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December 27, 2004

Yushchenko's Disease: A Tale of Two Poisons


by Thomas Boyle, M.D.

After weeks of rampant speculation and political intrigue of the highest order, the mystery of Viktor Yushchenko's rapid and startling facial disfigurement was settled with a simple blood test and reported with bold finality: The Ukrainian presidential candidate was poisoned with dioxin. Not just routinely poisoned. No, it was a silver-medal performance, scoring a blood dioxin level 6,000-times higher than normal – the second-highest level ever recorded. The case was immediately closed in dramatic fashion. Major media collectively breathed a sigh of relief that rippled across the Internet: Their unfounded and rash medical assumptions of poisoning were confirmed, and they were off the hook. After all, just because you jump to conclusions doesn't mean you can't land on solid ground.

With Yushchenko's medical mystery cleared up and off the table, the Ukraine – and the world – could go on with the new elections, elections that almost certainly will crown the righteous and harmed opposition party candidate.

Except Yushchenko could not have been admitted to the Rudolfinerhaus Clinic in Vienna for dioxin poisoning. And the medical records obtained from that clinic do not indicate that diagnosis. In fact, Viktor Yushchenko's problem is likely much more severe than record blood levels of dioxin. His problems are in all probability so severe and of such import for him and his party that he and the Rudolfinerhaus medical claque chanced a daring and bold gambit in order to hide the truth and simultaneously implicate his opponent. The truth is, Viktor Yushchenko may well be the victim of two poisonings, the more severe of which his physicians have yet to reveal.

How We Got to Here

Viktor Yushchenko claims he was poisoned during a Sept. 5 dinner with the head of the Ukrainian Security Service, Ihor Smeshko, and his deputy, Volodymyr Satsyuk. Yushchenko claims to have developed symptoms almost immediately, and during the next day, Sept. 6, he suffered severe abdominal and back pain. Yushchenko first sought treatment at Vienna's private Rudolfinerhaus clinic five days later, on Sept. 10. He went home in mid-September to resume campaigning, but he came back to the hospital later that month for more treatment and was released in early October – although still unwell – to continue his pursuit of the Ukrainian presidency. Yushchenko is certain that the poisoning took place at the dinner on Sept. 5, saying:

"That was the only place where no one from my team was present and no precautions were taken concerning the food. It was a project of political murder, prepared by the authorities."

Speculation was rampant in the media and on the Internet as to how Yushchenko's face became disfigured. The overwhelming opinion was a groundless assumption that, given the unusual appearance of the skin disease and the political circumstances surrounding an ideologically charged election, Yushchenko surely must have been poisoned, as he claimed. At the same time, the Ukrainian election was declared invalid and a second round of voting was scheduled.

At first, Yushchenko resisted further tests that would easily determine whether or not he was actually poisoned. However, certain blogs, including CodeBlueBlog, turned up chronological and medical inconsistencies in the story, and the undercurrents created by these voices forced Yushchenko to pursue a definitive diagnosis as a second election loomed.

During the obviously contrived and farcical weekend of Dec. 10, Yushchenko returned to the Rudolfinerhaus clinic, where his doctors drew blood and sent it off to Amsterdam for a "new" test that had not been previously available. Yushchenko was thereafter rapidly (within 12 hours) diagnosed with dioxin poisoning – a diagnosis that had previously stumped Yushchenko's physicians for months.

Poison Number One: Dioxin

Because dioxin does its damage by binding to cell material on a molecular level, the effects of its actions are delayed. It takes weeks to months to years to manifest dioxin poisoning. Chloracne – the skin condition Yushchenko is said to have – develops months to years after exposure. In the only two known analogous dioxin poisoning cases, the patients involved had no clinical symptoms besides upset stomach for six to eight months after the presumed exposure. Even then, they sought medical help only because of the development of acne.

Yushchenko, on the other hand, developed dramatic and severe symptoms almost immediately after his meal with the secret service on Sept. 6. After four days, the persistent, severe pain and generalized malaise forced Yushchenko to have himself admitted to the Rudolfinerhaus clinic in Vienna. There is no scientific or medical explanation that can account for this chronology of symptoms on the basis of dioxin poisoning.

Poison Number Two: Alcohol

There is another poison, however, that accounts for the timing, severity, and character of Yushchenko's symptoms as they relate to the dinner on Sept. 6: alcohol.

The New York Times reported that on the night of Sept. 5, 2004, Yushchenko and the Secret Service agents "drank beer and ate boiled crayfish from a common bowl, as well as a salad made of tomatoes, cucumbers, and corn. Later, they selected vodka and meats, and then cognacs for a last drink."

It was the next day, after drinking beer, vodka, and cognac at dinner, that Yushchenko developed the symptoms that drove him to Rudolfinerhaus four days later. The doctors at that Vienna clinic surely knew immediately what we can also deduce now: Yushchenko's symptoms indicate pancreatitis (inflammation of the pancreas), and the cause was binge drinking on the night of Sept. 5.

Pancreatitis is caused 65-80 percent of the time by either alcohol or gallstones. Yushchenko did not have gallstones. Pancreatitis – which can be caused by chronic alcohol consumption or by one night of heavy drinking –causes severe stomach and back pain and can occur shortly after the alcohol ingestion.

Newly discovered documents, including Yushchenko's official medical records, obtained from the Rudolfinerhaus clinic show conclusively that Yushchenko had pancreatitis. The Viennese doctors themselves flatly state that there is pancreatitis, and the laboratory and diagnostic test results shown are all consistent with that diagnosis. In addition, the test results show that Yushchenko also has an enlarged liver. This indicates that his drinking pattern is probably chronic and, because of that, he is on the road to developing severe liver disease. Here is the CT scan report from Rudolfinerhaus:

"Pancreas intermittently massive without clearly-defined edges, peripancreatitis."

And the ultrasound report states:

"Gallbladder without concretion [meaning: no gall stones].

"Diffusive enlargement of the liver [hepatomegaly]."

The ultrasound report states that the pancreas is normal, but this is a known and common error in abdominal ultrasound. This test is not sensitive for evaluation of the pancreas because of the pancreas' position in the abdomen. A CT scan is like a photograph of the abdomen, so it is much more accurate in evaluating this organ.

Despite claims that such imbibing is "typical" for an important meal in the Ukraine, such behavior represents an abnormal drinking pattern:

"The U.S. government defines moderation as no more than one drink per day for women and no more than two drinks per day for men."

Liver enlargement (hepatomegaly) is a frequent finding in alcoholics and can be a precursor to cirrhosis (an often fatal, end-stage liver disease). As stated previously, pancreatitis is a frequent complication of alcohol over-indulgence (acute or chronic), and "massive" enlargement of this organ, associated with blurred edges, is diagnostic (the medical term for conclusive) for pancreatitis.

Why Rudolfinerhaus?

The Rudolfinerhaus clinic advertises itself as a discrete and posh clinic. I have questioned, right from the beginning, the rationale for Yushchenko entering this medical facility if he truly had a mysterious ailment or needed high-end care. One of my readers, a computer scientist and an "expat Austrian," by his own description, commented:

"Had I an actual health problem, I would prefer, say, the U. of Vienna's teaching hospital (for most things), or the Lorenz-Boehler (trauma, accidents), and so on.

"A few years ago, the Rudolfinerhaus had the reputation of a Betty Ford clinic for the affluent, with an add-on wing for the yearly checkups of rich oil sheiks. Unless that rep has experienced a sea change since then, I must ask: Why would someone who claims to have been poisoned check into the place when the AKH is a stone's throw away?"

More has been learned about goings-on at Rudolfinerhaus that deepen the mystery of Yushchenko's choice of treatment centers. As first reported in the Transatlantic Intelligencer, and then by Justin Raimondo, there were some serious behind-the-scenes internecine struggles at the Rudolfinerhaus Clinic after Yushchenko's visit, culminating in the resignation of the clinic's chief, Dr. Lothar Wicke, after he made some skeptical remarks about the Yushchenko diagnosis of poisoning.

Raimondo quotes this source (a pay link, in German):

"[Y]ushchenko's people made clear to Wicke that he should not say anything more concerning the affair, since otherwise [as Wicke puts it] 'one would resort to other means against me and the hospital.' Dr. Wicke is also supposed to have received death threats at the time."

Newer revelations indicate there were other intertwining relationships on both sides of the political spectrum at Rudolfinerhaus. Regardless, the controversy and accusations in the clinic's board rooms – as well as the confusing and contradictory press reports that streamed from the clinic – demonstrate clearly that this is not a typical major medical center with high-end academic physicians. It isn't the place one goes for the best care. Bill Clinton didn't have heart bypass surgery at his local hospital in Westchester, N.Y. Neither did he look for some facility that provided privacy and five-star amenities to its patients. He went to the top heart hospital in area, The New York Hospital-Columbia Presbyterian Medical Center. Rudolfinerhaus is neither an academic institution nor major medical center; rather, it is a posh, private clinic, steeped in local and international politics, and able to provide more than just medical coverage, especially for the famous, rich, and politically connected patients it covets. This is not a hospital you would choose to solve a medical mystery or to access the highest levels of care. You would choose Rudolfinerhaus, however, to treat your alcohol-related complications discretely.

The conclusion of Yushchenko's official clinical medical record proves my point. Notice that although the physicians list the diagnosis of pancreatitis in the body of the medical report (not many reporters can read or understand the body of a medical report), they neglect to name those findings specifically in the report's conclusion. In fact, it took me quite a while to decode this bizarrely phrased report conclusion, and I will need to walk you through this. In the two-line report summary, the first conclusion is a dodge. In basketball, it's called a look-away pass. The report states:

"Acute proctolitis on the left side."

Huh? Skipping right over the enlarged liver and the "massive" inflamed pancreas, the doctors instead focus on the one asymmetric finding in the entire case: proctitis. Now that our attention is distracted (sort of like asking a computer to solve for pi) with this disconcerting conclusion, the clever doctors at Rudolfinerhaus tell us what's really wrong without really telling us at all. They say:

"The negative general and alimentary condition could have been caused by either an acute viral infection or by chemical substances that are not generally found in food products."

There may be translation problems here, but I believe by "negative" they mean unsatisfactory. His negative "general" condition would be his overall malaise and prostration. But the kicker in this conclusion – the nasty bug at the bottom of the coffee cup – is the word "alimentary."

In this sense, alimentary means all the organs of digestion, which, in its broadest definition, entails not only the esophagus, stomach, and bowel, but also the liver and pancreas.

So they are admitting that Yushchenko has problems with his liver and pancreas, as these organs are part of the alimentary tract and the alimentary tract is in a "negative condition." But they are not specifically saying hepatomegaly and pancreatitis.

This is certainly done on purpose, as proven by the juxtaposed diagnosis of proctitis, which is an inflammation of the rectum – the tail-most portion of the alimentary tract. Proctitis would have been included in the second conclusion, but they dissected it out (instead of pancreatitis and hepatomegaly) to deceive us by deflecting our attention and concentration.

The last phrase in the report is rather astounding: "could have been caused by either an acute viral infection or by chemical substances that are not generally found in food products."

So the reason for his illness is either a virus or … what is not generally found in food products? Poison. This statement specifically tosses the ball away from alcohol ingestion – the most common reason for Yushchenko's symptoms – which is clearly a food product.

This report was designed purposely to deceive the world by putting them on the trail of poisoning while deflecting attention from the obvious diagnosis: alcoholism. This is the type of report one would expect from a fawning celebrity halfway house, not a significant or major medical center.

Poisoned? Not!

From the beginning, I have said it seems ridiculous to imagine that anyone with any amount of sophistication or purpose would have dosed Yushchenko with poison. Especially dioxin, which has never been used to poison anyone! Detractors of this theory write variously that I don't understand how backward, stupid, and incompetent these spies are and life in the Ukraine is. I can't buy that. And neither can most other reputable sources and experts. As stated by Dr. Andrea Sella of University College, London: "If you really want to kill someone, you use cyanide or ricin or strychnine." And The New York Times said:

"Murder by poison has largely been relegated to the history pages, principally because science has overtaken the great advantage that the poisoner of old had over his pursuers: the ability to hide his work beneath the normal calamities that afflict human life."

Similar comments are common throughout the Internet and the media.

Finally, there is the theory that Yushchenko was poisoned not to kill him but only to disfigure him. This is a dubious proposition, because a moment's reflection would lead to the conclusion that the disfigurement could (and did) have the opposite effect. Also, chloracne cannot be predicted as a definite complication of dioxin poisoning, and its exact manifestation – given the rarity of its occurrence – also could not be predicted.

What are we left with?

1. Yushchenko may have been exposed to a large amount of dioxin (barring outright fraudulent manipulation of the blood drawn in Vienna and sent to Amsterdam). However, dioxin poisoning was not why he was admitted to Rudolfinerhaus on Sept. 10, 2004.

2. The chronology of the proposed exposure to dioxin, the manifestation of symptoms, and the appearance of chloracne do not fit the chronology of the claims made by Yushchenko and the Rudolfinerhaus clinic.

3. Yushchenko drank too much alcohol the night of Sept. 5 2004, and he likely drinks too much frequently.

4. Test results released from Rudolfinerhaus show conclusively that Yushchenko had pancreatitis and an enlarged liver, both of which are common sequelae of alcoholism.

5. Rudolfinerhaus tried to cover these findings with inaccurate press releases and a grossly and purposely misleading clinical report "conclusion." 

6. If Yushchenko keeps drinking, it is not unlikely that his liver and pancreatic disease will progress and he will be left with chronic pancreatitis (which can lead to diabetes and insulin dependence) and/or cirrhosis (which can lead to death by numerous pathways).

What we are left with is a story by Dickens or Hugo, and a tale for the ages.

Scheming politicians, nefarious spies, and bearded Viennese doctors weave in and out of a gloriously contrived plot set in a tottering former Soviet state. Titans struggle for the political helm as a rigged election falls apart, replaced by a second round of voting. Towering at the podium, the monstrously disfigured Yushchenko declares that he has been poisoned – an act completely at home in the Byzantine plot structure and apocalyptic themes of the story.

No writer worth his ink would deflate the balloon of this grand epic. The denouement calls for a soaring finish, not a tawdry crash. So the elections went off with the successful subterfuge that was crafted in Rudolfinerhaus and sold to a media that wanted to go along with the Dickensian tale.

But as Boris Yeltsin showed the world with his disgraceful public decline 10 years ago, alcoholism is not a disease that will be ignored. The occurrence of pancreatitis and hepatomegaly in Viktor Yushchenko spells out an ending that will not be disguised by fairy tales, just as it cannot be covered up by acne or a new election.

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Thomas Boyle is a graduate of the Columbia University College of Physicians and Surgeons, where he earned an M.D. After an intense year of medical internship in the Cornell Medical College system, he spent a year in the emergency department at Jacobi Hospital in the Bronx, New York. Following this, he completed a four year residency in diagnostic radiology at The New York Hospital Cornell Medical Center. He writes about medical issues at CodeBlueBlog.

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