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Venezuelan Official Confirms Chávez Receiving Cancer Treatments

Labels: World

CARACAS, Venezuela — President Hugo Chávez is receiving chemotherapy or radiation treatments in the aftermath of his most recent cancer surgery, a government official said for the first time on Friday.

Mr. Chávez has not been seen and has not spoken in public since his Dec. 11 surgery in Havana, including after officials said he was flown back to Venezuela and installed in a military hospital here on Feb. 18. His long isolation has fueled speculation about the gravity of his illness.

The government has given only partial information about his condition, leaving Venezuelans playing a guessing game, trying to piece together a fuller picture from the scant details that are parceled out.

The new information adds to the recent description by the president’s son-in-law, Science and Technology Minister Jorge Arreaza, of Mr. Chávez’s treatment as “palliative,” which could indicate that doctors consider his cancer incurable and they are concentrating their efforts on reducing pain or slowing the progress of the disease.

On Friday Vice President Nicolás Maduro said that Mr. Chávez was undergoing “complementary treatments,” a phrase that officials had used previously without specifying what the treatments were.

But this time Mr. Maduro added, “You know what the complementary treatments are, don’t you? Well, the chemotherapy that they apply to the patient after an operation, as he went through chemotherapy and radiation therapy after the operations in 2011 and 2012.”

Speaking after a mass to inaugurate a small chapel erected near the military hospital where officials say Mr. Chávez is staying, he described the treatments as being hard and said that Mr. Chávez is in a “battle for his life” but in good spirits.

Mr. Arreaza, the son in law, did not say what he meant by the term palliative treatments. Medical experts not involved with Mr. Chávez’s care said chemotherapy or radiation could be used as palliative treatments for cancer, such as to slow down the growth of a tumor that is causing a patient pain.

“The definition of palliative treatment is that the cancer can’t be cured and one is treating only to make the person comfortable and relieve discomfort,” said Dr. Julio Pow-Sang, an oncologist at the Moffitt Cancer Center in Tampa, Fla.

Dr. Edward Greeno, an oncologist at the University of Minnesota said that palliative treatments can go on for an extended period, depending on the type of cancer.

“It doesn’t always mean the end is close,” Dr. Greeno said. “Sometimes you can keep things controlled for a long time. But it does mean that you’re not trying to get rid of the cancer or control the cancer but you are providing symptom control and maybe provide increased survival time.”

Fans keep love alive for 'Walking Dead' star

Labels: Lifestyle

LOS ANGELES (AP) — From week to week fans simply never know which characters will survive the relentless zombie attacks on AMC's hit series "The Walking Dead."

That unpredictability keeps viewers on the edge of their seats and the shows' stars in a constant state of alertness.

"You see series and they last a long time and sometimes the writing gets lazy or the acting gets lazy. Because we're in a zombie apocalypse and anyone can go at any time, it sort of keeps us fresh and on our toes," Norman Reedus told The Associated Press Friday.

Fans lined up around the block to watch a panel discussion with Reedus and his co-stars at Paleyfest, the annual Southern California TV celebration. Many in the crowd showed their support for Reedus' crossbow-wielding character, Daryl Dixon, with their "If Daryl dies we riot!" T-shirts.

The 44-year-old actor says his vocal fan base is responsible for his character's impressive longevity in a series that seems to have no qualms in axing its most popular characters.

"Hell yes. Oh my god, yes," he said. "(They're) keeping me on the show."

"The Walking Dead" focuses on a rag-tag band of surviving refugees, including unruly brothers Daryl and Merle Dixon, who were not part of the series' comic book origins.

"I want to be Daryl Dixon in my next life," joked co-star Laurie Holden. "He's sexy and he's got the rugged thing going on."

When asked about his breakout star status, Reedus becomes humble and tries to turn the spotlight on his Golden Globe-nominated cast.

"I watch them grow and I watch myself grow. It's one of those acting things where like I'll be in a scene with her or with him and I'll say should I try this? And they'll go 'yeah' and I'll believe them and I'll trust them. Everyone wants everyone to just kill it," Reedus said with a laugh.

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Online: www.amctv.com/shows/the-walking-dead

www.paleycenter.org

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Follow Nicole Evatt on Twitter at http://twitter.com/NicoleEvatt

U.S. Judges Offer Addicts a Way to Avoid Prison

Labels: Health

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Economix Blog: Bernanke Defends Stimulus as Necessary and Effective

Labels: Business

The Federal Reserve’s chairman, Ben S. Bernanke, picked an unusual time to offer his most recent defense of the Fed’s campaign to stimulate the economy: 7 p.m. on a Friday night in San Francisco, 10 p.m. back home on the East Coast.

The basic message was the same as Mr. Bernanke delivered to Congress earlier this week: The Fed regards its current efforts as necessary and effective, and the risks, while real, are under control.

“Commentators have raised two broad concerns surrounding the outlook for long-term rates,” Mr. Bernanke told a conference at the Federal Reserve Bank of San Francisco. “To oversimplify, the first risk is that rates will remain low, and the second is that they will not.”

If rates remain low, it may drive investors to take excessive risks. If rates jump, investors could lose money – not least the Fed.

Regarding the first possibility, Mr. Bernanke said that the Fed was keeping a careful eye on financial markets. But he noted that rates were low in large part because the economy was weak, and that keeping rates low was the best way to encourage stronger growth. “Premature rate increases would carry a high risk of short-circuiting the recovery, possibly leading — ironically enough — to an even longer period of low long- term rates,” he said.

At the other extreme, Mr. Bernanke said the Fed could “mitigate” any jump in rates by prolonging its efforts to hold rates down, for example by keeping some of its investments in Treasury and mortgage-backed securities.

Three more highlights from the question-and-answer session after the speech.

1. Mr. Bernanke, asked about the outlook for the Washington Nationals, responded by accurately quoting the “Las Vegas odds” of a World Series appearance: 8/1.

2. Although the decision may be made under a future chairman, Mr. Bernanke said the Fed should continue to offer “forward guidance” — predicting its policies — even after it concludes its long effort to revive the economy.

“Providing information about the future path of policy could be useful, probably would be useful, under even normal circumstances,” he said in response to a question. “I think we need to keep providing information.”

3. Not surprisingly, Mr. Bernanke often is asked to reflect on the financial crisis. He offered something a little different than his normal response on Friday night.

“In many ways, in retrospect, the crisis was a normal crisis,” he said. “It’s just that the intuitional framework in which it occurred was much more complex.”

In other words, there was a panic, and a run, and a collapse – but rather than a run on bank deposits, the run was in the money markets. Improving the stability of those markets is something regulators have yet to accomplish.

Muay Thai Fighter Somluck Kamsing Returns to Home Ring

Labels: World

Rob Cox

Somluck Kamsing, right, fought Jomhod Kiatadisak last month in Bangkok as part of a string of comeback fights there.

BANGKOK — Before his Olympic gold medal, before his sponsorship deals, his movies and his music, Somluck Kamsing was one of thousands of young muay Thai fighters from Isan, Thailand’s poorest region.

“My family worked all day to be able to eat at night,” he said.

At a temple fair in their village, there was a small ring for muay Thai fights. Like many Isan men, Somluck’s father had been a fighter when he was young.

“My father put me in the ring, but I didn’t want to do it,” said Somluck, who was 7 or 8 at the time. “He hit me, so I had to fight.”

He won money, a trophy and his first fans. When Somluck walked around the village, people complimented his skill.

“I had a natural talent,” he said through an interpreter. “A gift from heaven.”

Local notice led to regional fame for the charismatic Somluck.

“I was a bet hunter,” he said. “I’d go from village to village fighting to earn money.”

Muay Thai is sustained by gamblers, who contribute to the atmosphere at matches but are more concerned with results than artistry. For others, muay Thai is a spectacle, and for a select few like Somluck, it is a way to a better life.

When he reached 15 and the minimum fighting weight, 100 pounds, he made his debut at the prestigious Lumpini Stadium here. As usual, the second and third tiers of the stadium, which holds 9,500 spectators, were full of bettors wiggling their raised fingers throughout the fights, indicating the changing odds of wagers among themselves.

Muay Thai, a sport closely linked to kickboxing that was adapted from hand-to-hand combat, is as known for intricate rituals like the prefight dance wai kru ram muay as for devastating elbow and knee strikes.

“Such a mixture of gentleness and violence is characteristic of the Thai people and their culture,” the Thai poet Montri Umavijani wrote.

Virat Vacirarattanawong, a Lumpini Stadium promoter, remembered watching the 15-year-old Somluck. “He was shining,” he said through an interpreter. “He had a kind of glamour about him. I didn’t know what it was, but I knew that he was not an ordinary boy.”

Thai fighters compete so frequently that they are usually considered veterans by age 27. But Kamsing, now 40, returned to the ring last fall and won. On Saturday, an American audience will get a chance to take the measure of Somluck when he faces Chike Lindsay in Pomona, Calif.

By the time Somluck was 18, he had competed in more than 200 bouts. Despite his ability, he never became a champion at Lumpini or at the smaller Rajadamnern Stadium, the nation’s other storied muay Thai arena. Somluck was considered such a prohibitive favorite that the big gamblers lost interest and the promoters did not want to risk their best prospects against him.

“I was out of a job,” he said. “I could not support myself.”

So Somluck switched to amateur boxing by refining the four striking tools of muay Thai — fists, feet, elbows and knees — into one. He approached matches the way he always did: before each fight, he paid respect to his amulet, which he believes protects him, and thought about his deceased father.

“The most important thing is I trust in myself,” he said. “I am a boxer. I have to believe that I can beat my opponent. For some of them I have to train, for some don’t. It is easy for me to read fighters.”

He was a success as a featherweight boxer. At 19, Somluck represented Thailand at the 1992 Olympics in Barcelona, Spain, and he won his nation’s first Olympic gold medal four years later. Some may remember Somluck as the boxer who bowed to each compass direction before his bouts at the 1996 Atlanta Games. In the final, he outpunched the Bulgarian Serafim Todorov, who had beaten 19-year-old Floyd Mayweather Jr. in the semifinals.

Somluck, then 23, returned from the Olympics a national hero. He had an audience with King Bhumibol Adulyadej. He received more than $1 million in bonuses from the government and his sponsors. “My life went from the earth to the stars,” he said. “I was famous. I was able to do advertising, movies, music, you name it. Everything changed.”

Jane C. Wright, Pioneering Oncologist, Dies at 93

Labels: Health

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

F-35 Jets Returned to Service by Pentagon

Labels: Business

The Pentagon lifted its grounding of the new F-35 jet fighter on Thursday after concluding that a turbine blade had cracked on a single plane after it was overused in test operations.

The office that runs the program said no other cracks were found in inspections of the other engines made so far, and no engine redesign was needed.

It said the engine in which the blade cracked was in a plane that “had been operated at extreme parameters in its mission to expand the F-35 flight envelope.”

The program office added that “prolonged exposure to high levels of heat and other operational stressors on this specific engine were determined to be the cause of the crack.”

All flights were suspended last week for the 64 planes built so far once the crack, which stretched for six-tenths of an inch, was found during a routine inspection.

Pratt & Whitney, which makes the engines, investigated the problem with military experts. The company, a unit of United Technologies, said on Wednesday that the crack occurred after that engine was operated more than four times longer in a high-temperature flight environment than the engines would in normal use.

The F-35, a supersonic jet meant to evade enemy radar, is the Pentagon’s most expensive program and has been delayed by various technical problems. The program could cost $396 billion if the Pentagon builds 2,456 jets by the late 2030s.

European Union Agrees on Plan to Cap Banker Bonuses

Labels: World

BRUSSELS — Bankers in Europe face a cap on bonuses as early as next year, after an agreement on Thursday to introduce what would be the world’s strictest pay curbs in a move politicians hope will address public anger at financial-sector greed.

The provisional agreement, announced by diplomats and officials after late-night talks between E.U. member representatives and the bloc’s parliament, means bankers face an automatic cap that sets bonuses at the level of their salaries.

If a majority of a bank’s shareholders vote in favor, that ceiling can be raised to two times a banker’s pay.

“For the first time in the history of E.U. financial market regulation, we will cap bankers’ bonuses,” said Othmar Karas, the Austrian lawmaker who helped negotiate the deal.

The backing of a majority of E.U. states is needed for the deal to be finalized.

Such limits, which are set to enter E.U. law as part of a wider overhaul of capital rules to make banks safer, will be popular on a continent struggling to emerge from the ruins of a 2008 financial crisis.

But it represents a setback for the British government, which had long argued against such absolute limits. The City of London, the region’s financial capital, with 144,000 banking staff and many more in related jobs, will be hit hardest.

As it stands in draft legislation, the cap would also apply to bankers employed by an E.U. institution but based elsewhere globally, for instance in New York, according to one official, who was not authorized to speak to the media.

There are also provisions for adjusting the value of long-term non-cash payments, so more bonuses could be paid that way without breaking through the new ceiling.

Ireland, which holds the rotating E.U. presidency and negotiated what it called a “breakthrough,” will now present the agreement to E.U. countries.

Irish Finance Minister Michael Noonan said he would ask his peers to back it at an EU ministers’ meeting on March 5 in Brussels.

The change in the law is set to be introduced as part of a wider body of legislation demanding banks set aside roughly three times more capital and build up cash buffers to cover the risk of unpaid loans, for example.

Some experts have criticized the E.U., however, for failing to keep to all of the so-called Basel III code of capital standards drawn up by international regulators to reform banking after the financial crash.

The agreement on Thursday will also require banks to outline profits and other details of operations on a country-by-country basis.

A ceiling on bonuses, the only one of its kind globally, is perhaps the most radical aspect of the new rules.

Many in banking argue, however, that such reform will do little to lower pay in finance, where head-hunters say some annual packages in London approach £5 million, or about $7.6 million.

“If the cap is implemented, it could result in significantly more complex pay structures within banks as they try to fall outside the restrictions to remain competitive globally,” said Alex Beidas, a pay specialist with the law firm Linklaters.

An earlier attempt to limit bankers’ pay with an E.U. law forcing financiers to defer bonus payments for up to five years merely prompted lenders to increase base salaries. But it would be harder for banks to raise base pay this time around.

Hedge funds and private equity firms will be excluded from such curbs, although they face restrictions on pay later this year under another E.U. law.

Well: Think Like a Doctor: The Man Who Wobbled

Labels: Health

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.
The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.
And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.
The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.
You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?
The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.
The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.
“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.
“Can you get up and show us how you walk?” Dr. Centor asked.
“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.
Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.
You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.