CodeBlueBlog: CSI MEDBLOGS UPDATE: ARAFAT'S DEMISE: AIDS, OR POISONING OR MALPRACTICE?

April 2005

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The Medical News From France Smells like Yesterday's Brie

What is the condition of Yassir Arafat? You couldn't possibly know by reading or listening to the news.

Seems that his wife has stepped into the picture and is running the news announcements, which should result in an even steadier flow of reliable and useful information than we've had:

Here's the latest breakdown and why none of it makes sense:

COMA: Isn't That a Robin Cook Novel?

Coma is an old term of limited medical use nowadays. Mostly it is reserved for patients who have had severe cerebral injury and are in a sleep like state. Here's a quite dumb statement from a spokesperson (a Mr. Shahid) who needs to go back to spokesperson school:

"He is in a coma. We don't know the type, but it's a reversible coma. ...

You don't know the type? But you DO know it is reversible? Wow. Let's call it Type BAD -- and, by the way, how is it reversible? Do you have to hit the clutch and shift?

Shahid suggested the coma occurred after he(Arafat, not Shahid) was put under anesthesia to have additional medical tests, including an endoscopy, colonoscopy, and a biopsy of the spinal cord.

First, endoscopy and colonoscopy are done with IV sedatives, not general anesthesia. Certainly, Arafat could have had an ARREST (heart or lungs fail suddenly) during the procedure which lead to his intubation and now, while he's hooked into the respirator (breathing machine/pump) the doctors may be giving Arafat paralytic drugs so that he doesn't fight against the tube that is down his throat. This is a common practice and constitutes a kind of "reversible" coma.

As for a BIOPSY OF THE SPINE... that is RIDICULOUS! Why in the world would anyone biopsy ANYONE'S spine? For those of you who don't know, the spine is literally a bundle of tightly packed, totally essential nonregenerating nerve cells. If you BIOPSY (take a chunk of tissue from) this bundle of cells, the patient wakes up with a neural deficit SOMEWHERE.

And there is NO medical reason to biopsy the spine, ESPECIALLY in a case like this. That's just wrong. (If they DID biopsy his spine however, that might explain the coma!).

What Arafat probably had was either a lumbar puncture/tap or a bone marrow biopsy. The tap is a procedure where a small needle is inserted into the spinal canal in the lower back WAY below the spinal cord. This fluid is then analyzed for things like infections (AIDS?), cancer and other rarer diseases. The bone marrow biopsy is done with a larger needle, to penetrate BONE (not spine tissue) in order to evaluate the bone marrow for the presence of blood cancers and other blood element abnormalities (maybe to evaluate the platelet problem).

AIDS IS IT STILL POSSIBLE?

Given the useless information coming out of France and the basic mystery of what disease Arafat has, HIV infection remains high on the diagnostic list. In fact, one report this weekend (NY Times) claimed that Arafat had liver failure. This would fit with my previous analysis of the reported work-up so far; and, liver failure is a known complication of Hepatitis B, which afflicts many AIDS patients.He could also have mental difficulties (hepatic encephalopathy) from the disease.

POISONED WAS ARAFAT POISONED?

This remains a possibility, again, especially given the lack of intelligent, believable medical information coming out of Paris (one problem when you try to cover things up, obviously, you leave the possibilities open...); and, LIVER FAILURE is associated with many types of poisonings (the liver is the blood's filter and poisons can be concentrated there); examples are certain metals and Acetaminophen (Tylenol), but there are many others. Also, chronic poisoning can result in mental status aberrations (crazy behavior -- think of the "Mad Hatter" a term derived from Mercury poisoning of hat makers in the 19th century), and Arafat may have displayed some of these (like in deciding to fly to France for his health care). So, although evidence is not available, poisoning is not excluded.

In Sum....things are bad when the question of "Are you alive or are you dead,"is NOT a simple yes and no answer:

the French foreign minister, Michel Barnier, asked if Mr. Arafat was dead, Mr. Barnier answered, "I wouldn't say that."

MORE TO COME.......CSI MEDBLOGS

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