CSI MEDBLOGS: YUSHCHENKO'S DISEASE: A TALE OF TWO POISONS

YUSHCHENKO'S DISEASE : A TALE OF TWO POISONS

 

STAT CodeBlueBlog SUMMARY

If you don't want to read the whole post

• Yushchenko seems to have been exposed to a large amount of Dioxin (barring outright medical fraud at multiple locations). This was not why he was admitted to Rudolfinerhaus
• The chronology of the exposure to Dioxin, the manifestation of symptoms, and the appearance of Chloracne does not fit the chronology of the claims made by Yushchenko and the Rudolfinerhaus clinic
• Yushchenko drank too much the night of September 5th 2004, and he likely drinks too much frequently
• Actual test results obtained from Rudolfinerhaus show conclusively that Yushchenko had pancreatitis and an enlarged liver, both of which are common sequelae of alcoholism
• Rudolfinerhaus tried to cover these findings with inaccurate press releases and a grossly misleading clinical report "conclusion" 
• If Yushchenko keeps drinking, it is NOT UNLIKELY that his liver and pancreatic disease will progress and he will be left with chronic pancreatitis (which can lead to diabetes and insulin dependence) and/or cirrhosis (which can lead to death by numerous pathways)

Here's The Long Version

A Tale of Two Poisons: An Unwritten Dickens Novel?

1. First Admission to Rudolfinerhaus not due to Dioxin poisoning

If we concede the issue that Yushchenko has a blood test demonstrating severely elevated Dioxin levels AND we concede that he has chloracne as a result of Dioxin exposure then Yushchenko was not admitted to the Rudolfinerhaus clinic in September for acute Dioxin poisoning four days earlier during his meal with the Ukraine Secret Service.

Chloracne develops months after exposure to Dioxin (italics mine):

Chloracne is a rare acne-like skin condition caused by certain toxic chemicals including the dioxins. It develops a few months after swallowing, inhaling or touching the responsible agent.

2. Yushchenko drinks too much

The New York Times reported that, according to their investigation, on the night of September 5th, 2004, Yushchenko ate with top Ukrainian Secret Service agents and, in the course of the dinner, he consumed: beer, vodka, and cognac.

Yushchenko arrived at the dinner around 11 P.M. By the time they got to cognac, it must have been the middle of the night (maybe Katerina was smelling Louis XIII cognac instead of Dioxin?):

The four men drank beer and ate boiled crayfish from a common bowl, as well as a salad made of tomatoes, cucumbers and corn. Later, they selected vodka and meats, and then cognacs for a last drink.

This is an abnormal drinking pattern:

The US Government defines moderation as no more than one drink per day for women and no more than two drinks per day for men

3. Yushchenko was admitted to Rudolfinerhaus for signs and symptoms related to pancreatitis -- a disease usually caused by alcohol

Thanks to reader and commentator pythagoras, here is an amazing link containing the official report of Yushchenko's hospitalization at Rudolfinerhaus. It states as diagnostic imaging findings:

Ultrasound:

Diffusive enlargement of the liver

CT Scan:

Pancreas intermittently massive without clearly-defined edges, peripancreatitis

Liver enlargement (hepatomegaly) is a frequent finding in alcoholics and can be a precursor to cirrhosis (= often fatal, end-stage liver disease). Pancreatitis is a frequent complication of alcohol over-indulgence (acute or chronic) and MASSIVE enlargement of this organ associated with blurred edges is diagnostic for pancreatitis (and a bad case of the disease at that). See my illustrative CT images here.

So the physicians at Rudolfinerhaus officially gave Yushchenko the same diagnosis  I gave him on November 30th, 2004 (see here).

The Ulcer Connection

Much was made of a NY Times report that endoscopy of Yushchenko at Rudolfinerhaus purportedly demonstrated that:

his digestive tract was dotted with ulcers from top to bottom

As it turns out, this was probably a cleverly manipulated phrase designed to obscure the fact that the fiber optic examination of Yushchenko's gastrointestinal tract revealed ulcers only at the top and bottom of Viktor's digestive tract, namely his stomach (=Gastritis) and his rectum (= the very terminal part of the GI tract; this is called "proctitis").

Again, according to the Rudolfinerhaus' own report Yushchenko demonstrated:

Acute active eruption of stomach ulcers, reflux gastritis of II degree

and

Acute proctolitis

Gastritis and its most severe manifestation (ulceration) is not uncommonly caused by alcohol:

Common culprits include alcohol... Although gastritis can occur in people of all ages and backgrounds, it is especially common in:

• People over age 60
• People who drink alcohol excessively
• Smokers
• People who routinely use NSAIDs, especially at high doses

Proctitis is inflammation of the lining of the rectum, called the rectal mucosa. As to why Yushchenko should have proctitis, I will not speculate, but he is know to have had both gastritis and colon ulcers before, according to the on-line newsletter Counterpunch (no source given):

Yushchenko's medical records show that from 1994 to 2004 he had the following diseases: chronic gastritis, chronic cholecystitis, chronic colitis, chronic gastroduodenitis, infection of the bowels, and Type II diabetes.

The salient point is that the ulcerations at the time of Yushchenko's Rudolfinerhaus visit, were not as extensive as initially indicated AND they can be explained away by both alcohol ingestion (a known and given here) and/or previously diagnosed conditions.

4. Rudolfinerhaus Clinic: A Place for Diagnostic Mysteries?

The Rudolfinerhaus clinic advertises itself as a discrete and posh clinic. I have questioned, right from the beginning, the rationale for Yushchenko entering this medical facility if he truly had a mysterious ailment or he needed high-end care. One of my readers, a computer scientist and an "ex-pat Austrian," by his own description, commented:

Had I an actual health problem, I would prefer, say, the U of Vienna's teaching hospital (for most things), or the Lorenz-Boehler (trauma, accidents), and so on.

A few years ago, the Rudolfinerhaus had the reputation of a Betty-Ford-clinic for the affluent, with an add-on wing for the yearly check-ups of rich oil sheikhs. Unless that rep has experienced a sea change since then, I must ask: Why would someone who claims to have been poisoned check into the place when the AKH is a stone's throw away?

More has been learned about goings-on at Rudolfinerhaus that deepen the mystery of Yushchenko's choice of treatment centers. As first reported in the Transatlantic Intelligencer, and then the on-line magazine, Antiwar.com, there were some serious behind-the-scenes internecine struggles at the Rudolfinerhaus Clinic after Yushchenko's visit. Apparently, the real "head" of the clinic, a Doctor Lothar Wicke resigned and according Antiwar:

It seems that his skeptical remarks concerning the unproven status of the "poisoning" accusations had proved injurious to his health. At a news conference held just after Yushchenko's first visit to Rudolfinerhaus, Dr. Wicke had accused unnamed individuals not on the medical staff of spreading "medically falsified diagnoses concerning the condition of Mr. Yushchenko." He also pointed to the complete lack of any evidence that the candidate had been poisoned, either deliberately or otherwise. This did not endear him to the Yushchenko crowd.

Quoting the Frankfurter Allgemeine Zeitung (FAZ), a leading German newspaper, and Austrian magazine Profil, Antiwar reports that Dr. Wicke received numerous death threats and explicit warnings from the "Yushchenko clan."

The author of this article, Justin Raimondo, goes on to quote this source (a pay link, in German):

"Thereafter Yushchenko's people made clear to Wicke that he should not say anything more concerning the affair, since otherwise [as Wicke puts it] 'one would resort to other means against me and the hospital.' Dr. Wicke is also supposed to have received death threats at the time."

Add to these new revelations the obviously staged drama of Yushchenko's brief return to the clinic for a diagnosis (see here), and previously noted inconsistencies in their reports, it is clear that the Rudolfinerhaus Clinic needs to be viewed as a hospital chosen by Yushchenko to protect the public from the full knowledge of his condition and its origins.

Punctuating this claim is the conclusion of the Rudolfinerhaus' clinical report which almost negligently does not mention the findings of pancreatitis and gastritis (both of which can be linked to alcohol ingestion) and instead, lists the one asymmetric finding : proctitis.

Conclusion: Acute proctolitis on the left side.

The negative general and alimentary condition could have been caused by either an acute viral infection or by chemical substances that are not generally found in food products.

Unless there is a translation snafu, the clinic's description of Yushenko's alimentary (gastro-intestinal tract) condition as negative is a flat-out lie. Worse, it is followed by the nonsequitor disclaimer that whatever he suffers from, it is caused by substances not generally found in food products (like grain alcohol?).

Thus the Rudolfinerhaus Clinic deflects alcoholism and implicates something nefarious -- like poisoning. This is the type of report one would expect from a fawning celebrity half-way house, not a significant or major medical center.

5. Poisoned? NOT

From the beginning I have said that it seems ridiculous to imagine that anyone with any amount of sophistication or purpose would have dosed Yushchenko with poison. Detractors of this theory write variously that I don't understand how backward, stupid and incompetent these spies are and/or life in the Ukraine is. I can't buy that. And neither can most other reputable sources and experts.

The New Scientist

Murder by poison has largely been relegated to the history pages, principally because it is now so easy to detect

But why dioxin? "If you really want to kill someone, you use cyanide or ricin or strychnine," Dr. Andrea Sella of University College London wrote in thenewscientist.com

The New York Times

Murder by poison has largely been relegated to the history pages, principally because science has overtaken the great advantage that the poisoner of old had over his pursuers: the ability to hide his work beneath the normal calamities that afflict human life

Similar comments are noted throughout the net and the media.

Finally, there is the theory that Yushchenko was poisoned not to kill him but only to disfigure him. This is a dubious proposition; because, a moment's reflection would lead to the conclusion that the disfigurement could (and did) have the opposite effect. Also, Chloracne can not be predicted as a definite complication of poisoning and its exact manifestation -- given the rarity of its occurrence -- also could not be predicted.

What are we left with?

Yushchenko seems to have been exposed to a large amount of Dioxin (barring outright medical fraud at multiple locations). This was not why he was admitted to Rudolfinerhaus.

The chronology of the exposure to Dioxin, the manifestation of symptoms, and the appearance of Chloracne does not fit the chronology of the claims made by Yushchenko and the Rudolfinerhaus clinic.

Yushchenko drank too much the night of September 5th 2004, and he likely drinks too much frequently.

Test results released from Rudolfinerhaus show conclusively that Yushchenko had pancreatitis and an enlarged liver, both of which are common sequrelae of alcoholism.

Rudolfinerhaus tried to cover these findings with inaccurate press releases and a grossly misleading clinical report "conclusion." 

If Yushchenko keeps drinking, it is NOT UNLIKELY that his liver and pancreatic disease will progress and he will be left with chronic pancreatitis (which can lead to diabetes and insulin dependence) and/or cirrhosis (which can lead to death by numerous pathways.

Stay Tuned

ADDENDUM: A NOTE TO MY READERS

CodeBlueBlog has not dropped the Yushchenko story. Neither have I dropped the other CSI Medblogs cases which remain open and will be revisited, when appropriate. At least two of the previous CSI Medblogs cases are actively under pursuit, and one of those cases may have a reemergence with important new findings soon.

I suffer from lack of personnel, researchers, editing crew, letter readers/writers blog maintenance staff, and HTML coding experts (I sent myself a memo to do better).

That being said, some of the topicality of the Yushchenko story is diminished, but there remain many questions. Enough so that "America's Best Political Newsletter," Counterpunch would take a lot of my story and write a feature article without attribution (let alone directly quoting me and attributing it elsewhere!).

The "Comments" section of the Yushchenko posts has been overheating, and there are two points, brought to my attention, that need rewording. #1. Although Chlorine products stink -- as I said -- Dioxin doesn't stink. Sorry. #2. Although Dioxin needs to be dissolved in fat, one would need only a small amount to do the damage seen, so it would not be hard to administer this dose.

Many thanks to a commenter pythagoras who has furnished me with important references, and has kept my position viable while I have been manning the furnace.

Comments

[TPB, Esq.]

Regardless of the alleged motives behind causing Yushchenko's ingestion of dioxin, the thing you don't address in the above essay is where there is a non-troubling justification for his ingestion of dioxin. In other words, if Yuschenko could have ingested it by accident by, say, taking dioxin proscribed for another (isn't it used to treat supraventrical tachycardia), wouldn't this make the story different.

Putting it a different way: let's take the Occam's Razor approach. Yuschenko has a toxin in his system. Yes, he's apparently an alcoholic and he had three types of liquor (in unknown quantities) that night. Is that necessarily relevant to the ingestion of the toxin? If he did ingest the toxin, as it seems, what are the possible causes of ingestion?

We're professionals, we lawyers and doctors, and we should probably leave conjecture to journalists (forgive my bias, but they're not necessarily a professional profession, so to speak), but it's interesting to consider the basic question of causation with regard to this toxin.

[per]

You are building your argument on sand.
1) If you assume that TCDD was administered during his meal with the secret service, your conclusion (1) follows. But the problem is that you are claiming god-like knowledge of when and who poisoned him. It could well be that the TCDD was administered earlier than this. If this is so, the september symptoms could have been a result of the tcdd toxicity.
2/3) There is no reason why alcoholics cannot be poisoned (by TCDD), and it would not be a surprise if acute TCDD poisoning had a synergistic effect with chronic alcoholism. None of which detracts from the main issue, which appears to be the massive amounts of TCDD he has.
4) You quote various "experts" on why dioxin is a bad poison; but the only thing in common that these "experts" have is lack of knowledge of dioxins, and poisoning. For example, Sella appears to be an inorganic chemist.
two of the examples given, strychnine and cyanide, are in fact useless poisons; because they act so quickly, and are so easily detected. The murder is seen for what it is.
VY could well have died before he developed chloracne. If so, no-one would have thought of dioxin. You can only detect dioxin, if you are looking for it. That sounds like a good poison to me.
per

[per]

There is some stuff reported which does seem bizarre.
1) VY is reported to be going to get a skin transplant. Won't work for dioxin poisoning
2) vy's levels of tcdd are now back to normal. Cannot be so, for the half-life reasons you made clear.
per

[MaDhOuSe MaDmAn]

I admire you for your continued resilience. but please: STOP IT!
;-}
merry christmas

[CodeBlueBlogMD]

Well, people requested a follow-up to explain where I stood given the revelations...but I promise to try and resist.

Back at you... :-)

[kyan gadac]

I'm sceptical about the claim that outright fraud would have to occur in multiple locations. Firstly, the only repoted level is in a mysterious quantity called "units" . Secondly, contaminating a sample would be dead easy. I haven't seen enough evidence here or elsewhere that tcdd has actually been found in a blood or other sample from VY.

[CodeBlueBlogMD]

I think you are correct.

Since posting I've learned that the Yushchenko blood samples that were tested were drawn at Rudolfinerhaus and "sent" to a clinic in Amsterdam.

In my original post regarding this weekend farce, of December 13th, I questioned why Yushchenko would go to Vienna to have a blood sample drawn and sent to Amsterdam for a diagnosis.

It's likely the obvious reason.

[Niko]

Something you might have missed (I will cross-comment this at Trans-Int, too):

http://www.washingtontimes.com/upi-breaking/20041217-070555-7473r.htm

"Soon after Yushchenko first claimed he had been poisoned, President Leonid Kuchma's son-in-law engaged a French public relations team to initiate a media campaign, centered on a Vienna clinic, calculated to disparage the poisoning accusations, the newspaper said.

Yffic Nouvellon of EuroRSCG and his public relations team arranged a press conference where Lothar Wicke, general manager of Vienna's Rudolfinerhaus Clinic, contradicted Yushchenko's poisoning allegations.

Nouvellon also contacted international media offering "evidence" Yushchenko had not been poisoned. When asked during the media campaign, Nouvellon denied any connections to Kuchma's family."

[Niko]

Another twist:

http://yorkshire-ranter.blogspot.com/2004_12_01_yorkshire-ranter_archive.html#110337430741297928

"[According to a Financial Times story which is not accessibly to non-subscribers] it seems that Dr. Wicke is an intimate of Leonid Kuchma and doctor to many of those close to him. (Kuchma's children, it turns out, were born in the Vienna clinic.) When Yushchenko pitched up in the place riddled with dioxins, Kuchma made a dash to Vienna accompanied by a group of spin doctors hired from the French PR firm EuroRSCG, who persuaded Wicke to hold a press conference denying the suggestion that the illness was indeed poisoning."

But then I wonder why Yushchenko would seek that clinic at first.

[Niko]

It turns out that Yorkshire Ranter's summary is misleading. Here's the original FT article from Google's cache:

http://66.102.9.104/search?q=cache:kcPLVAO7qNYJ:news.ft.com/cms/s/562812c6-4f8d-11d9-86b3-00000e2511c8.html+financial+times+wicke+eurorscg&hl=de

(...) Soon after Mr Yushchenko first claimed he had been poisoned, in a speech to parliament on September 21, Mr Kuchma's businessman son-in-law, Viktor Pinchuk, travelled to Vienna and discussed the claims with doctors at the Rudolfinerhaus clinic. He and his wife - Mr Kuchma's daughter, Elena Franchuk - had established contacts with Vienna's tight-knit medical community when their daughter was born in a different Vienna hospital in June 2003.

A team of public relations experts from EuroRSCG, part of the Paris-based Havas Group, also came to Vienna, headed by Yffic Nouvellon, who had worked with Mr Pinchuk and Ms Franchuk in Kiev.

Mr Nouvellon's team arranged a press conference where Lothar Wicke, the Rudolfinerhaus's general manager, contradicted Mr Yushchenko's poisoning allegations. Mr Nouvellon also contacted international media, including the Financial Times, offering evidence that Mr Yushchenko had not been poisoned.

Mr Nouvellon did not reveal his connection to Mr Pinchuk, and when confronted about it insisted he did not know Mr Pinchuk and that he had never been to Kiev. Michael Zimpfer, the Rudolfinerhaus's president, said he had cut the clinic's contact with Mr Nouvellon's team after Mr Yushchenko had informed him of EuroRSCG's ties to the Kuchma family.

"It was a big mistake to involve a company that was clearly biased to one side," Dr Zimpfer said.

Mr Pinchuk said he and his media businesses, which carried reports casting doubt on the poisoning allegations, "had only one goal, to find the truth. All our investigations at that time showed no trace of poisoning."

[Jim Hu]

My latest thoughts on this in the trackback above. I'd like to hear your thoughts on the team that was providing care:
"At present the patient is under the round-the-clock medical observation by the following doctors:
Univ. Dr. M. Zimpfer; anesthesia and intensive medicine
medical officer Dr. Andorfer; neurology
medical officer Prim. Dr. J. Szimak; general practitioner
Dr. Michitsch; general practitioner
Univ. Prof. Dr. E.M. Kokoschka; skin and reproductive organs
medical officer Univ. Prof. Dr. M. Zrunek; ENT specialist
Univ. Prof. Dr. L. Wicke; radiologist
Univ. Prof. Dr. A. Neuhold; radiologist
Univ. Prof. Dr. E. Ecker; orthopedic surgeon in cases of accidents
Univ. Prof. Dr. N. Korpan; general surgeon."

Doesn't seem like the distribution of specialties I'd expect, but maybe they're different in Austria. Wouldn't there be a gastroenterologist if it was here? I guess Kokoschka would handle the dermatology. The description of treatment also seems weird to me..." anesthetization and blood transfusion" ...or is that what he got from Korpan before going to Vienna?

[per]

Why have blood samples taken in Austria, and analysed elsewhere ?
Dioxin analysis labs are specialised chemical labs, which by and large do not have medics attached to them. Medic takes blood tissue sample in Austria, and chemists analyse where their instruments are. No conspiracy here...
per

[per]

Chain of evidence
there is a requirement for a chain of evidence if ever there is to be a prosecution. That is to say that police will have to supervise the process of blood sampling and analysis.
I am thinking that the conspiracy theory analysis is very high risk. If Vy has doped his blood samples, then this is going to be very obvious very fast.
per

[Jim Hu]

Per,

I agree that it makes sense that the labs are not where the clinic is. But why travel so far for a blood sample in the first place? One possibiity is conspiracy, but I think that it is more likely that the explanation is paranoia - Yushchenko's people fear tampering of any sample taken in Kyiv, or anywhere else within Ukranian borders.

But I'm not sure that doping would be detected later...who else would get access to samples from him?

[per]

Jim Hu
VY has promised a police investigation post election. If that happens, the police will have to take blood under defined circumstances, where the biological samples are under constant observation, from taking the sample through to analysis.
it will be interesting to see.
per

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