An analysis of Dick Cheney’s health and routine physical exam

Vice-president Dick Cheney completed his physical:

Cheney, 64, was at George Washington University Hospital for a colonoscopy, an upper endoscopy and a vascular screening. The procedures completed his yearly medical checkup.

In the first part of the exam last week, an annual heart checkup produced good news for Cheney, who has had four heart attacks, though none since he became vice president in 2001.

The latest tests found Cheney’s colon, or large intestine, to be normal, according to a statement from his spokeswoman, Lea Anne McBride.

The endoscopy “indicated mild esophagitis,” or swelling or irritation of the esophagus, the tube that leads from the back of the mouth to the stomach. The statement did not elaborate on the cause of Cheney’s condition. Esophagitis frequently occurs when acidic fluid flows from the stomach back into the esophagus. Other possible causes include excessive vomiting, surgery and some medications.

Cheney’s vascular exam also “identified small, dilated segments of the arteries behind both knees.”

That seems to be quite a comprehensive physical. Let’s talk about the tests he received, and what preventive services a 64-year old man should have.

Tests mentioned in the article that Mr. Cheney received

1) Colonoscopy
This is recommended for colon cancer screening every 10 years after the age of 50, or after the age of 40 if one is at high risk for colon cancer. Other options can include a fecal occult blood test either alone, or in conjunction with a flexible sigmoidoscopy (every 5 years), or a double contrast barium enema (every 5 years). Note that only the fecal occult blood test has been shown to decrease mortality.

2) Upper endoscopy
Unless Mr. Cheney had any symptoms of dyspepsia, or a history of upper GI tract disease, I am not aware of any recommendation for a routine upper endoscopy.

3) Peripheral vascular disease
Routine screening of peripheral vascular disease is not recommended. Perhaps Mr. Cheney’s history of vascular disease pressured his physicians into ordering this screening test.

Tests not mentioned in the article, but Mr. Cheney still likely received

4) PSA and digital rectal exam
There is still no data showing that a PSA correlates with a decrease in prostate cancer mortality, currently receives an I recommendation from the USPSTF. However, in this day and age, this test needs to be done.

5) Cholesterol
Without question. Even without his history of heart disease, routine screening is recommended.

6) Abdominal ultrasound for AAA
This is a relatively new recommendation. Given Mr. Cheney’s history of smoking, this was likely done.

7) Blood pressure
Routinely done and recommended.

8) Vaccines
Ensure that tetanus, pneumococcal, and influenza vaccines are updated. In the healthy population, only the tetanus and influenza vaccines are needed. Mr. Cheney’s heart disease makes the pneumococcal vaccine recommended before the age of 65.

9) Screen for depression
This is recommended.

10) Diabetes
Not sure if Mr. Cheney has diabetes. If not, his heart disease warrants screening for this. Typically a fasting blood sugar can be used.

But wait, shouldn’t he also have these tests?

1) Urine test looking bladder cancer
A routine urine test looking for hematuria as a possible sign of bladder cancer is not recommended.

2) Chest x-ray for lung cancer
He likely had a chest X-ray regardless, but there really isn’t any evidence supporting any screen for lung cancer.

3) TSH for thyroid disease
Again, inconclusive and not routinely recommended.

4) Routine EKG or cardiac stress testing
Given his heart history, absolutely. In the healthy population, a routine EKG or stress testing is not recommended.

5) Carotid ultrasound for carotid stenosis
Once again, inconclusive and not routinely recommended.

(“Cheney Completes Annual Physical”, AP/WashPost, Jul.17)

Cross-posted on Straightfromthedoc.

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