Presidential Pathology — Maimonides Emergency Medicine Residency

In honor of election season, let’s review some pearls and boards material surrounding our nation’s presidents!

Woodrow Wilson – Influenza, Stroke

1918: There is some suspicion that President Wilson caught the famous virus from the 1918 flu pandemic. He later suffered a TIA and a massive stroke (L hemiplegia) – his staff hid the severity of his stroke while his wife supervised his duties.

Influenza:

· Antigenic drift = small mutations that create different seasonal flus

· Antigenic shift = switches species

· Tamiflu = all hospitalized & high risk patients ASAP, low risk patients within 48hrs

o Tamiflu debate, click here

Stroke:

· Highest risk of stroke after TIA = 48hrs

· Blood pressure goals:

o Ischemic stroke, TPA eligible = Keep below 185/110

o Ischemic stroke, no TPA = 220/120

· TPA to be given within 4.5 hours

FDR – Polio

1933-1945: Photographers avoided taking pictures of FDR while he was in his wheelchair as it was viewed as a sign of weakness. Photos of him were deliberately taken only while the president was in a car or behind a desk.

Polio

· The WHO anticipated eradicating polio from the planet by 2023. However, President Trump’s withdrawal from the organization had led to a severe decrease in funding and that may need to be reconsidered. Check out this clip from Sunday’s Last Week Tonight With John Oliver to learn more.

Eisenhower – MI, Crohn’s Disease

1955: He stayed in Fitzsimons Army Hospital in Colorado for 7 weeks after his heart attack, but I couldn’t find how they treated it. Just a few months later, six months prior to his next election, he was diagnosed with Crohn’s Disease and required surgery. He went on to win the election.

MI: Lysis vs Cath

· Lysis if PCI cannot be performed in the “appropriate timeframes” below

· PCI timeframes:

o AMI within 2hrs = PCI in 60 minutes

o AMI within 2-3hrs = PCI in 60-120 minutes

o AMI within 3-12hrs = PCI in 120 minutes

Crohn’s Disease

· Typically 2nd/3rd decade of life, male, hx of IBD in the family

· Any part of the digestive tract from mouth to anus

· Skip lesions

· Full thickness inflammation (unlike UC = epithelial layer only)

Jed Bartlet – Multiple Sclerosis

2000: Widely acclaimed as the greatest president of our time, the Bartlet Whitehouse was rocked by scandal and outrage when it was revealed that the president and members of his administration had willfully omitted knowledge of the president’s devastating demyelinating disease. Despite the controversy, Americans saw past this lapse of judgement and reelected President Bartlet for a second term.

· Autoimmune, more in females, connected to psoriasis and thyroid disease

· Internuclear ophthalmoplegia = difficulty adducting eye = pathognomonic

· LP = Oligoclonal bands & IgG in the CSF

· MRI = optic nerve lesions, juxtacortical lesions, and Dawson Fingers

· Steroids for flares (inpt or outpt)

George W. Bush – Colonoscopy

2002, 2007: Colonoscopies aren’t that interesting but Bush did, indeed, hand over the power of the presidency to Dick Cheney on two occasions, each lasting just over 2hrs while he had routine colonoscopies.

Colonoscopy

· Q10yrs, starting at age 50 (unless family hx, familial adenomatous polyposis, etc.)

· Complications:

o Pyogenic liver abscess

o Infection

o Bleeding (post-polypectomy, 1 week after procedure)

o Perforation

o Post-polypectomy syndrome: peritonitis without perforation after a transmural burn in the colon

Kennedy – Addison’s Disease

1961-1963: It looks like JFK suffered from quite a number of medical problems: chronic back pain, colitis, UTI, abscess, possibly malaria, and apparently was on a brief course of antipsychotics after a change in mood when he started some antihistamines. The most famous of these maladies was his Addison’s Disease, for which he was on daily steroids.

Interestingly, Kennedy was wearing his back brace on the day he was assassinated, which kept his posture fully upright in the limousine prior to getting shot.

Addison’s Disease:

· Chronic adrenal insufficiency, autoimmune – patient’s on chronic steroids

· Hyperpigmentation

· Must be distinguished from acute adrenal insufficiency:

o Look for hyponatremia and hyperkalemia (low aldosterone)

o Hypoglycemia

o Refractory hypotension

o Hydrocortisone 100mg IV

REFERENCES:

https://www.cnn.com/2020/10/07/health/us-presidents-health-problems-wellness/index.html

https://www.healthline.com/health/diseases-of-presidents

https://www.ahajournals.org/doi/10.1161/STR.0000000000000211