What's Ahead for Clinton?

NEW YORK – Former President Bill Clinton (search), who narrowly escaped having a heart attack, should be able to resume his active lifestyle, his doctors say. But whether that includes campaigning in the remaining two months before the presidential election is questionable.

"He will gradually resume a fully normal exercise and work schedule," but that will take "weeks rather than days," said Dr. Allan Schwartz, chief of cardiology at New York Presbyterian Hospital/Columbia, where Clinton had a quadruple bypass (search) operation on Monday.

"I would encourage him to resume all activities, including campaigning, as we both deem safe and appropriate," he said.

What else is ahead for Clinton? Beer and burgers certainly aren't gone from his life, but they'll be rare treats on a recommended diet that is low in saturated fats and cholesterol. Clinton will be able to resume regular exercise in a couple of weeks, starting with walking and gradually building up to jogging.

And he'll be watched for signs of the blues, which many patients go through after confronting their mortality because of a health scare. But Clinton already is ahead in this respect, said Dr. Nieca Goldberg, a cardiologist at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association (search).

"People who have a positive outlook going in and a lot of social support have less risk of depression," she said.

Here are answers to questions about what lies ahead for Clinton.

Q. How long will he be hospitalized, and what happens there?

A. The usual stay is less than a week, long enough to ensure the bypasses aren't leaking and that there are no major complications. Patients usually are off a breathing machine and can sit up in bed a day after surgery. Within a day or two, they can start walking around.

Q. How long will it take Clinton to recover from the surgery?

A. Most patients are about 70 percent recovered at six weeks and fully recovered at two to three months, Clinton's surgeon said. About 30 percent who spend time on a heart-lung machine, as Clinton did, have some small but measurable problems with mental functioning, but these usually disappear within a year.

Q. How soon can he go back to jogging?

A. Bypass patients are encouraged to walk around but avoid strenuous exercise for the first month or so. After that, he'll be able to gradually increase the intensity of his activity, building to a light jog about two months after his operation.

People with "desk jobs" usually can return to work in four to six weeks, longer if their jobs are more physically strenuous.

Q. What kind of medication will Clinton have to take?

A. New guidelines from leading heart groups say that all bypass patients should be prescribed aspirin, a statin drug to lower cholesterol, and a beta blocker — a drug that prevents irregular heartbeats that are common after such an operation. If they have rhythm abnormalities, they also should be given an anticoagulant such as warfarin, the guidelines say. Clinton also likely will be kept on a drug called an ace inhibitor to control high blood pressure.

Q. What are the odds he'll have to return for another bypass in five to 10 years?

A. That depends somewhat on how well he takes care of himself now in terms of diet and exercise to make sure his arteries don't reclog. But this can happen for genetic reasons, too. Up to 30 percent of bypass patients can have blockages reappear years down the road.

Q. Why weren't Clinton's artery blockages found before they became so severe?

A. The blockages probably developed over many years, even decades, but weren't serious until recently, when they caused symptoms — shortness of breath and chest pain. Clinton did well on treadmill tests, so doctors had no reason to do an angiogram, a special type of X-ray that revealed his blockages on Friday.