CodeBlueBlog: CSI Medblogs: Mean Mein, Mask or Masque--The Face of Yushchenko Continues to Hide the Truth

April 2005

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Reader's of CodeBlueBlog have written to ask me if I can reconcile my hypothesis of The Mask of Yushchenko with an article, this weekend, by Elisabeth Rosenthal, of The New York Times.

The primary defense of my hypothesis is that it explains everything in the simplest way (see here and here and here). Poisoning SAYS something but EXPLAINS nothing. To support my theory, I lay out everything that we know about the case and show how it aligns with Stolichnaya. The proponents of poisoning have no evidence except that Yushchenko's face is too changed to believe that anything except poisoning could cause it. To summarize the intellectual weight of the "poisoning" crowd, I'll quote Yushchenko's mysterious Austrian physician, Dr. Michael Zimpfer, as he weighs in on the possibility of poisoning:

In this case, absence of evidence is not evidence of absence

That's a clever turn of a phrase, isn't it? Would you want this guy taking care of your presidential candidates? How about your mom?

The Devil in the Details

Zimpfer's clumsy insights aside, from a medical perspective, The Times' recitation of disparate clinical vignettes provides no coherent picture of any illness. It connects no dots . Now, maybe Rosenthal is inherently limited by her sources, but, about 2/3 through the article she indicates otherwise, stating:

Dr. Zimpfer provided extensive details of Mr. Yushchenko's hospitalizations

After titillating us with the possibility of insight and knowledge we are then given but a dwarf's thumbnail sketch of these "extensive" details, all of which seem to be positioned around explaining why Viktor needed an epidural catheter (a tube placed near the spine providing narcotics for pain relief); unfortunately, these adumbrations are never collected around a unifying diagnostic idea or hypothesis, and they do little to shuck my unifying hypothesis of alcoholism.

I Love You Just the Way You Are

For the Oliver Stone fans, who insist on pursuing poison as an etiology, one has to ask: How did poisoning cause Viktor's facies? According to The Times:

The candidate refused a biopsy of his face - which doctors suggested to try to narrow down the causes - because he did not want to campaign with stitches

Is that possible? I mean Yushchenko is harping about being poisoned and needs to travel with a tube in his spine for pain relief, yet the one test that may give an answer and lead to treatment -- a skin biopsy -- is rejected because he doesn't want to mar his face while campaigning? Hello? Hey Viktor, I don't want to be cruel, but stitches might improve your looks.

Absurdities aside, this is a lie (or a subterfuge), plain and simple (why are you lying Viktor?). A skin biopsy is about the size of a pencil eraser and can be covered by a flesh-colored band-aid. It does not require "stitches" and I could pick about twenty spots on that corrugated mug where the biopsy would be hardly noticeable. So, why would Yushchenko say such a silly thing, and why would The Times not call it into question?

And why not do all the tests necessary to rule out other (easily detectable) forms of poisoning? Here's Viktor's wife helping us out with the answer:

dioxin and related toxic chemicals are detectable in the body years after exposure. Ms. Gerashchenko said tests for such substances had still not been performed.

You know, for all the hue and cry about poisoning, Europe's "most illustrious doctors" are being pretty laid back when it comes to making a diagnosis. They must have a lot of blood samples from Viktor's hospitalization...can anyone tell me why tests for such substances have not been performed?

The Face That Sunk a Thousand Ships

As for my diagnosis of rosacea?

Dermatologists at Rudolfinerhaus initially suggested that the facial lesions could represent a slightly unusual case of a well-known condition called rosacea, where the face becomes swollen and lumpy. But Dr. Zimpfer said Mr. Yushchenko's skin nodules no longer indicated that disease.

So the skin nodules are talking? And they are saying: "We're not rosacea?" Why? If it isn't rosacea, please tell us why without adducing the comically anthropomorphic image of Yushchenko's skin nodules calling us off this diagnostic pathway.

It Tolls for Thee

The answer to my questions, that I am reading everywhere, is: He was poisoned! (doh!) The tautology of ignorance is like the tolling of a bell: loud and monotonous.

A key issue, to me, is whether or not Yushchenko was diagnosed with pancreatitis. Earlier reports specifically named this diagnosis. Rosenthal decides to be coy and describe pancreatitis without calling it such:

He arrived first on Sept. 10, severely ill and unable to walk, after five days of terrible abdominal pain. Initial testing showed that he had a high white-cell count and elevated liver and pancreas enzymes, suggesting inflammation of those organs. His tests were negative for all the obvious possibilities, like hepatitis caused by a virus...Scans showed that his liver, pancreas and intestine were, indeed, swollen

Pancreatitis is a disease that is closely and most frequently associated with alcoholism, and is an easy explanation for severe abdominal pain AND severe back pain (The Times article refers frequently to Yushchenko's intractable back pain).

Now, if Yushchenko had a CT of the abdomen (which he MUST have) that showed this "swelling" of the pancreas, here's what it would have shown:

Note: The pancreas is the comma-shaped gray thing centrally in this image. Observe that its contours are not sharply defined and there is some haziness right in front of it.

Here is a NORMAL CT of the pancreas:

See how, in this image, the pancreas has sharp edges (again, the pancreas is comma-shaped and, in this image it is resting on a curved light white cobra-shaped structure -- the splenic vein--), is clearly demarcated, and now, in retrospect, you can also observe that the pancreas in the first image, above, was slightly too big ( = enlarged, or "swollen").

There's NO mistaking this diagnosis. When I interpret a CT like #1 above, my conclusion in the dictated report is: PANCREATITIS. I DON'T say "swollen pancreas" That's for medical students, or the parents of medical students. So, I don't understand The Times' reporting of this clinical finding.

Okay so, did Viktor have pancreatitis? If his pancreas was swollen and his pancreatic enzymes were elevated, I and all the other doctors out there know the diagnosis: pancreatitis. Now, for sure, there are OTHER ways you can get pancreatitis...but 8/10 times, it's alcohol. So why not say that?

If we are given the diagnosis of pancreatitis then we have a disease -- alcoholism -- and then the only remaining task is to align all of the other signs and symptoms with this fact. This is something I've already done.

For me, this weekend's article creates two problems with my scenario:

#1: Rosenthal does not mention Yushchenko dropping out of site (? to a clinic) for five or six weeks after the diagnosis, something that was reported earlier. Although this is not germane to my hypothesis, it was a nice adjunctive piece of evidence that suggests some time in rehab

#2: We are told now, for the first time, that Yushchenko had endoscopy (looking through a fiber optic scope) that showed ulcers scattered throughout the gastro-intestinal tract (stomach, large and small intestine +/- esophagus). No delineating details about the nature, appearance, distribution or number of these ulcerations are given. I cannot comment on this shred of a clue, but neither can I position it in my overarching explanation.

Nonetheless, I've got the best explanation so far, and I await something in the Major Media that shows me how I am wrong.

STAY TUNED

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CodeBlueBlog

health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

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