BETHESDA, Md., Aug. 1-President George Bush, eight pounds lighter than he weighed in December, was declared fit for duty by doctors at the National Naval Medical Center here over the weekend.
The three-hour checkup was the 59-year-old Bush's fifth annual physical since taking office. The most recent examination was in December, delayed from his normal summer schedule by the election campaign.
Bush, nearly six feet tall, weighed 199.6 pounds in December. Over the weekend, his weight was down eight pounds, a loss that was attributed to an improved diet.
"The President remains in excellent health and 'fit for duty,'" his doctors said in a statement. "All data suggest that he will remain so for the duration of his Presidency."
Bush takes a daily multi-vitamin, low-dose aspirin, glucosamine/chondroitin, and an omega 3 supplement. He does not routinely use prescription medications.
The President exercises six times per week. His resting heart rate (seated) was 47 bpm. His resting blood pressure (seated) was 110/64 mm/Hg.
The doctors characterized his fitness as in the "superior" category for a man his age (greater than 99th percentile for 55-59 year-old men; Cooper).
He has, they said, a "low" to "very low" coronary artery disease risk profile, as judged by a coronary artery disease "activity-marker" evaluation (including C-reactive protein, homocysteine, and lipids), and "functional" studies (exercise treadmill test).
Results of lipid sub-unit and particle size analysis further support a "low cardiac risk" profile. Continued "therapeutic lifestyle measures" (i.e. reduced intake of saturated fat and cholesterol, regular physical activity, and weight control) are appropriate.
He is not taking a statin.
Sinus bradycardia, asymptomatic, non-pathologic, and consistent with a conditioned heart, they said.
There is a history of vasovagal syncope without pathology, sequelae, or recurrence.
The physicians reported symptoms consistent with occasional gastroesophageal reflux with well-defined triggers. They were considering "modification/elimination of triggers, routine medication, and/or endoscopy if symptoms become more frequent, refractory, or pronounced."
Bush has a history of benign colonic adenomas, with his most recent colonoscopy in June 2002 determined to be normal. He will have another colonoscopy in 2007 (or earlier, pending state-of-the-science, or incidental to upper endoscopy if indicated).
He has skin lesions consistent with solar damage. Treatment was not indicated, and sun-protection measures (e.g. sunscreen, wide-brimmed hats, etc.) were recommended. A seborrheic keratosis was treated with liquid nitrogen.
Bush has well-controlled seasonal allergic rhinitis.
He has a history of activity-related musculoskeletal injuries and is currently without symptoms or limitations.
He also has a history of mild high frequency hearing loss, unchanged from previous examinations. He has mild hyperopic astigmatism/presbyopia, fully correctable.
The full report:
Past Medical History
There is no past medical history of hypertension, diabetes, tuberculosis, sexually transmitted disease, or stroke. The President benefits from a "low" to "very low" (favorable) coronary artery disease risk profile with a favorable family medical history, absence of modifiable risk factors; superior fitness, favorable CAD markers (CRP, lipids, homocysteine) and functional studies ("stress echocardiogram"), and "minimal/mild" coronary artery calcification noted on anatomic study (coronary artery computed tomography, 2004).
Seborrheic keratosis excised 12/04.
Actinic keratoses identified and treated with liquid nitrogen 8/01, 12/01, 8/03, 12/04.
Telangiectasias, nasal bridge, consistent with solar damage, treated 8/03.
Vasovagal syncope, 1/02; solitary episode with identifiable precipitating event superimposed on longstanding, non-pathologic sinus bradycardia (consistent with a conditioned heart); evaluation 1/02, no sequelae, and no recurrence since 1/02.
Benign colonic adenomatous polyps removed on screening colonoscopy, 7/98, 12/99; Repeat colonoscopy in 6/02 was normal without polyps or mucosal abnormalities. Repeat exam anticipated in 2007.
Mild high-frequency hearing loss documented and stable on prior exams; speech frequencies excellent. Currently no symptoms.
History of seasonal allergic rhinitis; asymptomatic this spring with preventive seasonal use of nasal corticosteroid spray.
The President has a history of activity-related injuries as noted below, which resolved without sequelae and do not impact his current duties. He continues a vigorous aerobic, weight training, and flexibility program.
Musculoskeletal low back pain secondary to lifting; fully evaluated in 1990, currently asymptomatic.
Intermittent bilateral anterior knee pain, activity-related, with a left medial meniscal injury and subsequent surgical repair in 1997. Orthopedic and radiographic re-evaluation in 12/03 confirmed an old incomplete tear of the PCL of the right knee with resultant patello-femoral chondromalacia, post-traumatic degenerative changes, and asymptomatic medial meniscal damage, all most consistent with a remote athletic injury and physical activity. Symptoms resolved with quadriceps strengthening, cross-training (biking), and elimination of impact exercises (e.g. running) from his routine.
Right "calf" running injury (strain/tear), 4/03, most consistent with overuse. Symptoms resolved.
Minor abrasions secondary to injuries sustained while biking, all healed without sequelae.
Mild hyperopic astigmatism/presbyopia, fully correctable. Uses reading glasses as needed.
Blood transfusions: none
Past Surgical History
Appendectomy 1956
Left medial menisectomy 3/97
Medications
The President takes a daily multi-vitamin, low-dose aspirin, glucosamine/chondroitin, and an omega 3 supplement. He does not routinely use prescription medications.
Immunizations
The President's immunizations are current for worldwide travel.
Social History
- Tobacco: An occasional cigar
- Alcohol: None
- Caffeine: Diet sodas and coffee
- Exercise: The President exercises six times per week. Workouts include bicycling (15-20 miles, 15-18 mph), treadmill (low impact "hill-work"), elliptical trainer, free weight resistance training, and stretching.
- Other: The President has not missed work due to illness since his last physical exam.
Physical Examination
Vital Statistics
- Age: 59 years old
- Height: 71.75 inches (without shoes)
- Temperature: 97.5 degrees F (oral)
- Weight: 191.6 (last year 199.6)
- Body Composition: Body fat 15.79% (last year 18.25%; normal for age 16.5-20.5%; Cooper data)
- Resting heart rate (seated): 47 bpm
- Resting blood pressure (seated): 110/64
- Pulse-oximetry: 98% (room air)
System-specific examination summary
- ENT (ears, nose, throat): Normal (audiogram and nasopharyngoscopy were accomplished in 12/04, and were not indicated or repeated at this time). Physical examination of the head, neck, and thyroid are unremarkable. Thyroid function tests were normal.
- Eyes: No ocular pathology was discovered on ophthalmoscopic examination. Visual fields were normal. Uncompensated (uncorrected) distant visual acuity was 20/20 in both eyes. Corrected near visual acuity was 20/20 in both eyes (the President uses reading glasses as needed).
- Neurologic exam: Normal.
- Pulmonary: Normal. Chest x-ray unremarkable and unchanged.
- Gastrointestinal: Normal. Colonoscopy was last performed in June 2002. Symptoms reported consistent with occasional gastroesophageal reflux (GERD), with well-defined triggers (e.g. coffee, peppermint). Abdominal examination normal.
- Cardiology: Physical examination of the circulatory system was normal. The resting EKG revealed sinus bradycardia consistent with previous exams and aerobic conditioning. Fasting lipid panel: total cholesterol: 178 (desirable 40); "Large HDL": 32 ("lower risk" >30); "Large VLDL": 12 ("lower risk"
The President underwent Balke protocol exercise treadmill testing (ETT) with echocardiogram. He exercised for a total of 26:20 minutes achieving a maximum heart rate of 183. No signs or symptoms of cardiovascular pathology were noted. Stress echocardiogram was normal.
- Dermatology: No evidence of skin cancer or premalignant lesions. Lesions consistent with solar damage (e.g. telangienctasias) noted as in past. A small pigmented lesion, on left lateral neck, clinically consistent with an inflamed benign seborrheic keratosis; frozen with liquid nitrogen. No actinic keratoses were noted.
- Musculoskeletal: General musculoskeletal exam was unremarkable. Examination of the lower extremities revealed full range of motion and full motor strength without knee effusions or instability.
- Genitourinary System: Exam was within normal limits without evidence of prostate nodularity or hypertrophy. PSA was 0.5 (normal
Laboratories
A standard battery of routine screening laboratory tests was performed and was unremarkable.