Man diagnosed with stage 4 colon cancer at 29 shares symptoms: ‘It hit me pretty hard’

Today

Man diagnosed with stage 4 colon cancer at 29 shares symptoms: ‘It hit me pretty hard’

Meghan Holohan – March 21, 2023

When Brendan Menapace ate, he felt “terrible” and wanted to nap. He noticed blood in his stool and visited his doctor.

Having the support of his partner, family and friends made it easier for Brendan Menapace grapple with his stage 4 colorectal cancer diagnosis at age 29. (Courtesy Brendan Menapace)
Having the support of his partner, family and friends made it easier for Brendan Menapace grapple with his stage 4 colorectal cancer diagnosis at age 29. (Courtesy Brendan Menapace)

“I just turned 29, so I didn’t really think colon cancer,” the now 30-year-old tells TODAY.com. “All the symptoms really got worse, so I knew something was wrong, and (I needed) to find an answer.” After testing, Menapace learned he had stage 4 colorectal cancer.

“It was definitely surprising,” he says. “It hit me pretty hard.”

“Textbook” symptoms

In the summer of 2021, Menapace experienced pelvic pain, constipation, bloating and fatigue.

“I would eat and then pretty much immediately would want to lay down,” he says. “I felt terrible.”

He also noticed blood in his stool and couldn’t sit for more than an hour and a half, which he noticed while driving to vacation. After eating, he would feel so awful that he felt drowsy.

“In retrospect, it was pretty much the textbook things they say to look out for,” he says.

He visited a doctor who sent him for a colonoscopy in early October 2021. As soon as Menapace woke, he knew it was bad.

“They told me as I was waking up,” he says. “There was a plan pretty much immediately.”

Two weeks after his test, he started chemotherapy from the end of October until January. Then he underwent 20 radiation sessions to his pelvis until March.

“From there, basically things had shrunk enough that surgery was viable,” he says. “But chemo and radiation take a toll on your body, so I was in pretty rough shape.”

In May, doctors surgically removed his rectum, part of his colon and lymph nodes, and he received a temporary ileostomy bag as his colon recovered. In July, doctors reversed his ileostomy, and by October, a PET scan showed no evidence of disease.

“Until you hit that five-year mark, you’re not considered cured or cancer-free,” Menapace says. “Because of the way it spread, it wasn’t as simple as just cutting out the tumor or declaring me cancer-free.”

Brendan Menapace underwent chemotherapy, radiation and extensive surgery to treat his stage 4 colorectal cancer. (Courtesy Brendan Menapace)
Brendan Menapace underwent chemotherapy, radiation and extensive surgery to treat his stage 4 colorectal cancer. (Courtesy Brendan Menapace)
Colon cancer in young people

A recently published report from the American Cancer Society shows that the rates of colon cancer in young people are increasing. The reason for the increase remains a mystery.

“Rates were globally going down in older patients with screening, and we also thought this was one of those cancers that are cancers of aging, which is why you didn’t screen somebody until they were 50,” Dr. Ursina Teitelbaum, a medical oncologist at Penn Medicine, tells TODAY.com. “Now we’re seeing this trend towards younger and also more left-sided — the descending colon, sigmoid colon and rectum particularly — and we don’t really know why.”

Teitelbaum says older patients tend to have more cancer on the right side, which is the ascending colon. It’s unclear why younger patients see more left-sided problems. But it leads to certain symptoms.

“If it’s on the left side or in the rectum, you may have pain with bowel movements or abdominal pain in general. You might have a change in what we see in the caliber of your stool. Instead of a normal-formed stool, you might have a skinny stool,” she says. “This is a funny point of conversation because people get uncomfortable talking about their bowel movements. But it’s actually really important to pay attention.”

Other symptoms include:

  • Weight loss
  • Fatigue
  • Blood in stool
  • Shortness of breath
  • Pelvic pain

“I have one younger patient who was a very competitive biker who noticed instead of 100 miles a week, he could only bike 50 miles a week,” she says. “It turned out he had rectal cancer and (was) slowly losing blood, and that was the reason.”

Brendan Menapace's last chemotherapy treatment lasted for 46 hours and he carried it around in a fanny pack. (Courtesy Brendan Menapace)
Brendan Menapace’s last chemotherapy treatment lasted for 46 hours and he carried it around in a fanny pack. (Courtesy Brendan Menapace)

Some people feel embarrassed to talk about their bowel movements, even with their doctors, meaning they don’t get help as quickly as possible. Other barriers can make it tough for younger people to get a colonoscopy, too, further delaying treatment.

“A lot of younger patients, people in their 30s, 40s, might not even have a primary care physician. They don’t have any medical problems. They are perfectly healthy,” Teitelbaum explains. “There are other things that are difficult with (colonoscopies). You have to find someone to give you a ride. … You have to take a day off work. You have to have insurance. You have to be able to afford a prep. So, there are a lot of barriers.”

Current screening recommendations for colon cancer are, starting at 45, people need to undergo a colonoscopy every 10 years, which recently changed from 50. Teitelbaum believes that both patients and primary care physicians need to be aware that colorectal cancer can occur to younger people.

“The key for now is education and that’s not just educating people that are younger, but educating their health care providers that if someone comes in with blood in their stool or some of the symptoms, they might need to move screening for colorectal cancer higher on the differential,” she says. “Part of the problems is that hemorrhoids (are) really a common condition.”

Finding colon cancer earlier often means surgery alone can remove it. As it metastisizes, it becomes harder to treated.

“Once it spreads beyond to the liver, the chance of it being curable is much lower,” she says. “That said, I am happy to say most of the time, even when it’s not curable, it’s treatable.”

With colonoscopies, doctors can detect precancerous polyps and remove them before they become cancer.

“You can intervene and remove a polyp before it becomes cancerous,” she says. “That said, not every polyp will become cancerous. So, it’s a balancing act.”

Brendan Menapace experienced neuropathy when he underwent chemotherapy but is lucky that it stopped after treatment ended. (Courtesy Brendan Menapace)
Brendan Menapace experienced neuropathy when he underwent chemotherapy but is lucky that it stopped after treatment ended. (Courtesy Brendan Menapace)
‘Huge learning curve’

While Menapace received chemotherapy, he experienced neuropathy, numbness and tingling from nerve damage. As soon as treatment stopped, these symptoms went away. He has had to adjust to not having a rectum.

“It has been a huge learning curve and just the trauma to my colon and lower digestive system — things are never going to be the same,” he says. “There’s a new normal that I’m working toward and that takes a lot of work in its own right. I have to be careful eating.”

He returned to work and exercise, resuming as much of a “normal life” as he can.

“When I leave the house, I have to know where a bathroom is. … It’s something in the back of my head, and I have to think about something that I never had to before,” he says. “It’s hard to fathom the idea of something being different forever.”

With the help of his partner, friends, family and therapy, Menapace is trying to grapple with the changes he faces due to cancer. He encourages others to talk about their symptoms with their doctors, no matter how strange it might feel.

“You’re trained not to talk about your poop. You’re trained not to talk about your butt. This is not (what you talk about) in polite society. At first, I would rely on euphemisms and be kind of fake and make jokes,” he says. “If you’re not detailed on what you’re going through, you’re not going to paint the right picture for your care team. You’re not going to get the right care.”

This Is the One Thing You Should Do Every Night if You Want To Lose Weight, According To Registered Dietitians

Parade

This Is the One Thing You Should Do Every Night if You Want To Lose Weight, According To Registered Dietitians

Kaitlin Vogel – March 21, 2023

Plus a few easy-to-implement tips.

When it comes to weight loss, many of us first think of diet and exercise. However, there’s one thing you can do every night that can be a game-changer when it comes to weight loss.

In particular, it’s a habit that improves sleep—which is key to weight loss. “Sleep deprivation leads to decreased alertness, reaction time and ability to store memories,” says Joel Totoro, RD, Director of Sports Science at Thorne HealthTech. “Sleep deprivation can also lead to a decrease in immune function and a reduction in the release of growth hormones, as well as the hormones leptin and adiponectin—both of which have roles in fat gain and loss.”

Here’s the habit to practice if you want to sleep better and, as a result, lose weight.

Practice This One Sleep Habit To Lose Weight

If you want to manage your weight, stop eating (or at least don’t eat a big meal) a few hours before bedtime.

Going to bed on a full stomach may interfere with getting restful sleep which upsets the hormones that tell us we’re hungry and when we are full. As a result of poor sleep, you may be hungrier during the day, Elizabeth Ward, MS, RDN, explains. Also, poor sleep can make you gravitate toward foods that provide a quick energy boost, which are often filled with added sugar or other highly refined carbohydrates and add calories to your day.

“Eat a satisfying, balanced dinner with at least 25 grams of protein and stop eating after dinner,” says Ward. “Though calories consumed close to bedtime don’t automatically prevent weight loss, it’s easier to go overboard on food when snacking after dinner especially when these foods are high in fat and calories.”

Routine snacking every night can lead to a lack of interest in breakfast because you’re still full from the night before. As a consequence, you repeat the cycle of eating too few calories during that day and too many at night, which can keep you from shedding pounds in the long run, Ward concludes.

“If you want a snack, make it a modest portion of a high-protein food, like a handful of roasted edamame, Greek yogurt or a handful of pistachios,” says Ward. “Try to eat dinner as early as you can comfortably fit it into your lifestyle.”

Related: Here’s Exactly How Many Hours of Sleep You Really Need Every Night, According to Experts

Additional Tips for Better Sleep

Here are some best practices to help you preserve your sleep time (and, therefore, help with weight loss), according to Amy S. Margulies, RD, CDCES, LDN, NBC-HWC.

Make a sleep schedule

Try to go to bed and wake up at the same time each day. Yes, even on weekends. This will let your body get into a natural rhythm. Aim for a full seven to nine hours each night.

Make it consistent.

It’s common to think of sleep as something you can “make up.” But human bodies aren’t like bank accounts; we can’t make withdrawals and deposits whenever we want. We need plenty of rest as consistently as possible.

Limit distractions

Give your devices a rest! Texts, TV shows, games and funny cat videos will all be there for you the next day. Set a bedtime alert on your phone or stick a note to your TV reminding you of your bedtime—and theirs.

Ask for help

Overwhelmed with to-do lists? Delegate. Ask your kids to help wash dishes or enlist your partner for evening chores. See if a coworker can share the load on a big deadline. That way you don’t have to stay up late finishing other tasks.

Accept the unexpected

Interruptions and sleepless nights will come up from time to time. When they do, don’t dwell on your frustration—that stress can make it even harder to get back into your sleep rhythm. Just accept the interruption, think of it as a temporary lapse, and try again for better sleep the next night.

If these interruptions end up becoming a trend, think of what you can do to change the pattern and make it work for you.

US speeds up Abrams tank delivery to Ukraine war zone

Associated Press

US speeds up Abrams tank delivery to Ukraine war zone

Lolita C. Baldort – March 21, 2023

WASHINGTON (AP) — The Pentagon is speeding up its delivery of Abrams tanks to Ukraine, opting to send a refurbished older model that can be ready faster, with the aim of getting the 70-ton battle powerhouses to the war zone by the fall, the Pentagon said Tuesday.

The original plan was to send Ukraine 31 of the newer M1A2 Abrams, which could have taken a year or two to build and ship. But officials said the decision was made to send the older M1A1 version, which can be taken from Army stocks. Officials said the M1A1 also will be easier for Ukrainian forces to learn to use and maintain as they fight the invading Russian forces.

“This is about getting this important combat capability into the hands of the Ukrainians sooner rather than later,” said Brig. Gen. Pat Ryder, the Pentagon press secretary.

The Biden administration announced in January that it would send the tanks to Ukraine — after insisting for months that they were too complicated and too hard to maintain and repair. The decision was part of a broader political maneuver that opened the door for Germany to announce it would send its Leopard 2 tanks to Ukraine and allow Poland and other allies to do the same.

Speaking at a Pentagon press conference, Ryder said the tanks will be refurbished and refitted to make them combat ready for Ukraine. He declined to say where that work will be done.

It’s unclear how soon the U.S. would begin training Ukrainian forces on how to use, maintain and repair the tanks. The intention would be to have the training of the troops coincide with the refurbishment of the tanks, so that both would be ready for battle at the same time later this year, said U.S. officials, who spoke on condition of anonymity to discuss details not publicly provided. The Pentagon will also have to ensure that Ukrainian forces have an adequate supply chain for all the parts needed to keep the tanks running.

The Russian and Ukrainian forces have been largely in a stalemate, trading small slices of land over the winter. The fiercest battles have been in the eastern Donetsk region, where Russia is struggling to encircle the city of Bakhmut in the face of dogged Ukrainian defense. But both sides are expected to launch more intensive offensives in the spring.

Asked about the timing of the tanks’ arrival, Ryder said the Abrams are part of the medium- and longer-term military support the U.S. is providing to Ukraine. He said that as Ukrainian forces take or retake territory, they will also need to sustain those gains and deter Russia from regaining any footholds.

During a visit to a tank plant in Lima, Ohio, in February, Army Secretary Christine Wormuth met with officials there at length to determine the best options for getting the tanks to Ukraine.

“Part of it is figuring out — among the different options — what’s the best one that can allow us to get the Ukrainians tanks in as timely a fashion as we can,” without disrupting foreign military sales, Wormuth said at the time.

Officials at the plant, which is owned by the Army and operated by Reston, Virginia-based General Dynamics, said production totals can vary, based on contract demands. And while they are currently building 15-20 armored vehicles per month, including tanks, they can easily boost that to 33 a month and could add another shift of workers and build even more if needed.

Development of tanks for Ukraine would have to be squeezed in between the current contracts for foreign sales, which include 250 of the newest versions for Poland and about 75 for Australia. During Wormuth’s tour of the plant, workers were preparing to build an updated version of the vehicle for Poland.

Ukrainian leaders have persistently pressed for the Abrams, which first deployed to war in 1991 and has thick armor, a 120 mm main gun, armor-piercing capabilities and advanced targeting systems. It runs on thick tracked wheels and has a 1,500-horsepower turbine engine with a top speed of about 42 miles per hour (68 kilometers per hour).

Judge in Fox News, Dominion Case Says Network’s Legal Woes Mostly the Fault of One ‘Problem’ Host

The Wrap

Judge in Fox News, Dominion Case Says Network’s Legal Woes Mostly the Fault of One ‘Problem’ Host

Josh Dickey – March 21, 2023

In what’s playing out like an extended preview to the $1.6 billion First Amendment prize fight between Dominion Voting Systems and Fox News, both sides threw opening punches Tuesday in a Delaware court, where a judge is hearing summary arguments and other matters ahead of next month’s scheduled trial.

Dominion Voting systems opened this round, arguing before Judge Eric Davis that Fox News made a “household name” out of Sidney Powell, let hosts “run wild” and developed what the judge called a “Lou Dobbs problem.” Fox countered in the afternoon, arguing that a “reasonable” viewer could easily discern that the network was reporting on allegations and newsmakers’ theories.

Both sides have asked Davis to rule summarily in their favor, a routine stop for any civil trial that rarely works. But Fox and Dominion each put significant resources into their summary arguments and supporting documents, which have been widely picked over and scrutinized.

By the time the lawyers assembled Tuesday for their first live arguments before Davis, many details had already become familiar, as each side released troves of sworn deposition testimony, text messages, emails and other discovery-phase records this month – most of them rather embarrassing to Fox News. Davis was not expected to rule on the motions for summary judgment during the pre-trial hearing spanning Tuesday and Wednesday.

Also Read:
Even Rupert Murdoch Admits It: Fox News Hosts ‘Endorsed’ a Stolen-Election Narrative They Knew Was a Lie

However, Davis could rule this week on whether certain redacted material in those evidentiary depositions should be revealed, which could bring another wave (or trickle) of bombshell revelations. Those arguments and other minor pretrial matters were expected to be resolved before the April 17 start date.

Dominion is asking for $1.6 billion in damages – significant, but not a potential death-blow for the crown jewel of Rupert Murdoch’s media empire – for what it says are defamatory statements about its voting machines in multiple reports, guest segments and host commentary immediately following the 2020 election. Defamation cases hinge on “actual malice,” proof that the defendant intended harm – and Dominion has been pushing hard on that front in it pretrial efforts.

Fox has maintained it was merely doing the news, and was protected by its framing of even the wildest election conspiracy theories as allegations and speculation. Fox’s lawyers also argued Tuesday that there were, and still are, legitimate questions about security around Dominion machines.

Dominion’s receipts include 20 on-air instances of what it says are defamation – a notable number of them featuring Lou Dobbs. “Lou Dobbs Tonight” was an engine of the stolen-election narrative, and though Dobbs was fired abruptly after Joe Biden’s win was certified, depositions revealed that Fox brass had been looking to move him out up to a year before.

“This seems to be a Lou Dobbs problem,” Davis commented as Fox attorneys were going through the instances one by one.

The pre-trial hearing was expected to resume Wednesday.

Exercise therapy is safe, may improve quality of life for many people with heart failure

New Media Wire

Exercise therapy is safe, may improve quality of life for many people with heart failure

NewMediaWire – March 21, 2023

Statement Highlights:

  • A new scientific statement indicates supervised exercise therapy may help improve symptoms for people with one of the most common types of heart failure, known as heart failure with preserved ejection fraction (HFpEF), in which the heart muscle’s pumping strength is intact.
  • Exercise therapy had comparable or better results on improving exercise capacity for people with preserved EF compared to those who have heart failure with reduced EF.
  • The statement advises that Medicare and health insurers expand coverage of cardiac rehabilitation to include people with heart failure with preserved ejection fraction.

DALLAS and WASHINGTON D. C. For many people who have heart failure, supervised exercise training is safe and may offer substantial improvement in exercise capacity and quality of life, even more than medications, according to a new, joint scientific statement from the American Heart Association and the American College of Cardiology. The statement is published today in both the American Heart Association’s flagship journal Circulation and in the Journal of the American College of Cardiology.

Heart failure is a progressive condition in which the heart is unable to pump enough blood to the body either due to the heart muscle stiffening or from it losing pumping strength. Treatments are focused on reducing symptoms, such as shortness of breath and fatigue, and minimizing or delaying the consequences of the condition, which includes decreased quality of life; frequent hospitalizations; loss of functional independence; high health care costs; and increased risk of death.

The statement is a review of the latest evidence-based research to better understand the potential impact of supervised exercise therapy for the more than three million people in the U.S. living with chronic, stable heart failure with preserved ejection fraction or HFpEF. This condition occurs when the heart is stiff and does not relax normally to fill with enough blood to pump to the body, yet the heart muscle is still strong enough to pump well. In comparison, heart failure with reduced ejection fraction occurs when the left ventricle can’t pump with the force needed to push enough blood into circulation. In the U.S., heart failure with preserved ejection fraction is one of the most common forms of heart failure, with women disproportionately affected compared to men, according to the scientific statement.

“The prevalence of heart failure with preserved ejection fraction continues to increase due to aging of the population and the growing prevalence of risk factors such as obesity and Type 2 diabetes,” said Vandana Sachdev, M.D., chair of the scientific statement writing committee. “Improved management of this large population of patients who have HFpEF, many of whom may be undertreated, represents an urgent unmet need.”

Sachdev is a senior research clinician and the director of the Echocardiography Laboratory in the Division of Intramural Research at the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health, as well as the scientific lead for the new NHLBI heart failure program HeartShare.

In April 2022, recommendations were released by the American Heart Association and the American College of Cardiology for supervised exercise training for people with heart failure, regardless of the type. Sachdev clarified that, currently, Medicare only reimburses cardiac rehabilitation for people with heart failure with reduced ejection fraction (HFrEF).

“Exercising helps improve the heart’s pumping ability, decreases blood vessel stiffness and improves the function and energy capacity of skeletal muscle,” Sachdev said. “Exercise capacity is an independent, clinically meaningful patient outcome, and research has indicated that guided exercise therapy is actually more effective at improving quality of life for people who have HFpEF than most medications.”

Members of the writing committee critically examined research published since 2010 to assess the most current data on the impact of exercise-based therapies for HFpEF.

The studies evaluated various types of exercise, including walking, stationary cycling, high-intensity interval training, strength training and dancing in both facility settings and home-based training. Supervised exercise therapy generally occurred three times per week for each of the studies, and the duration of the programs varied from one month to eight months.

In the studies, researchers measured peak oxygen uptake, which is a way to assess exercise capacity by measuring the total amount of oxygen a person can breathe into the lungs during physical exertion. For people living with HFpEF, their peak oxygen uptake is often about 30% lower than that of a healthy person and considered below the threshold required for functional independence (and performing normal daily living activities such as carrying groceries).

The statement writing committee determined that supervised exercise training may lead to:

  • Increased peak oxygen uptake 12-14% an increase of more than 6-7%, is considered clinically meaningful.
  • Increased total exercise time by 21% a 10% increase is considered clinically meaningful.
  • Improved quality-of-life scores on the Minnesota Living with Heart Failure questionnaire by 49 points. The questionnaire has 21 items, each scored on a 0-5 scale. Total score is derived from adding the scores from each item.

The statement acknowledges there were variations in the baseline characteristics of people in the trials reviewed. Some of the studies excluded patients with some co-existing health conditions, and many groups of people in whom heart failure is prevalent including older adults, women, persons with low socioeconomic status and people from diverse racial and ethnic groups were under-represented in some research. Additionally, many of the studies were smaller, single-center studies, and most were relatively short term, so there isn’t enough information to assess long-term adherence, which the committee suggests should be addressed in future research.

“Overall, we did find that in people with chronic, stable heart failure and preserved ejection fraction, supervised exercise training is safe and provides substantial improvements in exercise capacity and quality of life,” Sachdev added. “Future work is needed to improve referral of appropriate patients to supervised exercise programs, and better strategies to improve long-term adherence to exercise training is needed. Hybrid programs combining supervised and home-based training may also be beneficial. Further, implementation efforts will need to include coverage by Medicare and other insurers.”

This scientific statement was prepared by a volunteer writing group on behalf of the American Heart Association and the American College of Cardiology. It is endorsed by the Heart Failure Society of America; the American Association of Cardiovascular and Pulmonary Rehabilitation; and the American Association of Heart Failure Nurses.

American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Kavita Sharma, M.D.; Steven J. Keteyian, Ph.D.; Charina F. Alcain, D.N.P., A.C.N.P.-B.C.; Patrice Desvigne-Nickens, M.D.; Jerome L. Fleg, M.D., FAHA; Viorel G. Florea, M.D., Ph.D.; Barry A. Franklin, Ph.D., FAHA; Maya Guglin, M.D., Ph.D.; Martin Halle, M.D.; Eric S. Leifer, Ph.D.; Gurusher Panjrath, M.D., FAHA; Emily A. Tinsley, Ph.D.; Renee P. Wong, Ph.D.; and Dalane W. Kitzman, M.D. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

The content of this press release and the associated manuscript is solely the responsibility of the authors and does not necessarily reflect the official views of the National Heart, Lung, and Blood Institute, National Institutes of Health or the U.S. Department of Health and Human Services.

Vladimir Putin’s health may be disintegrating and it should terrify us all

The Telegraph

Vladimir Putin’s health may be disintegrating and it should terrify us all

Colonel Richard Kemp – March 21, 2023

Russian President Vladimir Putin listens to Chinese President Xi Jinping during their meeting at the Kremlin in Moscow, Russia
Russian President Vladimir Putin listens to Chinese President Xi Jinping during their meeting at the Kremlin in Moscow, Russia

Images of Putin gripping his chair and squirming next to President Xi in Moscow have again fuelled speculation about his health. He was filmed limping during a visit to Crimea a few days ago and during a February meeting with Belarus leader Alexander Lukashenko his leg was shaking uncontrollably. Since Putin invaded Ukraine last year, rumours of his physical well-being have been rife, with a range of theories from cancer to Parkinson’s.

This may amount to little more than wishful thinking that the man whose actions have led directly to the deaths of tens of thousands may be falling apart, and CIA Director William Burns said last year: “As far as we can tell, he’s entirely too healthy”.

But if we imagine, for a moment, that he is suffering from some serious affliction, then that would have big ramifications. For one, the immense stress that must press upon him could rapidly exacerbate his illness and directly affect his mental processes and judgement. Even if Burns is right, the demands of running a country in any circumstances are huge, and we’ve all seen the way many national leaders appear to age prematurely over their time in office.

The pressure cooker inside 70-year-old Putin’s head must sometimes reach bursting point after leading Russia for a quarter of a century, presiding over a war which has been going catastrophically wrong for the last year. Such a crushing burden would be tough enough for the leader of a democracy, but as ruler of the Russian autocracy Putin is well aware that his end could come in a violent death. Short of that, he will also know that he could face jail time following the arrest warrant for war crimes issued last week by the ICC. If he is deposed, it is possible a new regime in Moscow might hand him over as happened to Slobodan Milosevic in 2021.

All this will be playing on Putin’s mind, although his troubles could have been eased by a lifeline from Xi during his visit, perhaps with promises of money, weapons and sanctions busting. That will have been his hope, but it might also have gone the other way depending on Xi’s calculations of where his interests lie. China stands to gain from this war, whichever side prevails.

Whatever the truth about Putin’s state of mind, we should be prepared for him to behave with growing irrationality unless he is able to dramatically improve his fortunes on the battlefield. That is far from certain, with Kyiv reportedly gearing up for a major offensive next month.

Those around him know far better than we do about Putin’s mental state and if they perceive a dangerous deterioration, or if he becomes physically or mentally incapable, it’s possible they could seek to bring him down. That is a more likely scenario than the much-discussed possibility of a coup inspired by disaffection over the way he is running the war. Any attempt to depose Putin, especially if he resists as is likely, could lead to a violent power struggle, instability and chaos across the country and potentially even civil war with untold consequences for Russia and the world.

Another possible impact of a Putin breakdown may be even more apocalyptic. His sabre-rattling over nuclear weapons earlier in the conflict was an attempt to cow the West. But those who argue that he will never use battlefield or strategic nuclear weapons based on the logic that it could lead to retaliation that will do much greater damage to Russia than Ukraine or the West should remember we could be dealing with a man fighting for his life and increasingly devoid of logical thinking.

While the circumstances today are different, it’s worth remembering that Hitler, who had become increasingly deranged as he contemplated the collapse of his Reich, ordered the destruction of all economic, industrial, transport, military and communication facilities in Germany. As Hitler’s diabolical orders were refused, we must hope that those in Putin’s nuclear chain of command would also refuse to press the button if they were told to do so.

Hope, though, is not a strategy and as we seem to be witnessing a deterioration in Putin’s condition, it becomes increasingly urgent that Western leaders prepare for the possible consequences. Much of the burden for that falls on US and British intelligence agencies, who will already have been doing what they can to covertly influence Putin’s key nuclear players and preparing – as far as possible – to shape events in the wake of a collapse in the Kremlin, including early engagement with whatever regime emerges. That will involve a race with Beijing’s Ministry of State Security.

Woke up, Republicans! How the GOP misses the point of UN’s climate change report

Sacramento Bee – Opinion

Woke up, Republicans! How the GOP misses the point of UN’s climate change report | Opinion

Jack Ohman – March 21, 2023

The latest U.N. climate change report comes out, and the GOP’s latest metaphor rolls out, again.

Said the United Nations chief in reaction to the report: “Our world needs climate action on all fronts — everything, everywhere, all at once.” The UN chief is calling on every country and every sector to massively fast-track efforts to tackle the climate crisis.

Meanwhile, Republican congressional members keep pushing for more fossil fuel exploration and look to undo actions Democrats have taken to confront global warming.

More from The Bee’s Opinion Team:

Kremlin Caught Stealth Editing Awkward Putin Video

Daily Beast

Kremlin Caught Stealth Editing Awkward Putin Video

Allison Quinn – March 21, 2023

Kremlin.ru/Handout via Reuters
Kremlin.ru/Handout via Reuters

The Kremlin has shifted to damage control mode after Vladimir Putin’s latest PR stunt was derailed by a public show of disgust for him.

The Russian leader made a show of his alleged visit to Ukraine’s Mariupol over the weekend, in which people identified by the Kremlin as local residents treated him as their savior, thanking him for Russia’s “help” and calling their new home a “little piece of heaven.”

In a brief part of the video that had apparently been overlooked by Putin’s team, however, a woman was heard shouting, “It’s all untrue, it’s all for show!” just as the Russian leader began reading his lines. Deputy Prime Minister Marat Khusnullin could be seen grinning uncomfortably as Putin’s security team set off to track down the lone protester.

Two days after the off-script comments were noticed in the video released by the Kremlin, that version was replaced on the official Kremlin website with a version in which the party crasher had been edited out, the independent outlet Mozhem Obyasnit noted Tuesday.

Putin’s alleged visit to the city—his first trip to Ukrainian territory since the start of his war—was the closest to the frontline he’d ever set foot. And despite the glowing testimonials from supposed local residents broadcast by Russian state television, many locals apparently saw right through the propaganda.

“Nobody fucking needs us here. Everything is done for a picture on TV, so that people in Russia will watch,” one resident wrote in a Telegram channel devoted to local news.

Others questioned why Putin didn’t visit the parts of the city decimated by his own military.

“And why take him there, he was only taken to places that were preserved and new buildings. Nobody will show him the empty pits under the foundations of destroyed houses.”

Anton Gerashchenko, a senior adviser to the Ukrainian government, seemed to suggest on Monday that Putin may have sent a body double to Mariupol.

Trump’s Arrest for Stormy Case Is ‘Beginning of the Fall’

Daily Beast

Trump’s Arrest for Stormy Case Is ‘Beginning of the Fall’

The Daily Beast – March 21, 2023

Photo Illustration by Thomas Levinson/The Daily Beast/Reuters
Photo Illustration by Thomas Levinson/The Daily Beast/Reuters

Donald Trump’s arrest seems imminent if the number of capitalized words in his Truth Social posts is some kind of metric, but there are still questions left unanswered.

Questions like: Why is Manhattan District Attorney Alvin Bragg’s indictment relating to Stormy Daniels likely to be the first for the former president and not one related to Jan. 6? Is House Speaker Kevin McCarthy in love with Trump or afraid of him? And, this big one: Will we see Trump do a perp walk?

Starting with the perp walk question, The New Abnormal political podcast co-host Andy Levy shares why he isn’t so hopeful with co-host Danielle Moodie on this all-Trump episode.

“I’ve seen supposedly serious people make this comment that we need to be worried about them charging Trump, because it may lead to riots in the streets. You already did that, first of all, [and] no, you don’t get a heckler’s veto if you break the law. If you break the law, you break the law,” says Andy. “That stuff cannot factor into charging someone, [but], it can factor into how you arrest them.”

“Trump was tweeting in all-caps about that they were debating whether to have him do a perp walk in handcuffs. That’s never gonna happen. We are never gonna see that, honestly, as much as I would enjoy it. We don’t really need that,” he adds, to Danielle’s dismay.

“I kind of do,” she jokes.

Then MSNBC legal analyst Katie Phang joins the show and gives Danielle insight into the “why this case?” question. According to Phang, a Trump indictment for something a while ago and not Jan. 6-related is still important.

“We need to appreciate the prosecution of the former President of the United States. Even if it’s for jaywalking. Why? Because you and I would be prosecuted for that crime.

The Truth About Those ‘Classified’ Biden and Trump Docs

“And so I am glad that even though this is an ‘old event,’ the payoff to Stormy Daniels to keep her quiet, to influence the outcome of the 2016 election may have been years ago, you know, damn it. I am glad. If he’s kicking his dog, he should be arrested and prosecuted. I believe this is the beginning of the fall of dominoes.”

Plus, Phang shares the indictment that she thinks will really “break the dam.”

Then, Jeff Sharlet, author of The Undertow: Scenes from a Slow Civil War, tells Andy what he learned while writing about the post-Trump world—like how right-wing grandmas have nasty things to say about Hillary Clinton—and why he doesn’t actually care about Trump like other Trump-era writers.

Ukrainians are riding tanks captured from an elite Russian unit into battle in Bakhmut, but their new gear may not last long

Business Insider

Ukrainians are riding tanks captured from an elite Russian unit into battle in Bakhmut, but their new gear may not last long

Michael Peck – March 21, 2023

Ukranian forces fire at Russian positions using a captured T-80 tank.
Ukrainian troops fire a captured Russian T-80 tank at Russian positions in the Donetsk region on November 22.AP Photo/LIBKOS
  • Ukrainian troops have repurposed an array of gear that Russian forces have left on the battlefield.
  • That includes T-80 tanks captured from the 1st Guards Tank Army, an elite Russian armored unit.
  • But Russian tanks are designed for Russian forces, and Ukraine might get limited use out of them.

There is poetic justice in the idea that a country under attack is using its adversary’s weapons against it.

No wonder Western observers have been thrilled by reports of Ukrainian forces capturing hundreds of Russian tanks and turning them against the invaders. No doubt Western governments were happy, too; the more weapons Ukraine captures for itself, the fewer Western countries may have to send from their own stocks.

Michael Kofman, the director of the Russia Studies Program at CNA, said that the gear Ukraine is repurposing includes tanks that were captured from Russia’s elite 1st Guards Tank Army and sent back into Bakhmut, the site of Ukraine and Russia’s deadliest fighting.

Kofman spoke at a March 13 event hosted by the Carnegie Endowment and described a recent trip to Bakhmut, where he said that he saw “a reinforcing tank platoon coming in from the Ukrainian side which was entirely made up of Russian T-80s that they had captured from 1st Guards Tank Army at Izyum.”

Russian soldiers sitting on a T-80 tank heading towards the Azovstal plant in Ukraine.
Russian soldiers on a T-80 tank heading toward the Azovstal plant in Mariupol on April 16, 2022.Maximilian Clarke/SOPA Images/LightRocket via Getty Images

“They were very easily identifiable,” Kofman added. “You can see an entire unit composed of nothing but captured Russian tanks.”

That the tanks were trophies from a 1st Guards Tank Army defeat must be particularly galling to Moscow. The unit earned fame as a Red Army formation from World War II. It was deactivated in 1998 but reactivated with great fanfare in 2014 as an elite, well-equipped force that became the Russian army’s prime ground maneuver unit.

The 1st Guard Tank Army took heavy losses in several battles around Kyiv and Kharkiv when it was deployed in Ukraine — and eventually had to be withdrawn for refitting.

Russian troops have been quite generous with their equipment, leaving an array of hardware, some of it undamaged, for Ukrainian forces to capture.

Living off captured hardware may work for insurgents, but it doesn’t work for armies that need advanced weapons for protracted operations, and Ukraine now faces the question of how long these vehicles will be in fighting condition.

Ukrainian mechanics working on the turret of a T-80 tank in Kharkiv
Workers upgrade a T-80 tank at the Malyshev Tank Factory in Kharkiv in July 2015.SERGEY BOBOK/AFP via Getty Images

While Ukrainian mechanics have worked wonders to restore captured Russian equipment — aided by the fact that most of Ukraine’s pre-war arsenal was based on Soviet-era designs — sustained operations with Russian tanks will require a stream of parts from Russian factories.

“They don’t have the parts that keep a lot of these running,” Kofman said. “So on paper you may capture a lot of vehicles, but you don’t have the engines, you don’t have the transmissions, you don’t have the parts to keep them going.”

While Ukraine needs tanks and will get use out of them, Kofman said that ammunition and other spare parts are higher priorities: “First and foremost, it’s artillery ammunition and replacement of artillery barrels. Alongside air-defense ammunition — that’s missiles and what have you, and air-defense systems.”

Kofman said that he believes Ukraine doesn’t need tanks as much as it needs armored vehicles to carry infantry into battle.

“Ukraine has very large brigades of mechanized infantry, but to be mechanized, they actually need to be riding on something. Otherwise, Ukraine has a lot of manpower, not a lot of mobility,” Kofman said at the Carnegie event.

Ukrainian soldiers stand next to a damaged tank in Izyum
Ukrainian soldiers with a damaged tank after the Russian withdrawal from Izyum in September.Metin Aktas/Anadolu Agency via Getty Images

A similar situation played out in World War II; one reason German-panzer divisions were so formidable early in the conflict was that they were the first to carry infantry in armored half-tracks — rather than in soft-skinned trucks — so that infantry could safely keep up with the tanks.

Large numbers of immobile Ukrainian infantry “might work for a defense-in-depth strategy and that might work for holding Bakhmut,” Kofman said, “but it’s not going to work if you want to go on the offensive.”

Kofman said that Ukraine still needs Western tanks, which have a more reliable supply of spare parts and ammunition. However, these tanks — including the older Abrams tanks the US has agreed to send — need to be refurbished and could take months to arrive.

Political and public attention is focused on tanks — as well as fighter jets — for reasons that are as much symbolic as strategic, but discussions that are “overly centered” on tanks risk neglecting other crucial factors, Kofman said.

Such discussions often don’t touch on “important things like force quality and training, expanding that, scaling it up, and dealing with the real challenges in the Ukraine force — things like communication systems, distribution of intelligence, surveillance assets, and intelligence,” Kofman said. “A lot of other things have been very significant in this war but are less spoken of.”

Michael Peck is a defense writer whose work has appeared in Forbes, Defense News, Foreign Policy magazine, and other publications. He holds a master’s in political science.