As I’ve written before, if the McCain campaign would simply release John McCain’s full cancer records, and the media would do their job, there would be no reason for us to speculate publicly as to whether John McCain is ill. Unfortunately, neither the McCain campaign nor the media has shown any intention of getting the bottom of McCain’s recent confusion, erratic behavior, and facial spasms. So I have asked a number of our readers who are M.D.s to weigh in. And they have.

This M.D. weighed in yesterday, and mentioned that he would have liked to have seen a full video of McCain’s speech in which he had the facial spasms and then became confused. The full unedited speech was online, so I sent it to him. Here is his report after having viewed the entire video:

There were several issues that I noticed upon viewing this video.

First of all – he clearly has a medical problem known as ptosis. This is demonstrated in him by his inability to hold up the eyelid on the left side. Another famous person who has this exact same problem is Forrest Whittaker. I have not really spent a lot of time looking at John McCain – not sure if this is a chronic condition. Nevertheless, that would suggest that he either has a significant central nervous system problem ( ie brain tumor ) OR something could be happening to the delivery of neuronal information from the brain to the eye. That would be over Cranial Nerve III. In my experience, diabetes is the most common cause of this problem – but old age is certainly right up there. Clearly, he could have had some severe damage to CN – III during surgery and or radiation therapy. If you look at the wiki entry on this problem – you can clearly see that diabetes and brain tumors are right up there as the causes. I would assume that if Senator McCain has had this problem for a while – this would have been thoroughly worked up. However, without access to him or his medical records – it is impossible to know. Furthermore, there are many subtle differences in ptosis and neurological problems like this – for example – what are the sizes of his pupils? – do they respond to light? etc etc etc – making certain diagnosis by video absolutely impossible.

Secondly, Senator McCain blinks constantly. Notice the blinking is much more prominent on the right eye – because the left eye as stated above is not functioning as well from a motor standpoint. If I had to guess, I would suggest that this possibly represents dry eyes. The seventh cranial nerve – or the facial nerve – is in charge of innervating the lacrimal gland or tear glands. That nerve is clearly compromised based on his other facial problems. It would not be a stretch to assume that his ability to make tears is compromised – and people tend to blink a lot when this happens. Again, there are many other questions I would like to ask him — does he have any trouble tasting food? – Do his eyes burn during the day? Again, this is all educated guesswork without a patient in front of you.

Thirdly, Senator McCain has very clear facial asymmetry – both neurologic and anatomic. By neurologic asymmetry, I mean that he clearly has trouble with his facial muscles and moving them around appropriately – this is obvious with still photos – his left mouth is hanging – not appropriately “up” like the right. When he smiles – he cannot seem to move the left mouth like his right. There are clearly other facial muscles involved – but not his forehead and eyebrows – both do quite well. This neurologic asymmetry is very likely secondary to massive nerve damage to cranial nerve VII on the left. He has evidence of damage to Cranial Nerve III and V as well. Cranial Nerves IV and VI are less likely to be involved because he does not seem to have trouble moving the actual eye itself – in other words he is not cross-eyed when he speaks. He has anatomic asymmetry – involving the big scar down his left face – as well as a pouched out area around his left jaw. This could be left over from facial reconstructive surgery – or he could have some lymphatic issues from radiation or surgery. I just would have no idea without medical records.

Toward the end of the video – when the massive nervous twitching was happening – his voice did seem to soften – and he paused frequently. There was no speech slurring. There did not seem to be any problem with other motor movements – ie he was still able to stand up straight – no leaning to one side or the other.

I still stand by what I said earlier – this twitching toward the end was distinctly different and corresponded to a time when he was confused. He momentarily did not appear as robust as he had been. Given these symptoms – and his obvious confusion – a visit to a physician immediately is in order. I would also add that cognitive dysfuntion like we have witnessed over the last several weeks is also quite concerning. He may be tired – but John believe me – that is what they all say. I see this kind of presentation all the time – concerned family members bringing grandpa in because something just is not right – and then on exam it is clear that grandpa has had a little stroke. He needs to be evaluated now.

In my professional career, I have done countless executive physicals and attestations to corporate boards and personnel offices. It is customary for men and women in leadership positions to get a thorough physical examination and follow up on anything out of the ordinary. In my career, I have seen several people turned down for jobs as CEOs or CFOs for the most trivial of reasons. This, however, is not one of those times. There are enough serious issues going on – pointed out to me today – that I believe he really needs to be evaluated and shoot straight with the American people – his future board of directors (assuming he is elected).