December 04, 2004

Was Yushchenko Poisoned?

Elisabeth Rosenthal (non-blogger!) is on the case:

New details of Mr. Yushchenko's hospital admissions in Vienna raise disturbing questions: Was the candidate poisoned or infected with some biological agent, and, if so, with what? What is his current state of health, in the middle of a pivotal battle for power?

In September, Mr. Yushchenko immediately said he had been poisoned, but that charge was lost among the heated political debates and demonstrations in the final weeks of the campaign, which culminated in the disputed election.

"Look at my face," Mr. Yushchenko told the Ukrainian Parliament on Sept. 21, after his first stint in the Vienna hospital. "Note my articulation. This is one-hundredth of the problems that I've had. This is not a problem of political cuisine as such. We are talking about the Ukrainian political kitchen where assassinations are ordered."

Opponents dismissively suggested that the cause of Mr. Yushchenko's hospitalization was bad sushi or too much alcohol; doctors here said there was no evidence of either. But some doctors point out that it is conceivable Mr. Yushchenko had the bad luck to develop a rare illness, difficult to diagnose, at the height of the campaign.

The issue has persisted because of the obvious disfigurement and discoloration of his face, which is swollen and pocked with large bumps and cysts, and is a dusky grayish color. The left eye is bloodshot and sometimes waters.

Last week a British toxicologist, Dr. John Henry, suggested that Mr. Yushchenko's symptoms were consistent with dioxin poisoning, which causes a severe form of acne called chloracne. The condition occurs months to years after exposure, when the body seeks to eliminate residue of the chemical through the skin. But cases of dioxin poisoning are extremely rare. Scientists debate whether a huge one-time dose could be delivered as a poison...

Political intrigue is not the norm at Rudolfinerhaus, an elite private hospital that caters to wealthy Austrians and foreigners.

Dr. Zimpfer provided extensive details of Mr. Yushchenko's hospitalizations. 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. Internal examinations of the intestine using an endoscope found he had ulcerations - essentially bleeding abrasions - of the stomach and throughout his intestine and bowel as well. Ulcers are typically not spread out in that way.

The doctors gave him supportive care, like intravenous fluid and a restricted food intake to rest the digestive tract. As he gradually recovered strength, he opted to get back to the campaign trail. Already, doctors noticed that he was developing odd lesions on his face and trunk.

Ten days later, the candidate returned, after three days of what he called excruciating back pain. Its source was again a mystery, since related lab tests and scans were normal.

The pain was so severe that doctors had to place a large intravenous line into Mr. Yushchenko's chest and essentially nearly anesthetize him with huge doses of opiates. Because opiates depress respiratory functions, his breathing rate slowed, and his vital signs had to be constantly monitored. More medicine would have required that Mr. Yushchenko be placed on a respirator, Dr. Zimpfer said.

Mr. Yushchenko and his doctors made a difficult choice: They decided to place an epidural catheter between his shoulder blades into the membranes of the upper spine so that medicines could be delivered to the nerves in his back without compromising his mental abilities.

Epidural catheters are common for pain relief in childbirth, but they are far riskier when they are placed for longer periods and in the upper back, closer to the brain and vital nerves.

Mr. Yushchenko was discharged three days later, leaving with a retinue of doctors and cartons of medical supplies. He was still on "plenty" of medication, said Dr. Zimpfer. They arrived in Ukraine, and, after a few hours, Dr. Zimpfer returned to Vienna, leaving Mr. Yushchenko in the care of another Austrian doctor.

"He was severely ill, but this does not all add up to a single disease or even a known syndrome," Dr. Zimpfer said. "At this point his diagnosis is just a description of all his symptoms."

Any M.D.s out there with thoughts? Anyone else have two cents to kick in? If so, comment below.

Posted by Gregory at December 4, 2004 04:38 PM

it's hard not to believe that he has been the victim of some evil misdeed.

I saw the pictures of his face and not being a Dr I can't say for certain that something that bad happening that fast isn't foul play but as I said it's hard not to think it is.

Posted by: Sherry at December 4, 2004 07:34 PM | Permalink to this comment Permalink

I wonder if this is the real reson Mr Putin is so adamant about Yushchenko not taking power. One has to assume that the full resources of the Ukrainian state will be used to find the truth behind this poisoning.

Posted by: Kevin Murphy at December 4, 2004 07:44 PM | Permalink to this comment Permalink

Code Blue Blog is skeptical but I don't think he's read the NYT article yet. I've left a trackback at his site to my post connecting your post and his posts (and I'll comment there after this) asking if he has. That was an odd sentence...sorry!

Posted by: Jim Hu at December 4, 2004 07:54 PM | Permalink to this comment Permalink

MD here. None of us without access to VY to at least take a history and do an exam can say with any degree of certainty whether it is foul play. The most benign explanation would be rosacea, although the lack of erythema and the pattern of the lesions on the face is unusual for that. I also don't buy CBB's claim that it's rosacea+makeup - there is a grayish tinge to his skin almost like what you see following administration of certain drugs like amiodarone, minocycline, some antimalarials etc. If he had applied a lot a make up to remove the erythema, I don't think you'd still see the gray pigmentation.

The new information that his whole alimentary tract is ulcerated is interesting and concerning. This strongly argues against the other benign hypothesis being put forward (chloracne due to "stress"). I'm not a dermatologist, but I'd be very surprised if this pathology is consistent with that diagnosis.

The less first hand information we have, the longer (and less specific, therefore more meaningless) the differential diagnoses. Unless he develops a visible, pathognomonic sign of some sort, the only people who can make the diagnosis are his own doctors. All the rest of us, including CBB (whose oddly excited proclamations about these recent medical "mysteries" have been somewhat amusing), are indulging in pure speculation.

Posted by: Mark at December 5, 2004 01:46 AM | Permalink to this comment Permalink

I understand the Austrian doctor who examined him refused to support the poison accusation & it is difficult to see why he would have an anti-western bias.

As assasination attempts go it seems about as stupid as trying to make Fidel's beard fall out - on the other hand that one seems to be true.

Posted by: Neil Craig at December 6, 2004 11:12 PM | Permalink to this comment Permalink

The russians will not permit the loss of their Black sea bases.

Posted by: Jerry at December 7, 2004 07:59 PM | Permalink to this comment Permalink

I believe he was poisoned-it would make sense.Either way- is his face going to get better?

Posted by: Carry at December 8, 2004 09:01 PM | Permalink to this comment Permalink

Thallium used to be a favorite of the Bloc. I'll have to check the symptoms, but in any event, the change is remarkable.

Posted by: John Burgess at December 11, 2004 09:35 AM | Permalink to this comment Permalink
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