The Rittenhouse Review

A Philadelphia Journal of Politics, Finance, Ethics, and Culture

Thursday, October 07, 2004  

Skipping Yet Another Physical
And: Does the President Have Liver Disease?

Is President Sworn Off suffering from iatrophobia, that is, the persistent, abnormal, and irrational fear of doctors? Or is he just averse to taking physicals?

I ask because the AFP reported Tuesday: "After undergoing his annual medical check-up in August 2001, 2002 and 2003, U.S. President George W. Bush has put the procedure off this year until after the November 2 election, his spokesman said." (See Yahoo News link here. [Link by way of Suburban Guerrilla.])

Spokesman Scott McClellan explained the delay to the AFP this way: "This has been a busier travel period for the president than the previous three years." McClellan said the president is in "great health" and that his doctors approved the postponement.

But is President Bush really in "great health"?

That question arises in my mind because I just finished reading Bush on the Couch: Inside the Mind of the President, by Justin A. Frank, M.D., easily one of the most fascinating and important books written about President Bush this year.

Dr. Frank, a clinical professor of psychiatry at the George Washington University Medical Center and a teaching analyst at the Washington Psychoanalytic Institute, submits the president to as rigorous a course of psychoanalysis as is possible from a distance, knowing -- and fully informing the reader all along the way -- the limitations of this enterprise. Nonetheless, psychoanalysts are, if nothing else, extraordinarily observant people, and Dr. Frank demonstrates how much can be learned from a person's behavior, his statements (both public and private), and from biographical and autobiographical material.

Bush on the Couch is a sort of sick thriller, a page-turner in every sense of the word. I read the book in one sitting. I suspect political junkies with an interest in psychoanalysis or psychotherapy, which I think includes (or should include) all such junkies by definition, will be captivated by Dr. Frank's tightly argued analysis of the very needy man in the Oval Office. Bush on the Couch wins a "Must Reading" recommendation from The Rittenhouse Review, the highest possible rating on a five-point scale.

My attention in this post, however, is consumed by Dr. Frank's brief discussion of the president's physical health, rather than his exhaustive report on the president's emotional problems. Dr. Frank writes in Bush on the Couch (pp. 190-191):

. . . President Bush's annual physicals are made public, and his medical history does suggest a few points of interest [from the standpoint of psychoanalysis]. The relationship between Bush's physical and psychological conditions is more important than has been the case with most presidents because of his history with alcohol. Two decades of heavy drinking can take its toll on both the body and the brain; whatever lasting neurological impact Bush's alcohol addiction may have caused forms a necessary part of our understanding of his capabilities. [Emphasis added.]

This is particularly important in the case of a self-proclaimed reformed drinker, whose abstinence must be accepted only on his word as a matter of faith. Though no one likely wants to consider the prospect of this president's drinking in the White House, attention must be paid to an item from his summer physical that the press overlooked -- the removal of a number of spider angiomas from his nose in August 2003.

Dr. Frank continues:

Spider angiomas are very small burst blood vessels -- capillary bursts; while they can appear without any apparent cause, they are most often seen in two circumstances: pregnancy or chronic liver damage from excessive alcohol abuse. The report contained no mention of abnormal liver function, yet the angiomas remain a legitimate source of concern. [Emphasis added.]

You can learn more about spider angiomas here, here, and here, and any number of other web sites. (You can see photographs of spider angiomas here.)

After doing some additional research, I became concerned. The comments that follow are my own, not Dr. Frank's, and, for a variety of reasons, including the fact that I'm not a doctor and have never seen the president, they are in no way intended to serve as a diagnosis.

My purpose in drawing attention to Dr. Frank's observations and taking them a step farther is simply to raise the kind of questions that should be asked of the president's doctors, and to express my concern, now bordering on alarm, that we may not have been provided with a complete assessment of his health.

From the site eMedicine we learn: "Rapid development of numerous prominent spider angiomas may occur in patients with hepatic cirrhosis, malignant liver disease, and other hepatic dysfunctions."

And this: "When spider angiomas occur in association with palmar erythema and pallid nails with distal hyperemic bands, consider cirrhosis of the liver. Patients with liver disease may manifest additional symptomatology, including splenomegaly, ascites, jaundice, and asterixis."

A little help for a few of the less familiar terms used above: palmar erythema is a reddening of the palms of the hands; the term hyperemic refers to increased blood accumulation, in this case at the ends of the patient's fingernails; splenomegaly is an enlargement of the spleen; and ascites is the presence of excess fluid in the peritoneal (i.e., abdominal) cavity. We'll get to asterixis in a moment.

Dr. Frank noted that the report on the president's 2003 physical "contained no mention of abnormal liver function." Were the president's liver functions tested at that time? If not, why not? If they were, what were the results and why were they not published? Have the president's doctors looked for or ruled out palmar erythema, pallid nails with distal hyperemic bands, splenomegaly, ascites, jaundice (not always as observable as you might think), and asterixis?

Now, as for asterixis, that's the one that really caught my eye. The General Practice Notebook, a British web site, provides an explanation that is both informative and revealing:

Asterixis describes a motor disturbance characterised by intermittent lapses of an assumed posture. It is commonly associated with liver failure where it produces the flapping tremor of hepatic encephalopathy characterised by jerky, irregular flexion-extension movements at the wrist and metacarpophalangeal joints [Ed.: joints in the fingers.], often accompanied by lateral movements of the fingers. The motor disturbance may rarely involve the arms, neck, tongue, jaw, and eyelids. It is usually bilateral, absent at rest, and asynchronous on each side.

(Note: Hepatic encephalopathy as defined by the MedlinePlus Medical Dictionary: "Hepatic encephalopathy is brain and nervous system damage that occurs as a complication of liver disorders. It is characterized by various neurologic symptoms including changes in reflexes, changes in consciousness, and behavior changes that can range from mild to severe.")

Sound familiar? It does to this layman.

So now I am left asking myself three questions. The first is the obvious question shared by many voters: Has the president, as he claims, been sober since age 40? The second is more obscure and undeservedly so: Does President George W. Bush have liver disease? And the third is just a reflection on the times: Will we ever know?

[Post-publication addendum (October 13): Thanks to reader H.R.C. I corrected the title of Dr. Frank's book, to which in the initial post, in some strange Freudian slip, perhaps, I consistently called Bush on the Coach.]

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