What is Wrong with Castro?
Lisa Marcucci, MD (from Inside Surgery)
"I can say that it (Castro's
health) is stable, but a real evolution in my health takes time."
This seems to indicate that his perioperative period was stable,
but that the overall prognosis is in doubt, based on the condition
necessitating the surgery, rather than the surgery itself. This
would most likely point to a malignancy, where many patients have
"successful surgery" but do not have surgical cures. Tumors that
fit into this "intestinal category" are pancreatic adenocarcinoma,
gastrointestinal stromal tumors, colon cancer, stomach cancer and
hepatobiliary cancer. In addition, they may be hinting at the
placement of a gastrostomy tube (a tube placed into the stomach
that relieves bowel obstruction) for diffuse carcinomatosis.
"I can not make up good news because that would be
unethical."
Again, this seems to portend an ominous prognosis. It seems likely
that any benign condition treated with successful surgery would be
championed as such. Intestinal surgeries that fall into this
benign category are for peptic ulcer disease, bowel obstructions
from adhesions,hernias, or bezoars, rectal prolapse, liver
resections for hemangiomas or infectious disease, and splenectomy.
If the Cuban authorities are using the term intestinal for
intra-abdominal or retroperitoneal, then the possible surgeries
include repair of aortic aneurysm and kidney surgery.
"Stress has forced (Castro) into surgery."
There are a few surgical conditions that can be worsened by stress
possibly, although the role of stress in exacerbating these
conditions is debatable. They would be inflammatory bowel disease
(Crohn's or ulcerative colitis), peptic ulcer disease, and
pheochromocytoma.
"(Castro) will be in bed for several weeks."
Although Cuban medicine is generally not considered to be of the
same quality as American medicine, it is considered advanced for a
Third-World country. Cuban surgeons probably know that bed rest
after surgery is now frowned upon. The current trend in
post-operative care is to ambulate patients as soon as possible.
In the biggest abdominal operations done on patients (liver
transplants, pancreas resections, aneurysm repairs) every effort
is made to get people out of bed in the first day or two. So, it
is hard to imagine what surgery would keep Castro in bed for
several weeks if he was not at a terminal stage of his life.
There is something suspicious going on here. If Castro had
some non-life threatening condition, why would the authorities not
simply say that he had a perforated peptic ulcer which was
successfully repaired and that the recovery time would be a week?
(énfasis nuestro)
My guess - Castro has widely metastatic colon or stomach cancer
and will be dead in the next several weeks without ever regaining
control of the country.
What is Wrong With Castro - New and Updated After the Photos
From the photographs (assuming they are real and not doctored fakes)
As we suspected, he is not dead.
He is also not intubated or on a breathing
machine at the time of the photos. It also appears
that he does not have or has not had a tracheostomy,
which is a hole fashioned into the trachea or
windpipe for long-term ventilator use. At the time
of the photos he was not using any supplemental
oxygen, although as it takes 60 seconds for most
patients to desaturate, any supplemental oxygen
delivered through nose prongs could have easily been
removed for the photos. It does not look as if he is
in danger of dying in the next several days.
He appears to be awake but looks very drawn and
tired and thin. It could qualify for cachexia, which
is the wasting syndrome that patients get with
cancer. It could also be associated with the normal
weight loss (tissue catabolism) that patients
undergo with any major surgery for any cause.
He is either sitting or reclining in the four photos
and not standing. the fact that he is not walking or
ambulating continues to be very curious to me. It
would seem to me that if they could have somehow
gotten him out of bed to stand, even for a few
moments to take a photo or to have him wave from a
balcony, they would have. One must consider whether
he is too incapacitated to stand or if he has a
functional problem with his legs. He is not smiling.
This is what makes me really think he is really
sick. On his eighieth birthday when he opens his
statement to his countrymen that "I feel very
happy..." he is not able to manage even a glimmer of
a smile??
Musings:He fails what physicians call
the "foot of the bed test". I have unfortunately
seen it all too often when patients are dying and
have lost their spark of vitality, their sense of
optimism and connectedness with life. Patients
particularly with end-stage cancer have (for lack of
a better term) a way of turning inward as they
contemplate their mortality and their approaching
death. Understandably, most people are very subdued.
(énfasis nuestro)
From the statement
"For all those who care about my health, I promise
to fight for it."
If he had a curable condition, why would it
not be something like, "I am regaining my health
after my surgery and will be back at work soon."
When a person says they are fighting a disease or
for their health it is usually a euphemism for an
expected bad outcome.
"To say that the objective stability has
considerably improved is not making up a lie."
This seems to indicate that he made it
through his surgery and is stable from a surgical
point, which is confirmed from the photo's - that is
he is awake and not on a breathing machine, etc.
"To affirm that the recovery time will take a short
time and that there is no risk would be absolutely
incorrect."
Okay, if it is not metastatic cancer, why
would the recovery time not be short and what would
the risk be? He is awake and sitting up and again,
not on a breathing machine. In many American
hospitals (cancer or no cancer) he would be a day or
two away from being discharged. He is clearly
communicating that he will not be appearing soon (or
probably ever).
"I ask you all to be optimistic, and at the same
time to be ready to face any adverse news."
In the US when a patient is about to die, we
tell the family to "get ready for the sad news."
Conclusion: I still believe that Castro's
diagnosis is some type of metastatic intraabdominal
cancer. It just seems to me that if it was at all
possible they would have wheeled him onto a balcony
for at least a few seconds of a live appearance.
When Pope John Paul II was really just hours from
death he appeared at the window of his room. The
photos from Havanna were intended, of course, to
portray that Castro is not as sick as he probably
is. Or maybe Castro just doesn't care anymore if he
makes a live appearance or not. I will bet my house
that we never see him alive again.
(énfasis nuestro)