Speaker: Robert Pascuzzi, MD, Professor Emeritus of Neurology, IUSM
Introduced By: Karen Bumb
Attendance: NESC: 84, Zoom: 40
Guest(s): David and Mag Zauner, Larry Daly
Scribe: Terry Ihnat
Editor: Ed Nitka
View a recording of today’s Zoom presentation at:
Today's Program 021224
Dr. Pascuzzi started out with an admonition having to do with diagnosing medical problems stressing the importance of examining the patient. He gave the example of a patient with isolated upper extremity weakness and loss of sensation. The differential diagnosis is quite large. When the patient was examined, it was obvious he had spikes bilaterally in his brachial plexus. No further work was needed.
A personal example would be a patient with right upper quadrant abdominal pain Dr. Pascuzzi was asked to see. When he was undressed, he had a rash of shingles across his right upper quadrant causing pain; so no gallbladder workup was needed.
President Zachary Taylor, who was also the father-in-law of Jefferson Davis, died suddenly after experiencing abdominal pain after having eaten fruit and iced milk at a picnic. Others developed the same symptoms as well. People wondered if it could have been poisoning as this would have been consistent with arsenic, but later studies proved he had no arsenic in his system. Thallium could have caused the same symptoms but that was not tested for. Most likely it was a bad case of gastroenteritis. He would have been in the wrong part of the country for “milk poisoning“ which was caused by cows consuming white snakeroot, thus poisoning the milk. His son-in-law, Jefferson Davis, incidentally, had trigeminal neuralgia.
President Richard Nixon was in Indianapolis to pick up his daughter, Julie Nixon Eisenhower, from the IU Medical Center in 1974. She was in town for a meeting, had gotten sick, and required abdominal surgery. Dr. Pascuzzi was a junior med student, and from the back of the crowd he could see Pat Nixon. In later years, Nixon had atrial fibrillation and was on warfarin for anticoagulation, despite which he had a left middle cerebral artery stroke leaving him with a right hemiparesis and the inability to speak. Brain swelling developed and rapidly progressed, and he died of intracranial hypertension. But testing revealed he had a normal prothrombin time (INR), thus was not effectively anticoagulated, and this may have led to the embolic stroke. Proper monitoring of his anticoagulant status may have prevented this.
Harry Truman had upper and lower extremity weakness caused by diphtheria as a child from which he recovered. He was chosen as FDR’s vice president for Roosevelt’s final term, during which FDR died of hemorrhagic stroke. Truman was chosen by the Democratic hierarchy to replace Henry Wallace, who was felt to be too far to the left. It was known that FDR was in poor health and might not live through another term, and it is thought that if Wallace had been president after FDR’s death, we may not have dropped the bomb on Hiroshima.
As for Abraham Lincoln, because of his body habitus, it was thought that he may have had Marfan syndrome, but the fact that he was physically strong goes against this. He had problems with
depression. He had been taking a medication with mercury which may have accounted for some of his irritability.
There was some discussion of professional competence and allowing people to continue to perform in their professions. In medicine we have QA committees, specialty boards, maintenance of certification, etc. These are not perfect, though pretty good. Airline pilots have the same. Thoughts are that it can apply to other professions as well.
Robert Pascuzzi, MD
(Photo: Carl Holl)
