Medical tribulations of politicians — degrees of transparency

Remarkably on the last day of the year, 3 political figures and their medical problems are in the news.  Here they are in order of medical transparency (highest first).

l. George Bush Sr. — the most transparent.  We are told what he has (pneumonia), when he was admitted to hospital when he was in the ICU, when he came out.  Docs call pneumonia ‘the old man’s friend’ not out of cynicism, but because its a mode of death with (relatively) little suffering.  The patient lapses into unconsciousness and usually dies quickly and quietly.  It took my cellist’s father only a day or two to pass away this month.  Clearly it isn’t invariably fatal, and Bush Sr. was now out of the ICU at last count (he’s 88).

2. Hilary Clinton — admitted to the hospital yesterday with a ‘blood clot’ somewhere, said to be a complication of the concussion she suffered a few weeks ago.  Also said to be under treatment with anticoagulants.  Most clots due to head trauma are inside the head and treating them with anticoagulants is a disaster.  The most likely type of clot given the time from the concussion is a subdural hematoma.  It is possible that she’s been so inactive since the concussion that she developed thrombophlebitis in her legs, in which case anticoagulation would be indicated.

More disturbingly, is that her passing out a few weeks ago is a sign of something more serious going on.  Hopefully not.

The powers that be should have told us where the clot actually is.

Update 5:50 PM EST — Well the powers that be did open up and it is a most unusual complication of head injury (and one I’d never seen in nearly 4 decades of practice) — a venous thrombosis in the head.  I’m not even sure it’s due to her head injury.  It might have even caused her syncope, but presumably she had some sort of radiologic study of her head when she fainted, which should have picked it up.  The venous sinuses draining the brain in the back of the head are notoriously asymmetric, so a narrowing attributable to a clot could just be a variant anatomy.  One very bad complication of cerebral venous thrombosis back there (which I saw as a complication of chronic mastoid bone infection — not head trauma) is pseudotumor cerebri.  I really wonder if these guys have the right diagnosis.

3. Hugo Chavez — Yesterday it was announced that he’s had a third complication since his surgery for cancer 3 weeks ago. Naturally, we’re not told just what this complication actually is. This is consistent with the information that has been released about his case.  We know almost nothing about his actual tumor (except that he has one).  He most assuredly is not free of cancer as he stated last fall.  He is said to have have a bleeding problem and a lung infection as the first two complications.

My guess for this third complication is that it is a dehiscence of his abdominal incision, which must have been fairly large for a 6 hour operation.  Dehiscence just means that the wound has spontaneously opened up exposing abdominal contents (which means that peritonitis is not far behind).  Why should this happen?  Two reasons — he’s had radiation to the area which inhibits wound healing, and he’s been on high dose steroids in the past (and perhaps presently) which also inhibits wound healing.

I don’t think he’s going to be able to take office 10 days hence, and doubt that he’ll come back to Venezuela alive.  Transparency has been zilch.  Hopefully the people of Venezuela are beginning to realize just how misleading the information they’ve been fed about his health has been.

This is the sort of thing physicians taking care of really sick people deal with daily, which may explain why your doc friends aren’t as jolly as you are at the New Year’s Eve parties you’re about to attend.

Nonetheless, Happy New Year to all ! ! ! !

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Comments

  • Curious Wavefunction  On December 31, 2012 at 12:40 pm

    “Most clots due to head trauma are inside the head and treating them with anticoagulants is a disaster.”

    Is that because most anticoagulants can’t cross the BBB?

    Happy New Year!

  • luysii  On December 31, 2012 at 2:38 pm

    They don’t need to. They do their damage within the confines of the circulatory system. I was taught in medical school, that a single cc. of blood contains enough clotting factors to coagulate all 5.5 liters of blood in our circulatory system. Coagulation/anticoagulation must be regarded as two giant fists pushing at each other. There are all sorts of anti-coagulation factors present in blood. Heparin (an anticoagulant) works by inhibiting one of them (anti-thrombin III).

    The most common cause of hemorrhage in the brain substance in Rochester Minnesota (the home of the Mayo clinic) in the 80’s was anticoagulation for TIA’s based on almost no evidence, and which isn’t done today (or shouldn’t be). It drove me nuts as a neurologist to see people suffer the complications of anticoagulation when the reasons for it were backed to no evidence. One horrible day I saw 3 patients — one had bled into the head, one into the kidney and one into the GI tract — all had been anti coagulated, for the most tenuous of indications. Also remember back then, we really didn’t have a good way to follow anticoagulation (the prothrombin time) the way we do today (the INR).

    Happy New Year to you too ! ! !

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