December 7, 2014

If Obama's "symptoms are consistent with soft tissue inflammation related to acid reflux and will be treated accordingly," does that mean he has acid reflux?

"Obama, 53, went to Walter Reed military hospital for a fiber optic exam of his throat and since swelling was detected, doctors decided to perform a CT scan as well... The CT scan was normal."

Am I right to think that the reason for the hospital trip was to exclude throat cancer? Does a normal CT scan mean there is no cancer? As someone with legal expertise, I see the weaseling in "consistent with soft tissue inflammation related to acid reflux." So I'm especially interested in comments from readers with medical expertise.

77 comments:

rhhardin said...

Acid reflux means too much lying. Now he's got swelling.

khesanh0802 said...

Will he pay the deductible and co-pays?

Anonymous said...

It is beginning to look like Christmas. More Obama is looking bad - more Hillary is looking good.

More and more people are saying (thanks to NYT) that Hillary was the star during the Clinton White House years.

If only, she was chosen in 2008!

So, now, 2016 is for Clinton.

The Take-Back-The White House Campaign has started. NYT has the "XX" angle already as a meme.

GOP: You are a toast. You were a loser to begin with. Now, this is the beginning of the end.

glenn said...

Well, he does smoke.

Quaestor said...

I'm not a medico (if I'm deleted, that's OK) so my opinion is worthless. Nevertheless I'd speculate that a CT scan would not have the resolution needed to detect early onset cancer. In light of Obama's history of smoking a biopsy, or at least a laparoscopic inspection of the esophagus should have been ordered. Chris Hitchens might still be with us if his cancer had been detected earlier.

The problem is a president's health is not primarily a medical issue, is it?

Michael K said...

You should be able to tell if reflux is occurring on endoscopy. The esophagus may have changes and the stomach contents can be seen flowing back into the esophagus.

It sounds like they were concerned about seeing "swelling." That's why the CT.

The most serious result of reflux is Barrett's esophagus, which is a change from normal squamous lining of the esophagus to columnar epithelium which is more resistant to acid. Barrett's esophagus is premalignant.

SociallyExtinct said...

A sore throat for 2 weeks is alarming and I'm hardly a doctor.

My question...what is a CT scan and can it be used to conclusively determine anything, or is it a tool used to eliminate/narrow possibilities?

ddh said...

Some weasel words in medicine present because of jurisgenic tortitus, but I suspect that the President's military physicians-- who cannot be personally sued for malpractice--are making a tentative diagnosis, which will be confirmed by observation or test results later on.

President-Mom-Jeans said...

I really hope it is cancer. Very aggressive cancer.

Quaestor said...

Does Obama have simple acid reflux, or is it GERD?

Original Mike said...

Is Zeke cool with the CT?

Beldar said...

I too have only legal training and experience, but in that I've seen many medical records. "X consistent with Y" is ubiquitous. As I am given to understand from past explanations by physicians, they write down objective symptoms and subjective complaints; from those they construct a differential diagnosis. If there's a particular diagnosis that seems a likely fit — but that they're not yet ready to confirm, at least in writing — they'll flag that for future re-consideration by themselves or others through this "consistent with" language.

You'd see this, I believe, in anyone's medical records, and I wouldn't ordinarily react to that phrase as being suggestive of weaseling or waffling or dissembling.

Because the words "President Biden" frighten me so badly, I pray for President Obama's health; I'm glad his CT scan was normal.

But because we are now talking about information released from a military doctor at the direction of the Obama White House, my default assumption is that someone has scrubbed and massaged it for political considerations. I don't need to see weaseling to know that, I only have to look at their history over the last six years.

Hagar said...

A CT scan for acid reflux?
I don't believe that much.

Ann Althouse said...

When I hear medical talk, it seems often to be saying what the observable symptom is, and even where there is a diagnosis of a condition, the condition seems to be only a statement of the symptom/symptoms.

I'm saying this as someone with anosmia. They have nothing to say about what caused it. They're just restating what the symptom is.

In the case of acid reflux, it seems only to be a statement of the symptom, which might have a number of causes, and then when they further distance themselves by saying "symptoms consistent" with the symptom, that sounds like they have nothing.

So they treat the chronic sore throat as if it's caused by acid reflux, but it's not as though that treatment would do anything harmful if acid reflux were not the cause of the sore throat. (It's just about what, when, and how much to eat and drink, mostly, I think.) So you change some things, and it might help with the symptom.

Tacitus said...

acid reflux is several orders of magnitude more common, so there's that. Unless there is post facto mention of a biopsy I would not suspect cancer.

Lord knows Obama has had ample reasons of late to be having the taste of acid and bile in his mouth.

Tacitus (MD)

Michael K said...

I think the CT was because of seeing some sort of "swelling" in the pharynx or esophagus. No mention of a biopsy. Then they said the CT was normal. Maybe an excess of caution.

Ann Althouse said...

"A CT scan for acid reflux? I don't believe that much."

What level of Obamacare gets you a CT scan when you complain of a sore throat?

But... at Michael K (the doctor who commented above) said, they did the CT scan after what they saw in the endoscopy.

Beldar said...

I would be interested in the sourcing for the article's confident description of Pres. Obama as "former smoker." Never in American history has there been so large or successful a conspiracy to conceal one cigarette smoker's broken promises and false reassurances that he has quit, will quit, did quit, etc.

It's probably Obama's least consequential set of lies, though, and the most forgivable.

pm317 said...

So big boy finally choked on the bile he spews on the rest of us.

Seen on another blog.

Beldar said...

Perhaps the physicians among us can elaborate on the distinction, if there be one, and if it be a significant distinction here, between "acid reflux disease" and episodic "acid reflux" of less than twice-a-week frequency.

pm317 said...

What level of Obamacare gets you a CT scan when you complain of a sore throat?

and, if it is diagnosed as cancer, will he have to consult the death panel? will he have to take the red or blue pill? Consult Zeke, the death doctor. Gruber may be unavailable.

Original Mike said...

"Will he pay the deductible and co-pays?"

He's the President. It's on you.

chillblaine said...

Aloe Vera, Mr. President. Grow your own and break a stalk off into your iced tea. Take that plant with you everywhere you go, like you are Leon in "The Professional," dragging that fern around.

Or, maybe this is a PsyOp designed to get us speculating whether the President is drinking. Worked during the Bush years.

Ann Althouse said...

"No mention of a biopsy. Then they said the CT was normal. Maybe an excess of caution."

No mention of no biopsy either.

A normal CT scan doesn't entirely exclude cancer, does it?

You could try to massage the info without lying by saying the CT scan was normal and not mentioning the tests you didn't do... right?

David said...

Of course they are concerned with cancer. He's a lifelong smoker.

Because he is the President, he gets every test possible to check things out. Smoking can aggravate reflux as can stress, and reflux is far more common than cancer. So for most of us, the endoscopy would probably be the end of it. For the President there's more.

Or maybe the endoscopy was concerning. They are not going to tell us.

(I have had chronic reflux for years. Aciphex completely controls it in my case, but if I miss the drug for more than a day, the reflux returns. )

richard mcenroe said...

Maybe it's not acid reflux OR cancer.

Could it be he's finally being eaten up by shame, embarrasment, guilt and fear of the consequences of his own actions?

*pause*


Naaah... he'd rather have cancer than any of those...

David said...

"A normal CT scan doesn't entirely exclude cancer, does it?"

No. Obviously cancer is a concern for him, but it can be undetectable for a while. Wait and see if he has another scan in 3-6 months.

My guess is that his symptoms must have been pretty strong. But smoking aside there's a lot in the way he lives that can trigger reflux. (Those hamburgers for example.)

pm317 said...

It was all unscheduled.. spur of the moment run to Bethesda and their explanation was that he was not busy otherwise and it fit his schedule.. yeah, it was a rainy, dreary day in DC. No golfing in the rain.

Original Mike said...

"But smoking aside there's a lot in the way he lives that can trigger reflux."

If I had to deal with Harry Reid, I'd have acid reflux (wait, I do have acid reflux...)

pm317 said...

"CT scan was normal"

CT scan apparatus worked normally.

DrSquid said...

If one follows the news often and for a long period of time, sooner or later you will come across a story that is right in your wheelhouse. As a practicing otolaryngologist with over 20 years in the military, I think my occasion has arisen.

Persistent throat irritation is extremely common, as is acid relux (aka GERD, laryngopharyngeal reflux). Less common but certainly not rare is squamous cell carcinoma of the pharynx/larynx, aka smoker's cancer. Average age of diagnosis is 58 years old, so our dear leader is in the ballpark for considering this diagnosis. It's a clinical picture I encounter several times per week, without the the presidential component.

The finding of tissue inflammation of the lower pharynx is the hallmark of acid reflux and would be easily detectable on fibreoptic exam; it's severity does not always correlate with the severity of symptoms. It would need to be fairly extreme to hide appearance of developing carcinoma. If I was concerned re this possibility of cancer I would do a direct laryngoscopy under anesthesia for careful inspection of the anatomy, then biopsy any suspicious sites. Typically the cancer is not hard to recognize and the pathologist confirms the suspicion.

I would not rely on a CT scan to detect and membranous changes I could not see with the scope. Perhaps these military doctors were just being extra cautious, or perhaps their commander in chief suggested the CT scan himself. Since putting the world's most powerful (and smartest!) man under anesthesia is sort a big deal, they appear to have chose the less invasive and less informative method of diagnosis.

Treatment of reflux is a "proton pump inhibitor", such as prilosec or nexium. Military hospitals were required to prescribe aciphex when I was in, not because it was the best, but because it was the cheapest. Doubt that has changed.

BTW I think Beldar has it about right in his understanding of doctor-ese

Bob Boyd said...

If you will remember, the extremist, Tea Party Republicans forced a cut of the WH kitchen budget as part of the sequester. As a result, Obama has had to eat a lot of mac & cheese, Top Ramen, junk basically. Then Hillary stops by the other day with some cookies she'd baked and.....well that was last straw. The poor guy's guts are boiling.

Hunt Brown said...

my experience with acid reflux is you know you have it before it's diagnosed... waking up with hot stomach acid spewing into your mouth is something you tend to take notice of and share with your medical professional.... and I think that sort of report would have been included in any basis for a diagnosis of acid reflux or gerd... and I've never had a MRI or cat scan for acid reflux... but then, I'm not the president. color me suspicious.

Ann Althouse said...

Thanks, DrSquid!

Interesting point about the use of the CT span to avoid an unconscious president.

Am I to understand that the "a fiber optic exam of his throat" referred to in the article is done without anesthesia and "a direct laryngoscopy" is something more extensive that they wouldn't have done?

Quaestor said...

I really hope it is cancer.

Fuck you, mom jeans. Fuck you very much.

Ann Althouse said...

By the way, DrSquid, can you confirm my observation that among otolaryngologists, the problem of the sense of smell isn't taken too seriously?

Squints said...

"I really hope it is cancer. Very aggressive cancer."

I disagree with just about everything the man has done and how he has conducted himself and the office. But I can't be for this. I can't wish this on anyone.

Wish your adversaries long and happy lives in this world. Trust that their due will come in the next.

[typo fixed]

Hagar said...

If they do not know what causes your problem and have no remedy for it, it is "phsaw, all in your head," and you, of course, is a woman too.

David said...

Thank you Dr. Squid.

DrSquid said...

The fibreoptic examination is done in the office with topical anesthesia. It takes only a few minutes. It does not allow any instrumentation of the target area. Direct laryngoscopy requires general anesthesia and can be very quick or take many minutes to complete

I don't think that anosmia is so much not taken seriously. It's more a matter of there is essentially nothing can be done about it in the extreme majority of cases, so perhaps we cop an attitude of indifference to hide our powerlessness to change it.

The list of possible causes of anosmia includes some pretty scary stuff, though I have never found any of those despite ordering numerous MRI's to investigate the complaint. If the source of the problem is not obstructive (fixable!), there's not much to be done.

John henry said...

The cat is on the roof.

John henry

John henry said...

If the prez becomes unconscious does that trigger the 25th(?) Amendment and president biden?

Ann? Anyone?

john henry

Francisco D said...

My mother has had GERD for over 30 years. She quit smoking, watched her diet, took her Prevacid and is extremely healthy at 80. I don't think Obama has to worry about this.

I can't stand the guy, but I would never wish cancer on him. The person above who hoped for aggressive cancer is just engaging in self-humiliation.

Michael K said...

"a significant distinction here, between "acid reflux disease" and episodic "acid reflux" of less than twice-a-week frequency."

GERD is a new term as the hiatal hernia of treasured memory is now obsolete as a diagnosis. The treatment is proton pump inhibitors, or older H2 blocker drugs like Zantac. For permanent cure, an operation called Nissen Fundalplication is one. That is an old operation but one that can now be done by laparoscopy. I think the Toupet variant is the usual laparoscopic version done. I had just begun to do them when my back forced my retirement.

General anesthesia for lesser procedures has taken on new seriousness with the Joan Rivers story.

Obama's smoking is the unmentioned factor in the doctors' concerns. My first thought on seeing the story was laryngeal carcinoma. Most esophageal cancer these days is adenocarcinoma from Barrett's esophagus. There is a new treatment for Barrett's and I referred a friend for it a year ago.

David said...

John said...
If the prez becomes unconscious does that trigger the 25th(?) Amendment and president biden?


No. The "trigger" is a human action. Read the amendment. It's pretty clear.

Beldar said...

There's a short — and fairly recent and noncontroversial — history of the POTUS using the 25th Amendment's mechanisms while undergoing general anesthesia. Given the political fixation and paranoia of the Obama White House, I wouldn't speculate whether, and to what extent, they'd view having to invoke those mechanisms as a political liability.

But they do evaluate everything, first and foremost, in political terms — a lesson learned from the Clintons and carried to even greater extremes by Obama.

Mike and Sue said...

I wonder if he underwent an EGD, they subsequently found Barret's esophagitis ( a pre-cancerous condition) and because he is Potus went directly (before histology was available) to CT to rule out esophageal cancer (Mediastinal lymphadenopathy, mass, etc.) If money was no consideration it's what I would want to satisfy my hypochondriac tendencies.

Mike and Sue said...

The laryngeal cancer concern in our smoking President is also a reasonable theory.

Anonymous said...

Dr.Squid: Your response was most informative. A question about "prilosec". Some months ago, my doctor said that I have an acidity issue - not sure, if he used the word, reflux - due to regular consumption of italian pasta. The sauce he said is the problem. He offered: prilosec. I take it regularly - that is everyday. The over-the-counter medication is most expensive. NPR - not sure completely, as it could be some other radio station - had a story a while ago which stated that "prilosec" can cause liver problems, leading to cancer.

So, why is "prilosec" being recommended? Is there reason that it is limited to temporary situation?

Thanks, Dr.Squid.

Hammond X. Gritzkofe said...

Barack Obama hospitalized. Luke Somers dead.

Tyrone Slothrop said...

I have acid reflux too, but the hallucinations usually subside after a few minutes.

Anonymous said...

Not much in it for Obama's doctor if all he needs to do is send down to the drugstore for some Prilosec; but if he diagnoses that a foot has to come off, why, he's looking at $30,000, $40,000, even $50,000 of immediate reimbursement.

George M. Spencer said...

Someone above mentioned that Obama's smoking has been covered up more than any other person's, etc.

Jackie Kennedy smoked like crazy. Remember she died of cancer. There are only a few photos of her with cigarettes.

MaxedOutMama said...

They did an endoscopy first, and that showed acid reflux and swelling. So - let's face it, this IS the president - they decided to do a CT scan to rule out other abnormalities of the digestive tract. He could have had acid reflux flaring up because of gall bladder problems or some other similar issue, including stomach obstruction.

Louis said...

This kind of news event always reminds me of The West Wing. In this episode, that's a cover story for a secret service maneuver following a false positive on some alarm. Season six I think.

Phil 314 said...

Quaestor at 11:37.

I would have said it differently but I agree with the sentiment.

He's still our President.

Joe Schmoe said...

Yeah, we don't want Obama to be a corpse, man.

Let's just let him eat his waffle.

Preferably without orange juice.

richardsson said...

Smoking is not the only issue with acid reflux. Too much alcohol and food late at night over a long period of time leads to acid reflux which leads to this. Esophageal cancer is no joke, a friend of my died seven months after diagnosis; a very miserable seven months.

Michael K said...

" Remember she died of cancer. "

Jackie Onassis died of non-Hodgkins lymphoma. There was a good comment attributed to her. Why did I do all those sit-ups ?

No association with smoking but prematurity is, as in Patrick Kennedy.

George M. Spencer said...

So, now, aside from looking into the possibility of a cancer, the press should also be aggressively asking how many cigarettes the President smokes every day and what other forms of tobacco, if any, he uses.

Drudge just ran this story:

"The Pima County Board of Supervisors will vote this month on whether to refuse to hire smokers and put a major pinch on the pocketbooks of those who already work there."

Perhaps we should do the same as a nation with regard to Presidents.

Zach said...

Dr. Squid: from your description, it seems like the CT scan would an unsatisfactory middle option -- if you wanted to move past the scope, you would go straight for a biopsy. (I hope I'm not putting words in your mouth; please correct me if I'm wrong.)

Is there anything for which a CT scan would be the first option?

DrSquid said...

Politico, I'm unaware of any connection between prilosec and liver cancer. Certainly hope there is not, I've taken 40 mg a day since '93.

Zach-no first line role for CT scan in initial diagnosis of aerodigestive cancer, i.e. of a primary cancer originating in the membranes of the mouth, throat, larynx. Many have been found that way as an incidental finding on a scan obtained for another reason e.g. a neck CT after trauma reveals asymptomatic lesion of hypopharynx, but then a flexible or direct scope would confirm it with tissue sample.

Getting into the weeds, suppose Obama complained to his underling that he had unexplained pain in one ear, w/o any change of his hearing. Then you might get a CT neck to look for occult primary (one you can't see, that has grown deep). But why they got the CT based on inflammation found on flexible endoscopy I don't really understand. Abundance of caution since he is the president is as good a guess as any

cubanbob said...

"Phil 3:14 said...
Quaestor at 11:37.

I would have said it differently but I agree with the sentiment.

He's still our President.

12/7/14, 2:30 PM"

Ditto.


"St. George said...
So, now, aside from looking into the possibility of a cancer, the press should also be aggressively asking how many cigarettes the President smokes every day and what other forms of tobacco, if any, he uses.

Drudge just ran this story:

"The Pima County Board of Supervisors will vote this month on whether to refuse to hire smokers and put a major pinch on the pocketbooks of those who already work there."

Perhaps we should do the same as a nation with regard to Presidents.

12/7/14, 3:13 PM"

No. Enough with the health fascists.

CT-ref said...

CT Scan would be first line screening or diagnostic for lung cancer - very hot topic currently among Radiologists. CT Scan for Acid Reflux - sounds odd. If you want soft tissue differentiation from swelling, choose MRI. I've known people with upper throat level acid reflux that takes 6 months to diagnose, so easy to misdiagnose, but the sinus endoscope does it quickly every time.

Paul said...

Will Obamacare pay for Obama?

Is he worth it?

Let's just give him some pain killers and send him home.

walter said...

Causation is difficult..but there is that recently announced Obama love story movie...

Mo5m said...

He has chewed nicorette gum for more than 6 years. It is only meant to be used for a few weeks or maybe months in order to quit smoking--not to be able to do photo ops without getting the shakes. One of the side effects of using nicorette gum is indigestion. But we really shouldn't even bother discussing because when has this administration ever told us the truth about anything?

MathMom said...

I think they wanted to rule out esophageal cancer.

And he's not a "former smoker".

RecChief said...

the guy has a sore throat, a symptom common this time of year, and ends up getting a CT scan? hmmm, maybe journalists should have pushed harder for his medical records, like they did with McCain, huh?

Ann Althouse said...

DrSquid: "I don't think that anosmia is so much not taken seriously. It's more a matter of there is essentially nothing can be done about it in the extreme majority of cases, so perhaps we cop an attitude of indifference to hide our powerlessness to change it."

Thanks for the honest answer! That's basically the impression I've had.

"The list of possible causes of anosmia includes some pretty scary stuff, though I have never found any of those despite ordering numerous MRI's to investigate the complaint. If the source of the problem is not obstructive (fixable!), there's not much to be done."

Yeah, that's what I've learned.

kcom said...

Ask Dr Squid if he believes that study about anosmics having on average seven years to live. Was that the gist of it?

John henry said...

Re my "the cat is on the roof" post. The phrase is a punchline from an old old joke. It occurred to me when reading about President Obama being hospitalized and cat scanned last night.

I wonder if it is just a coincidence that Mary Landrieu also lost yesterday by a big margin. Just before President Obama goes to the hospital?

This goes to something that I talked about both here and on another Madison forum a couple months back in connection with reports that he had basically checked out of his job and was just coasting.

I predicted that, assuming that repos got a good majority in the Senate, as they did, President Obama would resign.

It will have to be a multi-step process. (Hence the cat on the roof joke) He can't just come out and say "I'm tired of the job. I'm out of here." I said that he would resign in January or February for health reasons.

This fits the 4 step script

1) "I'm not feeling well" Last night

2) "Maybe it is something that needs treatment." Late December or so when tests have had a chance to come back.

3) "It looks more serious than the docs thought." Sometime in January

4) "I have something really major that is going to require surgery, chemo and rehab. I am going to have to step down temporarily. Don't worry, Joe B will take good care of things. I'll be back in a month or two." Phase 4 will happen in early February.

Whatever the illness is it will be something sympathetic. Bonus points if it can be tied to his being black or to the racism that so many Americans allegedly feel in their hearts. Maybe he can get the Revs Al and Jesse to pray at his bedside in a photo op.

I think the scenario is pretty unlikely. I do not think it is completely out of the realm of possibility.

John Henry

George M. Spencer said...

John--

Obama's no more going to resign than Hugo Chavez did.....

SgtPete said...

This is what I remember. The check valve above stomach, e.g. a sphincter, allows food to enter the stomach, and prevents stomach contents to return to the esophagus. The stomach has a pH of 2, hence can do a lot of damage to other organs in body. As this sphincter fails, it allows acid to enter the lower esophagus, a burning sensation to the patient will occur (GERD, acid reflux). If not taken care of, e.g. diet and some proton pump inhibitor, (stops or lowers production of stomach HCL) then this acid can and will change the morphology of the cells within the lower esophagus. This is called Barrett syndrome. As the morphology changes from normal to worse, these cells still reproduce, and some in time become cancerous. It takes a while, and medical treatments with diet can correct/prevent this condition. The President has many medical advantages, more so than someone on Obamacare. I won't go into Obamacare, I'm running low on Lisinoprill. SgtPete RN

Bad Lieutenant said...

for the record you can have an upper endoscopy without anesthetic. That is to say without being put under. I did it once when I had to get to work and they have passed new laws where you can't get and can't leave the doctors office for a considerable time after anesthesia. It's quite unpleasant but it's doable. Dr Michael K, I was told that I had hiatus hernia, what do they call it now?

claudia quinn cashman said...

I was just diagnosed with the SILENT reflux disease: laryngopharyngeal reflux. No heartburn symptoms. But lots of inflammation and tissue damage. Big diet changes in diet....no citrus, chocolate,carbonation,tomato or vinegar based things.... It goes on and on.
Had the laryngoscopy and saw the damage. Symptoms that sent me to an otolaryngologist were a dry cough and muscle spasming of throat muscles. Again, no GERD symptoms. Now I'm lookng at surgery to do the a tighten up on the stomach throat juncture. Obama can take proton pump inhibitors and gee, maybe stop smoking....
Just sayin'....

Anonymous said...

Here we r talking about a human life, and, shock to hear what some folks say. Remember he is a father to children, a husband etc. Would u like people to hate on u ? What a shame. U know yourselves. God b with u.