Bruce Willis and the Long-term Effects of Aphasia

View from Saskatoon Farm, Foothills County, Alberta. (Dr. Noorali Bharwani)
View from Saskatoon Farm, Foothills County, Alberta. (Dr. Noorali Bharwani)

Recently, Bruce Willis’ family announced that he will be taking a step back from his career of almost 45 years and more than 100 movies due to an aphasia diagnosis. Aphasia is a medical condition that leaves patients struggling to verbally communicate. It affects speech and the ability to read or write.

As of 2022, films featuring Willis have grossed over US$5 billion worldwide, making him one of the highest-grossing actors in the world.

About five years ago I wrote about this subject as one of my relatives was diagnosed with primary progressive aphasia. There are many types of aphasic conditions.

According to the Aphasia Institute, there are over 100,000 Canadians living with aphasia today and one in three stroke survivors are diagnosed with aphasia. As the population ages the incidence of aphasia is expected to increase.

An aphasic person cannot express himself or herself when speaking, has trouble understanding speech, and has difficulty with reading and writing or finding words.

Brain damage causes aphasia. This quite often happens after a stroke or head injury. It can happen if a person has a brain tumour or Alzheimer’s disease. It is important to remember primary progressive aphasia is not Alzheimer’s disease. In primary progressive aphasia the problem is a disorder of language with preservation of other mental functions of daily living for at least two years. Symptoms may get worse after that.

The effects of aphasia differ from person to person and can sometimes be eased by speech therapy. Most people affected by this condition can maintain ability to take care of themselves and pursue hobbies. In some instances, a person can remain employed.

Primary progressive aphasia may present in a number of different ways but it commonly appears initially as a disorder of speech, progressing to a nearly total inability to speak in its most severe stage, while comprehension remains relatively preserved.

Symptoms begin gradually, often before age 65, and worsen over time. People with primary progressive aphasia have a difficult road ahead. They are fighting against a condition in which they will continue to lose their ability to speak, read, write, and/or understand what they hear. The illness progresses slowly.

Medically speaking, primary progressive aphasia is caused by a shrinking of the frontal, temporal or parietal lobes in the brain, primarily on the left side. The condition affects the language centers in the brain.

Who is at a higher risk of being affected by primary progressive aphasia?  A person having learning disabilities and a person who has certain gene mutations – that is it may run in the family.

An individual who has aphasia should carry an identification card and obtain materials available from the National Aphasia Association. This helps in communicating about the person’s condition to others.

Unfortunately, people with primary progressive aphasia eventually lose the ability to speak and write, and to understand written and spoken language. As the disease progresses, other mental skills, such as memory, can become impaired. Some people develop other neurological conditions. With these complications, the affected person eventually will need help with day-to-day care.

People with primary progressive aphasia can also develop behavioral or social problems as the disease progresses, such as anxiety or irritability. Other problems might include blunted emotions, poor judgment or inappropriate social behavior.

The diagnosis of the condition is based on history of worsening communication skills, changes in thinking and behaviour over one to two years. Besides physical examination a doctor will order several tests including blood tests, speech and language tests, genetic tests, MRI, etc.

Unfortunately, primary progressive aphasia cannot be cured, and there are no medications to treat it. The good news is, some therapies, like speech and language therapy, may help improve or maintain your ability to communicate and manage your condition.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Mystery Surrounding Havana Syndrome

Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)
Ernesto "Che" Guevara mural in Havana, Cuba. He was a physician revolutionary. (Dr. Noorali Bharwani)

I hope you had a wonderful, safe holiday season, Christmas and new year. Omicron is spreading like wild fire. It is in the news 24-hours a day. So, I thought I will write about something which has been in my mind for a while. This illness is as mysterious as COVID-19. Luckily, it has not affected millions of people. It is called Havana Syndrome.

Havana Syndrome is a set of unexplained medical symptoms experienced by U.S. and Canadian government officials and military and intelligence personnel. This was first reported by the U.S. and Canadian embassy staff in Havana, Cuba in 2016. Since then, it has been reported from many other countries, affecting diplomats and non-diplomats including children.

Individuals started falling ill, many after hearing strange sounds and experiencing bizarre physical sensations, loss of balance with cognitive changes along with symptoms of mild traumatic brain injury.

A group of Canadian diplomats is accusing Canada’s government of withholding information about what the diplomats say are three new cases of brain injury resulting from Havana Syndrome that have been identified in the past two years.

They say that since March 2020, a total of 25 Canadian diplomats have been evaluated for potential brain injury by experts at Dalhousie University.

Media report says so far roughly 200 U.S. diplomats, intelligence officers, military officers and other government personnel, mostly based abroad, have experienced a strange and often debilitating set of symptoms.

Canada, like the U.S., has said it hasn’t determined a cause or culprit for what the U.S. initially deemed targeted attacks. A study commissioned by Canada’s government pointed the finger at likely overexposure to pesticides in Cuba, while a report by the U.S. National Academies of Science said the mysterious neurological symptoms are consistent with directed microwave energy and raised the possibility of a microwave weapon.

Cuba has denied any responsibility for the symptoms suffered by diplomats or having weapons that could produce such symptoms.

It has been more than five years since Havana Syndrome has been in the news. Do we know where did the illness start from? What is the cause – viral, bacterial, or psychological? Is Cuban, Chinese or Russian government involved? Is there a cure for the illness?

Symptomatic presentation varies. The symptoms range in severity from pain and ringing in the ears to cognitive difficulties. Other symptoms include dizziness, headache, fatigue, nausea, anxiety, and memory loss of varying severity. In some cases, diplomats and intelligence officers have left active service due to complications from the condition.

What are the leading theories as to what causes the syndrome?

This could be due to mass hysteria caused by anxiety and fear of the unknown. Second theory is this could be due to brain damage caused by microwave energy. Third theory is brain damage caused by ultrasound energy.

Ultrasound energy can cause permanent loss of hearing, problems with orientation and balance, tinnitus, and injury to the ear. This does not sound so different from the symptoms of the Havana Syndrome.

Several U.S. and Canadian intelligence and scientific experts are investigating this mysterious illness and try and determine the mechanism used in the attack. Diagnosis has been difficult because there have been so many different symptoms and some of them are subjective and difficult to measure. The diversity of symptoms also suggests a psychological rather than physical cause.

Recently, President Biden signed the Helping American Victims Afflicted by Neurological Attacks (HAVANA) Act, which authorizes additional medical and financial support for intelligence officers and diplomats affected by the syndrome.

CIA Director William Burns was quoted in the media saying, “I’m certainly persuaded that what our officers and some family members, as well as other U.S. government employees, have experienced is real, and it’s serious.”

Canadian diplomats, their spouses and children, who were based in Havana and were affected by this illness are suing the federal government for $28 million. We will see what happens.

Be safe and have a wonderful year.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!