The Opinion of a Consultant
I know a lot of opinions have been put forth in the Blogosphere recently rearding Viktor Yushchenko's facial transmogrification. Wizbang set off the fireworks and diagnoses were running rampant on the net thereafter. Highly respectable Blogs like Interested-Participant and Medpundit took a stab at a diagnosis (Leprosy -- that was titillating and awesome to imagine) while Flit found someone ready to diagnose cutaneous T-cell Lymphoma (look out for that!) and thereafter spurring several of my readers to write me asking for my take...
I've only had a few hours with the Viktor Yushchenko photographs, so I'm going OUT onto an iced-up limb here. As some visitors to this blog might know, however, I'm NOT afraid to set down my opinion. Here it is:
ONE: NO ONE could look at these photos and tell you what is wrong. First of all, there's not enough evidence, the lighting is not consistent, the detail is different on each photo, we don't know what the rest of his skin looks like, and we have VERY little clinical data to go on...but finally, realize, that with Photoshop out there these could be pictures of V.Y.'s Borzoi sniffing at the door of a porta-potty, cut and pasted to look like a respectable but poisoned Ukranian leader. You just can't trust them...and you shouldn't.
TWO: NO ONE, as usual, could read what the press or major media reports about this and cogently put together the likely illness because the PRESS and MAJOR MEDIA get just about everything in healthcare WRONG and when they don't get it wrong they mess up the data so that you don't whether headaches are associated with burning on urination or pimples are a complication of flat feet. You just can't rely on how the press transcribes what the doctors and clinical records tell them.
A Horse is a Horse
So all I can do is evaluate what we are all presented with and give the MOST LIKELY SINGLE DIAGNOSIS to explain it all. That's what my professors DRILLED into my head. First: the patient gets one diagnosis. Second, likely things are likely (or, when you hear hoofbeats don't expect to see Zebras come around the corner--it's going to be a HORSE).
This is about the only half-sane medical info I could cull from the press reports:
Doctors were unable to confirm suspicions of poisoning because Yushchenko first checked into the clinic four days after the symptoms appeared -- too late for tests to show if poisoning had occurred, Korpan said.
At Rudolfinerhaus, Yushchenko underwent a week of intensive treatment for several illnesses, including acute pancreatitis, a viral skin disease and nerve paralysis on the left side of his face, Korpan said.
. The Corner of Fifth and Vermouth
Do they make Stoli in the Ukraine?
If you see this picture enlarged you can appreciate the spidery red flush around his MALAR area (nose, under the eyes).
By history, V.Y. was doing fine until September when he had a BIG, important dinner with Ihor Smeshko, the head of Ukraine's internal security services. Four days later he checked in to some unpronounceable Vienese clinic (how do you translate AA?) to be treated for ACUTE PANCREATITIS -- a disease almost exclusively suffered by...alcoholics.
As an immunologically impaired alcoholic, V.Y. could easily be infected with pathogens and it is not hard to postulate that he at some point picked up a virus, and displayed the rash of viremia (virus in the blood), ending in left facial paralysis ( = Bells Palsy a not-unusual complication of viremia).
But, I know what you are asking. How did Vikto wind up looking like Theodin (son of someone) possessed by Wormtongue ? Or, THIS:
Well, to get to THIS final face, of the three faces of Yushchenko, we have to make one final stop on the diagnostic railroad: Rosacea (parenthetical remaks are my translations):
Rosacea is a common condition characterized by symptoms of facial flushing and a spectrum of clinical signs, including erythema (redness), telangiectasia (spidery vessels visible on the face), coarseness of skin (see above), and an inflammatory papulopustular (bumps and pimples) eruption resembling acne.
There is BIG FACTOR that makes Rosacea worse. And it's not running for the presidency of the Ukraine. It's alcohol:
Alcohol is among the scores of different triggers that can prompt or aggravate rosacea flare-ups in some patients. While drinking causes fewer reactions than "the big three" -- sunlight, heat, and environmental stress -- a new survey shows that just one alcoholic drink can trigger problems in two of three patients.
According to eMedicine:
Rosacea affects the central flush/blush areas of the face, (i.e forehead, nose, cheeks, chin), although ocular disease and extrafacial lesions are well-recognized features...Sebaceous hyperplasia (overgrowth of lumpy oil glands), fibrosis (hard, nodular tissue), and lymphedema (generalized swelling) characterize more severe forms of the disease...Prominence of sebaceous glands may be noted with the development of thickened and disfigured noses ..Ocular lymphoedema (swollen eyes) may be prominent ...Both seborrhea and seborrheic dermatitis/blepharitis (skin inflammation/eyelid inflammation) are not uncommonly observed in patients with rosacea.
Sometimes a Foible is Just a Foible
So, as much as we all want our leaders to be involved in the glamor of poisonings and radiation burns and mutants from another galaxy, most often they are afflicted simply with foibles -- and those are worse than pimples, but better than Leprosy.
hat tips to: Off Wing Opinion
**ADDENDUM NOTE of 12/02/2004**: a follow-up post to this article can be found ON THIS BLOG AT: