As a progressive, I am looking at the photos of Dick Cheney at the inauguration and cheering the cosmic justice that turned Darth Vader into a latter stage Mr. Hyde.  Those who speculate that, in a wheelchair, he would have been a lesser target for flying shoes certainly make a good point. There’s no question that much of the day’s audience was cheering both Cheney’s and Bush’s departure one way or another.


Dick Cheney AP Photo Saul Loeb Pool


As a doctor, however, I am curious as to whether the reason given for Cheney’s rolling entrance and exit—back strain—was truly the case.  Most back strains that occur with “moving boxes” are likely to be due to spasm of overstretched or torn back muscles, or possible compression and herniation of an intervertebral disk.  Lower back sprains without vertebral or disk injury may be treated with bed rest, but usually early ambulation is encouraged.  Victims often feel better walking or standing, rather than sitting.  So why would Dick Vader choose to spend the inauguration in a position that was likely to intensify his discomfort.

And, the unusual extended leg position Cheney had in the chair mimics the diagnostic straight leg raising test--which would actually aggravate lower back pain, especially if caused by a herniated disk.  Again, if Dick had to sit, why would he not opt for bending his knees to reduce the strain on his back?

We’ll probably never know the answers to these questions.  Was it vanity that drove our Dick to avoid walking stiffly to the inauguration site?  Or perhaps a cardiovascular or respiratory limitation that prevented him from ambulating, especially in the dry, freezing weather?  Heart failure, COPD, asthma, thrombophlebitis—the possibilities are endless.  The risks of angina and heart attacks increase with exposure to cold weather and physical exertion in the cold.   And, leg elevation can reduce edema (swelling) of the lower extremities and help return blood to a less than ideally functioning heart.

In light of these possibilities, bundling the former VP up and keeping his physical stress to a minimum was probably a wise choice for the outgoing administration.  After all, Dick can certainly use every minute he can salvage on Earth to prepare his case before the “man upstairs”—unlike his country--calls him for Judgment Day.