What Ails Castro?

Written by Dr. TimPublished February 04, 2007
Fidel Castro, borrowing a line from Mark Twain, would like you to know that reports of his demise are greatly exaggerated. Fidel Alejandro Castro Ruz, the 80-year-old dictator of the island nation of Cuba, transferred power to his younger brother on July 31 after "intestinal surgery" and has been recovering ever since.
The city of Miami is planning a mega-party to celebrate his death, but many of Castro's most bitter critics have been down this road too many times before and say they won't believe it until they can spit on his corpse. It's not surprising that it is not known what his illness is, or that there are conflicting stories about it, given the web of secrecy, fabrications and double talk that has swarmed around Castro since the inception of the revolution that eventually toppled the Batista regime. But based on what little is known, and using a little surgical detective work, we can get a pretty good idea of what happened. The first report out of Cuba was a statement from the government that said Castro had undergone surgery for stress-related gastrointestinal bleeding. His condition was reported as serious, but his return was to be expected in a few weeks. According to the official statement, Castro said his intense schedule "promoted in me a sharp intestinal crisis with sustained bleeding that obligated me to undergo a complicated surgical procedure." But during the next several days, when he didn't appear in public, rumors began to swarm: Was it cancer? Was he dying? The Bush administration, always last to know what's going on in the world, said it was caught off-guard by the reports of Castro's illness and had no idea what his condition was. As the speculation whirlwind reached tornado strength, the Cuban government released four photos of the recovering Castro, including one in which he is seated in a chair, holding up the August 12th edition of the state-run newspaper Granma and dressed in a red, white, and blue Addidas jumpsuit. The irony of the Communist leader dressed in a workout suit with the same color scheme as the American Flag and advertising a US corporation was lost on most Americans, as all attention focused on whether the photos were real or photo shopped. But Venezuelan President Hugo Chavez stopped over for a visit and had some photos taken with Castro, convincing the world that Castro was indeed alive, if not well. Additional state visits followed, with more pictures, an October video with Castro again reading from the current edition of the paper to prove it was not file footage, and lots of speculation.The statements of any of the politicians who have visited or spoken with Castro can be discounted outright, as they are not physicians, and all have their own axe to grind. The first report of reasonable veracity about Castro's condition came from Spanish surgeon Jose Luis Garcia Sobredo, the Chief of Surgery of Madrid's Hospital Gregorio Maranon, who responded to a "humanitarian request" from the Cuban government. He confirmed that Castro did not have cancer and was recovering. Subsequent reports leaked out of Maranon gave further details: Castro was suffering from an infection of his large intestine and had undergone at least three failed operations to repair damage from complications of diverticulitis. And here at last the story begins to make sense. The diagnosis of diverticulitis is likely to be true, not only because of the reports, but also because they match his age, history, and survival this far into this illness. To start with, examine all the major candidates for bleeding intestinal illness: diverticulitis, vascular problems, cancer, pre-cancerous lesions, inflammatory bowel disease, hemorrhoids. Vascular problems, a large group of problems having in common compromised blood flow to the colon, can be excluded because they have very different presentation and course of action than has been seen with Castro, and are almost exclusively treated with medical treatment rather than surgical treatment. Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, are chronic diseases that present long before the ninth decade of life. Hemorrhoids and pre-cancerous lesions (polyps) are easily treated and would not require a 6-month recovery, even in someone Castro's age.
For colon cancer to have been the cause of his illness, given the known symptoms and lengthy recovery, it would have to have been at least Stage III colorectal cancer, but the treatment of Stage III and Stage IV colorectal cancer (meaning that it is a large tumor that had spread at least to the lymph nodes and possibly to surrounding organs) includes chemotherapy, and there has been no hint of Castro having undergone chemo. Also, chemotherapy or not, survivability of Stage III or IV is poor, which could explain his failing health, but does not match with the repeated surgeries. What remains from our differential diagnosis is diverticulitis. Diverticulosis is a condition of the large bowel in which little outpouchings develop over the course of a lifetime. Think of a long skinny balloon, and along the balloon there are weak spots where the balloon pooches out. Changing -osis (presence of a condition) to -itis (presence of inflammation) means that an infection has set up shop in the outpouchings. This diagnosis agrees with his symptoms, his condition (as much as has been released by the Cuban government) and his history. Brazilian journalist Claudi Furiati, author of History Will Absolve Me, Castro's authorized biography, reported that Castro suffered from diverticulitis 20 years ago. Again, this agrees with the course of the disease, which develops later in life and can recur at any time.
More:
http://blogcritics.org/archives/2007/02/04/122928.php