(Addison’s) A piece of presidential history solved the puzzle

By Sandra G. Boodman
Special to the Washington Post
Tuesday, December 15, 2009

 

As she lay in a heap, trying to figure out how badly she had hurt herself falling headfirst down a flight of stairs in the middle of the night, Rebecca Woodings grasped just how sick she really was.

 

For months doctors had been ratcheting up the medicines used to treat her intractable allergies. At one point she was taking 10 drugs a day and getting allergy shots. An economist who works for a large Washington law firm, Woodings, 49, told doctors she was tired; she assumed her fatigue was a consequence of her allergies, which were also causing a persistent cough. She did not tell them she was so exhausted she had to sit on the sidewalk while waiting for a bus and couldn't stand long enough to cook a meal.

 

Hours before she tumbled down the stairs of her Takoma Park home last June, an astute pulmonologist had figured out what was wrong -- and it had nothing to do with her lungs. That night, as Woodings tried to move the wrist she had broken in the fall, she focused on her 6-year-old son, realizing that if she had smacked her head she could have died. "I kept thinking, what would have happened to my child?"

 

In the fall of 2008 Woodings began feeling unusually tired. Walking less than a mile to the Metro in the morning made her break into a sweat. "It was very tiring," she said, and she recalled feeling puzzled. "I'm not terribly out of shape and I'm not overweight." Once on the Metro, Woodings made sure to get a seat; standing for 20 minutes was unthinkable.

 

During her annual checkup in November, her long-time internist at George Washington University discovered a Vitamin D deficiency and prescribed a short course of high-dose supplements.

 

By December, the fatigue was worse. Woodings had to sit down in the middle of a hymn during a church service. "All these little white-haired people around me are standing, and I couldn't," she recalled. When she mentioned the incident to a friend who works at the National Institutes of Health, she was told the symptoms sounded like a heart attack. Alarmed, Woodings immediately headed to a nearby emergency room, where an EKG and a chest X-ray showed that her heart was fine and her lungs were clear. Her father, a retired physician, suggested that maybe an antihistamine was causing her fatigue. Woodings stopped taking it and felt slightly more energetic.

 

By February, she was forced to sleep propped up on pillows and was taking a prescription cough syrup, which had little effect. The mother of a typically energetic kindergartner, she had started falling into bed around 8:30, when her son did. One night, she was so tired she told him to put himself to bed and crawled into bed at 8. Her allergist began administering allergy shots, which didn't help. Another doctor -- not her regular internist -- suggested she cut back on her sleep and get more exercise. Woodings replied that she was so tired she worried she might fall off a treadmill.

 

Routinely she arrived at the office at 9 a.m., already worn out. "It's really difficult to talk about being exhausted at a law firm," she said. "It sounds wimpy," so she didn't mention it.

 

In March, when she was handed a demanding new assignment with multiple deadlines, two new symptoms surfaced: Woodings began retching unpredictably -- "that damn cough," she remembered thinking -- and developed ferocious leg cramps at night. By then she noticed another peculiarity: Although she literally could not stand long enough to wait for a light to change while crossing the street, she could manage if she kept moving, walking slowly in a circle.

 

In early April, she went back to the allergist. He diagnosed a bad sinus infection and doubled the medications she was taking to 10 per day, including a short course of prednisone, a corticosteroid sometimes used to treat severe sinus infections.

 

After the first day, Woodings said, she felt markedly better. A week later the cough had disappeared and her energy slowly returned.

 

But by Memorial Day the fatigue was back and Woodings realized her problem wasn't allergies. She had stopped taking the allergy drugs, deciding that they might be the cause; her cough was gone. Woodings called her internist, whom she had not seen in six months. The doctor was heading out of town and Woodings decided to wait until her return rather than see a covering physician. In the meantime her physician ordered several tests, including those for Lyme disease and HIV, as well as CT scans of her lungs and sinuses.

 

On June 5, Woodings was told she had a possible bacterial infection in her lungs -- but not tuberculosis -- and was referred to GWU pulmonologist Susan Hasselquist. When she called to make an appointment, she was told that Hasselquist's first opening was a month away.

 

Desperate, Woodings decided to lie. "I said, 'I can't wait. The potential diagnosis is active TB.' " She was given an appointment for the next day.

 

On June 10 Woodings met with Hasselquist, who listened intently as Woodings recounted the events of the previous seven months. Unable to obtain a blood pressure using an automated cuff, Hasselquist measured it manually and found it was an alarmingly low 90/55. The lung specialist recalled being struck by how weak Woodings was: She lay down on the examining table while they talked because sitting up was too tiring. Hasselquist said she kept thinking of, and discarding, possible diagnoses. "I knew if we just kept talking I'd figure it out," she said.

 

Her eureka moment occurred when she zeroed in on Woodings's deep tan and asked her about it. Woodings, who is normally very fair, said that other people had remarked on it and that she hadn't spent much time in the sun.

 

Suddenly, Hasselquist said, she was certain what was wrong, a hunch triggered by photographs she'd seen of a ruddy-looking President John F. Kennedy, who had Addison's disease, a rare endocrine disorder that occurs when the adrenal glands become damaged and fail to produce enough cortisol and aldosterone, hormones vital for metabolic function. Most cases are the result of an autoimmune attack in which the immune system slowly destroys the adrenal glands. Woodings's dramatic improvement while taking prednisone, the steroid prescribed to treat her sinus infection, was a vital clue: It is one of the medicines used to treat Addison's.

 

Kennedy received an Addison's diagnosis at age 30; his sister, the late Eunice Kennedy Shriver, is also believed to have suffered from the disorder, which affects one to four of every 100,000 people, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

 

Woodings had the classic symptoms of Addison's: progressive fatigue, muscle weakness, low blood pressure that falls further during a change in positions, and hyperpigmentation, which resembles a dark tan. The retching and legs cramps are also symptoms, although her allergies and cough are not.

 

Hasselquist did not mention her suspicion to Woodings because it would require confirmation from an endocrinologist. She said she suggested hospitalizing Woodings because she was so weak. When Woodings declined, Hasselquist warned her against standing up too quickly, which could cause dizziness.

 

After the appointment with Hasselquist, Woodings went straight home, ordered a pizza and went to bed. She awoke several hours later and headed for the bathroom to urinate. She remembers feeling dizzy, and then realizing she was at the bottom of the stairs, her wrist shattered. She managed to get up, call 911 and wake her son. Doctors in the ER set her wrist, told her to see an orthopedist because she would need surgery, then sent her home.

 

A few days later GWU endocrinologist Michael Irwig, to whom Hasselquist referred Woodings, confirmed the Addison's diagnosis. He prescribed prednisone and another drug Woodings will have to take for the rest her life to replace the hormones her body no longer produces.

 

Within a few weeks, Woodings said, she felt much better. Her energy level returned to normal, as did her blood pressure. Her tan is fading, and surgery on her wrist was successful.

 

"I can't fault any of the doctors," Woodings said, adding that she believes she should have called her internist early on, instead of consulting other physicians. "I think I could have described my condition a little better. I never said, 'I have to sit on the sidewalk waiting for a bus,' but rather, 'I'm tired all the time.' "

 

If you have a Medical Mystery that has been solved, e-mail medicalmysteries@washpost.com. To read previous mysteries, go to http://www.washingtonpost.com/health.

 

From http://www.washingtonpost.com/wp-dyn/content/article/2009/12/14/AR2009121402863.html

 

~~~~~~~~~~~~~~~

 

Feedback:

Woman's tale of Addison's disease proves the value of primary-care physicians

 

Tuesday, December 22, 2009

 

Of primary importance

 

"A piece of presidential history solved the puzzle" [Dec. 15], about the lady found to have Addison's disease, points out how crucial it is to have a primary-care focus in evaluating patients. Often patients scramble through a maze of specialists, as she did, without a strong primary-care clinician coordinating care.

 

My hope is that health reform will recognize the essential perspective that primary-care physicians from family medicine, geriatrics and internal medicine bring to patient care. They can save patients and the health-care system heartache and money. It is the most challenging field in medicine and the most holistic.

 

Our system should provide incentives for new medical school graduates to join these fields and reward these physicians appropriately. These doctors work very, very hard. Good primary-care clinicians are worth their weight in gold.

 

Christine Butler

Coordinator, Palliative Care Service

Sibley Memorial Hospital

Washington

 

From http://www.washingtonpost.com/wp-dyn/content/article/2009/12/18/AR2009121803706.html

Rare disorder explains JFK's health woes

A review of President Kennedy's medical records also shows a family history of autoimmune diseases.

By Susan J. Landers, AMNews staff. Posted Sept. 11, 2009.

 

New research points to an autoimmune endocrine disorder as the cause of at least some of President John F. Kennedy's health problems.

 

Despite his relative youth -- at 43, Kennedy remains the youngest person elected president -- and his seeming vigor, Kennedy "had the most complex health history of anyone to occupy the White House," said Lee R. Mandel, MD, MPH, senior medical officer of the aircraft carrier USS George H.W. Bush and a historian interested in presidential medicine. His findings were published in the Sept. 1 Annals of Internal Medicine (www.annals.org/cgi/content/abstract/151/5/350/).

 

For his study, Dr. Mandel combined evidence gleaned from his review of Kennedy's medical records at the John F. Kennedy Presidential Library and Museum in Boston, with material obtained from additional sleuthing. Kennedy's complex medical history has received much scrutiny since his medical records were made public in 2002.

 

Dr. Mandel found mentions of Kennedy being diagnosed with hypothyroidism and Addison's disease.

"The fact that Kennedy, who unequivocally had Addison's disease, also had hypothyroidism leads to the plausible conclusion that there was an autoimmune basis for his medical problems, and APS 2 [autoimmune polyendocrine syndrome type 2] explains these conditions," Dr. Mandel wrote.

 

"I saw the common thread that other people had commented on casually," he said in an interview. "I think he did have an autoimmune syndrome."

 

Autoimmune thyroid disease coexists with Addison's disease in two-thirds of cases. APS 2 typically occurs in early adulthood, at around age 30, the age Kennedy was when Addison's disease was diagnosed, Dr. Mandel said.

 

Autoimmune syndromes are often found in families, he added. "[Kennedy's] sister Eunice [Kennedy Shriver], who just passed away, was believed to have Addison's disease and his son, John F. Kennedy Jr., had Graves' disease."

 

Kennedy also had intestinal ailments likely caused by undiagnosed celiac disease, Dr. Mandel said.

 

In an era when media scrutiny is less intense than today, Kennedy and his physicians were able to conceal many of his health problems or attribute them to heroic activities. For example, back pain stemming from his degenerative condition was instead attributed to a war injury. Symptoms from his Addison's disease were described as a recurrence of malaria contracted in World War II.

 

But even if he were running for election today rather than in 1960, Kennedy's Addison's disease would likely not prove an obstacle. Even without modern advances, Kennedy's disease was well-controlled, Dr. Mandel said. He attributed that feat to Kennedy's endocrinologist, Eugene Cohen, MD, "the brains behind the management of the disease."

 

From http://www.ama-assn.org/amednews/2009/09/07/prsf0911.htm

My daughter Lisa Marie Bates died needlessly of Addison's disease

By: Gladys Bates

My daughter Lisa Marie Bates died in 1986 of Addison's disease.  She was misdiagnosed with vitilago a skin disorder, so doctors missed entirely that she had an auto-immune disease that attacks the adrenal gland.  One simple blood test to check her TSH level would have saved her life.  Lisa was only ten years old at the time.

The problem with Addison's disease is that only 1 out of 100,000 people get this.  Lisa's symptoms were classic, vitilago which are white spots, darkened pigment, and flu like symptoms.  Even in this day and age doctors can miss a case of Addison's.

Did you know that President Kennedy had this disease?  I have told hundreds of people about Lisa dying of this disease and hope to send this message out to the whole world for my daughter.

If you do happen to get a rare disease you are at a higher chance of not being diagnosed as doctors tend to look for more common reasons for you being sick.  If I had known about a pigment disorder (darkened pigment) or even vitilago (white spots) being associated with a disease that would have stolen my daughter's life I surely would have demanded that her doctors test her for Addison's.

She kept being diagnosed with flu's and they said don't worry its just a cosmetic problem that would not effect her health.  One of the best children's hospitals in the world missed Lisa's disease.  This should signal to you how easy it is for doctors to miss a case of Addisons.

This disease was diagnosed over one hundred years ago by a Doctor Addison.  Hopefully people reading this article will remember some of these symptoms as anyone, any age, at any time can get this disease.  I would just urge anyone in medical school to pay attention and who knows it could save a life one day.

Lisa's story saved a former co-worker's daughter.  There is a one in a trillion change of that happening.  I call that a miracle.  I hope this story saves more people, maybe yourself or someone you love.

From http://www.articlesbase.com/diseases-and-conditions-articles/my-daughter-lisa-marie-bates-died-needlessly-of-addisons-disease-1067084.html

From 1960...

The Candidates' Health

RECOVERING from his heart attack and his ileitis surgery, President Eisenhower set a precedent in the 1956 election campaign by frankly discussing the state of his health. Last week the Democrats picked up "the health issue" and were playing hard politics with it among themselves. Jack Kennedy began the intramural scrap by declaring that the presidency demands "the strength and health and vigor of ... young men." Supporters of Lyndon Johnson leaped to the conclusion that Kennedy was making a not-so-subtle allusion to L.B.J.'s 1955 heart attack. "Citizens-for-Johnson" Director John B. Connally countercharged that Kennedy secretly suffers from Addison's disease, an incurable but now controllable deficiency of adrenal secretions. And Johnson-lining India Edwards, former vice chairman of the Democratic National Committee, said: "Doctors have told me that [Kennedy] would not be alive were it not for cortisone."

 

The medical facts:

 

Jack Kennedy, 43, says that he did have a "partial adrenal insufficiency." He laid it to a war-born case of malaria, which itself required treatment through 1949. To supplement adrenal output, Kennedy took regular doses of cortisone from 1947 to 1951 and again from 1955 to 1958. He still takes oral doses of corticosteroids (cortisone-type medication) "frequently, when I have worked hard," although a recent test showed his adrenals to be functioning normally. Whether his is an arrested case of Addison's disease or a borderline adrenal insufficiency is unclear. In two years of almost ceaseless campaigning, Kennedy has displayed remarkable energy and none of the classic symptoms of advanced Addison's disease: chronic fatigue, weight loss, low blood pressure, anemia, or a bronzelike darkening of the skin.

 

Kennedy's earlier medical history is complex. Severe and recurring jaundice forced him to leave Princeton during his freshman year (when his health improved, he later went to Harvard). The Army rejected him because of a football injury to his back, but the Navy accepted him. The back was reinjured when a Japanese destroyer knifed through Lieut. Kennedy's PT boat in 1943. He spent most of 1944 in a Navy hospital, underwent a spinal disk operation, which was not fully successful. As a consequence, in October 1954, surgeons performed a delicate fusion of spinal disks. Slow to heal and set back by relapses that were complicated by the adrenal shortage, his condition became so grave that his family was summoned to his bedside. He had a third spinal operation the following February to remove a metal plate. Last rites were administered. But this time, after two weeks abed, recovery was rapid. Total time spent in the hospital or convalescing: seven months. Today, the only vestige of the spinal problem is that he still sleeps on a board, wears a light corset. Last week, at Kennedy's request, his two Manhattan physicians reported: "Your health is excellent."

 

http://www.time.com/time/magazine/article/0,9171,869575,00.html

Addison's Alerts, June 26, 2009

Patsy Moore: The private confessions of a Renaissance Woman
Cross Rhythms - Stoke-on-Trent,England,UK
But I also live with lupus and I have another auto-immune disorder that's known as Addison's disease which is in a fairly progressed state so those are the ...

 

George Christy 06-26-2009 George Christy
The Beverly Hills Courier - Beverly Hills,CA,USA
On page 83, Mercurio writes that, “An endocrinologist, Dr. K., soon becomes disconcerted by the full inventory of the presidential maladies:  Addison’s disease, thyroid deficiency, gastric reflux, gastritis, peptic ulcer, ulcerative colitis, prostatitis, urethritis, chronic urinary tract infections, skin infections, fevers of unknown origin, lumbar vertebral collapse, osteoporosis of the lumbar spine, osteoarthritis of the neck, osteoarthritis of the shoulder, high cholesterol, allergic rhinitis, allergic sinusitis and asthma.”    

Mercurio explains the severity of Addison’s disease, and the debilitating effects of “the subject’s problem list” of his health concerns, and the 24-hour regimen of medications and injections...

 

This has to be Addison's disease, right? Dehydrated & response to ...
By CVidrine
I started feeling poorly a couple years ago, but as a child I always had less energy than I thought I should - with an extremely hard time in mornings.
MESO-Rx - http://forum.mesomorphosis.com/

JFK and Addison’s Disease

By Robert E. Gilbert

Gravely ill, Kennedy was admitted to a London hospital in 1947. His doctor's verdict: "He hasn't got a year to live."

Throughout his early life, John Fitzgerald Kennedy seemed an unlikely prospect for national and international leadership. He was a "rather frail little boy" and almost died of scarlet fever at the age of three. Moreover, his mother has told us that this was "only the beginning": "almost all his life, it seemed, he had to battle against misfortunes of health." The family used to joke that if a mosquito bit Jack, the mosquito would surely die. In addition to the usual childhood illnesses, John Kennedy suffered from diphtheria, allergies, frequent colds and flu, hives, an irritable colon, a weak stomach which required a bland diet most of his life, and asthma- which caused him considerable difficulty as a teenager.

In 1930 [at the age of 13], he wrote his mother from boarding school complaining of blurriness and color blindness in his right eye – years later he would become hard of hearing in his left ear as well - and told his father that he had gotten dizzy and fainted at Mass. He underwent an appendicitis operation in 1931, had his tonsils and adenoids removed and came down with an enervating case of jaundice two years later, and in the mid-1930s developed a severe case of pneumonia.

Approximately one year later, he had to end his studies at the London School of Economics after coming down with another case of jaundice so severe that it required hospitalization. After returning to the United States and beginning studies at Princeton, where he would be close to the New York doctors who were treating him, the jaundice recurred and forced Kennedy to spend two months in Boston's Peter Bent Brigham Hospital and then move to Arizona to recuperate. In the fall of 1936, he entered Harvard University, where he was closer to his family, but illness followed him. A bad case of the flu prevented him from making the swimming team which was to compete against Yale, and in 1940, he developed a case of urethritis which recurred with some frequency throughout the remainder of his life. His bladder and prostate difficulties were so persistent, in fact, that shortly before his marriage he questioned one of his physicians about his ability to have children. During these early years, he was described as “a slight, very slight, young man.”

In addition to back problems so grave that his brother Robert said of him that “at least one half of the days that he spent on this earth were days of intense physical pain,” John F. Kennedy suffered from a debilitating, potentially life-threatening disease for at least the last 16 years of his life. Had Kennedy contracted it even a few years earlier than he did, he almost certainly would have died.

While on a visit to London in the fall of 1947, Congressman Kennedy became so seriously ill with weakness, nausea, vomiting, and low blood pressure that he was given the last rites of the Roman Catholic Church. The physician who examined him diagnosed his condition as Addison’s disease and told one of Kennedy’s friends that “he hasn’t got a year to live.” Journalist Arthur Krock, however, remembered being told by Joseph Kennedy, even before his son first ran for Congress in 1946, that Jack had Addison’s disease and was probably dying. Krock related that Joseph Kennedy “wept sitting in the chair opposite me in the office.” If Krock’s memory was accurate, it would appear that John Kennedy contracted Addison’s disease somewhat earlier than previously thought. Indeed, this might well explain Kennedy’s illness during his first campaign for the House of Representatives, when he collapsed during the final campaign event, a parade in Charlestown, sweating heavily and his skin discolored.

One of the common symptoms of Addison’s disease is a discoloration or bronzing of the skin. Although several of Kennedy’s biographers indicate that he did not have skin discoloration and/or that he insisted he did not, other observers found that he had a surprisingly deep tan, or yellowish skin, or skin of a greenish tinge. One who saw him during the 1960 campaign reported that his face was “lined and tanned to the extreme – and rough-looking, like the surface of a steak.” Theodore Sorenson, special counsel to the President, related that Kennedy once responded to a suspicious reporter’s question about his year-round tan “by exposing a part of his anatomy that had not been burned by the sun.” This, however, was no proof that his tan was natural, since Addisonian bronzing is “usually more marked on the exposed portions of the skin.”

Earlier, when a journalist had asked him about the unusual tinge of his skin, Kennedy replied with uncharacteristic candor, “The doctors say I’ve got a sort of slow motion leukemia, but they tell me I’ll probably last until I’m 45. So I seldom think about it except when I have the shots.”

When Addison’s disease was first discovered in the mid-1800s, it was regarded as fatal. Before 1930, 90 percent of persons with the disease died within five years; but in the late 1930s, researchers developed a synthetic substance, desoxycorticosterone acetate (DOCA), which greatly reduced the mortality rate. However, it remained important for those with the disease to avoid great stress, since stress increases the body’s need for steroids, which the Addisonian’s adrenal glands cannot provide.

Classic Addison’s disease has been caused by tuberculosis. Since John Kennedy never suffered from tuberculosis of any kind, he and his spokespersons maintained that he did not have Addison’s disease in the classic sense. Rather, they attributed his adrenal insufficiency to the physical strain of having to spend many hours in the water after his PT boast was sunk and to the case of malaria he contracted soon afterward.

Nevertheless, Kennedy was wholly dependent on the cortisone therapy that Addisonians rely upon for survival. Initially, he took 25 milligrams of cortisone by mouth; he then took it through injection. Also, he had implanted in his thighs DOCA tablets of 150 milligrams, which were replaced several times a year. There are even reports that the Kennedy family kept a reservoir of DOCA and cortisone in safety deposit boxes around the country so that Jack would have ready access to these medications wherever he traveled. One of his closest aides recounts that John Kennedy “used (and carried with him around the country) more pills, potions, poultices and other paraphernalia than would be found in a small dispensary.”

Addison’s disease often produces severe muscular cramping and thus may well have compounded Kennedy’s back problems. Clearly, the disease played an important role in heightening the dangers associated with his back operations in 1954. In the case of Addisonians at the time, even such a simple procedure as a tooth extraction might have been followed by death. The disease was so serious that occasionally patients who did not appear to be in any immediate danger would die suddenly. Surgery, therefore, was extraordinarily dangerous in Kennedy’s case.

An article that appeared in a 1955 issue of the AMA Archives of Surgery and examined the case of a 37-year-old male Addisonian who underwent spinal sugery at the New York Hospital for Special Surgery on October 21, 1954, is widely believed to have John Kennedy as its subject. Kennedy, after all, was a 37-year-old male Addisonian who had undergone surgery on the date and at the hospital specified. This article pointed out that the surgical procedures performed on JFK, a lumbosacral fusion and sacroiliac fusion, were considered dangerous because of his adrenocortical insufficiency due to Addison’s disease. Throughout the more than three-hour operation, the patient received hydrocortisone intravenously. In the postoperative period, this treatment was supplemented by added dosages of desoxycorticosterone, salt, and cortisone given intramuscularly. Except for a urinary tract infection which arose three days after the operation, a mild reaction to a transfusion, and a wound infection, the patient did not develop a full-scale “Addisonian crisis,” even though he suffered from “marked adrenocortical insufficiency.”

It was precisely the danger of an “Addisonian crisis” that led doctors at the Lahey Clinic in Boston to refuse to perform the operation in the first place, since they feared that Kennedy might not tolerate surgery well and die. Although their worst fears were not realized, Kennedy’s convalescence following his back surgery was protracted and painful. [White House physician Janet] Travell estimated that he suffered from a chronic infection in the soft tissues of his back for three and a half years after the back operations were performed. Addison’s disease, with its proclivity to render patients more susceptible to infection, almost certainly played a role in making Kennedy’s recovery so slow and agonizing.

By the time John Kennedy launched his presidential campaign in the late 1950s, new treatments for Addison’s disease (Meticorten and the fluorohydrocortisone derivatives or the glucocorticosteroid compounds) had been developed, the adrenal problems associated with the ailment had become entirely manageable, and a normal life span had become possible for the first time. Nevertheless, Kennedy’s physical condition was made an issue in the campaign, despite a statement by one of his physicians that he was “fully rehabilitated from the depletion of adrenal function which he had suffered as a result of his wartime injuries.”

As he battled Lyndon B. Johnson for the Democratic presidential nomination, some of Johnson’s allies made reference to Kennedy’s Addison’s disease and used it as an argument against his nomination. India Edwards, a southern Democratic party leader, told a group of reporters that “Kennedy was so sick from Addison’s disease that he looked like a spavined hunchback.” She also asserted that doctors had told her that were it not for cortisone, Kennedy would be dead. Another prominent Johnson ally, campaign manager John Connolly [not to be confused with Texas politician John Connally], charged that, if nominated and elected, Kennedy “couldn’t serve out the term” since “he was going to die.”

The Kennedy forces responded to these attacks by asserting that “John F. Kennedy does not now nor has he ever had an ailment described classically as Addison’s disease, which is a tubercular destruction of the adrenal gland. Any statement to the contrary is malicious and false.” In addition, Dr. Travell spent three or four hours with Dr. Eugene Cohen hammering out a statement on Kennedy’s health; it was dated June 11, 1960, and sent in letter form to Kennedy for release to the press. The two doctors found the statement difficult to write. In fact, Travell later admitted that they “fought over every word of it.” The statement read in part:

"We wish to point out that the fact that your adrenal glands do function has been confirmed by a leading endocrinologist outside of New York City.

With respect to the old problem of adrenal insufficiency, as late as December, 1958 when you had a general check-up with a specific test of adrenal function, the result showed that your adrenal glands do function."

After Kennedy won the presidential nomination of his party on the first ballot, there was considerable interest in the choice of his vice-presidential running mate. Highly revealing is a generally overlooked comment made by Philip Graham, late publisher of the Washington Post, in a memorandum concerning Lyndon Johnson’s selection for second place on the 1960 ticket:

"I told LBJ Jack would be phoning him and then…I returned to the vacant bedroom to call Adlai [Stevenson, the Democrats’ 1952 and 1956 presidential nominee]. In our prior talk he had argued for [Missouri Senator Stuart] Symington on pure expediency grounds and I had been a bit testy in pointing out that any VP was likely to be President." [Emphasis added]

During the general election campaign, an attempt was made to steal Kennedy’s health record; and the office of Dr. Cohen, the coauthor of the statement on his adrenal insufficiency, was actually vandalized. Also, prominent Republicans raised new questions about Kennedy’s health. Congressman Walter Judd of Minnesota, a former medical missionary and the 1960 Republican keynote speaker, stated unequivocally:

"For one thing I would like a flat answer to rumors in medical circles that Case Number Three in the American Medical Association’s Archives of Surgery, Vol. 71, relates to Senator Kennedy. If so, this represents information which Senator Kennedy is duty bound to make fully available to the consideration of every voter."

Republican questions about Kennedy’s health were diffused largely by the vigorous campaign he waged and by the image of vitality he projected. Except for the flu, acute sinusitis, and a case of laryngitis that “completely unnerved” him, he was well throughout the campaign period, and Dr. Travell saw him only once or twice. One of his closest aides expressed relief that the nominee’s “history of bed-confining fevers did not recur.” At one of his first press conferences after his election, Kennedy made an extraordinarily rare reference to the rumors of his ill health: he insisted to reporters, “I have never had Addison’s disease. I have been through a long campaign and my health is very good today.”

We know now that Kennedy’s Addison’s disclaimer was untrue, even though he may not have fully realized it at the time. Kennedy maintained that his adrenal insufficiency was a side effect of the malaria he contracted after the war. This is a possibility, since “malaria has been known to cause lesions in the adrenal cortex.” Since Kennedy did not suffer at any time from tuberculosis, he adrenal insufficiency seems likely to have resulted from atrophy of the adrenal glands. One medical specialist has reported that about half of all Addisonians he treated suffered from adrenal gland atrophy rather than from tuberculosis. Nine years after Kennedy’s death, his autopsy photographs were viewed by Dr. John Latimer who found that “no abnormal calcification could be seen…to suggest tuberculosis or hemorrhage of the adrenals. It is [my] firm belief that the President suffered from bilateral adrenal atrophy."

Dr. Travell later stated for the record that John Kennedy did indeed suffer from Addison’s disease. Asked in 1966 whether it would be fair to say “for a secret historical record” that Kennedy had had Addison’s disease, Travell responded:

"The term Addison’s disease has been extended at the present time to include all degrees of adrenal insufficiency and all causes of adrenal insufficiency. So that I would say yes to your question. At the present time, the broader meaning of this diagnosis would now cover his condition, although even 15 years ago it would not have."

As early as 1953, however, a physician associated with the Lahey Clinic had indicated that Kennedy had been suffering from and treated for Addison’s disease since the late 1940s. While that physician pointed out that Kennedy had been a patient of the Lahey Clinic since 1936 and had had “quite a variety of conditions,” he described his Addison’s disease as the most serious of Kennedy’s many ailments. Apparently, Travell did not speak for all of Kennedy’s doctors.

Kennedy insisted to aides that he did not have Addison’s disease, and he went so far as to tell one of them in 1959 that “no one who has the real Addison’s disease should run for the Presidency, but I do not have it.” When, around the same time, Dr. Travell tried to discuss his Addison’s disease with him, Kennedy retorted, “But I don’t have it, Doctor.” Travell explained to him, without evident success, that he didn’t have classic Addison’s disease, but that “doctors disagree maybe because they aren’t talking about the same thing.” In 1960, when one of his aides expressed unhappiness over the selection of Lyndon Johnson as his vice-presidential running mate, Kennedy replied, “Get one thing clear…I’m 43 years old, and I’m the healthiest candidate for President in the country, and I’m not going to die in office.”

There is no evidence that John Kennedy’s physical ailments had any negative impact on his conduct of the presidency. Indeed, Dr. George Burkley [head of the military medical unit at the White House] emphatically stated that “his back pain affected his normal conduction of the office of President in no way. He tended his office and went back and forth occasionally – at one point he was on crutches – but that did not deter him from his full duty as President.”

Burkley also asserted that adrenal insufficiency “was never a problem with the President when under my care.” Dr. Janet Travell agreed with this assessment, saying, “We had much smoother control of the problem of adrenal insufficiency while he was in the White House when he was in one place and not travelling around.” She added, “I thought…that his health would be more than adequate for him to carry the duties and responsibilities of the presidency, and indeed it was.” In the 34 months of his tenure, Kennedy missed only one day of work because of illness.

Indeed, rather than adversely affecting him politically, Kennedy’s physical ailments vitally contributed to the development of his character and to the formation of his political personality. Even more significant perhaps, John F. Kennedy’s ailment may have led to his meteoric political career – so far as his drive toward the glory of the presidency was an attempt, however subconscious, to prove his worth and demonstrate his strength by rising above all others.

Robert E. Gilbert is professor of political science at Northeastern University. This article is excerpted from his book The Mortal Presidency: Illness and Anguish in the White House. Copyright 1992 by Basic Books. Published by arrangement with Basic Books, a division of Harper Collins Publishers, Inc.

 

From http://www.jfklibrary.org/Historical+Resources/Archives/Reference+Desk/JFK+and+Addisons+Disease.htm

Adrenal Alerts, June 10, 2009

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Addison's Disease and two of its famous sufferers

From http://www.abc.net.au/rn/science/ockham/stories/s18569.htm

with Robyn Williams
on Sunday 31/01/1999
Addison's Disease and two of its famous sufferers
Summary:
John F. Kennedy and Jane Austin both had Addison's Disease. While John F. Kennedy survived the disease, Jane Austin died from it.

Transcript:

Robyn Williams: This week Ockham's Razor is presented by one of its great stalwarts: Dr Jim Leavesley, a great expert in the indispositions of the famous. He's now retired in the beautiful Margaret River south of Perth. Jim.

Jim Leavesley: It is not now fashionable in medical circles to call diseases by their eponymous names. To do so is said to be confusing to those not in the know. So pathologically descriptive names are used, the Greek or Latin bases which are supposed to be universally understood.

For we old fogies, the passing of a named disease is a pity, for not only do we honour the person who first described the condition, but eponymous names are often much more mellifluous than dry descriptive tags. For instance, it is much more satisfying to say someone has Charcot Marie Tooth syndrome, or von Recklinghausen's Disease, rather than the politically correct peroneal muscular atrophy or multiple neurofibromatosis.

But one or two have slipped through the net. Meniere's syndrome, Alzheimer's disease, Parkinson's disease, spring to mind as well as the one I wish to look at in conjunction with two of its victims, Addison's disease.

In 1795 at Long Benton, a village just outside Newcastle-on-Tyne, in northern England, the wife of the local grocer, Joseph Addison, was delivered of a second son. They called him Thomas.

A bright lad, he went on to Edinburgh to do medicine and qualified in 1815. From thence to Guy's Hospital, London, where he became an assistant physician in 1824 and the full works in 1837.

He was a contemporary of Richard Bright, of Bright's disease, and of Thomas Hodgkin, of Hodgkin's disease. What a trio.

Anyway, whatever mental jousting went on, it did not lift Addison's mood, for he was a chronic depressive. He made several attempts on his life until in 1860, he retired to Brighton, disturbed enough to have need of two constant attendants. Despite the care, within months he managed to elude them, flung himself down a stairwell and died of a fractured skull.

But let's go back a bit. On 15th March 1849, Addison had read a paper to the South London Medical Society entitled 'A Remarkable Form of Anaemia'. He cited three cases of increasing lethargy, but made no mention of those characteristic features we associate with his disease, skin pigmentation and low blood pressure. He didn't know how to measure that, anyway. He did note, however, that at post mortem there was a disease of the suprarenal glands, situated just above the kidney.

He did not connect the anaemia and suprarenal condition and said he had stumbled on a second condition, which he called 'melasma suprarenale.' It is this we now call Addison's disease. However, it did show for the first time that the adrenals were necessary for life, and it has been said that the whole of endocrinology dates from 15th March, 1849.

He did not publish until 1855, by which time he had separated the two anaemias, one he called 'pernicious', later known as Addisonian anaemia. The other he associated now with bronzed skin and suprarenal pathology, true Addison's disease. Publication produced no fanfares, no royal honours and his fame has been mainly posthumous. In any case, he was too late for our first famous patient with Addison's disease, who was that model of sense and sensibility, Jane Austin.
Like its houses, its chairs and its coffee pots, 18th century England has managed to convey to us a society which was at once both sensible and elegant. It seemed to manifest good manners, piety, and cultivated discernment.

At least it did if you were of 'the gentry', which was the case with Jane Austen, one of the greatest writers in the English language. It was a lifestyle which provided the ideal ambience in which her genius could flourish.

Daughter of a clergyman, the seventh of eight children, she led a life of gentility and ease spent entirely in the quieter rural southern England. She drew her characters from her own circle and never strayed from the world in which she moved.

Further, she was much too well bred to let her own name grace the title-page of her novels. All her books were styled as being written, 'By a Lady', as indeed they were.

Her towering reputation is based on only six works of fiction written between the ages of 34 until her death at 41. They have never been out of print in 175 years, and have flourished even more during the last decade or so.

She never married, and it appears the creative impulse, then customarily fulfilled by the task of being a wife and mother, was in her attained through her art. She took considerable pains to conceal from her friends and visitors the nature of her life's work, and wrote on small pieces of paper, the more easily to slip under a blotter or into a drawer if chanced upon. She said her books were her children and she was later remembered as the caring wit of the family.

Jane Austen was born 20 years before Addison, in 1775, into a closely-knit family in which she led a sheltered home life, interspersed with occasional visits to Bath to take the waters, or to the nearby houses of her elder brothers.

It all sounds like a rural idyll, and so it was, until June 1816, when at the age of 40, she had an attack of nausea and vomiting and low backache.

In July she was depressed and felt weak. This was put down to her dissatisfaction with the book, 'Persuasion', which she had just completed. Two months later it was noted she tired easily, had uncharacteristic mood swings and further back pains. She improved and life progressed in its customary premeditated way.
In December she declined an invitation to dinner, saying 'The walk is beyond my strength, though I am otherwise very well.'

The following months she wrote to a friend that she was stronger but felt 'bile' was at the bottom of her nausea and malaise.

All pretty vague so far. Then in March 1817 Jane wrote to her favourite niece, Fanny, and in it gave the clue which could lead us to the likely diagnosis. She wrote, 'I certainly have not been very well for many weeks; I have a good deal of fever at times, but am considerably better now and recovering my looks a little, which have been black and white and every wrong colour. Sickness is a dangerous indulgence at my time of life.'

She wrote to a friend two months later, recounting details of recurrent vomiting, concluding, 'My chief sufferings were from feverish nights, weakness and languor.'

We know the slightly built Austen was bright eyed and had an olive complexion, certainly not 'black and white and every wrong colour.' A visitor in May observed the author was looking very pale and spoke in a weak, low voice.

A concerned family moved her to Winchester to be nearer expert medical help. It was of no avail. Over a six weeks period she became progressively weaker and had a number of fainting fits, until on July 18th, 1817, after several hours of unconsciousness, Jane Austen died in the arms of her only sister, Cassandra.
So what did she have? Well I don't think she died of boredom, as someone unkindly suggested. The story is one of unimpaired intellect but increasing languor and intermittent backache, fainting attacks, gastrointestinal disturbances, and fever, especially at night. Night sweats are a well-known feature of tuberculosis. Added to all that, and crucially, is a darkening of the face. The delicacy of the era regrettably precludes us from knowing about skin changes elsewhere, especially the vagina, in the mouth or where pressure was applied to the skin, at the waist, for instance.

A number of conditions come to mind, but probably only one fits the whole scenario.

The lassitude could have been due to a rare neuromuscular condition, myasthenia gravis, but there seems to have been no speech or swallowing problems. Maybe the heart could be implicated with an infection of its valves, or bacterial endocarditis, but fainting crises are not a feature of this. Perhaps cancer of the stomach with anaemia from the slight but persistent blood loss which characterises the condition. The digestive problems did not seem either very great or progressive.

Skin discolouration occurs in a number of general diseases: the rare so-called bronzed diabetes, or haemochromatosis, but the other symptoms do not fit; chronic inorganic arsenic poisoning with its raindrop pigmentation and abdominal symptoms, or indeed poisoning from any of the heavy metals, lead especially, possibly from medication or water pipes. But the other history is inappropriate and no other family member was affected.

No, none of these seem right. From the admittedly rather thin records, coupled with the melancholy fact that living in the country she did have ready access to almost certainly tubercular contaminated milk, the most likely diagnosis is Addison's disease due to TB of the hormone producing suprarenal glands.

As we have seen, it was not until 1849 that Thomas Addison first described the malady. It's best known features are weakness and skin discolouration which he described as 'various tints of deep amber or chestnut brown.'

One alleged feature was not displayed. My old forthright chief used to claim, rightly or wrongly, that tubercular patients, possibly due to their low grade persistent fever, were almost always more sexually charged than the general run of the population. No hint of sexual impropriety in Miss Austen has come down to us.

Whatever her private life, we know from her books that Jane Austen was a consummate writer whose genius was tempered with gentle humour and a subtle insight into the nature of humankind. It is better we remember her thus, rather than someone who suffered from an uncommon and debilitating medical disorder.

Until the mid-20th century, tuberculosis was the prime cause of Addison's disease. Now it is likely to be an auto immune reaction, as was believed to be the case in that other famous sufferer and quite different personality, John F. Kennedy.

I have spoken before in this place about Kennedy, so will not burden you with the details again. But briefly, during the 1960 Presidential campaign, a Republican questioned the candidate about an article in the November 1955 edition of the American Medical Association's Archives of Surgery, and which was concerned with operating for one reason or other, on sufferers from Addison's disease. The questioner wondered if JFK was one of these cases.

The piece was entitled 'Management of Adrenocortical Insufficiency During Surgery'. Of the three listed cases, one told of an unnamed man in for a bone fusion, and insertion of a metal plate who had had Addison's for seven years, and who was managed by desoxycorticosterone pellets every three months and 25 milligrams of cortisone daily by mouth.

It was a typical bread and butter piece for that journal, but suddenly became hot political property when at the end of the piece the authors inserted a quite unnecessary throwaway line which sparked off the question. They simply wrote, 'The operation was accomplished on October 21st, 1954.'

Now on October 11th, on page 39 of The New York Times, it was reported that 37-year-old Senator Kennedy was entering hospital for spinal surgery. On the 21st it wrote he had undergone the operation that day. On February 26th 1955 it saw fit to record that the plate had been removed.

Now you don't need much nous to conclude that two people of the same age, with the same spinal condition, having undergone similar surgery in the same hospital and who returned on exactly the same day four months later to have the plate removed, were in fact one and the same. So we know for certain John Kennedy had Addison's.

His treatment was successful, but in those days, dosage of cortisone was chancy. Accumulating drug gave a fullness of the face, a so-called moon face, which in the President gave him those boyish good looks and appearance of rude good health which made him the darling of the chattering classes.

It increased energy and JFK's well-known bedroom athleticism may have been enhanced by the treatment, though his back will have suffered.

Kennedy did not die of the disease, Jane Austen did. Treatment was relatively unrefined in one and non-existent in the other. The basic cause in one was probably tuberculosis; in the other, an auto immune reaction. The victims had widely differing personalities, but both had one thing in common, and something which indeed they shared with Thomas Addison: they touched the lives of countless people in all corners of the globe and have gone on doing so long after their deaths.

Robyn Williams: Jim Leavesley, in forensic mood, as always. His book is called 'What Killed Jane Austen, and Other Medical Mysteries', published by Harper Collins.
Next week, Sue Taylor has trouble with elephants. I'm Robyn Williams.
Guests on this program:

Dr. James Leavesley
Margaret River
Western Australia
Author of the book: "What killed Jane Austen and other Medical Mysteries", published by Harper & Collins