A Doctor Weighs in on McCain from Yesterday

As I said in a comment on this blog, I’m not a doctor, but I wanted to hear more from one on McCain’s problems yesterday in the video and still photos I’ve posted below.  AmericaBlog has done that in two posts (post 1 and post 2).  I’m going to paste in AmericaBlog’s posts in full here.  This is a potentially serious issue.  As I said yesterday, I’m concerned for McCain himself.  But beyond that, I’m quite concerned about the nation, and the prospect that Sarah Palin could become president.

From Post 1:

Because John McCain won’t give the American people full access to his cancer records, and the media doesn’t seem to want to ask why McCain has become increasingly erratic of late, including showing facial ticks or spasms moments before exhibiting confusion, we’ve resorted to asking doctors to talk us through what we may be seeing. Here is an email from one doctor I received today (I’ve confirmed that this person is a real MD):

I would like to say something about the facial tics and twitching before I approach your video today. His left eye seems to have a significant tic or twitch much of the time. It is on the same side as his surgery to remove a melanoma – as you can see by the scar. Senator McCain may also have had radiation to the area during his treatment. There are two critical facial nerves that go right through that area – Cranial Nerve V and Cranial Nerve VII. Either one of those could have been damaged by the surgery and or radiation – and cause what we see today. Looking at his face and his scars – it appears that he had rather extensive exculpation – and this would not be an uncommon outcome. It would be interesting to actually examine him to see if there were any other deficits – because just looking at videos is complete educated guesswork.

Now – about the events of the day. I actually viewed the bumbling around the stage episode on TV while I was leaning over a patient today – and was somewhat concerned. In light of the fact that this occurred just seconds after the facial issues that you documented in the other video is very very disturbing. Let me put it like this. If I had seen a 70-75 year old man do that in front of me in the emergency room – that gentleman would be immediately admitted for what is known as a TIA. This is a mini-stroke that often comes before a big huge one. It is likely that if this occurred – Senator McCain may have realized something was wrong – and immediately began looking for an exit. This bumbling lost behavior followed by the initial onset of the symptoms is very commonly described by family members witnessing such events. Regardless, he should be admitted to the hospital for observation – ruled out for strokes with tests – and possibly be immediately begun on certain meds to attempt to abort any other such attacks. I have not been able to find video of his speech patterns around the time of the facial problems today – it would be interesting to note if there were any changes. If it does turn out to be a TIA – the patient would need further evaluation to note if his carotid arteries are blocked.

I showed this video to 3 colleagues today – AND a neurologist – all of us agreed – this is concerning and should be immediately evaluated. It is, however, impossible to make medical diagnosis via a video – unless you are Bill Frist or Tom Coburn. I would caution you to be careful about making any insinuations about his medical condition based on just that alone. However, I am concerned enough about what I saw of Senator McCain today that he should be seeing a doctor immediately.

Just talked to two more buddies – again – they totally agree – one of whom is ardent McCain supporter.

Post 2 after the jump.

As I’ve written before, if the McCain campaign would simply release John McCain’s full cancer records, and the media would do their job, there would be no reason for us to speculate publicly as to whether John McCain is ill. Unfortunately, neither the McCain campaign nor the media has shown any intention of getting the bottom of McCain’s recent confusion, erratic behavior, and facial spasms. So I have asked a number of our readers who are M.D.s to weigh in. And they have.

This M.D. weighed in yesterday, and mentioned that he would have liked to have seen a full video of McCain’s speech in which he had the facial spasms and then became confused. The full unedited speech was online, so I sent it to him. Here is his report after having viewed the entire video:

There were several issues that I noticed upon viewing this video.

First of all – he clearly has a medical problem known as ptosis. This is demonstrated in him by his inability to hold up the eyelid on the left side. Another famous person who has this exact same problem is Forrest Whittaker. I have not really spent a lot of time looking at John McCain – not sure if this is a chronic condition. Nevertheless, that would suggest that he either has a significant central nervous system problem (ie brain tumor) OR something could be happening to the delivery of neuronal information from the brain to the eye. That would be over Cranial Nerve III. In my experience, diabetes is the most common cause of this problem – but old age is certainly right up there. Clearly, he could have had some severe damage to CN – III during surgery and or radiation therapy. If you look at the wiki entry on this problem – you can clearly see that diabetes and brain tumors are right up there as the causes. I would assume that if Senator McCain has had this problem for a while – this would have been thoroughly worked up. However, without access to him or his medical records – it is impossible to know. Furthermore, there are many subtle differences in ptosis and neurological problems like this – for example – what are the sizes of his pupils? – do they respond to light? etc etc etc – making certain diagnosis by video absolutely impossible.

Secondly, Senator McCain blinks constantly. Notice the blinking is much more prominent on the right eye – because the left eye as stated above is not functioning as well from a motor standpoint. If I had to guess, I would suggest that this possibly represents dry eyes. The seventh cranial nerve – or the facial nerve – is in charge of innervating the lacrimal gland or tear glands. That nerve is clearly compromised based on his other facial problems. It would not be a stretch to assume that his ability to make tears is compromised – and people tend to blink a lot when this happens. Again, there are many other questions I would like to ask him — does he have any trouble tasting food? – Do his eyes burn during the day? Again, this is all educated guesswork without a patient in front of you.

Thirdly, Senator McCain has very clear facial asymmetry – both neurologic and anatomic. By neurologic asymmetry, I mean that he clearly has trouble with his facial muscles and moving them around appropriately – this is obvious with still photos – his left mouth is hanging – not appropriately “up” like the right. When he smiles – he cannot seem to move the left mouth like his right. There are clearly other facial muscles involved – but not his forehead and eyebrows – both do quite well. This neurologic asymmetry is very likely secondary to massive nerve damage to cranial nerve VII on the left. He has evidence of damage to Cranial Nerve III and V as well. Cranial Nerves IV and VI are less likely to be involved because he does not seem to have trouble moving the actual eye itself – in other words he is not cross-eyed when he speaks. He has anatomic asymmetry – involving the big scar down his left face – as well as a pouched out area around his left jaw. This could be left over from facial reconstructive surgery – or he could have some lymphatic issues from radiation or surgery. I just would have no idea without medical records.

Toward the end of the video – when the massive nervous twitching was happening – his voice did seem to soften – and he paused frequently. There was no speech slurring. There did not seem to be any problem with other motor movements – ie he was still able to stand up straight – no leaning to one side or the other.

I still stand by what I said earlier – this twitching toward the end was distinctly different and corresponded to a time when he was confused. He momentarily did not appear as robust as he had been. Given these symptoms – and his obvious confusion – a visit to a physician immediately is in order. I would also add that cognitive dysfuntion like we have witnessed over the last several weeks is also quite concerning. He may be tired – but John believe me – that is what they all say. I see this kind of presentation all the time – concerned family members bringing grandpa in because something just is not right – and then on exam it is clear that grandpa has had a little stroke. He needs to be evaluated now.

In my professional career, I have done countless executive physicals and attestations to corporate boards and personnel offices. It is customary for men and women in leadership positions to get a thorough physical examination and follow up on anything out of the ordinary. In my career, I have seen several people turned down for jobs as CEOs or CFOs for the most trivial of reasons. This, however, is not one of those times. There are enough serious issues going on – pointed out to me today – that I believe he really needs to be evaluated and shoot straight with the American people – his future board of directors (assuming he is elected).

As I said, we have to know what’s in these medical records.  There are serious potential consequences.  We are not trying to pry into someone’s private records.  There isn’t much that’s more private than medical records.  But I agree with the doctor in the AmericaBlog post: McCain needs to level with us.  We have to know to evaluate him and his ticket properly.  Maybe it won’t matter and Obama will be elected (I hope for this regardless of McCain’s health issues).  But maybe it will matter.  We have to know.