UNDER CONSTRUCTION

Maladies and Conditions

This style... ... means the event occurred while President.



appendectomy Appendectomy was performed in 1923 after several episodes of right lower quadrant pain beginning a year earlier. Histopathologic examination showed "chronic catarrhal appendicitis" 1a . Over the years, dense adhesions would develop between the omentum and the appendectomy scar 2



"melanoma" 3 In August or September 1944, Eisenhower had a superficial blackish nodule removed from his trunk because it was thought to be a malignant melanoma. Kay Summersby's book mentions an incident involving an "infected cyst," which was the cover story for the operation. The lesion proved to be a seborrheic keratosis, but Eisenhower appears never to have been told this. MORE



chimney, then quit After a few days of limiting his smoking, Eisenhower decided that counting his cigarettes was worse than not smoking at all, and he quit. He never had another cigarette in his life. ... Eisenhower was frequently asked how he did it; he replied that it was simple, all he did was put smoking out of his mind. It helped, he would add with a grin, to develop a scornful attitude toward those weaklings who did not have the will power to break their enslavement. He [remarked]: "I nursed to the utmost ... my ability to sneer." In March 1949, Eisenhower's friend and personal physician, Dr. Howard Snyder, told Ike he would have to cut down his smoking from four packs of cigarettes per day to one pack: 4a



arthritis One day a White House visitor noticed the President was wearing leather bandages on his left wrist. When Ike explained that he had a mild arthritic condition there, the visitor said he was glad it wasn't serious. "I should say it is serious!" exclaimed Ike indignantly. "It means that I can't play golf!" Was this a manifestation of his Crohn disease? Boller 5a tells this story:Was this a manifestation of his Crohn disease?



Crohn disease For 33 years after his 1923 appendectomy, Eisenhower had episodic lower abdominal pain. The diagnosis of partial small bowel obstruction was entertained in a November 1947 episode, which ultimately resolved spontaneously. In May 1956 a small bowel series led to the diagnosis of regional enteritis (Crohn disease) affecting the terminal ileum. 1



infarct 6a. Eisenhower had a left anterior myocardial infarction in September 1955, while on vacation at his in-laws' house in Denver. He was transported by car to Fitzsimmons Veterans Hospital and placed in an oxygen tent. His EKG showed ventricular and supraventricular premature beats. Although he developed a friction rub, he was treated with heparin 6 . Eisenhower broke with precedent and released detailed information about his illness to the public, but nevertheless, some of what the public learned was carefully choreographed MORE 6 . Eisenhower's long term treatment included coumadin 35 mg/wk, a low fat diet, and maintenance of weight at 175 pounds MORE



post-infarct mental state From the time of his infarction in September 1955 to the time of his announcement to seek re-election, "Eisenhower apparently went through the period of anxiety, denial, and depression common to most cardiac patients" 6 . For example, he was observed to be depressed in Gettysburg toward the end of 1955, but not to have signs of it such as psychomotor retardation, early morning awakening, constipation, and decreased appetitite 6b



bowel obstruction Eisenhower developed vague, ill-defined discomfort in the lower abdomen at 12:30 am on June 8, 1956. His physician arrived at the White House 30 minutes later and found moderate distention and tympany, but no particular point of abdominal tenderness. The President slept fitfully for the next few hours. Tap water enemas in the morning gave no relief. The pain became colicky and centered on the umbilicus and right lower quadrant. At 10:30 am he vomited 1500cc of bile-stained fluid. His pulse was 92, and his blood pressure had fallen from 140/100, when first seen, to 100/76. When seen by a consultant, Eisenhower was listless, apathetic, perspiring freely, had somewhat cool and clammy skin and a pulse of 120. After 600cc of D5W [sic] given intravenously, the hemodynamics improved and the President was tranferred to Walter Reed General Hospital. Eisenhower's chronic anticoagulation therapy was suspended. By 1:00 am on June 9, the 4 consulting surgeons unanimously felt surgical intervention was indicated. (However, the consultants had to be browbeaten into this consensus! See below.) Distention of the small bowel, seen on the initial x-ray, was increasing. At 2:20 am the President was induced and intubated and the operation began. Electrocardiographic observations were made during the 2 hour procedure. By 1:00 am on June 9, the 4 consulting surgeons unanimously felt surgical intervention was indicated. (However, the consultants had to be browbeaten into this consensus! See below.) Distention of the small bowel, seen on the initial x-ray, was increasing. At 2:20 am the President was induced and intubated and the operation began. Electrocardiographic observations were made during the 2 hour procedure. At operation, the terminal 30 to 40 cm of the ileum had the typical appearance of chronic "dry" regional enteritis. The bowel immediately proximal to this was greatly dilated, moderately edematous, but pink. An ileotransverse colostomy was performed, bypassing the obstruction. The procedure was uneventful; 500 cc of blood were given. At operation, the terminal 30 to 40 cm of the ileum had the typical appearance of chronic "dry" regional enteritis. The bowel immediately proximal to this was greatly dilated, moderately edematous, but pink. An ileotransverse colostomy was performed, bypassing the obstruction. The procedure was uneventful; 500 cc of blood were given. The post-operative course was smooth as well, save for a fever and minor wound infection on the 11th post-operative day. He began conducting official business on the fifth post-operative day. The post-operative course was smooth as well, save for a fever and minor wound infection on the 11th post-operative day. He began conducting official business on the fifth post-operative day. 1



deciding to operate 7 Without surgery, Eisenhower's 1956 bowel obstruction could easily have killed him (see above). Even so, the decision to operate was contentious. Eisenhower had had a serious heart attack just nine months earlier, and this made surgery risky. As you might expect, it is difficult to decide to operate on the President of the United States when he might not survive the operation. In Eisenhower's case, it took some dramatics from his personal physician to convince the consulting surgeons that they needed to operate. MORE This episode illustrates one of the cardinal perils in delivering medical care to the President.



deciding to run again In 1956 Eisenhower had to decide whether to run for a second term. Health concerns were a major part of this decision. Both his heart attack and the operation for a bowel obstruction had occurred within the previous 12 months (see above). Although his physicians ultimately assured him that he was physically fit to run for re-election, Eisenhower apparently did not have complete confidence in their opinion. In a private conversation he expressed hope that the physicians "knew what they were talking about since the job of being president could not be performed by anyone who was not in good condition." 7



stroke

After remaining in seclusion for 3 days, Eisenhower returned to work, his speech not yet back to normal. To some, the press coverage of his difficulties in this period seemed "unnecessarily savage and sadistic," since some reporters seemed to be counting the number of goofs Eisenhower made during a press conference. But unlike the 1955 heart attack and the 1956 abdominal operation, the 1957 stroke occurred at a time when important presidential meetings were scheduled 6a. While speaking to his secretary on November 25, 1957, Eisenhower found he could not complete his sentences. When examined he had neither motor nor sensory impairment. The diagnosis was occlusion of the left middle cerebral artery. Eisenhower, who was 67 years old and had three years remaining in his second term of office, was already taking coumadin at this time 6a After remaining in seclusion for 3 days, Eisenhower returned to work, his speech not yet back to normal. To some, the press coverage of his difficulties in this period seemed "unnecessarily savage and sadistic," since some reporters seemed to be counting the number of goofs Eisenhower made during a press conference. But unlike the 1955 heart attack and the 1956 abdominal operation, the 1957 stroke occurred at a time when important presidential meetings were scheduled MORE



cholecystectomy The first symptoms of cholecystitis occurred in August 1966 with a history of indigestion, belching, postprandial and mild substernal discomfort. Gallbladder x-rays showed cholelithiasis with multiple stones. It was difficult to distinguish the substernal discomfort of gallbladder disease and cardiac disease. Cholecystectomy under general anesthesia on December 12, 1966 was uneventful, and resulted in the removal of 16 stones. Eisenhower was discharged on the 15th hospital day 2



4 infarcts, 14 arrests One of the most remarkable and fortunate things about all this is that although he was unconscious a number of times his intellectual functions, memory, and recall and interest in current events were not compromised. His energy reserve was low, however, so his activity was restricted to three periods of 45 minutes out of bed each day. His morale and spirits were magnificent considering all he had been through. 2 MORE (Between his first infarction in 1955 and the April 1968 infarct, he had suffered two additional infarcts. Thus, the August 1968 event was his seventh myocardial infarction.) From April through August 1968, Eisenhower had 4 heart attacks and 14 cardiac arrests.(Between his first infarction in 1955 and the April 1968 infarct, he had suffered two additional infarcts. Thus, the August 1968 event was his seventh myocardial infarction.)



intestinal obstructions Episodes in May 1967, August 1967, June 1968, December 1968, February 1969. The last of these resulted in an operation on February 23, 1969. (Given Eisenhower's cardiac history in 1968, described above, this must have been a difficult decision). Postoperative convalescence was largely unremarkable, except for the close attention which had to be paid to his fluid status because of his heart disease. 2



prostatic hypertrophy During the recovery from the February 1969 laparotomy, a suprapubic catheter had to be inserted because of prostatic hypertrophy. 2



balloon pump This story may be apocryphal, but here goes. In the late 1960s, the intra-aortic balloon pump (IABP) was being readied for its first use in a human. Its developers thought that private insurance companies would not stand for such a radical new therapy, and approached the military, asking them to keep an eye out for IABP candidates in military hospitals.

One day, the call came. A retired general was hospitalized in Walter Reed Army Medical Center. He had a history of multiple infarcts and was now end-stage. The IABP scientists were all ready to go, until they found out the general was Eisenhower. They declined the opportunity because they worried that if the IABP failed in him, it would permanently ruin the future prospects of the device.