After Fetterman’s stroke, doctors examine the prospects for the Senate campaign
What is really the prognosis for John Fetterman, the Pennsylvania Democratic Senate candidate who suffered a stroke on May 13?
The 52-year-old Lieutenant Governor of Pennsylvania won his party nomination a few days later, setting up one of the most consequential Senate competitions of the mid-term elections. But urgent medical issues remain.
He was discharged from the hospital, his campaign said Sunday, and Mr. Fetterman he said doctors assured him he would make a full recovery, but the campaign did not say when he will be able to return to the campaign.
“I’ll take the time I need now to rest and get to 100 percent so I can go full speed soon and flip this seat in blue,” Mr. Fetterman said in a statement on Sunday, adding that he felt “fantastic. “but destined to” continue to rest and recover “.
With such an important race in the balance that a Senate majority could decide, Mr. Fetterman’s state of health is of intense public concern. Yet despite his repeated requests, his campaign did not make him or his doctors available to discuss his stroke and medical treatment.
And specialists in stroke, heart disease and electrophysiology have said that some of the campaign’s public statements do not offer sufficient explanation for the diagnosis Mr. Fetterman described or for the treatment they claim to have received.
The stroke, he said in a statement released from his campaign, was caused by a blood clot. He said the clot was the result of atrial fibrillation, a condition in which the upper chambers of the heart beat chaotically and are out of sync with the lower chambers of the heart. The campaign said the clot was successfully removed by doctors at a nearby community hospital, Lancaster General Hospital.
On May 17, primary election day, Mr. Fetterman was implanted with a pacemaker and defibrillator which, his press office said in a statement, “will help protect his heart and address the underlying cause of the his stroke, fibrillation (A-fib), regulating heart rate and rhythm. His press office said he should fully recover from the stroke.
Medical specialists asked about Mr. Fetterman’s treatment with a defibrillator. They say it would only make sense if he has a different condition that puts him at risk of sudden death, such as cardiomyopathy, a weakened heart muscle. This heart condition may have caused the blood clot. Or, doctors say the campaign may be correct on the afib causing the clot.
Thrombectomy, the method likely used to remove the clot, also indicates that Mr. Fetterman has had more than one small stroke, although prompt treatment may have prevented damage and saved his brain.
“I’ve only been in the hospital for over a week,” Fetterman said in a statement. “I am aware that this is serious and I am taking my recovery seriously.”
In a brief interview on May 20, Gisele Barreto Fetterman, Mr. Fetterman’s wife, told the story of her stroke, from her point of view.
“We had been campaigning on the road,” he said. “We had breakfast and he was feeling fine.”
The couple got into the car to drive to an event at Millersville University when, she said, “the left side of her mouth went down for just a second.”
“I had a gut instinct that something was going on,” Ms. Fetterman said. “I yelled at the soldier, ‘I think he has a stroke.’ He said, ‘I’m fine. What are you talking about? I’m feeling fine.’ “
The state police soon took Mr. Fetterman to Lancaster General Hospital, where his treatment began. Ms. Fetterman said it was going through her groin, which suggests she had a thrombectomy, a procedure in which doctors slide a small plastic tube through her groin, advance it into the brain, and then extract the blood clot using suction or a wire mesh.
It wasn’t until two days later that his campaign reported that Mr. Fetterman had been hospitalized with a stroke. When asked about the delay, Ms. Fetterman said, “Less than 48 hours is pretty impressive timing when dealing with sensitive medical issues.”
Shortly after that question, Rebecca Katz, a senior consultant in Mr. Fetterman’s campaign, abruptly cut off the phone call with Ms. Fetterman.
The medical specialists said some aspects of the story were difficult to reconcile with their knowledge of stroke treatment.
Dr. Lee Schwamm, a stroke specialist at Massachusetts General Hospital and a professor of neurology at Harvard Medical School, said doctors only perform a thrombectomy when a large cerebral artery is blocked.
“You usually wouldn’t do this for someone with just a little face down,” she said. Dr. Schwamm wondered if the doctors who examined Mr. Fetterman in the hospital had noticed other symptoms, such as a loss of left-sided vision or a lack of left-sided awareness, often called “neglect.”
“These strokes tend to be very serious,” says Dr. said sponge. “He’s lucky he went to a hospital that can treat him.”
Pressed on the stroke symptoms described by Ms. Fetterman, a spokesperson for Mr. Fetterman wrote in an email that he “told The Associated Press last week that Gisele ‘he noticed that John was not himself and shortly thereafter began to mumble his speech. ‘”
But what caused the stroke?
Ms. Fetterman said her husband knew she had atrial fibrillation, which confers a high risk of stroke, and that she had been taking blood thinners, a standard method of reducing stroke risk in people with atrial fibrillation, “on and off.”
But pacemaker and defibrillator treatment is a conundrum if all he had was atrial fibrillation, medical specialists said.
“This doesn’t make any sense at all,” said Dr. Brahmajee Nallamothu, an interventional cardiologist at the University of Michigan.
Dr Elaine Wan, associate professor of medicine in cardiology and cardiac electrophysiology at Columbia University Medical Center, said defibrillators, which always come with pacemakers, are used to prevent sudden death. They are usually implanted in people with weakened heart muscle, or in those who have survived an episode where the heart has stopped, or in people with a genetic predisposition to sudden cardiac death.
“We wouldn’t use it for atrial fibrillation,” said Dr. Wan said.
Dr. Rajat Deo, an associate professor of medicine and cardiac electrophysiologist at the University of Pennsylvania’s Perelman School of Medicine, agreed on the use of defibrillators and said he shared Dr. Wan’s suspicion that Mr. Fetterman has a damaged heart.
“I think it would be fair to say that he has at least two separate problems,” said Dr. Deo said of Mr. Fetterman. “One has atrial fibrillation, from which he most likely suffered a stroke which was successfully treated.”
He added: “The second problem is that he probably has some underlying heart condition that increases the risk of ventricular arrhythmias and therefore sudden cardiac death.”
The afib could be related to the other condition, Dr. said the deodorant. Patients with weakened heart muscle are also at risk of developing atrial fibrillation.
On the other hand, Dr. Deo says Mr. Fetterman’s atrial fibrillation may have nothing to do with his weakened heart. Without further information from the doctors about him it is impossible to know.
Dr Deo added that if Mr. Fetterman is receiving appropriate state-of-the-art medical therapies and is protected with a defibrillator from sudden cardiac death, “he should do well enough as he continues his campaign.”
Experts have also raised concerns on the prospects of former Vice President Dick Cheney, who was implanted with a defibrillator in 2001. He finished two terms in the White House, including a hard-fought re-election in 2004.
And there is time before the general election campaign in Pennsylvania begins in earnest: It is unclear who will be Mr. Fetterman’s opponent, as the Republican race remains. too close to call and could go to a recount.
But Dr. Wan was less optimistic than Dr. Deodorant about Mr. Fetterman.
“He is at risk for sudden cardiac death,” he said. “For someone in the electoral campaign who could cause concern”.