Senator John Kerry, a lean athlete who is the picture of health as he skis, skates, cycles and windsurfs, is in robust condition, he and his doctors said in their first extended interviews discussing his medical history. Mr. Kerry, 60, the Democratic presidential nominee, and his doctors discussed in great detail his health, particularly the surgery to remove his cancerous prostate gland in February 2003. It was one of two operations that disrupted his campaign. The second repaired a painful shoulder injury last March.
Mr. Kerry could become the first "cancer survivor" to be elected president, but he rejected the term as creating an unfair stigma. He is free of any vestiges of the cancer and characterized it as a nonissue in an interview in Las Vegas on Sept. 16. "I am cured," he said. "I am cancer-free, and the percentages of me being cancer-free 10 years from now are about as good as they get."
Mr. Kerry's doctors said they had told him that he was cured. They based their optimism on an array of tests and concluded that he had a less than 3 percent chance of a recurrence in the next nine years. Even if the cancer came back, it could be treated without seriously interfering with presidential duties, Mr. Kerry's doctors and experts said.
"The likelihood that he is going to have a significant problem with this cancer is infinitesimally small," said Dr. Patrick C. Walsh, the Johns Hopkins University urologist who performed the operation. The five-year death rate for the kind of prostate cancer that Mr. Kerry developed is virtually zero.
In a 20-minute interview, Mr. Kerry pledged to disclose any ailment he might develop as president "if it's relevant to my ability to conduct my office or to affect the country in some way."
Mr. Kerry, who has signed a living will outlining his wishes if he is incapacitated, said that he and his running mate, Senator John Edwards of North Carolina, had not discussed how a transfer of power, if necessary, would be invoked under the 25th Amendment. He said he would do "whatever's appropriate if a moment arrives." He added: "People will tend to know when that moment's arrived. They either happen with time to talk about it or they happen in a way that it's automatic."
Mr. Kerry's participation in strenuous activities like windsurfing, bicycle races of up to 112 miles and weight lifting has kept him exceptionally fit, he said. He would be in even better shape if he were not campaigning, Mr. Kerry said, "but for somebody who is running for president, I'm in about as good a shape as I think anybody could be."
To show his full recovery from the orthopedic surgery that he underwent last spring to repair tears in a biceps tendon and a muscle in his right shoulder, Mr. Kerry thrust both arms straight up as if to signal a touchdown and smiled. Before the operation, pain and weakness hindered him from raising his right arm overhead or lifting an object. Occasionally, pain from the muscle tear awakened him.
Mr. Kerry's injuries as a young man, however, seem to have given him more trouble - political trouble, that is - than his shoulder surgery.
A group of veterans has challenged the validity of the three Purple Hearts that Mr. Kerry received for wounds he suffered while serving on Swift boats in the Vietnam war. These critics suggested that the shrapnel that hit him in one mission was rice, not metal.
However, CT scan X-rays taken at Massachusetts General Hospital in Boston document that two pieces of metal shrapnel are embedded deep in Mr. Kerry's left thigh, next to the femur, said Dr. Gerald J. Doyle, Mr. Kerry's personal physician in Boston who reviewed the X-rays at the request of this reporter, who is a physician. Doctors treating the wound in 1969 decided to leave the shrapnel in place. "One piece of shrapnel is about the size of a bullet, the other a bit smaller," Dr. Doyle said.
Mr. Kerry said, "I can't tell you I really feel it," but "it's back in here somewhere," as he slapped his thigh.
The author Douglas Brinkley wrote in "Tour of Duty," his account of Mr. Kerry's Navy service, that the young officer injured his arm and suffered "a slight concussion" when he was thrown against the bulkhead of a Swift boat. Mr. Kerry said that he hit his head but that in using the word concussion with the writer he meant "the concussion of the explosion" and never said he had "a cerebral concussion" because that diagnosis "is not in my medical records."
Mr. Kerry was confident, affable and answered all questions in the interview.
Earlier, Mr. Kerry gave three of his doctors permission to speak about his health with this reporter. Each doctor, interviewed separately, said that Mr. Kerry had instructed him not to withhold any information about his medical history.
Before presidential elections over the last 24 years, The New York Times has looked into the health of presidential nominees.
In the past, White House and personal physicians have at times misrepresented or lied about a president's health. For example, Franklin D. Roosevelt's doctors did not disclose the heart and vascular disease that caused his death, and John F. Kennedy and his family denied reports that he had Addison's disease, or adrenal insufficiency, and required hormone injections.
In 1992, a Democratic president candidate, Senator Paul E. Tsongas of Massachusetts, and his doctors said he had been cured of a lymphoma cancer. In fact, Mr. Tsongas had had a recurrence of the disease and died of it a day short of what would have been the end of his first term had he been elected.
Mr. Kerry, in expressing confidence that he was cured of prostate cancer, pointed to former Senator Bob Dole of Kansas, 81, who underwent the same operation in 1991, five years before he lost the presidential election to Bill Clinton.
Mr. Dole "is doing great today," Mr. Kerry said. "There's your answer."
Since his surgery, blood tests performed every six months to check Mr. Kerry's prostate-specific antigen, or P.S.A., a marker for cancer, have indicated no recurrence. The latest test was performed Sept. 18 in a house call by Dr. Doyle.
Reasons for Concern
Mr. Kerry's P.S.A. was in the normal range when his cancer was detected during an annual checkup in December 2002. But because the figure had risen by 70 percent over two years, both Teresa Heinz Kerry, the senator's wife, and Dr. Doyle independently felt the need to check further.
Mrs. Heinz Kerry keeps a sharp eye on her husband's health. In an interview on Sept. 20, she said that her husband told her in November 2002 that routine blood tests performed through the Attending Physician's office at the Capitol were "fine" and that he was particularly pleased about a cholesterol count of 195.
"Cholesterol isn't everything," she said she told him.
The P.S.A. test was a normal 3.24 nanograms per milliliter. But Mrs. Heinz Kerry said she told her husband, "it's low, but high for you" and urged him to see Dr. Doyle in Boston and repeat the tests.
When the doctor examined Mr. Kerry on Dec. 17, 2002, it was his patient's first checkup in nearly two years. A standard digital examination and an ultrasound test found no nodules or other prostate abnormality that might signal cancer. His new P.S.A. level was a normal 3.4 nanograms per milliliter. Nevertheless, Dr. Doyle said he was concerned because the figure had crept up from 2.7 in Feb. 2001 and 2.0 in Dec. 1999 and Nov. 2000.
So Dr. Doyle consulted Dr. Alex F. Althausen, a urologist, who recommended a biopsy. "The rate of increase was what alarmed us both," Dr. Doyle said.
After learning that an ultrasound "isn't a fail-safe" test, Mr. Kerry decided he wanted a biopsy.
After fitting Mr. Kerry into his schedule between surgeries on Dec. 20, Dr. Althausen told Dr. Doyle that the biopsy specimens did not look suspicious to his naked eye, Dr. Doyle said.
But the real test was viewing the biopsied tissue under a microscope, and the pathology report showed cancer in five of the pieces that were removed.
Mr. Kerry was one of more than 200,000 men in the United States in whom prostate cancer is diagnosed each year. About 1 in 6 American men will develop the disease at some point, but only 1 in 33 will die of it, the American Cancer Society says. The reason is that prostate cancers often do not develop until men are in their 70's or older and often grow slowly; men who develop prostate cancer often die of other causes.
Dr. Doyle wanted to inform Mr. Kerry about the finding in person, as he usually does. "Most patients are overwhelmed when they first learn they have cancer, and many lose their focus," he said.
But for four days over the long holiday weekend, (Christmas was midweek) Dr. Doyle's attempts to leave messages for Mr. Kerry at his Senate and local offices failed because the voice mailbox was full. He finally reached Mr. Kerry on Christmas Eve at his home in Sun Valley, Idaho.
"To have to tell someone over the phone is difficult," Dr. Doyle said. "But I had to because we wanted to get things squared away as soon as possible."
When he delivered the news to his patient, Dr. Doyle said, "He didn't miss a beat and just asked all these appropriate questions right away as though it were someone other than himself."
"What does this mean?" Dr. Doyle said Mr. Kerry asked him. "What are my options? What is the time frame we are talking about here? How soon can we get moving on it?"
Mr. Kerry recalled, "A lot of things went through my mind," including memories of his father, who died of prostate cancer at age 85 in 2000. (Studies show that a family history of prostate cancer increases the risk of developing the disease but not the rate of its progression.)
"My dad had radiation, and I saw just how he lived at the end, and I didn't want to go through that," Mr. Kerry said.
After consulting with people who had different treatments for prostate cancer, Mr. Kerry said, "I knew what I wanted and needed to do."
"I made the decision, boom, and we booked the surgery, and 30 days later I did it," he said.
Mrs. Heinz Kerry said she had read about Dr. Walsh, who had developed a nerve-sparing prostate operation that preserves continence and potency for many patients, and suggested the couple call him.
The decision to have the surgery in Baltimore irked many doctors in his home, Boston. Mr. Kerry said he regretted that attitude, and that he preferred to recuperate near his office in Washington. The operation, removing the entire prostate gland, was performed on Feb. 12, 2003 and "went by the book," Dr. Walsh said. His patient, though, did not allow himself much time to recover.
"He needed to be at a major event out in California two weeks later," Dr. Walsh said. "So he shortened his recovery schedule by a little bit just to make it fit."
Mr. Kerry said, "It takes you a little longer to get back up to speed than you think because they put a bunch of stitches in you, and I was surprised at how many."
"The prostate slowed me down a little bit at a critical time," Mr. Kerry said. "It was an annoyance; it was aggravating."
The pathology report was the best that Mr. Kerry could receive: the cancer was confined to the left side of the prostate gland. And on the Gleason scale, a standard measure of the severity of prostate cancer, Mr. Kerry's score was 6 out of 10, considered a very favorable finding.
If Mr. Kerry had a recurrence, Dr. Walsh said, "he would be astonished, and so would I, and I am telling you this with the very conscious understanding of what happened to Senator Tsongas."
Dr. Peter T. Scardino, the chief urologist at Memorial Sloan-Kettering Cancer Institute in Manhattan, who is not connected with Mr. Kerry's case, said that while "there are no guarantees," he agreed with the prognosis given Mr. Kerry. "Something bizarre could happen as an exception to the rule, but it would be extremely surprising," Dr. Scardino said.
If Mr. Kerry's cancer did return, it could be controlled by radiation therapy over six weeks, Dr. Scardino said. "That would almost certainly not interfere with his functioning as president except" to limit travel during that period and for the fatigue that often follows radiation therapy, he said.
Sports Take a Toll
The shoulder operation last March was Mr. Kerry's second on that joint. He has also had surgery three other times for sports-related knee injuries, said Dr. Bertram Zarins, an orthopedist at Massachusetts General Hospital. Dr. Zarins said that Mr. Kerry injured one knee twice (skiing and soccer), and the other playing softball.
Mr. Kerry's first shoulder injury was in May 1992 when he fell from a bicycle and broke his right clavicle. The fracture healed but the scar tissue that formed put pressure on a nerve in the shoulder, which was relieved by minor surgery in 1993, Dr. Zarins said.
Late last January, Mr. Kerry grabbed a railing on a campaign bus when the vehicle lurched, tearing a biceps tendon and subscapularis muscle in the previously injured right shoulder.
Dr. Zarins said he initially recommended that Mr. Kerry wait for the injury to heal. But Mr. Kerry continued to have pain and weakness, limiting the function of his right, and dominant, arm.
Timing for such surgery is critical; results are better if it is performed soon after the injury. If it is put off too long, the muscles and tendons wither and repair can become impossible.
After it became clear that the conservative treatment failed, the surgery was performed March 31.
"We waited longer than we normally would like because of" Mr. Kerry's campaign schedule, Dr. Zarins said. Mr. Kerry's recovery was speedier than most patients', Dr. Zarins said, because "he's very coordinated, a good athlete, has good pain tolerance and followed instructions well."
"He did everything the way it should be," Dr. Zarins said, and now "there are no problems with the shoulder."
Mr. Kerry takes no medications on a regular basis. But last summer Dr. Doyle said that he might recommend that Mr. Kerry start taking a statin drug, which lowers cholesterol, after the election. The reason was that tests of his total cholesterol and "bad" cholesterol, or L.D.L., showed that the counts had risen over the last two years.
Cholesterol counts can be influenced by exercise and diet. Mr. Kerry's total cholesterol has fluctuated between a high of 238 in 1995 and a low of 167 last February. It was at 228 last April, 215 in November 2003 and 195 in February 2003. (Risk of heart attacks rises at levels greater than 200, the American Heart Association says.) Over the same period, his bad cholesterol, or L.D.L., rose to 154 from 137 and 121, raising the possibility of a statin prescription.
Because Dr. Doyle wanted to measure the lipids - fatlike substances - after an overnight fast to get a more accurate reading, he paid a house call to Mr. Kerry in Boston on Sept. 18 to draw blood for a new set of tests. But when Dr. Doyle arrived about 10 A.M., as scheduled, his patient had eaten breakfast.
An Eye on Cholesterol
Nevertheless, the new test results were better. Mr. Kerry's total cholesterol was 194 and his L.D.L. 122. Dr. Doyle said that he would like to lower Mr. Kerry's L.D.L. to below 100, even to 70, but that he was reluctant to prescribe a statin drug during the campaign, in part because of the risk of side effects like muscle weakness and liver damage. He said he would re-evaluate the situation later this year.
Mr. Kerry's tests for thyroid and other functions were normal, Dr. Doyle said.
Mr. Kerry, who stands 6 feet 4 inches and has weighed between 180 and 185 pounds for many years, lost seven pounds campaigning earlier this year. But he gained eight pounds after Dr. Doyle recommended peanut butter sandwiches and ice cream to substitute for the meals that the senator often skipped because of a hectic schedule.
"To hell with the cholesterol," said Dr. Doyle, who offered his patient a political tip. "You can't have a gaunt-looking person running for president because people will draw conclusions that are erroneous."
Because of Mr. Kerry's excellent performance in vigorous activities, Dr. Doyle said he had not performed tests for heart disease, like an echocardiogram, exercise stress test or noninvasive CT scans.
Mr. Kerry has had pneumonia twice , once from a virus while a student at Yale, the other from pneumococcal bacteria while in the military in 1967. He has also had occasional bouts of bronchitis that have been treated with antibiotics, bronchial dilators and topical steroids. His lung function is normal
Mr. Kerry also has mild asthma and suffers from seasonal allergies like hay fever, and occasionally takes medications for them. Dr. Doyle said.
Until surgery in 1974, Mr. Kerry had a misalignment of his jaw that prevented him from biting properly and made a loud clicking noise when he ate. "It was exasperating," Mr. Kerry said. While critics have suggested the procedure was cosmetic, both he and his dental surgeon, Dr. Walter C. Guralnick of Massachusetts General Hospital denied that.
Mr. Kerry recently suffered a campaigner's nightmare - hoarseness from laryngitis. "I am talking all day long, so the voice pays a price," he said in the interview. He reduced the acidity in his food to minimize gastric reflux, which can aggravate the problem. Mr. Kerry has colonoscopies every three years because of polyps that were detected in 1985 and 1993. None were found on his last colonoscopy two years ago. He has tested negative for H.I.V., and has never been in trouble with the law for drug or alcohol abuse.
What an absolute crock. There is no shrapnel.... even Kerry's own stories don't indicate that he got hit in the butt by any metal.... He said RICE. If there is metal in there.... well, Terezzzza better inventory her "marital aids"; Something must have been left behind in Jean Effen Kerrie's behind..
