With both Mayor Guilliani and Fred Thompson having a history of cancer, the problems of presidential health should be part of the discussion of who should be elected president.

This is not a new worry, since presidents such as Eisenhower and Wilson had strokes while in office.

But the most controversial health issue still discussed is about the mental competency of Franklin Roosevelt during his final year in office.

At HistoryNewsNetBlog, Professor Alonzo Hamby, author of a book on Roosevelt, writes an article that discusses Roosevelt’s terminal illness, and whether or not physicians should have warned Roosevelt not to seek re-election in 1944.
Alas, since he is a professor, not a clinical physician, the professor goes off on a tangent discussing an “iUniverse” book by one Dr. Harry A. Goldsmith postulating that Roosevelt’s final illness was terminal cancer.
Dr. Goldsmith points to a mole on Roosevelt’s forehead that disappeared from photos in 1940, and suggests that the president had melanoma type skin cancer, instantly turning Roosevelt’s final illness into a conspiracy theory.
This is not a new hypothesis: The author of the book first made this claim back in the early 1970’s based on heresay evidence, saying that a physician mentioned this in a lecture years earlier.

The Time article in 1971 about this controversy dismisses the claim, quoting one of Roosevelt’s physicians:

But Dr. Howard G. Bruenn, the Navy cardiologist who served as F.D.R.’s physician in the year before his death and signed the death certificate, vehemently denies that the President had cancer. Bruenn, now 74 and retired from Manhattan’s Columbia Presbyterian Medical Center, conceded in a 1970 article that the nation had not been told the truth about F.D.R.’s health. The President suffered from severe high blood pressure, congestive heart failure and arteriosclerosis. But, he says, “Mr. Roosevelt did not have a cancer—of that there is no question.” Bruenn believes that the abdominal pain was most probably caused by inflammation of the gall bladder—and possibly some gallstones—and the weight loss by the low-calorie, low-salt, low-fat diet ordered for F.D.R. to control his blood pressure and treat his gastrointestinal problems. He insists that Lahey never mentioned a diagnosis of cancer during consultations with him and that the President’s medical charts carried no mention of any operation to remove a facial lesion.

In medicine, the dictum is: When you hear hoofbeats, think horses, not zebras.

Only doctors who trained before the mid 1960’s can remember when severe hypertension was barely treatable, and every doctor had patients like Roosevelt in his or her practice.  Often those with mild to moderate high blood pressure (top number 140-170) had few symptoms. But eventually the  high blood pressure damaged their kidney, heart, or blood vessels.

Often at this point, the kidney damage from the high blood pressure would make the blood pressure go even higher (200-260), i.e. the “malignant” phase, where the prognosis was death within five years.

People with such high blood pressure often died of stroke or heart problems (either congestive heart failure, where the lungs fill with fluid due to a weak heart pump, or from a heart attack, lack of oxygen from the overworked heart muscle).

You didn’t always need a major stroke to cause neurological or thinking problems.The high blood pressure would cause dizzy spells and headaches, and episodes of numbness and weakness and confusion due to “mini strokes.

And failing kidneys would make your body retain fluid,causing a sore, swollen abdomen, (often the liver was swollen from congestive heart failure), swollen legs, ulcers on the legs, and shortness of breath. Kidney failure would also cause clinical depression, lack of energy, and slowness in thinking.

Roosevelt’s last few years are typical for this slow death. Much has been made of his weight loss/thin face, and his slow loss of stamina at the end of his life. But this is what we used to see with hypertension before medicines were available to treat the disease.

Dr. Hamdy’s article on Medscape describes those days:

Before the advent of these medications, there was very little that could be done to manage hypertension. The Kempner diet[2] was tasteless, unappetizing, monotonous, and insipid. Very few patients were able to tolerate it for significant periods. It consisted of boiled or steamed rice in plain water with no salt, and of fruit (except nuts, dates, avocados, and dried or canned fruit). Water and fluids were restricted. Even among the very few who could tolerate this diet, the reductions in blood pressure were of doubtful significance and probably did not exceed the random spontaneous variations in blood pressure.

So did Roosevelt have cancer?

Well, most skin cancers don’t kill, and the one that does (i.e. melanoma) either is cured when it’s removed or if it has spread, it tends to kill a lot faster than the time line in Roosevelt’s case. He could, of course, have had another cancer (bowel or lung, for example) but there is no evidence that this was his main medical problem, and indeed probably wouldn’t have anything to do with his final illness.

Roosevelt’s final illness had many geopolitical repercussions, some that last until this day. As Dr. Hamdy points out:

“…even though Roosevelt was known to have had hypertension for more than ten years.[1] It is still debated whether Roosevelt’s hypertension and probable complicating heart failure clouded his judgment during the Yalta Conference with Churchill and Stalin only eight weeks before his death. How different would the world have been after the Second World War had the United States, Britain and France liberated Berlin as opposed to the Soviet Union?…”

So, should doctors be worried about the health of the presidential candidates?
The answer is yes.
But remember: We know about Thompson’s and Guilliani’s cancer. But there is no way of knowing if the other candidates might develop cancer or another  illness that might complicate their term in office.

Just look at Bill Clinton, who had bypass surgery only a few years after leaving office. Or Reagan’s bowel cancer (which was removed and cured during his term in office).
Probably the best way to approach health in candidates is to ask questions, but remember: Behala na. Whatever will be will be.

And, if one believes in a deity, remember that everything will work for good in the long run….including the illnesses of kings and presidents.

After all, Roosevelt is not the only great leader whose stroke may have changed history. As Dr. Hamdy remarks:

Similarly, one may wonder what would have happened if Stalin, who also had hypertension, did not sustain a fatal stroke in 1953 and was still alive and in control of the Soviet Union during the Cuban missile crisis….

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Nancy Reyes is a retired physician living in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog. 

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