium that hydrochlorothiazide produces.
There was no mention of McCain's psychological or emotional state in the documents beyond numerous references to him being "pleasant and energetic."