Experts doubt stress caused Castro's bleeding

Experts doubt stress caused Castro's bleeding
BY JOHN DORSCHNER AND JACOB GOLDSTEIN
jdorschner@MiamiHerald.com

Cuba's official explanation that stress caused Fidel Castro's bleeding
is probably false or misleading, experts said.

''Stress is not playing a role here as far as I'm concerned,'' said
Jeffrey B. Raskin, the the Unversity of Miami's interim chief of the
division of gastroenterology.

His thoughts were backed up by experts at the Cleveland Clinic, Mount
Sinai Medical Center and South Miami Hospital.

Noting that any thoughts he would give from afar on a patient he hadn't
examined would be speculative, Raskin said he thought the bleeding might
have been from a fairly serious cause if it could not be stopped by less
invasive means, such as endoscopy -- snaking a small tube through the
intestine to deal with the problem.

Raskin said Castro's age -- he will be 80 years old next month -- and
his rumored Parkinson's condition -- could cause the surgery to be more
complicated and dangerous. Raymond Sandler at the Cleveland Clinic in
Weston said surgery on someone Castro's age would certainly be
``high-risk.''

Jamie Barkin, chief of gastroenterology at Mount Sinai Medical Center,
questioned whether the use of the word ''complicated'' in describing the
surgery was suspect because much gastrointestinal bleeding can be
handled easily.

''Either that's a publicist's word or there's something wrong with him
that's really bad,'' said Barkin. ``It could be anything from
inflammation to a tumor.''

Severe bleeding that would require complicated surgery, which is what
the Cuban government announced, could be an indication of a broad range
of serious problems, but Raskin said it was hard to know without more
knowledge.

''They could be hiding something more serious,'' he said, but without
further information, it was impossible to tell.

Peptic ulcers -- lesions in the stomach or the top part of the small
intestine -- are the most common cause of ''high-volume,
life-threatening'' intestinal bleeding, said Dr. Peter Kelsey, a Harvard
gastroenterologist. Bleeding ulcers can often be treated with endoscopy
and drugs, though in rare cases surgery is required.

Alfredo Rabassa, a gastroenterologist who works at South Miami Hospital,
said it was possible stress could intensify problems with an existing
condition, but would not by itself cause bleeding. Sandler at the
Cleveland Clinic said it was ''basically a myth'' that stress caused
stomach or intestinal bleeding.

Almost all ulcers are caused by some combination of a bacterial
infection and the use of common painkillers such as aspirin and
ibuprofen, Kelsey said. Castro was probably treated with drugs such as
these after he broke two bones in a 2004 fall, but the drugs alone would
not usually be enough to cause an ulcer serious enough to need surgery,
Rabassa said.

Castro's bleeding might also be caused by colon cancer. In that case,
the outlook would depend on the extent to which the cancer has spread.
Typical treatment could include both chemotherapy and surgery to remove
part of the colon.

In the official explanation given Monday night, a Cuban spokesman read a
purported letter from Castro in which he said that his trip to Argentina
and work commemorating the anniversary of the assault on the Moncada
barracks involved ``days and nights of continuous work, barely able to
sleep, my health, which has withstood all trials, was subjected to
extreme stress and broke down.

``This provoked an acute intestinal crisis, with sustained bleeding,
that obliged me to face a complicated surgical operation. All details of
this health accident are evident in the X-rays, endoscopies, and filmed
materials. The operation obliges me to spend several weeks in repose,
away from my responsibilities and duties.''

That explanation is so vague that it makes it impossible to know the
root cause of the bleeding, doctors said. Dr. Charles Gerson, of the
Mount Sinai school of Medicine in New York, listed a range of
possibilities. His conclusion:

``Unless he has colon cancer that's spread, all of it is treatable''

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