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Office of the Press Secretary

For Immediate Release September 25, 1999
                           PRESS BRIEFING BY
                              JOE LOCKHART
                           DR. CONNIE MARIANO

                        Bethesda Medical Center
                           Bethesda, Maryland

2:52 P.M. EDT

MR. LOCKHART: Hello. Welcome again here. As I'm sure you know, we've just completed the President's fifth physical examination here at Bethesda Naval. The President was quite pleased that we got through this very quickly and efficiently, in just about five hours. He began at 8:45 a.m. this morning, finished at about 1:45 p.m. You have a statement from the White House that describes the results of the physical examination. I think it's fair to say that the doctors gathered, led by Dr. Mariano, believe the President is in excellent health.

You will be getting shortly, as soon as the Xerox machine allows, a memorandum from Dr. Mariano that goes through the different procedures that were performed today and the results as available.

I want to take a moment to thank everybody here at Bethesda Naval who I think has done a good job on the public affairs front of taking care of you guys and taking care of the President. I particularly recognize Admiral Bonnie Potter, who the President welcomed and congratulated her on her recent addition of another star. She is the first woman admiral in the Navy Medical Corps and quite an accomplished person that the President appreciated.

Again, the President was very happy that this all went so efficiently, got through quickly. He managed to catch a lot of the golf this morning on the Ryder Cup. He plans to go back to the White House this afternoon, watch the rest of that and be in for the evening.

The way this is going to work is that Dr. Mariano is going to come up in a moment and walk through what happened during the day. At that point, when she's complete, we will turn the cameras off, we'll do some Q and A for five or ten minutes and then we'll be done and everyone can go home.

Dr. Mariano.

DR. MARIANO: Thank you, Joe. Thank you for all being here today.

As in the past, the President has been evaluated by a panel of physicians who are all board-certified in their specialty and who are well respected in their fields. Today, 12 consultants included physicians from both the military and civilian sector. I'd like to briefly introduce each one and as I mention their name, if they could just step forward to be recognized.

Dr. James Suen, Professor and Chairman of the Department of Otolaryngology and Head and Neck Surgery, University of Arkansas. Dr. Talal Nsouli, Associate Professor of Allergy Immunology at Georgetown University Hospital; Dr. Sushil Jain, Head of the Department of Optometry; Dr. David Adkison, Head of Orthopedic Surgery; Dr. Robert Kellogg, Department Head of the Physical Therapy Department; Dr. Craig Williams, the Navy Specialty Advisor for Podiatry; Dr. David Corbett, the Chairman of the Department of Dermatology; Dr. Paul Christenson, the Chairman of the Department of Urology; Dr. Richard Morrissey, the Chairman of the Department of Cardiology; Dr. Oleh Haluszka, the Director of Gastrointestinal Endoscopy at the University of Maryland Medical Center; and Dr. James Butler, Chairman of the Department of Gastroenterology. Thank you, Doctors.

As you know, this is President Clinton's fifth physical examination as President. His last exam was performed here at Bethesda in October, 1997. In 1998, the President did not receive an annual physical exam because of scheduling difficulties. But I'm sure he would be the first to agree that he did undergo multiple stress tests throughout that year. With the President's permission, I have released a report summarizing the medical findings from today, which you should be receiving a copy.

I would like to briefly go over that report. Let's start off with the numbers. Our 53-year-old President weighed in at 214 pounds on his 6-foot 2-inch frame. His weight falls within the normal range of 190-220 pounds for a man of his height. It reflects an 18-pound weight gain since his exam in 1997.

As a result of his weight gain, the numbers in his lipid panel are also elevated. His total cholesterol was recorded at 196, triglyceride count of 82. His HDL was 46; the LDL was 134, with a ratio of 4.3. Now, although these numbers are elevated since the President's last evaluation, they are still in the normal range, except for the LDL, which should be 130 or less. And, as a result, the physicians have recommended that the President focus again on a low-calorie diet and focus more attention also to his exercise regimen.

The other issues we looked at included the most recent episode of hoarseness. As you know, he's currently recovering from this year's episode of hoarseness following his trip to New Zealand. Our ear, nose and throat specialist examined his vocal cords and found swollen vocal cords, which were consistent with chronic irritation. We attribute this to gastroesophageal reflux and voice overuse. We have recommended that the President use voice rest for the next 10 days.

The President's chronic reflux was evaluated by an upper endoscopy procedure. To perform this procedure, the gastroenterologist used a special instrument called an endoscope that allowed him to look directly at the esophagus and the stomach. We performed this procedure without sedation, and the President tolerated it well. And the test revealed a normal esophagus and a normal stomach.

In terms of the President's allergies, as you know, the President continues to receive allergy shots every week. In view of his current hoarseness, the allergist recommended that we modify his medication regimen at least for the next week because of the hoarseness.

The dermatologist also evaluated the President in terms of his acne roseacea and his actinic keratosis, which are due to chronic sun exposure. The dermatologist did find two small actinic keratoses, which were noted, over the President's right eyebrow. And these were treated with liquid nitrogen.

Regarding the President's intermittent episodes of low back pain, the orthopedic surgeon and physical therapist consulted with him and recommended that he continue using stretching exercises.

In March of 1997, the President underwent surgical repair of the quadriceps tendon of the right leg. He was reevaluated today by the surgeon who performed that surgery and found to have completely recovered.

For his eye examination, the President had his reading glasses updated, and he underwent screening for glaucoma. His test was negative for glaucoma.

In 1997, the President was also prescribed hearing aids for high-frequency hearing loss. His hearing test was updated today, and demonstrated no significant change from two years ago.

And then, finally, in terms of testing, he did undergo an exercise treadmill test. I've listed the details in the report. The cardiologist felt his performance was outstanding for a man of 53 years of age.

And those are the major points of interest from the exam. As I mentioned, the details are in the report, which President Clinton has consented to release to you. And I will turn this back to Joe Lockhart to moderate any questions you may have. Thank you.

MR. LOCKHART: The report that Dr. Mariano is referring to is what we're waiting for. It will have the names of all of the doctors here, and will also have the names of the procedures, with the correct spellings. It will be here shortly, so you don't need to worry about it.

Let me turn this to questions, and I think we'll turn the cameras off. As soon as you're all ready, and we'll go to --

Q The reflux problem, what's causing that and how do you treat that?

DR. MARIANO: Actually, we've got some very good experts on the whole issue of reflux. There's been a lot of interest in the medical community about chronic reflux. And I think the person to do that justice would probably be Dr. Jim Butler. I'll have Dr. Butler come up and comment on that.

DR. BUTLER: A reflux disease is when acid flows up into the esophagus. And we feel that some of the President's hoarseness is probably secondary to gastroesophageal reflux disease. He's being treated with several different medications, right now, for his reflux. And -- I don't know what else you want me to say.

Q Diet? What sort of --

DR. BUTLER: There are dietary things for reflux, as well: not eating right before you go to bed; staying away as much as possible from caffeine, chocolates, fatty foods will also help prevent reflux.

Q And -- is that the medication?

DR. BUTLER: There are several different types of medications you can use.

DR. MARIANO: He's on Prilosec and Propulsid. He's been on that for several years now, primarily to control acid production and also to increase the tone of the lower esophageal sphincter, which allows acid to flow up into the esophagus.

Q -- about the medication, isn't there some sort of surgical procedure --

DR. BUTLER: Yes, there are several surgeries. One is called, Nissen fundoplication, and that is an option even for somebody who doesn't like to take medicine -- and that is an option to have that done, instead of being treated with medication. For right now, we're continuing with medications for the President.

Q In layman's terms, could you sort of explain a little bit more about the actinic keratoses and just how serious this is?

DR. MARIANO: Dr. Corbett is very good on that. Go ahead, Dr. Corbett, please.

DR. CORBETT: Actinic keratoses are due to chronic sun exposure. It's an accumulative amount of sun exposure. We typically get over about half of our lifetime's worth of sun damage by the time we're 20. These keratoses come once the body can no longer repair the solar damage that's done. We usually count them as a pre-cancer, figuring a small percentage of them, figure up to 10 percent, could possibly turn into a squamous cell type of skin cancer if they went untreated. They can also be tender and red and rough.

Q Can you tell us about what sort of exercise the doctor recommended?

DR. MARIANO: Dr. Adkison, do you want to --

DR. ADKISON: Sure. Well, the basis of any decent exercise program is first stretching, to maintain good flexibility of the joints. And that's primarily what we've emphasized. The President maintains a very active workout program, mostly in the White House gym. And so we encouraged him to continue with that, but certainly to emphasize stretching of multiple joints.

MR. LOCKHART: I'd like to make a couple of points on this. I think in talking to the President after the physical, I think as many of you know after the knee injury and the physical therapy regimen that he undertook, he basically changed his exercise regimen away from the jogging that he was well known for early in the administration to more stretching, more work in the gym, both with the Stairmaster and with weights.

And I think what he believes is, you know, he thinks looking at the weight gain he believes that some of it just comes from the more exercise, the more work with weights, but he believe his -- you know, he would much happier if he lost about 10 pounds.

Q Joe, any kind of -- this is muscle or --

MR. LOCKHART: Well, you work for Bloomberg. You can do the math. (Laughter.)

Q -- weight gain --

MR. LOCKHART: No, I think he -- you know, I think he keeps rough track of it and, like all of us, it fluctuates from time to time. But I think, as the doctor said, he does have a good exercise regimen. I think he, like anyone, needs to watch his diet, stay on the exercises. You all know, traveling with us, sometimes we make it impossible for him to do either of those things.

But I think what he believes would -- he would feel best and most fit if he could drop about 10 pounds.

Q Any chance of jogging again to do that?

MR. LOCKHART: No, I think the regimen that they've prescribed for him is quite good. It's just a question of some of the demands we make on him sometimes make that more difficult.

Q -- the excessive travel, and it's hard to get anything like that done. When he's in the White House for a week, how many days does he work out?

DOCTOR MORRISSEY: He stated three or four times a week, that he's been using the Stairmaster, going to the gym, and also doing light weight exercises and the stretch. It's a pretty good regimen if he's available to do it.

MR. LOCKHART: Yes, and on the road we have -- most times, at most of the hotels we stay at they have gyms, which, you know, many of you have seen him there early in the morning or late at night trying to get a workout in. There are just some days where, you know, if you look at his schedule on Thursday and Friday, it's hard to see how you could have gotten real exercise in. He may have, but he was working from the beginning of the morning until late at night.

So it's obviously -- I think it's a frustration at times not being able to do it on a more precise, regimented schedule. But I think, just by looking at the President you can see that he's in pretty good shape. But he'd like to do a little bit more and take off about 10 pounds.

Q How did you modify these allergy treatments?

DOCTOR NSOULI: I think what we decided to do is to cut down on the antihistamines that might cause more dryness of the throat and possibly increase, contribute more in the hoarseness. And we're going to keep him on decongestants right now. And he keeps taking his allergy shots.

Q Doctors, how would you describe the overall health of this 53 year old man, who weighs 214 pounds, if he was not the President of the United States?

DR. MARIANO: I'll turn it over to the cardiologist, who did the treadmill.

DR. MORRISSEY: I think the President is in outstanding condition. I believe the President is in outstanding condition and, where his work schedule permits, does a very good regimen as far as staying in shape and participating in exercise. We know that we like to see at least 20 to 30 minutes of exercise, and he achieves that when he's using the Stairmaster program that he has, in addition to stretching exercises laid out by Dr. Adkison and the weights.

When you look at basic health you want to make sure you're eating the right foods. He keeps an eye on the diet he's following. You want a regular exercise program. You put that all together and it keeps you in good physical condition. I think he's in outstanding physical condition.

Q Doctor, can you repeat your name, please?

DR. MORRISSEY: Morrissey.

Q And your first name?


Q Joe, how is the 10 days of voice rest going to work?

MR. LOCKHART: Can you ask me after the doctors have left? (Laughter.) We plan to implement immediately their advice, and we'll talk out in the parking lot about what we're really going to do. (Laughter.)

No, obviously, you saw from this week that we tried to turn the President's schedule around to give him at least one day. It's very, very difficult, given the commitments that he's made and the work schedule that he has, to do exactly what the doctors have recommended. But I think the President is concerned about the hoarseness and his ability to continue to make the fine speeches he makes around the country. So I think we're going to do our best to make sure we get him the rest he needs.

Q Given that prior commitments make it impossible to literally take 10 days off, what are the consequences, how long will it take him to heal, how much longer will it take him to heal and are there any complications that will come from --

DR. MARIANO: -- if he persists and --

DOCTOR LEONARD: He has some edema of his vocal cords, just from talking too much and some from the reflux as well. He had this happen two years ago, when he went to Australia; and then he just returned from New Zealand, talking on the plane where there is low humidity and talking and loud noises contributes to this swelling and problem.

And the problem is that unless he rests his voice, that edema won't go out and he will have to cut back on a lot of the unnecessary talking, such as yelling at football games today. He's going to watch the Razorbacks, and I told him not to yell. But he really has to cut back on his talking, as well as his speeches.

Q But yesterday he gave, like, five speeches, didn't he, Joe?

MR. LOCKHART: Steve, please. We told them two. (Laughter.)

Are we all done? Anything else? Thanks, everybody. Thank you, Doctors.

END 3:10 P.M. EDT