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say that Trump has a physical addiction to the substance, i.e. would suffer withdrawal symptoms if the substance were withdrawn.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. Page 1 follows: Page 2 follows: Page 3 follows:

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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⬅ Donald Trump: 2018 Physical Examination