September 24, 2016
Dr. Lisa Bardack’s Faustian Bargain
By Jay Michaels
“Oh what tangled webs we weave, when we first practice to deceive.” Sir Walter Scott
When Dr. Lisa Bardack[*] was asked to become Hillary Clinton’s personal physician in 2001, it had to have been a crowning moment in the career of the Mt. Kisco internist. Dr. Bardack could have anticipated little downside. She already had the responsibility — and legal obligation under HIPAA — to protect the privacy of her patient. She and her staff would have to be especially scrupulous in the case of a senator with presidential ambitions, but this should not have posed a serious problem.
Unfortunately, Hillary Clinton corrupts everyone who serves her. And this year Bardack encountered difficulties she could not have foreseen in 2001:
1. Clinton developed serious medical issues.
2. The candidate was being videoed, not only during campaign stops, speeches, townhalls, and the rare press conference, but before and after events — by individuals with cell phones who were under no obligation to obey orders given to servile journalists to turn off their cameras.
3. The internet not only permitted the mass distribution of these videos and photos, but it enabled those who were curious to check Bardack’s reports against information available on reputable medical sites. It also enabled skeptical physicians to share their doubts with hundreds of thousands of readers.
In July 2015, the Clinton campaign asked Bardack to give the candidate a clean bill of health. She was to disclose, selectively, some of her patient’s medical history. But the letter was not widely analyzed until after the disturbing September 11 video by Zdenek Gazda, the Zapruder of 2016. It was no longer possible to dismiss those asking questions about Hillary’s health as right-wing conspiracy theorists, and the campaign now requested a second letter from Dr. Bardack explaining the event. The physician duly issued a report on September 14. Now her real problems began.
Let’s take a look at the two letters and some of questions doctors have asked about the diagnoses and treatment.
I. The letter of 12 July 2015
Bardack’s summary revealed a couple of major health problems that had not been previously disclosed. We had been told that Clinton suffered an elbow fracture in 2009 and a concussion in 2012. The fact that a woman in her mid-60s would fall twice ought perhaps to have raised some red flags. In particular, unless you’re being tackled or attacked, a concussion can usually be avoided by the body’s reflexes. Arms are extended to break the fall.
But now the public learned that some time in 2009 and in December 2012, the month of the concussion, Clinton had suffered blood clots.
She already had a history of clotting. Running for the Presidential nomination in the fall of 2007, Hillary gave an extended interview on her 60th birthday in which she disclosed that she’d had a life-threatening medical emergency in 1998. The crisis had been kept a secret not only from the public, but from her staff, who were told she had a sprained ankle. Clinton’s foot had swollen and she was in great pain. A White House doctor told her to rush to Bethesda Naval Hospital, where the diagnosis of a blood clot was made. “That was scary,” Hillary said, “because you have to treat it immediately — you don’t want to take the risk that it will break lose and travel to your brain, or your heart or your lungs. That was the most significant health scare I’ve ever had.” Clinton assured the reporter that she was no longer on blood thinners. This was probably the last time Hillary spoke candidly about her health.
What Clinton had was a deep vein thrombosis, or venous thromboembolism (VTE). The blood clot is usually in the leg, and in Hillary’s case, it was behind the right knee.
Now Dr. Bardack revealed that Hillary had had two others. The first, in 2009, was another VTE, but the second was still more serious. It was a right transverse cerebral venous sinus thrombosis (CVST). This is a clot in one of the two channels between layers of the dura, the membrane enclosing the brain, which receive blood and cerebrospinal fluid. A clot here means that blood flow out of the brain is impeded, and there is the potential for a hemorrhage if there’s leakage into the cerebral tissues. The Johns Hopkins Health Library refers to it as a rare form of stroke affecting only five in one million individuals. It’s treated with anti-seizure medicines as well as anticoagulants, and the complications range from impaired speech, difficulty moving parts of the body, and vision problems to death.
There were two problems in the 2015 letter relating to the clot:
1) Clinton, her physician wrote, “began anticoagulation therapy to dissolve the clot.” But this is not something anticoagulants do. Two of these drugs are mentioned by Bardack: Lovenox, which was discontinued in 1998, and Coumadin (warfarin).
Bristol-Myers-Squibb, its manufacturer, says explicitly that the medication doesn’t dissolve clots:
COUMADIN has no direct effect on an established thrombus, nor does it reverse ischemic tissue damage.
Every doctor prescribing Coumadin knows this. Because of patient expectations, all reputable medical sites, like the NIH’s PubMed, repeat the warning.
There are thrombolytic (clot-dissolving) drugs, injected by catheter or infused through an i.v., but none are mentioned by Bardack. In any case, the embolisms for which thrombolytic agents are indicated don’t correspond to Clinton’s, and these drugs are never referred to as anticoagulants.
2. A second problem comes with the duration of the symptoms. Bardack says that these lasted for less than two months. But according to Bill Clinton, his wife’s injury “required six months of very serious work to get over.”
Of course it could be that the four addition months of symptoms were the result not of the concussion, but the CVST. However, it would not be easy to differentiate these symptoms. One is instinctively disinclined to take the former President’s word on anything, but there’d be no reason for him to exaggerate the length of time it took his wife to recover.
In any case, what the public was told was an elbow fracture (Hillary sported a State Department sling) and a concussion (she was jokingly presented with a football helmet by her minions) coincided with problems much more ominous.
3. A third issue in the 2015 letter is Bardack’s final evaluation of her patient. Twice she calls Clinton “a healthy female” and concludes that “she is in excellent physical condition and fit to serve as President of the United States.”
While Bardack could hardly have been expected to write otherwise, the truth is that anyone who is on lifelong Coumadin is not in excellent physical condition. As is well known, warfarin was developed as a rat poison, and increases significantly the risk of intercranial bleeding. A recent ten-year study of 32,000 veterans found that nearly one-third developed intercranial bleeds while on warfarin. The vets were over 75, but the high figure was still very disturbing, though probably not surprising to most physicians.
Dr. Milton Wolf, a board-certified radiologist, writes, “Coumadin carries a substantial risk for patients, particularly those with fall risk. Spontaneous hemorrhage common, intracranial and elsewhere. I see it commonly, including life-threatening brain bleeds. Normal, healthy patients are NEVER, NEVER prescribed Coumadin.” There are safer anticoagulants. “Coumadin is typically given to those who can’t afford the newer drugs or reserved for cases that are refractory to the safer drugs.” Wolf speculates that Clinton probably has a hypercoagulable blood disorder. Coumadin would otherwise be given only to patients with chronic atrial fibrillation (like the vets) or with prosthetic heart valves, both of which can cause hypercoagulation.
The interactions with warfarin are also sobering. In addition to avoiding both NSAIDs and acetaminophen, users are advised not to use, or to use with caution, antibiotics, anti-fungal medications, anti-depressants, and seizure medication — carbamazepine (Carbatrol, Equetro, Tegretol), phenobarbital (Solfoton), and phenytoin (Dilantin).
Whether or not Hillary has been put at risk by seizure medications, the whole world now knows about her propensity to fall. The airplane and podium stumbles and her being helped up a short flight of steps had gone viral long before the 9/11 collapse. And we know nothing about the falls that have occurred off-camera, except for the one that gave her a concussion. Family friends have told Ed Klein these falls are frequent. And head trauma is the number one concern for patients on Coumadin.
4. Still another disclosure in Bardack’s July 2015 letter raised eyebrows. In addition to taking Coumadin for the rest of her life, Hillary will also be on Armour thyroid until she dies. Unlike CVST, hypothyroidism, an underactive thyroid gland, is common. In fact, the most frequently prescribed drug in the U.S. (though not the most lucrative) is Synthroid, synthetic levothyroidoxine, the major hormone the gland produces.
Armour thyroid is an extract of desiccated pig’s thyroid. The therapy dates to the 19th century, and the American Association of Clinical Endocrinologists recommends that it not be used. But a case can be made for natural thyroid therapy, and one recent study found that more patients prefer it, though there was no difference in the control of symptoms. These include memory problems and difficulty thinking clearly. A physician who is one of the most vocal advocates of natural thyroid switched to a different brand of natural thyroid after Armour changed the tablet formula in 2009.
II. The letter of 14 September 2016
1. Bardack disclosed that Clinton was given a brain scan for an ear infection after she had “experienced significant improvement in her symptoms.” The physician of a patient “in excellent health” would not normally order a CT scan for an ear infection that was being successfully treated by antibiotics and a myringotomy tube. Bardack’s caution, however commendable, suggests she was worried about some underlying problem.
2. Bardack then discusses Hillary’s pneumonia. When an upper respiratory infection persisted for a week after Clinton had been prescribed antibiotics and allergy medicine, Bardack, on Sept. 9, ordered “a non-contrast chest CT scan, including a CTA calcium score.”
According to Dr. Wolf, a CTA (a CT angiogram) scan always requires a contrast. On the other hand, a CT calcium score study must always be non-contrast, otherwise “the coronary calcifications would be masked by the contrast in the arteries.” The radiologist concluded that “Hillary’s doctor just claimed Hillary got a perfect score on a test that does not exist.”
It’s likely that Bardack misstated what she’d ordered — though one would think she would be extraordinarily careful in a letter that would be read by millions. A coronary calcium scoring CT does not use contrast, while a CTA requires it. A simple thoracic CT, which is what Hillary must have received, may or may not be done with contrast.
3. Then there’s the finding from the scan: “a small right middle-lobe pneumonia,” further described as “a mild non-contagious bacterial pneumonia.”
Doctors immediately questioned this diagnosis. There is no such thing as a non-contagious pneumonia, tweeted Dr. Wolf. How did Hillary pick it up? What about all the reports the campaign circulated about staffers who’d come down with pneumonia, including manager Robbie Mook?
While bacterial pneumonia is not as contagious as viral pneumonia, there is no test to determine whether or not a patient is contagious. A doctor defending Bardack listed three types of bacterial pneumonia not likely to be contagious. The only one that Hillary could possibly have had was aspiration pneumonia.
The dubious adjective “non-contagious” may have been dictated to Bardack by Clinton. The problem, obviously, was that after her collapse, the candidate went directly to her daughter’s apartment, where she presumably exposed her grandchildren to pneumonia, then, 90 minutes later, bounced out of the building, exulting that it was a beautiful day in New York, and embraced a little girl, exposing her, too, to the infection.
Other doctors have also pointed out how the photo-op undercut the “pneumonia” explanation. “I’m feeling great,” Hillary said three times, not something a pneumonia patient is likely to exclaim.
4. Apart from a case of “mild non-contagious pneumonia,” what felled Clinton on September 11th, wrote Bardack, was that “she became overheated and dehydrated.” Even MSM reporters questioned the “overheated” pretext. The day was partly cloudy and the temperature about 80, with a slight breeze. Dehydration is hardly less suspicious. First of all, it’s been used repeatedly for other falls. And medical science has come up with a cure for dehydration. While Marco Rubio was ridiculed for taking a swig of water in the middle his reply to the President’s 2013 State of the Union address, no one who valued his job would criticize Hillary for “re-hydrating” during an event. One would expect that someone who had experienced multiple falls and was on Coumadin would take every precaution to avoid dehydration — especially when it’s such a simple matter.
5. If Hillary’s dramatic recovery casts doubt on Bardack’s diagnosis, so does the fall itself. It was not a swoon, as one might expect, where Clinton appeared woozy, lost consciousness, and her knees buckled. Instead, she becomes stiff and immobile. She is propped up against a bollard. It’s only when the Secret Service agents attempt to propel her forward that she falls. It’s not clear she’s lost conscious; she is just frozen, unable to move.
6. Pictures taken of Clinton en route to the van also undermine Bardack’s explanation. In one, Hillary is being given what appears to be a finger squeeze test.
The test is a neurological exam, sometimes used also as a test for arthritis. There would be no reason to administer it to a patient suffering from pneumonia.
In the second photo, the same woman, Christine Falvo, appears to be monitoring Clinton’s pulse as they walk. Hillary has her other hand pressed against her chest, an unusual position for someone in motion, but a good way to disguise the pill-rolling tremor associated with Parkinson’s disease.
Also present in the photos, inevitably, is the bulky African-American Secret Service agent who clearly has had some medical training. When Hillary froze during a speech on August 4, it was he who rushed to her side, put his hand on her back, kept repeating, “Keep talking, keep talking,” and then shooed away the other agents. Some sites have posted pictures of him holding what appears to be a diazepam injector, used for seizures, but the images are too blurry to positively identify the object.
There is no photo of either the Secret Service medic or Falvo offering the dehydrated Hillary a bottle of water.
7. Bardack’s 2015 letter mentioned the Fresnel prism glasses Hillary wore to eliminate double vision. The 2016 letter makes no mention of the Zeiss Z1 blue lenses she was wearing on September 11th. These are used to help prevent seizures, particularly in photosensitive epilepsy, and improve motor control. They are not normally prescribed for patients with pneumonia or seasonal allergies.
8. Also unmentioned by Bardack are Hillary’s repeated coughing episodes, going back at least to January of this year. Here’s video of eight. Has Clinton had pneumonia for nine months? Or is this a symptom of a neurodegenerative problem causing pulmonary aspiration?
9. Finally, the fact that Hillary was not rushed to a hospital after the collapse and given another CT suggests that her handlers knew exactly what was going on. And it wasn’t pneumonia.
The physician who has put forward the most plausible case that Hillary is suffering from Parkinson’s disease is Dr. Ted Noel, whose videos I linked in a recent blog post.
Though there’s been no sign so far of the pill-rolling tremor or the shuffling gait characteristic of Parkinson’s, other evidence suggests Clinton is suffering from the disease, or experiencing side effects associated with the drug most commonly used to manage it, levodopa, which include disorientation and confusion and dyskinesia (involuntary muscle movements).
Examples of the latter are Clinton’s spasmodic head movements while being questioned by several reporters (attributed by Hillary to her cold chai tea) and, less dramatically, her response to the light show at the end of the Democratic convention.
Dr. Noel has a newer video out that further undercuts Bardack’s credibility. In addition to mentioning Wolf’s point about CT angiography, he carefully describes problems with the oxygen saturation levels reported by Hillary’s physician, and her use of an outdated test to manage Clinton’s hypothyroidism.
If she doesn’t have Parkinson’s, Hillary clearly has some major neurological disorder.
Bardack has already been targeted by Google reviewers. Purportedly coming from Chelsea is a one-star rating and the comment, “My mother died of Parkinson’s after she was diagnosed with pneumonia.”
Lisa Bardack will be fortunate if satiric reviews are the worst consequences for the disinformation campaign she has helped wage in Hillary’s behalf.
[*] Bardack was raised in Larchmont, NY, in affluent Westchester County, the daughter of Lester Bardack and Judith Frankle. Her father was president of Ulano Industries, a Brooklyn chemical manufacturer, and her mother a rabbi, formerly of Congregation B’nai Elohim in Scarsdale and later an instructor at Western Connecticut State. Bardack’s sister Amy, also a Conservative rabbi, was recently appointed Director of Education for the Jewish Federation of Greater Pittsburgh. Both sisters married doctors who were themselves the sons of doctors.
Bardack graduated from Penn and NYU Medical School. She did her residency at Cornell University Medical Center in New York, now Weill Cornell, was board certified in 1993, and joined Mt. Kisco Medical Group, later CareMount Medical, the largest medical group in the state, with over 500 physicians and 500,000 patients, where she’s Chair of Internal Medicine.