White House Physician, Navy Rear Adm. Dr. Ronny Jackson, performed President Donald Trump’s annual physical last week are released the following results:

From Politico:

President Donald J. Trump has completed his first periodic physical examination as President of the United States. I performed and supervised the examination with appropriate specialty consultations and diagnostic testing. The exam was conducted January 12, 2018 at the Walter Reed National Military Medical Center.

The purpose of this exam was to provide the public with an update of the President’s current health status and to ensure the President continues to enjoy all the benefits of good health. This examination focused on evidence-based health screening and disease prevention.

With President Trump's consent, I release the following health information:

Vital Statistics

Age: 71 years, 7 months

Height: 75 inches

Weight: 239 pounds

Resting heart rate: 68 bpm

Blood pressure: 122/74 mm

Hg Pulse-oximetry: 99% room air

Temperature: 98.4 degrees F

Physical Examination by System (to include studies)

Eyes: Uncorrected visual acuity was 20/30 bilaterally, with corrected visual acuity of 20/20 bilaterally. Visual fields were normal. Fundoscopic exam was normal bilaterally. Intraocular pressures were normal bilaterally. No ocular pathology was discovered.

Head/Ears/Nose/Throat: Normal exam of the head, ears, nose, mouth, and throat.

Dental: Healthy teeth and gums.

Neck: Normal thyroid exam. No noted lymphadenopathy. Auscultation of the carotid arteries normal.

Pulmonary: Lungs clear to auscultation. A screening Low Dose CT of the chest demonstrated no pulmonary pathology.

Cardiac: Heart exam normal. Regular rhythm. No murmurs or other abnormal heart sounds noted. ECG with normal sinus rhythm, rate of 71, normal axis, and no other significant findings. Transthoracic Echocardiogram demonstrated normal LV systolic function, EF 60-65%, normal LV chamber size and wall thickness, no wall motion abnormalities. RV normal, atria grossly normal, all valves normal. Exercise Stress Echocardiogram demonstrated above average exercise capacity based on age and sex, and normal heart rate, blood pressure, and cardiac output response to exercise. No evidence of ischemia noted and wall motion was normal in all images.

Gastrointestinal: Normal exam. No masses, hepatomegaly or splenomegaly noted. Normal optical colonoscopy with no polyps or abnormal findings completed June 2013. Repeat colonoscopy not indicated and was deferred until next periodic physical exam.

Genitourinary: Normal exam.

Extremities/Musculoskeletal: Normal throughout. Full range of motion in all joints. Strong distal pulses and good capillary refill in all extremities. No swelling or edema noted.

Neurological: Examination of cranial nerves, cerebellar function, deep tendon reflexes, motor function, and sensory system all normal. Cognitive Screening Exam using the Montreal Cognitive Assessment was normal with a score of 30/30.

Dermatologic: Normal exam. No evidence of melanoma , basal cell carcinoma, squamous cell carcinoma, or any other significant dermatologic disease.

Laboratory Results

Lipid Panel:

Total cholesterol: 223 (mg/dL)

Triglycerides: 129 (mg/dL)

HDL cholesterol: 67 (mg/dL)

LDL cholesterol: 143 (mg/dL)

Cholesterol to HDL ratio: 3.3\

Complete Blood Count:

WBC: 5.5 (K/UL)

HGB: 16.1 (g/dL)

HCT: 48.7 (%)

PLT: 241 (K/UL)

Extended Metabolic Panel:

Fasting Blood Glucose: 89 (mg/dL)

BUN: 19.0 (mg/dL)

CREAT: 0.98 (mg/dL)

ALT: 27 (U/L)

AST: 19 (U/L)

Hemoglobin AlC: 5.0 (%)

Vitamin D: 20.0 (ng/ml)

PSA: 0.12 (ng/ml)

TSH: 1.76 (ulU/ml)

Urinalysis:

Appearance: Clear

Protein: Negative

Ketones: Negative

Glucose: Negative

Blood: Negative

Past Medical History

• Hypercholesterolemia

• Rosacea

Past Surgical History

Appendectomy (age 11)

Social History

• No past or present use of alcohol.

• No past or present use of tobacco.

Medications

Rosuvastatin (Crestor), 10 mg daily to lower cholesterol.

Acetylsalicylic Acid (Aspirin), 81mg daily for cardiac health.

Finasteride (Propecia), 1 mg daily for prevention of male pattern hair loss.

Ivermectin Cream (Soolantra), As needed for treatment of Rosacea

Multivitamin (Centrum Silver), Daily for overall health maintenance.

Immunizations

  • • Prevnar 13 (to prevent pneumococcal pneumonia) and Twinrix (to prevent hepatitis A/B) given.
  • • Routine vaccinations, to include seasonal influenza, all up to date.
  • • All indicated travel vaccinations up to date.

Summary

The President’s overall health is excellent. His cardiac performance during his physical exam was very good. He continues to enjoy the significant long term cardiac and overall health benefits that come from a lifetime of abstinence from tobacco and alcohol. We discussed diet, exercise and weight loss. He would benefit from a diet that is lower in fat and carbohydrates and from a routine exercise regimen. He has a history of elevated cholesterol and is currently on a low dose of Rosuvastatin. In order to further reduce his cholesterol level and further decrease his cardiac risk, we will increase the dose of this particular medication. The President is currently up to date on all recommended preventive medicine screening tests and exams.

All clinical data indicates that the President is currently very healthy and that he will remain so for the duration of his Presidency.

President Trump is in “excellent health.”

 

At the above height and weight, Donald Trump’s BMI is 29.9 placing him in the overweight category just shy of the 30 BMI cut off for obesity.

His blood pressure and heart rate are excellent for his age, especially in the absence of a blood pressure medication.

His pulse oximetry demonstrating the oxygenation of his blood is excellent as well.

An uncorrected vision test of 20/30 means that without glasses, the president has near perfect vision.

A low dose CT of the chest is not routine during annual physicals in non-smokers, but is reassuring that he most likely doesn’t suffer from lung cancer, the number one cancer killer in America.

His EKG, which evaluates electrical abnormalities of the heart secondary to disease or heart attack, confirmed the ideal heart rate.

His echocardiogram, and ultrasound evaluating heart structures and pump activity, demonstrated no heart failure or issues with the filling or pumping of blood, as well as confirming normal anatomy (valves, wall thickness, etc).

A stress test evaluates for cardiac ischemia, or loss of blood flow to heart muscle during rest and exercise, and was normal as well.

A normal colonoscopy in 2013 suggests his next screening colonoscopy wouldn’t be performed until 2023 unless he had pain, rectal bleed, changes in his stool, or any risk factors for colon cancer.

The Montreal Cognitive Assessment was given to evaluate cognitive function and is not routinely done during annual physicals.  This was performed and passed with a 30/30 score.  The test evaluates memory, orientation, visuospatial and executive brain function, recall, concentration and language fluency.  An example is shown here.

His cholesterol is elevated but his good cholesterol is strong and his ratio of cholesterol to HDL is well within goal.

cholesterol-levels-chart

 

The remaining blood tests looked very good, especially his HBA1C and blood glucose evaluating for diabetes.

Of note is his Vitamin D level which appears low-normal and could put him at risk for osteoporosis.  It does not appear a bone density test, Dexa scan, was performed.

A PSA of 0.12 is reassuring as well although is not recommended as a screening test for prostate cancer.

It's been suggested that President Trump loses 10-15 lbs and increases his exercise activity.

My opinion, for a 71-year-old man with high cholesterol, President Trump is way ahead of the curve.  I’m a fan of Crestor, his cholesterol lowering medication, and credit his lipid profile numbers to his use of the statin.  His weight is an issue but I think the White House has a bowling alley, chefs who could make asparagus taste like meat, and secret service who wear fitbits.  I think he’ll be just fine.

This is a developing story.

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Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.  The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

 

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Investigators believe the Las Vegas Route 91 Harvest Concert shooter, Stephen Paddock, suffered from severe mental illness that was never diagnosed. This seems obvious to us, as anyone who would kill 59 innocent people and wound hundreds more could never be of sound mind.

 

However, one would think a person this mentally unstable would leave a pattern of behavior footprints that would have been picked up earlier in his life.

 

Although no motive has been established in the shooting, investigators have interviewed multiple acquaintances who knew the 64-year-old real estate investor and were told he was disconnected, stand-offish, and lacked multiple social interactions. However, he easily flew under the radar as he had a girlfriend, appeared to be close to his mother, and had successful real estate dealings that funded his gambling habits.

 

Most mass shootings are committed not by those who spent time in mental institutions but by those who dined, shopped, and lived near their victims. And many have been under the care of medical providers, being prescribed medications that address psychological symptoms.  So how do mass shooters evade proper diagnosis?

They don’t fit the stereotype

 

To the layman, the average person with severe mental illness appears highly erratic, confused, unpredictable.  To a trained medical professional, the same symptoms would trigger their suspicions as well.

 

But the average killer may be a psychopath, being impulsive, antisocial, and exhibiting violent behavior.  If they don’t act violent or violently impulsive, they can elude the interviewer.

They may hide from the public

 

A mass shooter will plan their attack, may stake out locations, and but will overall remain isolated to avoid arousing suspicions. And a psychopath, may exhibit antisocial behavior.  So as they stay remain isolated and introverted, they allow less opportunity to be “made.”

They fly under the radar

 

As in Stephen Paddock’s case, he flew under the radar as he did not avoid the public.  He would drink, gamble, frequent casinos and appear to be very successful in his business/real estate dealings. With lack of a criminal record and violent interactions, the average person wouldn’t deem him suspicious of committing such a heinous act.

They don’t want to be treated medically

 

Many people with mental illness may have symptoms they wish to control, but will stop short of admitting they have a medical condition that needs treatment.  Those who suffer from delusions or psychosis may believe others are exhibiting the abnormal behavior, so why would they want to undergo treatment themselves?

 

Moreover, if they fear being “turned in” by the medical provider interviewing them and revealing homicidal ideation, they will be less inclined to seek medical help.

They may not have health insurance

 

If an individual with severe mental illness has difficulty maintaining a job, he/she most likely will be without employer-paid health insurance.  This limits access to seeking medical help all the more.

 

The chilling truth is we have killers who live among us who may plot and plan right under our noses.  Let’s pray they leave enough clues that they get caught before they carry out their plans.

 

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 Daliah Wachs is a guest contributor to GCN news. Doctor Wachs is an MD,  FAAFP and a Board Certified Family Physician.    The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.

Published in News & Information