Donald Trump: 2018 Physical Examination


diet
 
Trump is partial to fast food and Diet Coke, as these quoted excepts show:
  • From 1:
    A recent book by former campaign manager Corey Lewandowski and former aide David Bossie, Let Trump Be Trump 2, said the presidential candidate would often eat one McDonald's meal a day consisting of two Big Macs, two Filet-O-Fish sandwiches and a chocolate shake -- a menu that would total at least 2,400 calories and more than 3,400 milligrams of sodium.
  • From 3, referencing the same book:
    Trump's fast-food diet is a theme. "On Trump Force One there were four major food groups: McDonald's, Kentucky Fried Chicken, pizza and Diet Coke," the authors write. The plane's cupboards were stacked with Vienna Fingers, potato chips, pretzels and many packages of Oreos because Trump, a renowned germaphobe, would not eat from a previously opened package. The book notes that "the orchestrating and timing of Mr. Trump's meals was as important as any other aspect of his march to the presidency," and it describes the elaborate efforts that Lewandowski and other top aides went through to carefully time their delivery of hot fast food to Trump's plane as he was departing his rallies.
  • Despite having tweeted in 2012 "I have never seen a thin person drinking Diet Coke" 4 and calling the beverage "garbage" 5, Trump drinks a dozen of them each day 6. By pressing a button on his Oval Office desk, he summons a White House butler to bring him one 7. In 2011 said that he likes a "little caffeine" and that, while he likes tomato juice and orange juice, "Coke or Pepsi boosts you up a little" 8.
    Comment: This is a considerable caffeine intake. It is safe to say that Trump has a physical addiction to the substance, i.e. would suffer withdrawal symptoms if the substance were withdrawn. One would also not be surprised if the underlying drive to consume that much caffeine arose from a need to counteract daytime somnolence, given that Trump (a) does not sleep much, and (b) by virtue of his obesity is at elevated risk for obstructive sleep apnea, which is a cause of daytime somnolence. (And in a vicious cycle, the caffeine may of course prevent him from sleeping more.)
Beyond fast food, "Mr. Trump has always relished gossiping over plates of well-done steak, salad slathered with Roquefort dressing and bacon crumbles, tureens of gravy and massive slices of dessert with extra ice cream" 6.

At Trump's first presidential physical (2018), his physician prescribed a change in diet SEE BELOW. Trump was non-compliant 9. Comment: The fundamental mistake of aging is to presume (or hope) that the body can tolerate in later life what it could tolerate with impunity earlier in life, or that the future is even as predictable later as it is earlier 10. Trump is making precisely this mistake, perhaps misled by the longevity of his parents, who did not pursue the same physiological path as him. Bacchus has already started sending in his bills, which will inevitably become due in full.



circus-like physicals
 
For physical exams while he was a private citizen, Trump said, "Well, I try and do it every year" 11. His long-time personal physician has written: "He has had an annual physical exam in the spring of every year" 12.

As a candidate, Trump issued three statements about his medical health:

  • 2015: (December)   MORE 13 (Physician statement #1)
  • 2016: (September)  MORE 12 (Physician statement #2)
  • 2016: (September)  MORE 11 (Interviews: Dr. Oz, Fox)
Since taking office, Trump has had more-or-less yearly physical examinations at Walter Reed National Military Medical Center:
  • 2017: (January)  Takes office.
  • 2018: (January)  SEE BELOW 14 Press briefing: MORE 15
  • 2019: (February) MORE 9
  • 2019: (November) MORE 16
The main medical results from these evaluations are tabulated elsewhere MORE, and are discussed in various pages.

Comment: Incredibly, these physical examinations, which one would expect to be routine, staid affairs, took on circus-like characteristics:

  • The 2015 report had ridiculous, unprofessional hyperbole that made Trump's physician a national laughingstock. It later emerged that Trump wrote this report himself.
  • The 2018 report was delivered during a press conference in which the President's physician made good-humored and properly caveated remarks that commentators unfairly inflated to ridiculousness.
  • The first 2019 report, though more subdued (and, sadly, far less complete), still contained unsupportable prognostications from the new presidential physician.
  • The second 2019 report, for Trump's "interim checkup" if that's what it really was, is a shambles. Subtexts of the nonsensical statements from the White House and the President's physician strongly suggest it was not a routine examination at all, but a hurried, abrupt consultation at Walter Reed for undisclosed medical reasons.

Hence, three times in two years confidence in the office of the President's physician was undermined -- a low ebb in its history. Even with a perhaps unwarranted acceptance that the President's medical team has been completely and honestly forthcoming, all this sturm und drang is itself dangerous, as it can easily detract from substantive medical issues -- as it already seems to have done with Trump's sleep.


More...
A day after Trump "heavily slurred his words" during a speech in early December 2017, the White House announced that a physical exam was planned, saying that the exam had been in the works before the slurring incident 1.

This is the publicly-released report of President Trump's physical examination of January 12, 2018.

Comment:

With its depth and breadth, this is really quite an extraordinary document, with kudos to Dr. Jackson. His general openness and honesty is much better appreciated from reading the long press briefing he gave at the time of the report's release MORE.

There are, however, multiple identifiable instances where the truth has been stretched, omitted, or garbled:

  • The President's height was exaggerated.
  • The "stamina" discussion (in the press briefing) omits Trump's admitted exhaustion in May 2017.
  • The abdominal exam was described as "normal" but of course the exam was abnormal for obesity.
  • Only one visual acuity reading is provided, and it is not stated whether it is for near-vision or distance-vision. Presumably it is distance-vision and the much worse near-vision acuity was deliberately suppressed.
  • Coronary calcium scores were omitted from the report but disclosed in response to a press question. The physician stumblingly appeared to say that he thought the scores were not significant, but of course they are.
While minor in themselves, these issues are a reminder that, without defined standards for the Presidential medical examination, the public will never truly know the President's state because it is just so simple to tailor the message as desired, by omitting information. Here we see a clear bias toward suppressing data showing even a hint of abnormality.

The other major fault is the lack of formal sleep assessment -- a pretty large lacuna.

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Cited Sources
  1. Johnson, Jenna; Bernstein, Lenny. Trump's first official physical exam could provide new clues about his health. Washington Post. January 12, 2018.   Available on the web at: https://www.washingtonpost.com/politics/trumps-first-official-physical-exam-could-provide-new-clues-about-his-health/2018/01/11/81924536-f640-11e7-beb6-c8d48830c54d_story.html
  2. Lewandowski, Corey R.; Bossie, David N. Let Trump Be Trump: The Inside Story of His Rise to the Presidency. Nashville: Center Street, 2019 (2nd ed.) [1st ed. 2017].
        
  3. Kranish, Michael. Trump's campaign: Big Macs, screaming fits and constant rivalries. (Published 2 Dec. 2017. Downloaded on 2019-12-20.) Available on the web: https://www.washingtonpost.com/politics/trumps-campaign-big-macs-screaming-fits-and-constant-rivalries/2017/12/02/18bcfa30-d6bd-11e7-b62d-d9345ced896d_story.html
  4. Trump, Donald J.. [Tweet: I have never seen a thin person drinking Diet Coke.]. (Published October 14, 2012. Downloaded on 2019-12-21.) Available on the web: https://twitter.com/realdonaldtrump/status/257552283850653696
  5. Trump, Donald J.. [Tweet: The Coca Cola company is not happy with me--that's okay, I'll still keep drinking that garbage.]. (Published October 16, 2012. Downloaded on 2019-12-21.) Available on the web: https://twitter.com/realdonaldtrump/status/258262904091058176
  6. Haberman, Maggie; Thrush, Glenn; Baker, Peter. The President's Periodic Physical Exam. (Published Dec. 9, 2017. Downloaded on 2018.) Available on the web: https://www.nytimes.com/2017/12/09/us/politics/donald-trump-president.html
  7. Pace, Julie. Nearing 100 days, Trump says his presidency is "different". (Published April 24, 2017. Downloaded on 2019-12-20.) Available on the web: https://apnews.com/205ad54dc72e4ab69b3a214c96eeb9ce/trumps-100-days-rattled-establishment-some-surprises
  8. Hedegaard, Erik. Donald Trump Lets His Hair Down. (Published 13 May 2011. Downloaded on 2019-12-24.) Available on the web: https://www.rollingstone.com/movies/movie-news/donald-trump-lets-his-hair-down-247616/
  9. Conley, Sean (D.O.). The President's Second Periodic Physical Exam. (Published February 14, 2019. Downloaded on 2019-11-25.) Available on the web: https://www.whitehouse.gov/briefings-statements/memorandum-physician-president-2/
        

    Comment: The document is archived here -->   MORE

  10. Bernstein, Lenny. Age injects unpredictability into Trump's tenure. Washington Post. 20 Jan. 2017.
  11. Cillizza, Chris; Blake, Aaron. Donald Trump's interview with Dr. Oz was just as amazingly strange as we thought it would be. (Published 15 September, 2016. Downloaded on 2019-12-01.) Available on the web: https://www.washingtonpost.com/news/the-fix/wp/2016/09/15/donald-trumps-visit-with-dr-oz-was-just-as-amazing-as-you-though-it-would-be/
        

    Comment: Also includes annotations by Cillizza and Blake. Their interview transcript is archived here: MORE

  12. Bornstein, Harold N. [Public Letter]. (Published 13 Sept. 2016. Downloaded on 2019-11-30.) Available on the web: https://assets.donaldjtrump.com/DJT_Medical_Records_.pdf
        

    Comment: Dr. Bornstein became Trump's physician in 1980. Bornstein's letter is linked to by Frizell (op cit) and is archived here -->   MORE

  13. Bump, Philip. Donald Trump's doctor came down with a case of Trumpitis. (Published 26 Aug. 2016 (revision of original Dec. 2015 story). Downloaded on 2019-11-25.) Available on the web: https://www.washingtonpost.com/news/the-fix/wp/2015/12/14/donald-trumps-doctor-has-come-down-with-a-case-of-trumpitis/
        

    Comment: This articles relates to the first of Dr. Bornstein's letters, reprinted here -->   MORE

  14. Jackson, Ronny L. (M.D.). The President's Periodic Physical Exam. (Published January 16, 2018. Downloaded on 2019-11-21.) Available on the web: https://www.whitehouse.gov/wp-content/uploads/2018/01/Summary-of-Physical-Exam-for-President-Trump-12-Jan-2018.pdf
        

    Comment: The document is archived here -->   MORE. Also highly informative is the press briefing where the report was delivered: MORE.

  15. Sanders, Sarah; Jackson Ronny. Press Briefing by Press Secretary Sarah Sanders and Dr. Ronny Jackson. (Published 16 Jan. 2018. Downloaded on 2019-12-28.) Available on the web: https://www.whitehouse.gov/briefings-statements/press-briefing-by-press-secretary-sarah-sanders-and-dr-ronny-jackson-01162018/
        

    Comment: A transcript of the press briefing is archived here --> MORE

  16. Conley, Sean (D.O.). Interim Check Up. (Published November 18, 2019. Downloaded on 2019-11-21.) Available on the web: XXXXXXXXXXXXXXXXXXXXX
        

    Comment: The document is archived here -->   MORE


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