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Real Presidential Migraines and Other Presidential Ailments

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With the media buzzing daily about the politicians vying for a place in the upcoming presidential primaries and this summer’s news story about Michelle Bachmann’s migraines, it seems an apt time to look back at some of our past president’s medical conditions.

Starting off with real “Presidential Migraines” US leaders who were known headache sufferers included Thomas Jefferson (cluster headaches), John F. Kennedy (migraines), and Harry Truman (stress headaches).

It’s widely known that William Taft was obese, Ronald Reagan suffered Alzheimer’s Disease after his presidency and that George Washington had severe dental problems (and research conducted on some of his dentures in 2005 concluded that Washington’s alleged wooden choppers were actually made from a combination of ivory, gold, and lead, along with some human and animal teeth).

One of the more interesting cases was that of Woodrow Wilson. The president, who led the country during World War I and who appeared to be in satisfactory health, suffered debilitating strokes in 1919 during his second term in office. In fact he suffered from hypertension and may have had his first stroke at age 39. Although he was severely incapacitated with left sided paralysis and blindness in most of his vision, he kept his condition secret from his Cabinet, the public, and even the Vice President. His personal physician would never publicly admit the true scope of Wilson’s health. A reporter was hired to write a fake interview.  In June 1920, a carefully staged photograph was released showing him signing a document. Despite the impact of the stroke, he served out his term with his wife Edith carrying out much of his work behind the scenes.

Aspects of Franklin Roosevelt’s failing health were also covered up. In addition to polio, the impact of his smoking, and general presidential stresses due to the WWII, FDR had extreme hypertension, coronary artery disease, and heart disease. Prior to the 1944 election, he began making plans for his funeral and memorial, giving farewell gifts to his friends and employees and burial instructions to his son. He died in April 1945, only three months after he began his fourth term of office. Exactly who participated in the cover up, including the role of his personal physician, has been a mystery, with FDR’s medical records having gone missing from a locked safe.

Also secretive about his health was Grover Cleveland, who had a cancerous growth removed from his jaw and had a rubber prosthesis implanted to disguise the effects of the surgery. His condition was undisclosed to the public until well after his death (which was not from cancer).

John F. Kennedy suffered from endocrine problems for most of his adult life, as well as back problems and an array of gastrointestinal issues. He took hormones, steroids, and other assorted medications on a regular basis. Although giving the impression, publicly, that he was of satisfactory health, the reality was anything but and he, too, kept much of his maladies a secret.

Some of the more quirky medical afflictions among our past Commanders in Chief include boils on the buttocks (Jefferson), hemorrhoids (Carter and FDR), sleep apnea (Taft), and gout (Van Buren and Buchanan). Plus, a vast majority of our leaders snored–not a health hazard, but perhaps of some frustration and lack of sleep for their First Ladies.

Longevity and Common Sense Ways to Achieve It

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The quest to live a long healthy life is a journey of universal appeal. Like the Mobius Strip at left, which has no end, there are those who pursue eternal life. As Woody Allen said, “I don’t want to achieve immortality through my work; I want to achieve immortality through not dying.”

The average lifespan in the United States has increased substantially in the last 100 years, from 47 to about 80. A major factor was the development of antibiotics in the mid-twentieth century. Recent advances in treatment of cardiovascular disease, stroke, and cancer have produced further life extensions.

Maximum lifespan is the theoretic maximum age humans can achieve. This is determined by the Hayflick limit, which defines the number of times cells can divide. To date, this lifespan generally last about 120 years. While everyone has his or her own maximum lifespan, it rarely runs to 120 years of age. The genetic factors that regulate this and are determined by one’s DNA, are mostly immutable at the current time. But the question remains: If our individual maximum lifespan is written into our DNA, how do we achieve that?

To understand how to live longer, we must first understand how and why we die short of our theoretic maximum. More importantly, what are the factors that one can alter?

Under age 45, believe it or not, the most common cause of death is accidents. In my case, at age 26, I was within seconds of dying when I encountered a problem with an airplane I was student piloting, which nearly crashed during a maneuver. Fortunately, I only managed to scare some cows (and myself). Whereas I was able to figure out the problem and avoid an untimely demise, many incidents are often difficult to avoid.

Alcohol is frequently a contributing factor in quite a large number of fatal accidents. Likewise, an alterable factor in trauma-induced death is the wearing of helmets while biking, motorcycling, and snow skiing. Actress Natasha Richardson’s tragic death to what was deemed initially to be an insignificant head trauma is only the most recent notable example. I was once asked to help evaluate the death of a female passenger who fell off the back of a motorcycle that was coming to a stop. Despite riding at a very slow speed, when she fell backwards striking her head on the pavement without a helmet, she died immediately.

It is also interesting note that since 1994, deaths from traffic accidents have steadily decreased due to mandatory seatbelts, airbags, and improved automotive design. Yet, taking its place is a different type of accident which, for the first time ever, outnumbers traffic deaths: drug-related deaths. And a leading proportion has been misuse of prescription drugs, a sadly preventable form of death.

Under age 65, the largest number of human deaths relates to cancer. Such tremendous strides have been made in cancer therapy that many cancers can now be regarded as not a death sentence but as a chronic illness if not cured entirely. The reduction in cigarette smoking has been a great help not only to cancer but even more so to preventing vascular disease. Cessation of cigarette smoking may decrease risk of vascular disease by as much as 70% in some.

Vascular disease is the largest cause of death in the over-65 age group. In fact, heart attacks and strokes account for over one-third of the annual death toll for all ages combined. This we have the biggest opportunities for prevention.

Hypertension is a significant factor in vascular disease and kidney failure. Ideal blood pressure is around 100/60. Physicians have more aggressively treated hypertension every year. Recently, treatment is recommended for pressures chronically over 130/80.

Hyperlipidemia, abnormally elevated levels of lipids or lipoproteins in the blood, is treatable in most cases and is another independent risk factor in vascular disease. The use of statins has been a leading factor toward improved health and also appears to help reduce the risk of Alzheimer’s disease.

A more subtle contribution to risk reduction has been the use of anti-platelet drugs, particularly aspirin. An effective preventive therapy for stroke and heart attack, aspirin also helps in the prevention of certain types of colon cancer and possibly breast cancer.

Prevention or treatment of obesity is also important. There are an estimated 300,000 preventable deaths annually from diabetes, for which obesity is a huge risk factor. Obesity is also an independent risk factor in many other diseases like heart disease and hypertension. Curiously, underfeeding (but not undernourishment) is well known to increase lifespan in rats. This type of underfeeding, which is really a diet aimed to achieving the lower limit of ideal weight, can positively impact health and longevity in humans as well.

Overall, although you cannot change who your parents are and the DNA they gave you, you can manipulate the environment to which the DNA is exposed and get the most out of it in terms of improved health and longevity.

The Truth About Migraines

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Migraines sound pretty boring as a blog topic. Actually they aren’t. I know. I take care of them. And I have them myself. And I named my first novel Presidential Migraines.

Migraines have been in the news this summer when it was leaked that Congresswoman Michelle Bachmann, a Presidential candidate, has them. The press claimed Ms. Bachmann might be laid up for days at a time and this could impact her effectiveness in the Oval Office.  The story is almost certainly nefarious political fiction; these days migraines are well treated in the vast majority of people, be they Presidential candidates or anyone else.

Migraines affect 12% of the American population with 18% of females and 6% of males having at least one per year). Yet, they are clearly underdiagnosed, a core reason being that some people with migraines never get headaches. Estimates are 3%, but I suspect that is grossly low because most people don’t think they have a migraine unless it includes an incapacitating headache and head-in-the-toilet vomiting. To neurologists that would simply be called  a bad migraine. 

Take my migraines, which I never knew ran in my family for every known generation until I started asking questions. At age 27 as a G2 neurology resident at the University of Minnesota, I experienced spells where I thought I was going to pass out, couldn’t think straight, and was dizzy, but had no headache. To be sure that I wasn’t simply hypoglycemic, I had my blood checked. Normal.  Same for CT and EEG. Then I spoke to Mom—often an excellent resource—and she clued me in on our family’s history with migraines. In fact, as I child, I had a few emergency room visits for possible appendicitis, which turned out to be abdominal migraines. This goes to show it’s not always in your head!

Hemiplegic migraines run in some families, where the sufferer  becomes paralyzed on half his body (with or without a headache), almost like a stroke. Some get aphasic; they can’t speak or understand–or both–even though they know exactly what they want to say! This can also cause partial or total blindness (scotoma and hemianopsia). Some people even pass out–not from the pain either.

Certain foods and medications are known to be precipitants of migraines, such as cheese, chocolate, red wine, and hormones. If you’re prone to migraines, you may need to curtail or avoid consumption or usage altogether.

To this day I rarely get actual headache symptoms. On rare occasions, I may find myself reading the same medical report three times and can’t understand it–I recognize that to be a symptom of my migraines and simply take two ibuprofen.

If you suspect you have migraines and are concerned, you should seek the help of your physician or a neurologist. Neurologists are specialists who deal with migraines as well as other brain diseases.

US Navy SEALs

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While writing Greek Flu, I wanted to learn more about the Navy SEALs so that I could accurately portray them in my story. I was privileged during my research to meet a large number of active and retired SEALs. I wanted to know not only the technical details of what they did but also who they are. I was also able to meet some of their families and spend time with them. These days, after the bin Laden mission, there are a lot of SEAL “experts” who have come forth. I make no such claims, but have reviewed chapters of my book with some experienced SEALs for general accuracy; any inaccuracies are solely mine–either by intent or error. I believe my depiction of the SEALs in Greek Flu is factual and intriguing.

The Special Warfare insignia, or "SEAL Trident."

SEAL is an acronym for SEa, Air and Land. They are a group of men who take their job of protecting the United States to heart.  The concept of “Team” really means something to them. During some meetings I was asked if I “was Team.” Hopefully that meant that I was at least holding my beer correctly. One funny story is that after meeting with all these brave men, my wife confided that her biggest fear was that despite my age I would somehow convince the Navy to let me be a SEAL!

SEAL history goes back to WWII when in 1942 the Amphibious Scout and Raider School was started in Florida. They trained the first Naval Combat Demolition Unit (NCDU) to reconnoiter land areas and dispose of obstacles. NCDU was first utilized in Operation Torch in North Africa. By 1943, after serious problems in Tarawa, the Navy realized the need for underwater demolition of obstacles. Eventually, nine Underwater Demolition Teams became Combat Swimmer Reconnaissance Units and, ultimately, Navy UDTs.

In the 1960s it was realized that the United States must development unconventional warfare with guerilla and anti-guerilla abilities. Mainly from UDTs with commando experience in Korea, modern SEAL units were formed with bases in San Diego and Virginia Beach. They were so effective that it was estimated that 200 Viet Cong were killed for every SEAL life lost.

Their many battles are beyond the scope of this page. But whether in Iraq, Afghanistan, or the latest hot spot, Naval Special Warfare continues to evolve and serve with the demands of the day, either alone or in coordination with other services branches, some of which attend SEAL reunions as well.

http://www.sealswcc.com/

Transient Global Amnesia

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As originally posted on Dr. Lyle’s Writer’s Forensics blog.

“Where am I?” you ask the nurse on the locked psychiatry ward.

“You are in County General,” he replies.

“Where is that?”

“Downtown. You were found wandering inside a coffee shop, confused, and without identification.”

“I remember nothing since I left home this morning. My memory is just blank.”

“Your husband is on his way. I called him a few minutes ago after you were able to recall your name and phone number for me. He said you pulled your car out of the garage, ran into the tree in front of your house, left it there, and then drove his car to your clinic. He said he had a day off so he slept in and has been trying to reach you ever since he realized something was amiss, but you left your purse, briefcase and cell phone in your car. You went to work, went through mail, charts and dictated letters. Your secretary said you seemed a little different–she thought something was definitely wrong when your dictations didn’t make sense. She said you went out for lunch and never came back. By that time your husband had called your office and the police brought you here, confused from the coffee shop.”

Transient Global Amnesia or TGA is a condition I diagnose in patients 2-4 times per year. There are many causes, but often none is found. Almost all patients have a full recovery, but in a few, the condition will recur. My first case was essentially the one described above–an MD whose TGA was caused by an unusual medication reaction. In almost all cases, patients function somewhat normally but their judgment is impaired and they make no memories.

My second case was a man who also wound up in the locked ward. He had a continuous epileptic attack but was able to talk to me reasonably well.  He was confused, but fluent in speech. I went through my usual protocol of blood tests, an electroencephalogram (EEG), and brain scans. When I looked at the results of the EEG, I noticed that he was having continuous seizure activity, yet was not moving a muscle. I re-examined the patient to see if I had missed some shaking, eye twitching, or anything that might look epileptic, but I saw nothing abnormal.  I gave him a large intravenous dose of a seizure medication. The next morning, he was totally recovered. He recalled nothing of the day before or of my examining him twice.

Other causes of TGA may include a large number of factors including migraines and various chemical abnormalities, as well as stroke-like problems. There are other patients who simply have psychiatric problems or feign the condition after perpetrating certain criminal acts or hoping to get an edge in legal cases.

Overall, Transient Global Amnesia is a fascinating condition that demonstrates the complexities of the brain and our limited understanding of what is the organ of the human body that we understand the least. The brain is the last frontier of medicine.