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Fetterman pledges to debate, while experts say it will take time to assess stroke impact

Fetterman Erie Rally 2 - 8-12-22
Gene J. Puskar
/
AP
Pennsylvania Lt. Gov. John Fetterman, the Democratic nominee for the state's U.S. Senate seat, speaks during a rally in Erie, Pa., on Friday, Aug. 12, 2022.

Democratic Senate candidate John Fetterman moved to answer mounting criticism from Republican rival Mehmet Oz on Wednesday, saying he would face Oz in a debate sometime next month — despite Oz’s public speculation that a stroke in May left Fetterman unable to do so.

“We’re absolutely going to debate Dr. Oz,” Fetterman said in a statement Wednesday evening. “It has simply only ever been about addressing some of the lingering issues of my stroke, the auditory processing and we’re going to be able to work that out.”

But while Fetterman told the online journal Politico that his condition “gets better and better every day,” he acknowledged that “no one really knows” how long it will take to fully overcome the effects of the stroke. And experts agree that for doctors and voters, the challenge is that medical science can only say so much in advance about how well a patient will recover.

In a statement, Oz’s campaign mocked Fetterman for releasing the "BIG NEWS” that “John Fetterman has agreed to debate at a SECRET DEBATE.”

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Fetterman acknowledged that his campaign is considering the use of closed captions during the debate, as he has done during his recent media interviews, to address the lingering effects of his stroke. His campaign didn’t respond directly to a question about what accommodations he might require in the Senate.

But Dr. Ray Reichwein, a stroke neurologist and co-director of the Penn State Stroke Center, said that as part of their standard of care, Fetterman’s doctors would assess his ability to work and perform tasks like driving a car. If doctors are guiding Fetterman back to work, Reichwein said, it’s probably a sign “that he's doing fairly well.”

The campaign has said that while his ability to understand and produce speech has been affected, his underlying cognition is unaffected. Pooja Khatri, the division chief for neurology and rehabilitation medicine at the University of Cincinnati School of Medicine, says that is possible.

“I'll have people tell me, ‘My loved one was confused because they have aphasia,’ and really, they're they're actually not confused at all,” said Khatri, who also oversees the National Institute of Health’s clinical trials for strokes in the United States. “They're just having trouble getting the words out that they want to say or understanding what you're saying.”

Mitchell Elkind, the chief clinical science officer for the American Heart Association, said most tests used to determine cognitive ability can’t assess skill with more complicated cognitive tasks, such as engaging in a political debate. A stroke might affect verbal communication skills, he said, but leave the ability to engage in written communication untouched.

“The ultimate proof of whether somebody can debate would be to see how they perform in a debate,” he said. “It wouldn’t be how they perform in the neurologist’s office.”

In any case, he said, “I can't tell a professional musician how good they sound. Only their audience can.

A demanding job

During the past few weeks, Oz has sharpened his attacks on Fetterman’s health. On Tuesday, U.S. Sen. Pat Toomey, whose pending retirement created the vacancy Oz and Fetterman are hoping to fill, said debates are critical for voters to decide between candidates. He questioned whether Fetterman’s health would prevent him from doing the job.

“It's a demanding job that requires lots of communication,” Toomey said. “And based off what I've seen, I have my doubts whether John Fetterman is up to the job."

Two U.S. senators in recent years have suffered strokes. Democrats’ efforts to pass legislation in Congress was put on hold earlier this year when Sen. Ben Ray Luján of New Mexico suffered a stroke. Lujan, who was 49 at the time of the stroke, required some physical therapy and described his recovery four months later, as “miraculous,” without any lingering effects on his speech.

In 2013, Mark Kirk, a Republican from Illinois, returned to the Senate a year after suffering a stroke at roughly the same age Fetterman is now. In a 2015 article in the Atlantic, Kirk’s aides also said the stroke altered his speech and made him less capable of extemporaneous oratory and more prone to gaffes. Kirk lost his 2016 bid for reelection.

Neither Kirk nor Lujan responded to WESA requests for comment this week, but on Wednesday Lujan told reporters he believed Fetterman would be able to serve in the Senate.

Terry Madonna, a longtime political observer and the senior fellow for political affairs at Millersville University, said many aspects of being a senator rely on language skills.

“You don't have to have a debate to get to be a successful senator,” he said. “But if indeed his health doesn't improve and he has trouble communicating with voters, that's another question.”

Still, Fetterman has billed himself as the potential 51st Democratic vote in the Senate. And Madonna said Fetterman could deliver on much of the agenda he is campaigning on, even if his communication skills aren’t fully restored.

“Given the high level of partisanship and the polarization” in Congress, Madonna said, “every vote now matters.”

‘Location, location, location’

One of the clearest signs of how well a stroke victim will recover over the long term is how they do in the early days.

“If your arm were paralyzed but you start to get some movement in the arm, that's a good prognostic sign that you're going to have more,” Khatri said. “And people tend to recover over weeks and months and sometimes years if they have more recovery to do. So the same goes for speech.”

Fetterman’s campaign said that he is working with a speech therapist and continues to improve. The campaign pointed to a recent video interview in which he responded smoothly to questions on MSNBC with the help of closed captions.

But his delivery in public appearances has at times been halting, and he has sometimes seemed at a loss for words. At a Labor Day event with President Joe Biden, for example, Fetterman spoke for three minutes, sometimes repeating words and pausing awkwardly.

Prior to the speech, Fetterman navigated the mile-long route of Pittsburgh’s Labor Day parade with no apparent difficulty, though he did not speak with reporters gathered at the end of the parade route.

Fetterman has said he walks miles each day — exercise Rechwein said can improve cardiovascular health and release chemicals that improve brain recovery. And the prognosis for younger patients like Fetterman is frequently related to where the stroke occurred in the brain.

“The brain is like real estate,” Rechwein said. “Location, location, location.”

Strokes whose effects on the brain are more patchy, rather than concentrated in a particular area, are easier to recover from, said Reichwein. Likening the brain to a city, he said, “If you strike the heart of a downtown, you can really disable [it]. If you have patchy areas of injury to the suburbs, the city can still function fairly well.”

‘One plus one equals three or four’

Among other factors, Fetterman’s health may have been compromised by his ties to Braddock, the long-struggling steel town where his work as mayor defines him as a public figure.

Fetterman famously made his home right across the street from the Edgar Thomson steel mill. In 2020, the journal Cardiology published a study that looked at the impact of air pollution on people who, like him, lived in Allegheny County between 2007 and 2017 and had an irregular heartbeat. The study showed that residents in that category were a third more likely to suffer a stroke if they were living in the county’s most polluted areas.

Dr. Deborah Gentile, who works with asthma patients in the Mon Valley, said air quality has improved considerably since Fetterman moved to Braddock two decades ago. Still, she said, “There is an air pollution problem over in Braddock, and it's both short-term exposures as well as long-term exposures.”

Fine particulate pollution from industrial facilities can get into people’s lungs and travel to the heart, she said. That damage can mix with other factors to increase stroke risk.

“It's not one plus one equals two,” she said. “It's one plus one equals three or four.

Fetterman’s campaign didn’t directly respond to a question about whether industry is doing enough to protect the health of residents in Braddock, but a spokesman said “John has said countless times that he’s proud to live right across the street from the last steel plant in Pennsylvania.”

Among the other risk factors for a stroke is an irregular heartbeat, with which Fetterman has acknowledged being diagnosed in 2017. Although Fetterman lost around 150 pounds in the year after that diagnosis, his campaign said in June that he didn’t take medicine prescribed for him to prevent blood clots.

The stress of campaigning can also take a toll. And Rechwein said that while life on the campaign trail shouldn’t complicate Fetterman’s recovery, it can exacerbate challenges such as difficulty in speaking.

“You won't make yourself worse in the overall scheme of things generally,” he said, “but you can kind of make the symptoms appear worse.”

Oliver Morrison is a general assignment reporter at WESA. He previously covered education, environment and health for PublicSource in Pittsburgh and, before that, breaking news and weekend features for the Wichita Eagle in Kansas.