PHILADELPHIA — Former President Gerald Ford continued improving from a small stroke, but doctors said Friday that his release from the hospital is being delayed as they try to figure out what's causing his painful and swollen tongue.
Robert Schwartzman, chairman of neurology at Hahnemann University Hospital, where Ford, 87, has been treated since Wednesday morning, said the tongue problems may be the result of trauma such as biting the tongue, an infection, or a tumor.
While Schwartzman had said a tumor was "very unlikely" during a press briefing Thursday, an MRI of Ford's tongue later that day showed an abnormality that "may be a growth" or tumor, he said.
Michael Ezekowitz, who is chairman of medicine for the hospital and has been involved in Ford's care, said the "mass" on the MRI "clearly does not look like a neoplasm" or growth. That possibility, however, can't be "totally excluded" without further tests, he said.
Schwartzman and Carole Thomas, chief of the hospital's stroke program, said evaluation of the tongue will prevent Ford from leaving the hospital until at least Wednesday. Because he may need a biopsy, doctors have kept the former president on heparin, a quick acting, intravenous blood thinner that can be discontinued if a surgical procedure is needed. Before he goes home, he'll switch to Coumadin, an oral blood thinner, that has to be taken for several days before hospital discharge.
Thomas said doctors want Ford to be completely stable from the stroke before attempting further diagnostic procedures, such as a biopsy. Stroke patients are more vulnerable to breathing or neurological problems during surgery or anesthesia.
Schwartzman said Ford's neurological progress was "excellent" and he was almost back to normal.
Thomas said his balance was "not 100 percent but it's very good." He was exercising enthusiastically. "He's outrunning the physical therapists," she said. "They're actually have to hold him back."
Ford's wife, Betty, said in an interview taped Thursday and broadcast yesterday on NBC's "Today" show that doctors have encouraged her husband to resume his swimming, golf and other activities after his release.
"This is a little scary," Betty Ford said in the interview. "The more he knew, I think, the more he realized how serious it could have been. . . . It's given us both a realization of how tenuous our lives together are."
The tongue problems began in Colorado, where the Fords have a home, shortly before the couple left for the Republican convention, a family spokesman said.
Ford, who has a history of sinus problems, went to Hahnemann at 1 a.m. Wednesday complaining of the swollen tongue and facial pain. Doctors diagnosed a sinus infection and sent him back to his hotel.
He returned at 9 a.m., suffering from balance problems, confusion and weakness in his left arm. Schwartzman then diagnosed at least one small stroke in the brain stem. The stroke and tongue problems are unrelated, he said.
Daniel Kelley, director of head and neck oncology and skull base surgery at Temple University Hospital, said a skilled neuroradiologist usually could tell from the MRI whether a tongue abnormality was caused by an infection, injury, growth or cyst.
But it can occasionally be difficult on an MRI to tell the difference between a site that had been bitten repeatedly and a growth, said Randall Weber, professor and vice chairman of otolaryngology, head and neck surgery at Hospital of the University of Pennsylvania. Someone who had suffered a stroke might bite his tongue repeatedly because of loss of control or feeling.
Tongue pain and ear pain caused by a tumor generally comes on slowly, he said, over weeks or months. Swelling, he said, is usually a "pretty advanced presentation."
The treatment for a tongue infection, which might require a biopsy, is antibiotics, Kelley said. A bite on the tongue would simply require time to heal.
A variety of cancers can affect the tongue. Those most likely to cause swelling would be located at the back of the tongue. Prognosis varies depending on the type and size of the cancer, said Kelley, who recently wrote a medical textbook chapter on tongue cancers.
"Cancer of the tongue, although curable, is a serious problem," he said.
Doctors usually treat cancers at the base of the tongue with radiation, with or without chemotherapy, Weber said. The cancers often are advanced when diagnosed and have a high rate of spread to lymph nodes.