Ronald Reagan was born into a very poor family, but he found success in everything he did. He was a member of his Eureka College football team and captain of the swim team. After graduation, he became a sports announcer on several regional radio stations. He moved to Hollywood in 1937, became an actor who was later elected leader of the actors' union, then governor of California and then President of the United States. He left the presidency with a 63 percent approval rating. At age 74, he was successfully operated on for colon cancer, and at age 83 he was diagnosed with Alzheimer's disease which eventually killed him.
In November 1994, Reagan wrote to the world, "I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer's disease . . . At the moment I feel fine." However, there were some warning signals that preceded his diagnosis. In his early seventies, when he was first elected president, he had some signs of forgetfulness, wore a hearing aid and sometimes slept through presidential meetings. At age 75, he was unable to recognize former CBS White House correspondent Lesley Stahl and had difficulty remembering some people's names. However, he did not show obvious signs of dementia until age 82, three years after he left the presidency. He lost his ability to recognize old friends, but he continued to take walks and play golf. At age 89 he fell and broke his hip and recovered after having his hip surgically repaired. By age 90, he stopped making public appearances and spent most of his waking hours with his wife, Nancy. He eventually died at age 93 when nerve damage caused by his Alzheimer's disease probably caused him to aspirate food into his lungs and he died of pneumonia.
He developed hearing loss around the time that he was first elected president, and wore a hearing aid first in his right ear and later also in his left ear. Loss of hearing can be due to many things and certainly does not cause Alzheimer's disease, but it is associated with a significant increased risk for dementia in later life (Aging & Mental Health, May 29, 2014;18(6):671-673). Dementia is also associated with loss of other senses: loss of vision (NEJM, December 6, 2017), loss of smell (J of the Am Geriatric Soc, September 25, 2017), loss of taste (J Alzheimers Dis Parkinsonism, April 25, 2015;5(1)) and loss of coordination (Expert Rev Neurother, May 2011;11(5):665–676).
At age 74 he had a three-hour operation to remove a colon cancer. Two years after his original diagnosis of colon cancer, he had a colonoscopy to check for a possible recurrence. Doctors removed four newly-formed polyps from his colon, which showed no signs of cancer. Colon polyps are considered pre-cancers, and anyone who has colon polyps is considered to be at increased risk for colon cancer and should be following an anti-inflammatory program to help prevent colon cancer. Colon cancer is associated with eating mammal meat, processed meat, sugar added foods, sugared drinks, and fried foods and not eating lots of fruits, vegetables and nuts (JAMA Oncol, January 26, 2017). People who have had colon polyps should also exercise, avoid overweight and not be vitamin D deficient. Colon cancer has killed many famous people, including Audrey Hepburn, Farrah Fawcett, Jack Lemmon, Milton Berle, Elizabeth Montgomery, Jackie Gleason, Eartha Kitt, Claude Debussy, Francis Harry Compton Crick, Mistislav Rostropovich, Mildred "Babe" Didrikson Zaharias, Charles M. Schulz, Vince Lombardi and Tip O'Neill.
At ages 74 and 76 while he was president, Reagan had basal cell skin cancers removed from his nose. Basal cell skin cancers rarely spread to other parts of the body so they usually can be removed and cured by simple destructive or surgical procedures. However, when they grow around the nose, ears, eyes and lips, they can spread underneath the skin where they cannot be seen, so the rule is that almost all skin cancers in these areas should be removed by Mohs surgery, in which doctors cut out what they think is the entire cancer and look at the removed tissue under a microscope. If they see clear skin 360 degrees around the removed skin, they do not have to do any further surgery. However, if the removed skin has a cancer at its outside margins, the doctor then has to go back and keep on removing skin until a clear 360 degree margin of normal skin around the removed skin is seen. In the first nasal cancer surgery, the doctors removed Reagan's entire tumor with the first cut. On the second nasal cancer surgery, the doctors had to remove two sections of skin. Over the years, the same two dermatologists removed several other skin pre-cancers by freezing them with liquid nitrogen sprays. Basal cell skin cancers usually are caused by excessive exposure to sunlight, and Reagan had spent a lot of time outdoors in California, walking and playing golf and other sports.
Benign Prostatic Hyperplasia (BPH)
At age 76, President Reagan complained of difficulty starting his urinary stream. His doctors found a very large prostate surrounding and squeezing the tube that carries urine from the bladder to the outside. They performed a transurethral prostatectomy, in which a Roto-Rooter-like device is inserted into the urinary tube. They scraped out 23½ grams of prostate tissue, which means that his prostate was about double its normal size (which is about the size of a walnut). They analyzed the removed tissue and found no evidence of prostate cancer.
At age 90, Reagan fell at home and broke the long bone of his upper leg at the hip. The next day surgeons inserted pins, screws and a plate to put the pieces of bone together. The most difficult part of treatment was getting a patient with dementia to exercise because broken bones do not heal well without movement. Without exercise during his recovery, he could be expected to suffer bed sores, urinary tract infections, severe constipation and a worsening of his confusion. Lack of activity after surgery markedly increases risk for heart failure, pneumonia and blood clots in the legs. Pain after hip surgery can be severe, but most of the effective pain medicines can suppress coughing and breathing to cause the patient to aspirate his food into his lungs, which can lead to pneumonia. Prior to falling and breaking his hip bone, he must have had progression of his dementia and a marked decrease in his activities as he was rarely seen outside his home and he had given up his walks in the park.
Lessons from Reagan's Medical History
Eighty percent of all Americans over the age of 85 suffer from Alzheimer's disease or other forms of dementia, and being very successful or intelligent does not protect you. We do not know what causes dementia, but infections and inflammatory lifestyle habits are suspected. Scientists have not found any specific germ common to most cases of dementia, and not all doctors agree that an inflammatory lifestyle causes dementia. At this time the best we can say is that you may be able to reduce your risk for dementia by following anti-inflammatory habits: exercising every day, avoiding overweight, eating an anti-inflammatory diet, and keeping vitamin D levels above 20 ng/ml. These same behaviors also appear to reduce risk for colon cancer and other cancers, diabetes, heart attacks and strokes.
February 6, 1911 – June 5, 2004
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