The primary care physician for Pennsylvania’s Democrat nominee for U.S. Senate, Lt. Gov. John Fetterman, said he is ready for “full duty” work in public office following his stroke in May but noted he is still “exhibiting symptoms of auditory processing disorder.”

Dr. Clifford Chen, MD,  Fetterman’s doctor who contributed to his campaign earlier this year, penned a letter for the candidate on October 15 stating he “has no work restrictions and can work full duty in public office.” He also noted that the candidate’s auditory processing disorder (ADP) symptoms persist. 

His speech was normal and he continues to exhibit symptoms of auditory processing disorder which can come across as hearing difficulty,” wrote Chen. “Occasional words he will ‘miss’ which seems like he doesn’t hear the word but it is actually not processed properly.” 

“His hearing of sound such as music is not affected,” Chen added. “His communication is significantly improved compared to his first visit assisted by speech therapy which he has attended on a regular basis since the stroke.”

WebMD notes that those with ADP “have a hard time hearing small sound differences in words.”

“Someone says, ‘Please raise your hand,’ and you hear something like ‘Please haze your plan,'” an example of APD on the website states. A study published by the National Library of Medicine states that “[m]ost adults with auditory processing disorder (APD) often have trouble at work.”

While appearing on MSNBC’s 11th Hour in August, Fetterman’s wife, Gisele, told Stephanie Ruhle, “it’s just basic auditory processing, and there’s [sic] expecting to have full recovery over the next several months.”

Fetterman suffered a severe stroke just days before the Democrat primary in May and, in recent months, he faced mounting pressure from local and national newspapers, including the Washington Post and Pittsburgh Post-Gazette, to debate his Republican opponent, Dr. Mehmet Oz.

Fetterman, who struggled with words at public events since the stroke, finally agreed to a debate that will take place Tuesday night in Harrisburg and will be broadcasted by Nexstar. After Fetterman’s campaign announced it would participate in the debate, Oz’s team reported that the Democrat’s campaign “asked for closed captioning during the debate – for the moderators and for Doctor Oz.”

On Monday, Politico’s Holly Otterbein shared a memo from the Fetterman campaign that seems to taper expectations for the Democrat’s performance Tuesday and get ahead of the narrative.

“This debate is unprecedented – there’s never been a closed-captioned political debate in a high-profile Senate race where one of the candidates is dealing with a lingering auditory processing challenge while recovering from a stroke,” the memo reads in part, adding:

We are prepared for Oz’s allies and right-wing media to circulate malicious viral videos after the debate that try to paint John in a negative light because of awkward pauses, missing some words, and mushing other words together. The captioning process may also lead to time delays and errors in exchanges between moderators and the candidates. In fact, because the captions are going to be typed out by human beings in real time, on live TV, some amount of human error in the transcription is inevitable, which may cause temporary miscommunications at times. It it impossible to control and unavoidable. That’s OK – what matters is that people get to see and hear John’s values. 

In June, Fetterman’s cardiologist asserted that “he should be able to campaign and serve in the U.S. Senate without a problem” if he takes his health seriously and follows doctors’ orders.