Interesting couple of blog entries, one
here:
This is what I have been able to learn: McCain has had four melanomas. Three of these were "in situ," i.e., very superficial, caught at the earliest stage they can be detected, and of no threat if removed upon discovery. However, the left temple melanoma at issue here, which was excised from an area of relatively thin skin, was described as being a Stage 2A lesion that was 2cm, 2.2mm in diameter. Further, it was HMB-45 and S-100 positive; these are special stains, which, if positive confirms the diagnosis of melanoma skin cancer. Despite finding this information, I could find no mention of the Breslow level of the lesion, which describes the depth of the lesion related to the micro-anatomy of the skin, nor could I find any or data about ulceration, mitotic rate, or other common markers that help determine a patient's prognosis after a serious episode such as McCain's in 2000. Because all of this data is a part of the standard pathology report about any melanoma, I can only conclude that the actual pathology report for this skin cancer was not released last spring, when reporters were allowed a few hours to review over 1,000 selected pages from McCain's medical records. The absence of this information is very troubling as this lesion still has significant potential to be life-threatening.
The prevailing statistics suggest a 10 year survival rate of 65% from malignant melanoma. "For patients with a melanoma like Mr. McCain's who remained free of the disease the first five years after the diagnosis, the probability of recurrence during the next five years was 14% and death 9%." (Lawrence K. Altman, MD, NY Times, March 3, 2008).
Remember, however, that the true depth of McCain's lesion in the thin skin of the temple (Breslow level) is not known. Thus, the potential for metastasis (that is, spreading of the skin cancer to internal organs) cannot be determined without more information. This information must have been available to his surgeons and given that McCain had a sentinel node biopsy evaluation (reported as negative) and the removal of an unknown number of lymph nodes from the left neck, (all also reported as negative for melanoma), it strongly suggests that the information his surgeons gave them cause for concern. The steps they took were are common unless there is a real concern about the possibility of spread at the time of biopsy. Metastases in melanoma may bypass the regional lymph nodes in any case.
I just can't fathom why the guy's gotten a pass from the media starting back when they were releasing his 1,173 pages of medical documents for only three hours' time. Remember when they crucified Eagleton when it was discovered he'd been treated for depression? If melanoma has a 10-year survival rate of 65% and his first diagnosis was 8 years ago (not even factoring in the recurrences), how the fuck longer do they really expect him to last?
Now, to compound the issue,
this blog ponders the possibilities he's on the verge of stroking out on us, as well:
I would like to say something about the facial tics and twitching before I approach your video today. His left eye seems to have a significant tic or twitch much of the time. It is on the same side as his surgery to remove a melanoma - as you can see by the scar. Senator McCain may also have had radiation to the area during his treatment. There are two critical facial nerves that go right through that area - Cranial Nerve V and Cranial Nerve VII. Either one of those could have been damaged by the surgery and or radiation - and cause what we see today. Looking at his face and his scars - it appears that he had rather extensive exculpation - and this would not be an uncommon outcome. It would be interesting to actually examine him to see if there were any other deficits - because just looking at videos is complete educated guesswork.
Now - about the events of the day. I actually viewed the bumbling around the stage episode on TV while I was leaning over a patient today - and was somewhat concerned. In light of the fact that this occurred just seconds after the facial issues that you documented in the other video is very very disturbing. Let me put it like this. If I had seen a 70-75 year old man do that in front of me in the emergency room - that gentleman would be immediately admitted for what is known as a TIA. This is a mini-stroke that often comes before a big huge one. It is likely that if this occurred - Senator McCain may have realized something was wrong - and immediately began looking for an exit. This bumbling lost behavior followed by the initial onset of the symptoms is very commonly described by family members witnessing such events. Regardless, he should be admitted to the hospital for observation - ruled out for strokes with tests - and possibly be immediately begun on certain meds to attempt to abort any other such attacks. I have not been able to find video of his speech patterns around the time of the facial problems today - it would be interesting to note if there were any changes. If it does turn out to be a TIA - the patient would need further evaluation to note if his carotid arteries are blocked.
I showed this video to 3 colleagues today - AND a neurologist - all of us agreed - this is concerning and should be immediately evaluated. It is, however, impossible to make medical diagnosis via a video - unless you are Bill Frist or Tom Coburn. I would caution you to be careful about making any insinuations about his medical condition based on just that alone. However, I am concerned enough about what I saw of Senator McCain today that he should be seeing a doctor immediately.
Honestly, it's hard to imagine the guy would even last a year into his
*shudder* term. :thumbsdown:
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