Monday, January 15, 2018

Trump Said to Be in ‘Excellent Health’ After Annual Physical

President Donald J. Trump has just finished receiving his first physical since he entered the White House in January 2017, and has been declared in excellent health, though details have not yet been released.

At a press briefing immediately after the physical, Navy Rear Adm. Ronny L. Jackson, MD said the exam went very well, according to a statement tweeted by Sarah Sanders, the White House press secretary.

The last health information about Trump was released in September 2016 in the form of a five-paragraph letter from his personal physician, Harold Bornstein, MD.

The president was described as 6’ 3”, 236 pounds, with blood pressure of 116/70, a blood sugar level of 99, and lipid readings within the normal range – with an HDL of 63, LDL of 94, and triglycerides of 61. His coronary artery calcium score was 98, which is defined as mild heart disease, but an electrocardiogram and chest x-ray conducted in April 2016 were normal, Dr. Bornstein said.

The then-candidate’s PSA score was low. His last colonoscopy, in 2013, found no polyps. The one-page letter stated that Trump’s testosterone level – 441.6 – was in the normal range, as were liver and thyroid function tests.

At the time, Dr. Bornstein noted that Trump was taking rosuvastatin (Crestor, AstraZeneca), a low-dose aspirin for heart attack prevention, finasteride (Propecia) to treat male-pattern baldness, and antibiotics for rosacea.

My Take:
Politics aside there are some interesting observations about the 2016 physical report.

At 6’3” and 236 pounds he was obese which is still obvious when you see him on television. More important, he meets the standard for polypharmacy given the number of drugs he is taking. The statins obviously create his “favorable” lipid readings. The low-dose aspirin is of real concern as the medical standard of care calls for daily aspirin to prevent a second heart attack or stroke, not as primary prevention as eluded to above. Either he has already had a heart attack or his physician is not following the standard of care.

Finasteride is used to treat male pattern baldness but it’s primary use is to treat BPH (benign prostatic hypertrophy). It prevents testosterone from converting to dihydrotestosterone, which may account for his low PSA score and adequate testosterone levels.

The calcium score is perhaps the most interesting finding. It is generated from a high-speed CT scan of the heart. This is a great test that can detect heart disease ten years earlier than a cardiac stress test. However, the test is seldom run by physicians and not covered by insurance. The test is under $200 but most cardiologists prefer the $6,000 cardiac work-up.

The Bottom Line:
This is today’s definition of excellent health – an obese man taking four medications with mild heart disease. A tribute to health care in America.

Source: January 12, 2018 Medscape

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