Dr. John G. Sotos, a.k.a. Doctor Zebra

The Health and Medical History of President Ronald Reagan

Dr. John G. Sotos, a graduate of Johns Hopkins University School of Medicine, is a cardiologist in Palo Alto, California, and was advisor to the television series House. Online, he goes by the pseudonym Doctor Zebra. Sotos is author of Zebra Cards: An Aid to Obscure Diagnosis and The Physical Lincoln, in which he investigates Abraham Lincoln’s health problems. Following is part of a medical history of President Ronald Reagan that Sotos compiled from a variety of primary and secondary sources and posted at his Web site Medical History of American Presidents. It covers Reagan’s various “maladies and conditions” and overall health—from a rather difficult birth, to being shot, to Alzheimer’s disease and his demise from pneumonia. Courtesy of Dr. John Sotos and doctorzebra.com.

Maladies & Conditions

Birth & Childhood

Reagan’s birth was long and difficult (to a degree that his mother was advised not to have more children) (Cannon, 2004, p. A1). He weighed 10 pounds at birth. In that era of high infant mortality, Reagan’s father bragged about his fat little “Dutchman” and the name stuck (Bumgarner, 1994, p. 281).

“Apparently, in spite of the rather stark poverty of his family, Reagan’s childhood was almost free of illness” (Bumgarner, 1994, p. 281).

Severely Nearsighted

He was so nearsighted that, as a college football player, his vision was limited to the square yard of turf occupied by the opposing team’s guard. His vision disqualified him from serving in combat units in World War II (Bumgarner, 1994, pp. 281–282).

As a child, Reagan would have to sit in the front row in class to see, which embarrassed him. In sports, Reagan sometimes got hit in the head with the ball he could not see. It was only at age 9 or 10 that a visiting nurse made the diagnosis. Reagan later said that when he got glasses, he was surprised to discover that trees had leaves and that butterflies existed—neither of which he had ever been able to see (Deaver, 2004).

Later in life, Reagan wore contact lenses. When delivering a speech he would remove one lens so he could read his notes and leave one lens in so he could see the audience. Thus, for those around Reagan it was common practice to see him reinserting a contact lens after speaking (Deaver, 2004).

Pneumonia

Pneumonia in 1945 caused him to lose 17 pounds (Associated Press, 2004b). Comment: The reference does not say whether antibiotics were used. Given the severity of the episode, Dr. Zebra suspects not.

Femur Fracture

Reagan fractured a femur in 1949. A “serious fracture,” it may have resulted from falling off a horse (Reynolds, 1980, pp. 25–26).

Quit Smoking

Reagan was a smoker, but quit (Boller, 1981, p. 354), supposedly after his brother developed cancer of the voice box (Altman, 1980, pp. A1, A28). Comment: Easily quitting smoking can be one of the earliest signs of Alzheimers disease.

Prostate

After a series of urinary tract infections, Reagan had prostate stones surgically removed in 1966. “Since the surgery he’s had no problems at all.” For many years afterwards Reagan had regular checkups from a urologist in Sa.nta Monica (Reynolds, 1980, pp. 25–26).

Stones

Another reference says Dr. T. Burton Smith performed a transurethral prostatectomy on Reagan in 1967, presumably because of his history of “well-documented benign prostatic hypertrophy and several episodes of prostatitis” (Beahrs, 1994, pp. 86–96). Thus, it is unclear if Reagan had one or two urological operations in the 1960s. (Probably one.)

Severe cold

About 1978 Reagan had a severe cold that required antibiotics. A chest X-ray was taken because the cold went to his chest. The X-ray was normal (Reynolds, 1980, pp. 25–26).

TMJ Degeneration

Reagan presented with left-sided jaw pain in December 1977. It proved to be degeneration of the temporomandibular joint and was treated with cortisone injection. It did not recur in the next three years (Reynolds, 1980, pp. 25–26).

Thumb Arthritis

Reagan had osteoarthritis of the proximal thumb joint on his right hand. As of 1980, he was not taking medication for it (Reynolds, 1980, pp. 25–26).

Drank Little

Reagan was reported to drink very little alcohol. His favorite cocktail was “a weak orange blossom” (Bumgarner, 1994, p. 282).

Chronic Hay Fever

Reagan underwent hyposensitization shots for hay fever and may still have been getting “maintenance” injections at the time of his 1980 election. With this course, his hay fever “was under control.” He did not have adverse effects from the shots (Reynolds, 1980, pp. 25–26).

General Health

At the time, Reagan was the oldest man ever to seek the presidency. Thus, there was concern during his campaigns over whether his health was up to the job. He sought to downplay these concerns by vowing to resign the presidency if he became medically unfit (Altman, 1980, pp. A1, A28). He also authorized the release of information about his medical history.

Quotes from the primary (Reynolds, 1980, pp. 25–26) of his six (Altman, 1980, pp. A1, A28) physicians include: (1) “He is in excellent health. He just underwent a strenuous campaign and had no problems whatsoever. His resistance to colds was remarkable.” (2) “He exercises every day with a wheel device and rides horseback at his ranch whenever he can. . . . It’s a single small wheel—such as you might see on a kid’s wagon—to which two handles are attached.” (3) “I think he is quite able to handle stress. . . . He doesn’t take vacations very frequently.” (4) “I know he eats moderately, and we’ve told him he should avoid excessive amounts of animal fats and carbohydrates.” (5) “The standard treadmill tests [have shown] no evidence whatsoever of underlying coronary artery disease. We have also found no evidence of any neurological impairments.” (6) “When I have done different physical examinations on him, . . . he’s totally relaxed and undemanding. He goes through those tests in a place that is especially set up for him and where he could pull rank but he doesn’t. . . . He just accepts the fact that we’re doing all these tests. He doesn’t ask many questions.”

Height

Reagan was 6 feet 1 inch tall (Page, 2004). He weighed 190 pounds in December 1980 (Reynolds, 1980, pp. 25–26).

Blood Type O-positive

Both Ronald and Nancy Reagan are O-positive (Abrams, 1992, pp. 59–60).

Shot

Reagan was shot on March 30, 1981. A long-nosed .22 caliber bullet, fired from a pistol, ricocheted off the presidential limousine and entered Reagan’s chest, under his left arm. The bullet was of the exploding type, but it did not explode. The main threat to Reagan’s life was from blood loss and a collapsed lung (Bumgarner, 1994, pp. 282–283).

After entering Reagan’s body, the bullet ricocheted off his left-sided seventh rib. By now the bullet was deformed into a dime-shaped mass, and when it entered Reagan’s left lung, it did considerable damage to the lung tissue. The lung began bleeding and collapsed. The bullet lodged about one inch from the heart.

The first-line treatment for a collapsed lung is a chest tube—a plastic tube that is inserted through the skin, between the ribs, and into the chest cavity where the lungs sit. This is not a difficult procedure, and medical students are often allowed to insert a chest tube (under supervision) after having seen just once how to properly do it. Dr. Zebra was told that a medical student at the George Washington University School of Medicine, doing a rotation in the emergency room, had earlier that day seen a chest tube inserted. Furthermore, the resident supervising the student told him, “Okay, you get to put in the chest tube on the next case that comes in.” Shortly thereafter, an ashen Reagan walked through the door and collapsed. The resident immediately looked at the student and said: “No!” (H. Zucker, personal communication, ca. 1987).

It has been noted that Reagan’s wound was, at the outset, “much more life-threatening than that of Garfield or McKinley, who would both have almost certainly survived” had modern surgical care been available to them (Bumgarner, 1994, p. 283).

Throughout the episode, the president’s staff was, in the words of Reagan’s physician, Dr. Daniel Ruge, “anxious to portray the president as being well. . . . But nobody is very well after being shot, and having had an anesthetic, and having lost a lot of blood and having it replaced” (Abrams, 1992, p. 74). Reagan lost over half of all the blood in his body (p. 64). Ruge felt that Reagan did not recover completely until October, that is, six to seven months after the shooting (Abrams, 1992, p. 74).

Former aide Michael Deaver says Reagan became more stubborn after the shooting. Reagan believed that he was “chosen” for his role by a higher power, and that the shooting was a reminder of this. He therefore decided to more closely follow his own instincts (Deaver, 2004).

Hearing Aids

It has been speculated that Reagan’s hearing loss, and eventual use of hearing aids bilaterally, was caused by exposure to gunshot noise while filming numerous western movies in Hollywood (Bumgarner, 1994, p. 282). At the time of his 1980 election, the hearing loss was described as “moderate” (Reynolds, 1980, pp. 25–26). The hearing loss may have been asymmetric to some degree. Reagan’s chief of staff, Donald Regan, once tried to deliver a message to Reagan during a press conference, “but Reagan could not hear since Regan was talking into Ronald’s deaf ear” (as cited in Bumgarner, 1994, p. 282). Reagan was fitted with a $1,000 custom-made hearing aid in 1983 (Associated Press, 2004b).

Dyed Hair

How can a 70-year-old man have a full head of hair with no gray?

The answer comes from Gerald Ford’s observation that “Ronnie doesn’t dye his hair, he’s just prematurely orange,” referring to the fact that “[o]range on a middle-aged man means he’s been playing unsupervised among the Clairol” (Heimel, 1999).

Exercised

Reagan worked out “about 5:00 or so each afternoon, or when the work was done,” for an hour or more in a White House bedroom that had been converted into a gym with exercise equipment. He would then take a bath (Bumgarner, 1994, p. 282).

Colon Cancer

A 1984 proctoscopic examination disclosed a small polyp in Reagan’s colon. Biopsy showed it was benign. In March 1985, another polyp was found, as were trace amounts of blood in his stool. A change in Reagan’s diet eliminated the blood. He underwent endoscopic removal of the polyp and colonoscopy on July 12, 1985, at Bethesda Naval Medical Center. Colonoscopy disclosed a second, more dangerous tumor—a villous adenoma—that could only be removed by surgery (Abrams, 1992, pp. 197–198).

Although Nancy Reagan apparently preferred to delay surgery until the following week on the advice of her astrologer, Reagan preferred to have the surgery the next day—to avoid having to repeat the colonic preparation (Abrams, 1992, p. 198).

The operation lasted 2 hours and 53 minutes. The right-sided portion of Reagan’s colon was removed—about two feet of length. Exploration of other abdominal structures found no spread of the cancer. The tumor was ultimately classified as a “Duke’s B,” meaning it had invaded the muscle of the colon, but was confined to the bowel wall (Abrams, 1992, p. 202). Postoperatively, one of the surgeons remarked about the then-74-year-old president: “This man has the insides of a forty-year-old” (Bumgarner, 1994, p. 285). Reagan left the hospital on July 20 (Reagan, 1985a).

As a result of the surgery, Reagan transferred presidential power to Vice President Bush for 7 hours and 50 minutes (Abrams, 1992, p. 204) It is often written that Reagan invoked section 3 of the 25th Amendment to make this transfer, but he did not explicitly invoke the amendment (Abrams, 1992, pp. 199–201).

Colonic Polyps

Reagan had CAT scans every six months after his 1985 cancer surgery. It is not clear whether one of these scans or another test discovered two polyps in Reagan’s colon in 1987. The polyps, said by his physician, Dr. John E. Hutton, to be small and apparently benign, were removed during colonoscopy at the White House on July 28, 1987 (Bumgarner, 1994, p. 286). Comment: The date may not be exactly correct.

Skin Cancer

A small basal cell carcinoma (a type of skin cancer) was removed from Reagan’s nose on July 31, 1987. Later, a larger area of tissue surrounding the lesion was excised, under local anesthesia at Bethesda Naval Hospital (Bumgarner, 1994, p. 286). Comment: The date may not be exactly correct.

Another basal cell carcinoma was removed from his neck in 1995 (Associated Press, 2004b).

Prostate Enlargement

Underwent transurethral prostate surgery in November 1987 because of benign prostatic hypertrophy. The procedure went smoothly (Bumgarner, 1994, p. 286; MacMahon & Curry, 1987, p. 3). Had (perhaps) previously undergone the same operation in 1967 (Beahrs, 1994, pp. 86–96) (see above).

“The Cold War began to end when two elderly gentlemen discovered that they shared a common difficulty with their bladders.” Soviet foreign minister Andrei Gromyko was at the White House. Reagan was supposed to raise one crucial, secret issue when the two were alone. Security people watched Reagan and Gromyko alone in the Oval Office, nodding in conversation. Afterwards, U.S. State Department people asked the Soviets for their reaction to the secret issue. The Soviets looked blank. What secret issue? “Reagan, 73, had asked Gromyko, 75, only if he would like to use the private presidential lavatory. Indeed Gromyko would. Very much. He went first. Reagan went second. They washed their hands and, much relieved, the two old fellows strolled in to lunch. Arms control was forgotten, but a certain rapport had been forged among the faucets” (Walker, 1995, pp. 288–289).

Gastroenteritis

(Bumgarner, 1994, pp. 286–287).

Adhesions

[Reagan] required “surgeries to eliminate scar tissue” that developed as a result of the 1985 colon cancer operation. In 1990 additional scar tissue forced postponement of a planned trip to Europe (Associated Press, 2004b). Comment: “Scar tissue” undoubtedly refers to adhesions.

Bleed

[Reagan suffered an] epidural hematoma after falling off a horse while vacationing in Mexico. [He] underwent neurosurgery at the Mayo Clinic in Rochester, Minnesota (Associated Press, 2004b).

Alzheimer’s Disease

At one time Reagan “possessed a remarkable memory that his brother described as photographic” (Cannon, 2004, p. A1). Soon after graduating from college, he auditioned for a sports announcer job by “re-creating the fourth quarter of a Eureka College football game from memory” (Cannon, 2004, p. A1). (Reagan had played in the game.) As an actor, “much of Reagan’s early career was spent in the B-film division, where his knack for quick memorization made him a valuable asset. Producers of B-films, as Reagan often put it, ‘didn’t want them good, they wanted them Thursday’ ” (Cannon, 2004, p. A1).

By contrast, as president, in his 70s, “He forgot the names of Cabinet officers, trusted aides, and visiting dignitaries. In Brazil, he toasted the people of Bolivia” (Cannon, 2004, p. A1). A friend tells Dr. Zebra of a film clip in which Reagan, as president, is asked a question, only to look completely blank until his wife, Nancy, whispers an evasive answer in his ear (audible to the camera), which Reagan then speaks.

Recovering from being shot (three months into his presidency), Reagan became disoriented in the intensive care unit. His physicians, therefore, pressed to have him moved to a hospital suite (Abrams, 1992, p. 67). Comment: In retrospect, this was probably a sign of Reagan’s slipping mentation. Yes, Dr. Zebra is aware of the many reasons people get disoriented in an ICU, but let’s face it, it does not often happen to 40-year-olds. This is especially true given a physician’s statement that during Reagan’s recovery “[h]e always had a high pain threshold and required only small amounts of pain medication” (Beahrs, 1994, p. 90).

In 1993 Reagan became increasingly forgetful. Alzheimer’s disease was diagnosed during his annual visit to the Mayo Clinic in 1994. His condition was announced to the public in a carefully worded letter to the American people on November 5, 1994 (Cannon, 2004, p. A1).

There is an interesting photograph of Reagan, taken in 1996, that shows a visible sign of his Alzheimer’s disease. He is shown standing with a model of the USS Ronald Reagan, a ship named in his honor, along with his wife and the CEO of the company building the ship. Reagan’s necktie peeks out below the button of his suit coat. Reagan was extremely careful with his appearance all his life—as an actor and as a president who wore $1,000 suits—so this tiny slip is actually significant, as a sign of inattention caused by his disease. There was a case in which this sign was actually responsible for the diagnosis of Alzheimer’s disease in a business executive (Alvarez, 1943, pp. 100–101).

Was Reagan symptomatic while in office? There was speculation about his mental function as early as 1987, just after he underwent his third major operation while in office (prostate). In response, Reagan held a press conference on March 19, 1987, in which he performed extremely well in front of a hostile press (MacMahon & Curry, 1987, p. 3).

Reagan’s mother was “senile” for “a few years” before she died of atherosclerotic disease at age 80 (Altman, 1980, pp. A1, A28).

Hip Fracture

Reagan fell at his home on January 12, 2001, breaking his hip. He was taken by ambulance to St. John’s Health Center in Santa Monica, California. On the morning of January 14, Dr. Kevin Ehrhart led the surgical team that “inserted metal pins and screws into Reagan’s hip.” Dr. Ehrhart expected that Reagan’s recovery would be complicated by coexisting Alzheimer’s disease (Sanchez, 2001, p. A2).

Death: Pneumonia

[Reagan] died of pneumonia on June 5, 2004 (Associated Press, 2004a).

Comment: Pneumonia is a frequent complication of Alzheimer’s disease. Reflexes that normally prevent aspiration of mouth contents into the lungs may be lost or severely diminished in Alzheimer’s disease. The lungs are normally sterile, so this introduction of infectious agents into the lungs can lead to pneumonia. Aspiration pneumonia can be difficult to treat.

Odds & Ends

References

Abrams, H. L. (1992). “The president has been shot”: Confusion, disability, and the 25th Amendment in the aftermath of the attempted assassination of Ronald Reagan. New York, NY: W. W. Norton, 54–74, 197–202, 204.

Altman, L. K. (1980, June 11). Reagan vows to resign if doctor in White House finds him unfit. The New York Times, pp. A1, A28.

Alvarez, W. C. (1943). Nervousness, indigestion, and pain. New York, NY: Paul B. Hoeber, 100–101.

Associated Press. (2004a, June 6). Reagan to be honored with state funeral. Chicago Tribune. Retrieved from http://www.chicagotribune.com/news/nationworld/bal-funeral0606,1,2596318.story

Associated Press. (2004b, June 8). Reagan legacy includes raising awareness of several diseases. CNN. Retrieved from http://www.cnn.com/2004/HEALTH/06/05/reagan.health.ap

Beahrs, O. H. (1994). The medical history of Ronald Reagan. Journal of the American College of Surgeons, 178, 86–96.

Dr. Zebra has not checked the correspondence about this article and the author reply that appear at Journal of the American College of Surgeons (1994), 179, 763–764.

Boller, P. F. Jr. (1981). Presidential anecdotes. New York, NY: Oxford University Press, 354.

Bumgarner, J. R. (1994). The health of the presidents: The 41 United States presidents through 1993 from a physician’s point of view. Jefferson, NC: McFarland, 281–283, 285–287.

Devotes one chapter to each president, through Clinton. Dr. Zebra depends heavily on this book, which is written for the layperson, is well referenced, and has areas of speculation clearly identified. Dr. Bumgarner survived the Bataan Death March and has written an unforgettable book, Parade of the Dead, casting a physician’s eye on that experience.

Cannon, L. (2004, June 6). Actor, governor, president, icon. The Washington Post, p. A1.

Deaver, M. [Interview]. (2004, June 14). Charlie Rose show. [Television series]. San Francisco, CA: KQED.

Heimel, C. (1999, February 3). Combover Congress: How can we trust our leaders to manage impeachment when they can’t even manage their hair? Salon. Retrieved from http://www.salon.com/news/1999/02/03newsb.html

Caveat emptor: no written source for these statements is known to Dr. Zebra.

MacMahon, E. B., & Curry, L. (1987). Medical cover-ups in the White House. Washington, DC: Farragut, 3.

Page, S. (2004, June 23). Time-tested formulas suggest both Bush and Kerry will win on Nov. 2. USA Today. Retrieved from http://www.usatoday.com/news/politicselections/nation/president/2004-06-23-bush-kerry-cover_x.htm

Reagan, R. (1985a, July 13). Letter to the president pro tempore of the Senate and the speaker of the House on the discharge of the president’s powers and duties during his surgery. Retrieved at http://www.reagan.utexas.edu/archives/speeches/1985/71385b.htm

This letter is deposited in the Ronald Reagan Presidential Library. The online version of the letter has been incorrectly annotated by the library staff to underplay the seriousness of the condition Reagan had. The annotation says the operation was to remove a polyp, when it was actually to remove a malignant cancer well past the polyp stage.

Reynolds, J. (1980, December 8). How healthy is Reagan? U.S. News and World Report, 25–26.

An interview with Dr. Reynolds.

Sanchez, R. (2001, January 14). Reagan recovering at hospital after surgery. The Washington Post, p. A2.

Walker, M. (1995). The Cold War. New York, NY: Henry Holt, 288–289.

Zucker, H. (ca. 1987). Reagan’s emergency room treatment [Personal communication].

Zucker was in the emergency room at George Washington University on the day that Reagan was shot.