The NYTimes has an interesting photo of Obama on one of their articles. THIS PHOTO. Maybe it’s an optical illusion, but dang, his arm is long, and his fingers are long…and as a doc, it made me stare…
No problem. Probably tall and thin, like his father.
Several others in his African family have the long thin fingers PHOTO link
So no big deal. Half the basketball players in the world are like that.
But if he walked into
my office, and I saw those hands, the first thing I would think is: Arachnodactyly: Marfan Syndrome.
Photo from AllAboutArthritis, a corporate website that discusses Orthopedic problems.
What is Marfan syndrome, and should it be discussed as a health question if suspected in a Presidential candidate?
Yes and no.
Abraham Lincoln had it, so no, it doesn’t mean Obama can’t be president. But it does mean his doctors need to keep an eye on his aorta.
Political junkies can move on, because the rest of the article is about Marfan Syndrome.
Marfan Syndrome is common.(1 in 10,000 individuals). It is an inherited disorder, autosomal dominant, which means if you have it, half your kids will have it. However, it has variable expression, so that one person might have all the problems and another person have only a few symptoms or none.
It is a genetic defect where your connective tissue is weak.
Humans have all sorts of tissue, and connective tissue is what keeps everything connected. Doctor Chen has a nice article here if you want the biochemical details. But the easiest way to think of it is bad glue: that some of the stuff that keeps things together can stretch easily.
Unlike many syndromes, there is no ethnic variability, but like many genetic syndromes, some cases are probably genetic mutations, although given the fact that most cases of Marfan probably are so mild that they never get diagnosed, this is hard to prove.
Marfan Syndrome is a clinical diagnosis. That means there is no lab test. You diagnose it by old fashioned physical examination.
Many of these features are related to the bone and can include: Long face, high arched palate, long slender fingers, flat feet, spinal problems, and chest abnormalities (pectus excavatum).
Except for the last one, these problems are not medical problems.
Since your ligaments are lose, you are prone to get scoliosis (crooked back). You might be double jointed. the arm span is longer than the height of the body, and you can pull your thumb down until it hits your wrist.
And because the connective tissue holding the lens of the eye is weak, one problem is that people with Marfans are prone to get their lens dislocated. The eye is also prone to nearsightedness and iris problems.
So who cares? Why worry if someone might have Marfan Syndrome?
And the answer is: In some patients, the connective tissue of the heart valves and the Aorta are also weakened in the syndrome, and this can lead to disaster if not watched carefully.
You can be born with a weak Mitral valve, leading to the need for cardiac surgery as a child. You can develop problems with Mitral Valve prolapse.
But for adults, the danger is the aorta: The Aorta can dilate (balloon up) where it meets the heart. This messes up the Aortic valve. And the weakness of the Aorta makes it prone to develop a devastating disease called dissecting Aortic Aneurism.
A dissecting Aortic aneurism is what killed John Ritter (who did not have Marfan’s) and it is not only dangerous even when treated, it is also something that is rare and easily overlooked, since the symptoms are similar to those of an ordinary heart attack. Our First Gentleman Mike was diagnosed and treated when his started to dissect, so it is not necessarily fatal if you diagnose it in time.
So what do you do if you think you have Marfan syndrome?
Don’t panic.
Get your doctor to check you out, and have him/her listen to your heart, and maybe order a Cardiac ultrasound.
If you have Marfan syndrome, get regular checkups by your eye physician and have your doctor keep an eye on your heart with examination and with ultrasounds, or if there is a problem, with the newer MRI/MRA examinations.
High blood pressure and pregnancy can make things worse, but a lot of patients can lower their risks with medicines, including beta blockers.
If you get chest pain, let the Emergency room doc know you have Marfan syndrome.
This is only a superficial summary, so if you want more information, go to the National Marfan Foundation website.
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Nancy Reyes is a retired physician living in the rural Philippines. She writes medical essays at HeyDoc Xanga Blog.
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10 users commented in " Health note: Does Obama have Marfan Syndrome? "
Follow-up comment rss or Leave a TrackbackAbraham Lincoln apparently did not have it.
A 1962 theory that Lincoln had Marfan syndrome has little currency today.
Abraham Lincoln was both tall (6 ft 4 in) and thin (160–180 lb). He had long arms and legs, and large, narrow hands and feet. Contemporary descriptions of his appearance indicate that he was stoop-shouldered, loose-jointed, and walked with a shuffling gait. In addition, he wore eyeglasses to correct a visual problem. It is not surprising then that many have concluded that he suffered from Marfan’s syndrome. Certainly, he shared a great-great-grandfather with a man who had a confirmed diagnosis of Marfan’s. In fact, this observation, reported by Dr Harold Schwartz in 1959, was the beginning of a mystery that has taxed historians and doctors ever since. However, Lincoln showed few other signs of Marfan’s. He had visual problems, but examination of his eyeglasses reveals he was farsighted and not nearsighted – a classic symptom of Marfan’s. Also, a cast of his hands has shown that they were muscular and powerful, and not the slender hands of someone with Marfan’s syndrome. Although the fun of the mystery is often in the debate and not in the answer, this is one theory that could be tested: a limited amount of bone fragments and hair from Lincoln was retained by the attending physician at the time of his assassination. Molecular testing using these samples could end the debate in an instant.
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A978
Mental note to self: “Don’t piss off a doctor”. They’ll get you in the end.
Um……actually there is a DNA test for Marfan. It isn’t 100% accurate but, along with a clinical diagnosis based on obvious signs you can be pretty sure whether you have it or not.
Once one person in the family has been found to have the fibrillin mutation other members can be assessed using DNA linkage analysis which is pretty accurate in most cases, I believe.
Has anyone considered Obama looks like he has Marfan’s Syndrome? 6′1″ is a little short for a Marf but not unheard of.
Another article recently stated he had undergone an EKG test & it was normal. An EKG is NOT diagnostic - he needs an ECHOCARDIOGRAM! Undiagnosed Marfan affected persons rarely live past their 40’s without treatment due to aortic dissections or aneurysms.
Also, what about Joe Biden’s history of brain aneurysms? If the Dem’s win & both of them die we are STUCK with Peloski!!!
If I wasn’t already voting Republican I would simply because Palin I can live with, Peloski I can’t!
Wether you’re a medical doctor, a journalist or a mere mortal, publicising/writing/printing/publishing/announcing unsolicited medical diagnose is at the very least rude, if not unethical and irresponsible. To me those are signs speculative brown press and mercenary “journalism”.
I read your article with great interest. As a medical student, I had also wondered about Obama’s physical features and the possibility of Marfan’s syndrome. In response to the previous comment from WTF, I would tend to disagree. This article clearly doesn’t make any diagnosis with regard to President Obama, but rather raises an interesting question, and provides a jumping off point to educate the public with regards to a syndrome that is frequently seen by medical professionals.
Before you go off on a tangent, diagnosing president Obama with a thin face, I think you need to look at most Africans who live in the horn of Africa, as they often meet those characteristics; long thin face, slender bodies, tall, etc.
Having said that, you need to consider that most Marfans patients are not very muscular, the last two fingers on the hands are usually longer than the first two, and they have a tendency to be short in the waist and have long legs. Hopefully, you have seen his topless photos in Newsweek proving that he has neither Pectus excavatum or pectus carinatum.
All tall thin people, do NOT have Marfans. He would look odd, having short arms and fingers with a tall body.
Marfan’s is genetic & autosominally dominant. Expressed as such & NOT as a random mutation, it can present variously & does not have to be fatal (mutant vs familial is often most severe). My family has textbook Marfan’s, including a member who was not even tall (5′5″) dead of it. It can present incompletely. It can present with all the heralds of the disorder & not be fatal if the most severe symptom (congenital aneurysm) is not present/does not develop. Conversely, one w/no outward physical heralds can drop dead w/that one symption: aortic aneurysm. On a scale of 1-10 for outward appearance for Marfans, Obama might not be a sure 9 or 10, but he’s way above a 5. It is not rude to speculate about the fitness to lead concerning the “leader of the free world.” This includes mental, moral and physical fitness. His medical conditions, if any, should have been open to voters, like it or not. It is their right to weigh all things in order to choose an executive. A student of presidential history would know that, this has not been done in the past & that several presidents served w/severe health conditions ranging from cancer to stroke, heart failure or Addison’s Disease. WHile we all muddled through somehow without knowing, it still represents subterfuge in a job that should be the most transparent in the nation. The voters themselves, and not political hacks and spinners/managers, must decide by weighing all factors– who should head the executive branch and armed forces, esp. in a nuclear world. Given the truth, the electorate could very well decide that this or that health condition is of no consequence in the light of other factors. On the other hand, this is for the voters to decide after having access to all available inforation, and no one else . Beginning a presidency by not trusting the judgement of the people is the beginning of an untrustworthy presidency.
Obama certainly looks the part. Hmmm…
And here he plays basketball. If he does have it, I’d have my heart or aorta monitored including a genetic screening.
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