Madonna has a lot of controversy brewing this summer.  So let’s add something else to her pot and mix it up some more…

More pictures after the jump…

Madonna is said to under enormous strain, with rumors circulating about an affair with Alex Rodriguez, a crumbling marriage to Guy Ritchie, rehearsals for a world tour, and they look to have taken a toll.  Click to People Magazine to see her latest picture.

Doesn’t she look awful?  Whether that is surgery or stress, her face looks way different than it did a few weeks ago.  And I don’t care what they say about angles, look at her hands and her arms.  they are way too skinny and bulging for normal.  What do you think?  Are the cheeks from botox?  The arms from too much exercising or weight loss?

Photos: PR Photos