I agree that the health of the presidential candidates is fair game. I did not criticize anyone for addressing this issue. What I criticized was trying to diagnose him, or speculating in public about diagnosis, from video evidence without having the proper expertise to put this limited evidence into the context of clinical experience.

Nice. More polite than STFU, I admit, but the message is the same, neh?

I concede the finding is clearly not new, and thus of no concern. I viewed the video of the “suspension” speech and the convention speech side by side — McCain’s face looked dramatically different between the two, so I assumed the deficit was new. Clearly it’s a waxing & waning phenomenon, which should have but did not occurred to me.

As I correctly indicated in the OP, the evidence suggested a peripheral lesion. But based on the highly limited video evidence at hand, I disagree with your implication that stroke was an impossible cause. It may not have been the fact today, which is fortunate, but it remains a possible and reasonable etiology and in a candidate who has so jealously guarded his medical records, the concern is valid.

Moreover, I take issue with the implication that this is somehow an unseemly, partisan, or out-of-bounds question to raise. When an aspirant to the highest office develops an (apparently) new deficit, it is highly relevant to his fitness to serve.

The one correction I would make (which is not his fault as he lifted it from a reliable resource) is that forehead Botox (the location of treatments used for cosmetic purposes) does not cause eyelid ptosis. It may cause brow ptosis (drooping of the brow, which is not what McCain has) but not lid ptosis.

That’s why you’re a neurologist, and I’m a surgical oncologist.

But coincidentally I just saw that political video clip that shows a photo of McCain’s melanoma prior to surgery and it suprised me how advanced it appeared in that photo; I’d never seen that. It was multinodular and multifocal. The first thing that I thought of when I noticed McCain’s ptosis was not stroke or brain tumor, but rather local recurrence. Especially if he’s had ptosis for a while, a local recurrence could just be causing non-specific tissue edema. Just saying…

No, John McCain’s facial asymmetry is a result of his melanoma surgery, the rotation of a full thickness skin flap to cover the defect left when his melanoma was excised, and his superficial parotidectomy. Also, he had a modified radical neck dissection on the left, which impairs the lymphatic drainage from that side of his face.

In any case, a recurrence large enough to cause facial edema would be very difficult to miss and almost impossible to cover up. So sayeth this surgical oncologist, anyway.

Finally, John McCain’s melanoma was a Stage IIA, and I discussed it in detail here. To boil it all down, it’s unlikely that McCain has recurred after eight years of no recurrence. Is it possible for him to have a recurrence? Yes. But his having survived eight years without one makes it fairly unlikely that he will suffer one in the next five years.

I only began to notice McCain’s ptosis a few days ago, so I just Googled ptosis and McCain today to see what’s others have noticed. If you say he’s had it all along that’s OK with me.

But coincidentally I just saw that political video clip that shows a photo of McCain’s melanoma prior to surgery and it suprised me how advanced it appeared in that photo; I’d never seen that. It was multinodular and multifocal. The first thing that I thought of when I noticed McCain’s ptosis was not stroke or brain tumor, but rather local recurrence. Especially if he’s had ptosis for a while, a local recurrence could just be causing non-specific tissue edema. Just saying…

By the way, I usually vote republican so I’m not grinding any political ax here. Also, I’m an MD, just for disclosure…