[NBC Politics.NBC News] Secretary of State Hillary Clinton ... sometimes described as America's Blond Eminence and at other times as Mrs. Bill, never as Another Charles Evans Hughes ... was admitted to a New York City hospital on Sunday after doctors discovered that a blood clot had formed, the State Department said in a statement.
Now this is an area within my subspecialty, so permit me to mount my soapbox.
Given what we are told, there are four reasonable potential locations --
1) leg below the knee. That could be due to inactivity stemming from her concussion. We usually do NOT treat these with anti-coagulants. However, 20% of below the knee thrombi will propagate to above the knee so they should be monitored at frequent intervals (ultrasound). We do use NSAIDs, rest and physical therapy.
2) leg above the knee (proximal deep vein thrombosis, DVT). This is a serious medical situation. About 20% of these will break off and cause a pulmonary embolism, and 5 to 20% of those (1 to 4% of all proximal DVT) are fatal. We treat these immediately with a proper anti-coagulant (heparin followed by warfarin or with a low-molecular weight heparin such as Lovenox). A patient usually is hospitalized for a proximal DVT though lately we've had success keeping them at home with daily or twice-daily Lovenox injections. There is some enforced reduction in activity but we don't like to keep people immobile, since immobility is one of the risk factors to get a DVT in the first place.
3) pulmonary embolism (PE). This is serious and can be life-threatening, indeed fatal. These require immediate hospitalization, immediate anti-coagulation, and careful monitoring. There are a number of complications that may occur, from right heart failure to arrhythmias, circulatory collapse, pneumonia, etc.
Both a proximal DVT and PE require a diligent search for why they occurred. The usual causes are 1) advancing age 2) immobility 3) trauma 4) cancer 5) genetic pre-disposition to clotting 6) use of certain medications (e.g., oral contraceptives). Recurrence is common, particularly in the time period following cessation of anti-coagulation (usually done for 6 to 12 months).
4) blood clot within or just above the brain (e.g., subdural hematoma or traumatic brain contusion). If this, the cause is almost certainly trauma from a fall. I note this is how Katherine Graham, past publisher of the Washington Post, died -- she slipped and fell and suffered head trauma with a bleed and clot. These are, of course, extremely serious. Note that head trauma with a bleed/clot is very different than a DVT/PE situation.
So again I repeat my question -- where is the clot?
If #2, #3, or #4, and I were her doctor, she wouldn't be doing anything other than house rest and computer solitaire for a couple weeks until I knew that I had the problem well in hand.
That no one will say, and that we now see that there is and has been a fair bit of the story withheld, and that there has been phony stories put out there (e.g., partying in the Dominican), suggests to me that there is something serious going on.
She's entitled to privacy in her medical affairs as a person. But as Secretary of State, we the public need to know if she can do the job or not.
Philippe Reines, a deputy assistant secretary, said in the statement that the clot stems from a concussion Clinton sustained several weeks ago.
Reines said that Clinton, 65, is being treated with anti-coagulants at New York-Presbyterian Hospital in Manhattan. She will be monitored there for the next 48 hours, he said.
"Her doctors will continue to assess her condition, including other issues associated with her concussion," he said. "They will determine if any further action is required."
Isn't warfarin one of the key ingredients in rat poison?
Posted by: Rambler in Virginia ||
12/31/2012 0:11 Comments ||
Rat poison indeed Rambler...since rats can't perform a reverse peristalsis (throw up) they ingest the Warfarin (Coumadin as an Rx) and bleed out internally. I've been on the stuff for years due to AF. Careful monitoring is required.
Fred has it right..if this is due to a fall and she is manifesting a subdural hematoma...serous indeed.
Despite our political differences...I wish her a speedy recovery.
--- Much has been withheld.
--- Another possibility: She could have suffered an intimal tear in a carotid or vertebral artery (1) with a clot forming around that or (2) leading to a carotid artery dissection with intramural hematoma.
An arterial tear and clot is possible, particularly after a fall, but many times (not always and not even usually) in that scenario there is an associated stroke (CVA). There's been no report of a stroke. So I think that scenario is less likely, but I wouldn't take it off the table.
Posted by: Steve White ||
12/31/2012 1:05 Comments ||
---Much has been withheld.
Does indeed appear that way. Very FDR'ian. If we begin seeing her in a golf cart....well. I must say however, an impaired Hildebeast would be an improvement over a narcissistic, spiteful Champ.
My own observation is that blood clots are frequently associated with frequent flyers and our Secretary of State has most certainly been a frequent flyer.
Posted by: Abu Uluque ||
12/31/2012 11:14 Comments ||
What the NBC reporter is saying, and he is correct to say this, is that a clot associated with traumatic brain injury (my scenario #4) is one in which you do NOT treat with anti-coagulants, as that can make the bleeding (which caused the clot) worse. Indeed it can be a fatal mistake.
This is why, when someone has a stroke, we always get a CT or MRI scan prior to starting anti-coagulation: we anti-coagulate for a thrombotic stroke (clot) but not for a hemorrhagic stroke (bleeding).
For a subdural bleed, if she had one as a result of trauma, one would NOT treat with any sort of anti-coagulation whatsoever.
All of this makes me think that she's had a DVT or PE, but it sure would be nice if she and her team (or her BOSS) were forthcoming with details. The last thing we need right now is a crippled Secretary of State.
Posted by: Steve White ||
12/31/2012 11:37 Comments ||
"But as Secretary of State, we the public need to know if she can do the job or not."
She never could. How does a blood clot change that?
Posted by: Barbara ||
12/31/2012 11:57 Comments ||
How can the docs be so certain she has a blood clot but so uncertain about its location? What kind of generalized symptoms would manifest that would indicate a clot?
From Instapundit: The suppression of information the site of the clot suggests 2 radically different theories: 1. fakery/exaggeration to evade testimony, or 2. something horribly serious. I read Sepkowitz to exclude the middle ground.
Posted by: Deacon Blues ||
12/31/2012 14:57 Comments ||
Hillary is at NY - Presbyterian in Manhattan.
This is a place with a very good reputation.
They don't admit you unless there is a problem.
They don't shoot you with anti coagulants unless there is a serious reason to do it.
Posted by: lord garth ||
12/31/2012 16:10 Comments ||
"In the course of a routine follow-up MRI on Sunday, the scan revealed that a right transverse sinus venous thrombosis had formed. This is a clot in the vein that is situated in the space between the brain and the skull behind the right ear. It did not result in a stroke, or neurological damage. To help dissolve this clot, her medical team began treating the Secretary with blood thinners. She will be released once the medication dose has been established. In all other aspects of her recovery, the Secretary is making excellent progress and we are confident she will make a full recovery. She is in good spirits, engaging with her doctors, her family, and her staff."
"She is in good spirits(perhaps sedated), engaging(possible eye movement, but not speaking) with her doctors, her family, and her staff."
Bill: "Best New Years Eve, evah! C'mon honey, Hillary's not coming home tonight..."
Posted by: Frank G ||
12/31/2012 19:11 Comments ||
"Mr. Clinton, we can bring in a cot so you can stay with Mrs. Clinton if you'd like?"
"Heh...on New Yeah's Eve? Ah don't think so, hunny. Y'all got plans fer the night? Ah always had a thang fer nurses..."
I was just thinking (yeah, a scary thought), what would be the effect on Social Security if everyone was required to join in pols, bureaucrats, teachers the works.
Take control of their pension funds to the amount they should have been paying in for the last 10 to 20 years and go forward from there. They could all keep any other pension/retirement fund that their employers provide as long as the employers want to keept on providing after their half of SS is due.
What daya think? Would that set a fox amongst the chickens?
So sit back, grab the popcorn, and watch as algos proceed to respond with furious stupidity to every single unsourced, unvalidated, and untrue rumor and various other flashing red headlines.
As for those millions of people who, like the guy in the basement in Office Space, and like the New Normal Schrodinger cat, are employed and unemployed at the same time but certainly unpaid, better luck next time.
I just Love America, the people spoke in November, they wanted more of the "Obama Magic".
Employed and unemployed at the same time! Magic.
Well, sit back and relax, let us see the Congress and the President pull a Rabbit out of a Hat.
Posted by: Au Auric ||
12/31/2012 10:50 Comments ||
Iblis - I heard that described many years ago as "The Admiral's Barge Syndrome", said barge ferrying Admirals from the Pentagon to the Hill across the Potomac, so they don't have to weaste time in traffic. Threaten to cut the budget and the Navy does not shut down the Admiral's Barge, they cut an aircraft carrier.
"You make me go on a diet and I'll cut muscle, not fat."
First civilians to go are those up against "the Gray Ceiling", Tipper. Not judged on lack of merit but flat maintenance cost. Good luck bringing back this experience from AFG, IRQ, BOS, PAN, GRE and all the other dirty little encounters since the start of VTM/CMB/LAO. Before the end of this administration[sic] there will be need of them.
Mrs. Ret. works for BUMED and is not worried; she heard occasional talk about one day a month furlough. but that was 2 weeks ago, she's been on leave since then......
Perhaps she will have new word on Wednesday night.
[Iran Press TV] US President Barack Obama Ready to Rule from Day One... has blamed congressional Republicans for the so-called fiscal cliff deadlock, saying their refusal to raise taxes on the rich is the main obstacle to finding a solution to the looming economic crisis.
"They (Republicans) say that their biggest priority is making sure that we deal with the deficit in a serious way, but the way they're behaving is that their only priority is making sure that tax breaks for the wealthiest Americans are protected," Obama said in a prerecorded interview for NBC's Meet the Press program that was broadcast on Sunday.
"That seems to be their only overriding, unifying theme," the US president added.
Obama also warned that the failure to reach a deal on taxes and spending cuts would have serious consequences for the US economy.
"If people start seeing that on 1 January this problem still hasn't been solved, that we haven't seen the kind of deficit reduction that we could have had, had the Republicans been willing to take the deal that I gave them...then obviously that's going to have an adverse reaction in the markets," he said.
The president noted said the priority was to ensure taxes do not rise for middle-class families, saying that would "hurt our economy badly."
"That's something we all agree on. If we can get that done, that takes a big bite out of the fiscal cliff," he said.
In response to Obamas comments, House Speaker John It is not pronounced 'Boner!' Boehner ... the occasionally weepy leader of House Republicans... issued a statement, saying Obama should not cast blame on Republicans for a possible failure to avert the nearing crisis and that the president was equally responsible.
Obama: Republicans unified around protecting the rich
Really??? How many banksters have you sent off to the Federal Bureau of Prisons in the last term for their market activities that lead up to the 2008 crash and market manipulation? Can we mention MF Global? /rhet question
Easy enough to fix.
Begin taxing luxury goods:
1) cars over $30k
2) non-commercial boats
3) housed providing more than X sqft per occupant
4) property providing less than X $ of declared income per unit
5) private aircraft providing less than X $ of declared income per passenger seat mile
6) second 'residences', etc...
A good start.
It really has become clear that Champ's marxist beliefs ("from each according to his ability, (now itis clear that if you make more than others that is your ability and is expected of you), to each according to his need (and they, the elites, will define the baseline)".
Class warfare is both a way to harness the envy of the masses, and their resentment that others have what they don't (notwithstanding any judgement of their efforts to do the things needed to gain more, work, education, initiative, persistence), as well as a tool to create over time a leveling of expectations from equality of opportunity (American vision of limited government and capitalism) to equality of outcome (socialism/communism in all the dreary variants that have failed).
The bite comes as people begin to see that the fundamental principle of property ownership, whether it is physical, material or capital (wages) is the heart of the change, along with the reversal of the role of government (elites) from servant to master. Many, many of our fellow citizens comprehend nothing of the way the system was based on the idea of true property rights, immune from the reach of government beyond the taxation taken at the inception of ownership. The most egregious example is of course the estate tax, at any level, since it reflects multiple levels of taxation in its creation, and literal confiscatory governmental power at its taking at death, creating an essential life-estate status for any and all property. This is now devolving through the "progressive" tax structure to wider levels that rival or surpass the rates of serfdom in mideval Europe during the feudal ages. People are becomming wage-serfs again, but also now suffer the egregious taking of their earnings disproportionately to pay for the ruling class and their special wards, the 47% of the populace who are essential takers, not makers, and whose voting power is manipulated through emotive slogans and media for the ignorant (broadcast tv and the scerotic print organs in their death throes).
All this sets the stage for the next true requirement, that pesky 2nd amendment, and the need to disarm the burdened class as much as possible, since the true intent of the 2nd amendment was the power to create a standing militia for the common defence, and that was able to resist tyrannical central government, now an ominous portent on the horizon, so much more quickly that ever imagined even a decade ago. (The founding fathers knew their history and grounded in Hobbs, Locke and Rousseau, also saw the power of the Barons and the militia to compel King John to sign Magna Carta, a cautionary tail worthy of knowing).
I know this is a screed my friends, but it is heartfelt and cathartic, and might resonate for many of you as we await the "change" this truly evil man has planned. I am more fearful than at any time in my life for the future of the nation and our form of government.
They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.
The second Amendment guarantees the other freedoms. We are not like other countries where basic rights have been given up as a knee-jerk reaction to singular horrible events caused by deranged individuals. As Americans we are sorry and we grieve but our fundamental rights do not hinge on the acts of the unhinged. If politicians react to such events by chipping away at basic freedoms, they do not understand and or they care little for these basic rights. These rights were maintained across the more than two centuries since we became a country with the blood of patriots. To give up these rights easily is the path to tyranny, statism and dictatorship. History in Europe and other places tells us that giving up these basic rights invites tragedies far larger than the local tragedies we have witnessed recently.
A multi-volume chronology and reference guide set detailing three years of the Mexican Drug War between 2010 and 2012.
Rantburg.com and borderlandbeat.com correspondent and author Chris Covert presents his first non-fiction work detailing
the drug and gang related violence in Mexico.
Chris gives us Mexican press dispatches of drug and gang war violence
over three years, presented in a multi volume set intended to chronicle the death, violence and mayhem which has
dominated Mexico for six years.