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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  • luysii  On March 4, 2012 at 7:14 pm

    CARACAS, Venezuela (AP ) – Venezuelan President Hugo Chavez revealed Sunday (4 Mar ’12) that a new tumor recently removed from his pelvic region was of the same type of cancer as a baseball-sized growth extracted from that part of his body about eight months ago.

    In his first TV appearance in nine days, Chavez said the surgery and follow-up tests showed the tumor was “a recurrence of the initially diagnosed cancer.

    Here’s #1 above ” 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.”

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