1,173 pages of records detail McCain's health

FOUNTAIN HILLS, Ariz. — As he sought the presidency twice in the past decade, Arizona Sen. John McCain has been the object of unusually aggressive medical care by doctors, who Friday released records that document he has been cancer-free for almost eight years.

The release of what the campaign described as "every single piece of paper" in McCain's medical records for the past eight years is an attempt to confront concerns about the 71-year-old presumed Republican nominee's fitness to serve as president and questions about his age. He will turn 72 in August and would be the oldest president ever elected to a first term.

"Senator McCain wanted to be very transparent," said Nick Muzin, a Washington doctor who is serving as a medical adviser to the campaign. "He wanted to dispel any notions that he is in any way unfit to be president."

About 20 "pool" reporters were allotted three hours to examine 1,173 pages of records covering the last eight years. The campaign also made available three of McCain's doctors at Mayo Clinic Scottsdale, the Arizona campus of the hospital which has a headquarters in Rochester, Minn. McCain receives his medical care under a pseudonym, which reporters were asked not to disclose.

The records detail the five-hour operation in August 2000 to remove the most severe of McCain's four cases of melanoma, efforts to reduce the facial puffiness the surgery produced and the strategy of dermatological hypervigilance that followed.

Melanoma is a form of skin cancer that is rapidly fatal if it spreads to distant organs, such as the lungs and brain. Physicians examine the senator's skin every three or four months. He has had more than a dozen patches of abnormal skin cut out or chemically destroyed this decade.

All the melanomas were independent of each other, said Dr. John Eckstein, McCain's personal physician of 16 years at Mayo. "There was and is no evidence of recurrence or metastasis — meaning spread — of the invasive melanoma ... the prognosis for Sen. McCain is good because the time of greatest risk for recurrence of invasive melanoma is within the first few years after the surgery," he said.

McCain's doctors have also paid meticulous attention to complaints unrelated to his skin. He has been treated for kidney and bladder stones, had surgery for an enlarged prostate and been evaluated several times for dizziness originating in the inner ear. He has also had four colonoscopies, two exercise stress tests and innumerable CT scans and blood analyses.

McCain's last complete physical was March 10. He dropped six pounds in the past year, to 163, which he told Eckstein was due to his "long days and frenetic pace." He said he has two drinks a month.

The records shed light on why the 2000 surgery was more extensive than what is normally done for melanoma that has not spread beyond the deepest layers of skin.

In a meeting attended by McCain, his wife, Cindy, and an unidentified "physician friend," Mayo Clinic ear, nose and throat surgeon Michael Hinni described how he was going to remove a large oval piece of tissue from the left side of the senator's face.

He told them "it seems feasible to use this incision to remove all of the lymph nodes in his neck that are at risk, as he is going to incur the morbidity [damage] of the incision" anyway.

A "sentinel" lymph node — located by injecting the melanoma with blue dye before surgery — proved to be cancer-free. Nevertheless, a total of 38 lymph nodes, along with a portion of the parotid salivary gland, were removed.

The large opening in McCain's face was filled with a flap of skin that was cut from behind his ear.

The records suggest McCain was concerned about his appearance after the surgery, complaining several times the scar was "thick" and visible and that his face appeared swollen. He underwent a minor operation to minimize the scar and later wore a facemask designed to put pressure on the scar to help it heal.

In addition to his battles with cancer, McCain has been treated for slightly elevated cholesterol, arthritis and noncancerous polyps in the colon. The doctors described his various ailments as minor and said they should not interfere with his ability to serve as president.

"I want to say emphatically: Senator McCain enjoys excellent heath and displays extraordinary energy," Eckstein said. "There is no medical reason or problem that would preclude Senator McCain from fulfilling all of the duties and obligations as president of the United States."

McCain, who was a two-pack-a-day smoker until quitting in 1980, reported dizziness in 2000. This was diagnosed as "benign positional vertigo" and was treated by teaching him to move his head so as to relieve the sensation.

Doctors said tests of his heart showed no sign of cardiac disease that would increase the risk of a heart attack. The records indicate that during two stress tests for his heart, he was able to exercise on a treadmill for 10 minutes.

"He feels well. Has hiked the Grand Canyon rim to rim in 3 days this August," one of his doctors, Suzanne Connolly, wrote in November 2006. "Energy level is good."

Doctors detected bladder stones in 2001 and shattered them with a laser while also performing surgery to reduce the size of his prostate. He continues to have four kidney stones and takes medicine to reduce the likelihood of future ones, his doctors said Friday.

Doctors said they discovered and removed noncancerous polyps from McCain's colon during a routine screening this year. He continues to be mildly bothered by degenerative arthritis in his shoulders, hands and knees, in part because of abuse at the hands of his captors as a POW.

McCain is taking several medications, including simvastatin for high cholesterol, low-dose aspirin, hydrochlorothiazide to reduce the stone-forming calcium in his urine and amiloride to counteract the loss of potassium that hydrochlorothiazide produces.

There was no mention of McCain's psychological or emotional state in the documents beyond numerous references to him being "pleasant and energetic."

McCain jokes about his age, and when asked, he often concedes he's "older than dirt."

But his aides know his age could become an issue. They hope the release of his records and that keeping up a busy schedule will help quell it.

His likely Democratic rival, Barack Obama, is 46, lean and agile, and a frequent basketball player who says he has quit smoking. Neither he nor opponent Hillary Rodham Clinton has released their records.

Material from McClatchy Newspapers, Chicago Tribune and The Associated Press is included in this report.