Tag Archives: Hugo Chavez

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 ! ! ! !

Where is the hard-hitting investigative press ?

Hugo Chavez is a very sick man, something noted in previous posts — summarized in this post of 26 February ’12

http://luysii.wordpress.com/2012/02/26/diagnosis-by-media-release-the-continuing-saga-of-hugo-chavez/

Since that time he’s had to fly back and forth to Cuba for radiation therapy after his second surgery.  More to the point, he had to cancel an appearance 9 days ago (probably because he wasn’t doing well) missing a chance to confront President Obama.  Then, nothing from him except a few twitter posts. As expected, rumors flourished, so today he called a Venezuelan TV station saying that he was still alive.

All duly reported by Reuters, the BBC, the Associated press, The Telegraph (U. K).

Do you notice anything strange about this?

We’ve seen all sorts of pictures of him being greeted by Raul Castro as he gets off the plane to Cuba (and gets back on), pictures of him with Fidel, and probably video clips of him in Cuba (I wouldn’t know as I watch almost no television).

Don’t you think that at least one of these organs of supposedly investigative journalism could have asked why there is no picture of him?  Could it be that he doesn’t look as well as he has in the past?

24 April ’12 (5:30 PM EST) –At some point this afternoon a video of Hugo purporting to be filmed yesterday in Cuba was released to Venezuelan TV.  Perhaps this post or something like it triggered the release.  We still don’t know what he has, other than it’s some form of cancer, and whether it has spread from its site of origin.   He says he’ll be back to Venezuela in 2 days.

30 April 12 — The press  is finally starting to look a bit more closely at the news being released. There still has been no discussion of why he arrived back in Venezuela in the middle of the night, when no one is around to see what he looks like.  However, in today’s Bloomberg article about his request to go back to Cuba for ‘more treatment’, it was noted that, according to him, his 5 radiation treatments have been completed, so presumably he’s going back for something else (any area of the body can take only so much radiation).  Since getting back to Venezuela on the 26th, he’s remained out of sight, just emitting twitters and (I think) phonecalls now and then.

Diagnosis by media release — the continuing saga of Hugo Chavez

After declaring himself cured of cancer last October, Hugo Chavez is now in Cuba for more surgery.  I’ve posted on him before.  Here are the relevant excerpts.

From 31 August 2011

My opinion of docs who diagnose over the phone, or who render opinions on people they’ve never seen is not high, although we all indulge in this from time to time.

But here I am, about to indulge in the same thing concerning a very public figure.  Why?  Because what I’m about to say has received absolutely no attention in the press that I can find.   First, look at these 3 pictures of Hugo Chavez.

http://www.guardian.co.uk/commentisfree/2011/jul/24/hugo-chavez-cancer-popular 24 July

http://www.guardian.co.uk/world/2011/aug/01/hugo-chavez-hair-cut-venezuela  1 August

http://www.guardian.co.uk/world/hugo-chavez 31 August

What’s the point?  The rather remarkable change in his facial appearance over this short period of time.  In just 6 weeks or so he has developed the classic face of someone receiving very high doses of corticosteroids (Cushingoid facies).  The loss of hair due to his chemotherapy is irrelevant — it happens to most and is reversible when the chemo stops.

It also implies either that his docs are grossly overtreating him or that he is a very sick man. Doses of corticosteroids high enough to produce such massive facial change should never be used lightly.  Back in the day, this was all I had for the flareups of multiple sclerosis, and it was never easy on patients.

We do not know what sort of cancer he has, if it has spread, and if so, how far.    If his cancer was curable don’t you think it would have been trumpeted in one of his nearly daily press releases?

More worrisome for Chavez, is the fact that high doses of corticosteroids, invariably produce side effects.  One you are seeing — the change in facial appearance.  Two others are the invariable worsening of diabetes (should he have it) and the much increased possibility of stomach ulcers and bleeding.  Both are fairly easily managed, particularly ulcers — none of my MS patients ever got ulcers because I began treating them as if they already had one (e.g. milk and maalox) when I started the corticosteroids.  This was long before we know about Helicobacter and ulcers

High doses of corticosteroids usually produce a sense of euphoria.  Cognitive processes aren’t as good, and they are one of the few known causes of reversiblecerebral atrophy.

Far more worrisome for Venezuela and the rest of us, is the psychosis occasionally seen with high doses of corticosteroids.  He is a man of enormous power, and hopefully no one has given him nuclear weapons.

From 16 August 2011

Also if he had a curable form of cancer, don’t you think he’d have told us exactly what it is?   More likely, he’s putting on a front so his regime doesn’t collapse.  Years and years ago I was a member of the Council on Foreign Relations in a western town.  Various speakers were brought in — General Maxwell Taylor, etc. etc.  The most interesting  was the current Egyptian ambassador (or an attache).  He said that the governments in the mideast were all ‘one bullet governments’ — which was all it would take to change their direction radically –all were run by one man at the top —  this before the assassination of Anwar Sadat.

At least we see Chavez.  Recall the last hospitalization of Yasser Arafat in France.  We were told that everything was going well.  What we were not told until very late, was that all this information was from the family and not from the people taking care of him.  The investigative press was nowhere to be found.

This is unlikely to change.  The powerful will always be able to warp the medical system to their desires.   Think Michael Jackson, or even president Woodrow Wilson (incapacitated by a variety of strokes in his last years in office).

 Now on to the present.

We are told by Chavez or someone permitted to speak for him, that he has a 2 centimeter lesion, either at the site of the old surgery or near it.  Assume, for better or worse, that this is true. What does it mean?  Well, one of three things:

1. Stop calling this a lesion.  Only tumors act like this. No one gives chemotherapy enough to make your hair fall out for ‘lesions’ that aren’t tumors.

2. They couldn’t get the whole tumor out (meaning it’s incurable), and despite the high doses of steroids he’s on (recent pictures of him show his face even more  Cushingoid than the 3 cited above) the tumor has grown further and needs to be removed (for any of several reasons, none of which is good).

3. At the time of the initial surgery, they thought they had removed the tumor, and the present 2 centimeter lesion has grown from something they didn’t see, because it was too small.  Assume that what they missed was 1 milliMeter in diameter.  Anything larger wouldn’t have been missed (assuming the people operating on him were competent — but ask Fidel about that — he’s still recovering years later from whatever they did).  Since the lesion now 2 centimeters, this means that its volume in milliMeters is 4188 cubic milliMeters (4/3 pi r cubed, with r = 10).  This is roughly 12 doublings of the tumor, or around 1 doubling every 17 days.  The chances of a benign tumor growing this fast are remote (although my late mother had exactly that in her pelvis and lived another 40 years).

Now for some social commentary (which I usually avoid).  If you know anything about dogs, you’ll know that despite a rather fantastic variety of sizes and shapes, they recognize each other instantly.  Who hasn’t seen a chihuahua going right up to a great dane?

Who does the Chavez regime support?  The late Muammar Gaddafi, and now Assad in Syria.  Here’s a clip from the Times – http://www.nytimes.com/2012/02/23/world/americas/chavez-appears-to-use-venezuelan-fuel-to-help-syrias-assad.html. Who else supports Assad as he uses his army to slaughter the civilians opposing him?  The regimes of Russia, China and Iran (to be distinguished from the people actually living there).  Forget the verbiage they emit — Chavez quoted Jesus as he left for Cuba, Iran loves (their particular brand of) Islam, Russia is devoutly antireligious, China is God knows what, but they slaughtered their own 20 years ago in Tiananmen square.  They’re all the same.  They know a kindred spirit when they see one.
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