The White House has announced that on Friday, January 12th, Trump.45 will attend a physical examination under the direction of White House physician Admiral Ronny Jackson, a board–certified Emergency Medicine doctor.
From NBC News:
President Donald Trump is getting his first medical checkup since taking office, a head-to-toe exam on Friday as questions swirl about the health and fitness of the oldest person ever elected to the nation’s highest office.
In advance, the 71-year-old president has pushed back vigorously against suggestions he’s mentally unfit, declaring himself “a very stable genius.”
Trump raised concern last month when he slurred some words on national TV. When asked about it, White House press secretary Sarah Huckabee Sanders said questions about Trump’s health were “frankly, pretty ridiculous” and blamed his slurred speech on a dry throat, “nothing more than that.”
More questions have been raised in the weeks since, given the tone of some of his tweets and the reported comments of some of the people who deal with him day to day. Some were recently published in a new book about his first year, which Sanders denounced as “complete fantasy” for its portrayal of Trump as undisciplined, child-like and in over his head.
Trump was 70 when he was inaugurated a year ago to handle the 24/7 demands of being president. Ronald Reagan, who served two terms, was a year younger when he took office in 1981.
Trump took the unusual step of threatening legal action to try to suppress publication of “Fire and Fury: Inside the Trump White House,” by Michael Wolff. He then drew even more attention to the book and the debate about his fitness with weekend tweets stating that his two greatest assets in life “have been mental stability and being, like, really smart.” Trump noted his success in business, reality TV and presidential politics, saying: “I think that would qualify as not smart, but genius … and a very stable genius at that!”
The president is to fly by helicopter Friday afternoon to Walter Reed National Military Medical Center outside Washington in Bethesda, Maryland, for the exam.
There is no requirement for a president to have a physical, but modern officeholders undergo them regularly and release a doctor’s report stating that they are “fit to serve.”
Trump will not undergo a psychiatric exam, the White House said. Officials did not address a different type of screening, assessments of cognitive status that examine neurologic functions including memory. Cognitive assessments aren’t routine in standard physicals, although they recently became covered in Medicare’s annual wellness visits for seniors.
Dr. Ronny L. Jackson, a Navy rear admiral who is the president’s official physician and director of the White House Medical Unit, is coordinating the exam. Jackson provided care for President Barack Obama, conducting and supervising the last of three physicals Obama had during his eight years in office.
How much of Trump’s health information the public gets to see is up to him, but Sanders said she expects him to release the same kind of details as past presidents.
In September 2016, during the presidential campaign, Trump released a five-paragraph letter from Dr. Harold Bornstein, his longtime physician, in which the gastroenterologist concluded that Trump “is in excellent physical health.” A year earlier, Bornstein said in a December 2015 letter: “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.”
The 2016 letter put Trump’s blood pressure and cholesterol measurements in the healthy range, but he does use a cholesterol-lowering statin medication. His EKG, chest X-ray, echocardiogram and blood sugar were normal. The 6-foot-3 Trump weighed 236 pounds, and his body mass index, or BMI, of 29.5 put him in the category of being overweight for his height.
Trump takes Crestor for his cholesterol, a low-dose aspirin for heart attack prevention, Propecia to treat male-pattern baldness and antibiotics for rosacea. The one-page letter stated Trump’s testosterone level, 441.6, was in the normal range, as were his PSA reading for prostate abnormalities and tests of his liver and thyroid.
Congratulations, and none too soon, Mr. President. Trump.45 , as always used to having his own idiosyncratic way, is the only President in modern times to keep his medical history tightly under wraps.
We saw a ridiculous semi-opinion from the Estimable Dr. Bornstein in late 2015, who inherited Trump.45 as a patient from his father’s medical practice in Manhattan. Bornstein’s medical letter of fitness was a model of poor medical presentation and communication, including the statement that Trump.45 , if elected, would be the healthiest President ever.
After Trump.45 secured the Republican nomination in the summer of 2016, and perhaps anticipating his intended attacks thereafter on Hillary Clinton ‘s health status and energy level, including her fainting episode, Trump decided to go big, and dazzled with a live TV appearance on Dr. Oz to have him review a partial letter of physical exam results, to bolster the earlier Bornstein medical opinion with a bare bones medical disclosure.
Trump.45 has since switched doctors to rely on Admiral Jackson as the White House physician, but apparently has not submitted to a full physical examination or medical evaluation until now, another year after his Dr. Oz on air consultation.
We can certainly expect a proper examination by a skilled physician this week, despite the idiosyncrasies of the nation’s First Patient.
Something to Think About
There are those who have raised questions about Trump.45’s present cognitive function most recently, allegations not based on medical exams or testing, but from observations at more or less of a distance. The White House has taken to dismissing such imputations as absurd, disgraceful, fantastical, or worse. Trump.45 is privately said to be sorely aggrieved and claims any concerns are just so much more FAKE NEWS entirely put up by losers and haters.
Motivations aside, the White House and Trump.45 surrogates have not offered any actual clinical evidence to support their non-medical, full medical clearances, except to state in various indignant tones of voice and timber that Trump.45 seems fine, is doing his job as always, works harder than anybody else, that he is a genius, and/or that any derogatory words attributed to his advisors or staffers were false, made up, misunderstood, or misdirected. So there.
The defenders of the President, including the President, may or may not be right. However, mere affirmations, however deeply felt and vividly expressed, do not decide the issue. Reagan said “Trust, but Verify:”
Not bad advice.
Were he not out one-and-only current President, Trump.45 would be entitled to a generous amount of personal privacy with respect to his own medical conditions, illnesses, symptoms, physical and mental fitness condition, or lack thereof.
The problem is that he is not currently a private citizen, On a temporary basis, he is the leader of our entire country, and holds the most powerful political job that American can bestow. The whole nation is entitled to know that his health is being well looked after by competent professionals, and that any illnesses or diseases he may suffer from are being properly treated, so he may fulfill his critical job obligations to the rest of us. We are entitled to rely on his full physical and mental capabilities. If Trump.45 has a treatable medical condition, the nation is entitled to be sure it is being properly addressed.
When Trump.45 is no longer President, he may resume with relish any lifestyle choices he wishes to embrace, and freely take or not take medical advice as he chooses. While he is Commander-in-Chief, there are some limits on his personal freedoms. Just as his personal security is arranged by the Secret Service, and not 100% governed in accord with his personal preferences. Yes, it may be an annoyance, but that is part of the price Trump.45 pays for holding the job he fought so hard for. And there are compensations: Hail to the Chief, instant reservations, the best equipped personal plane in the World, lots of time for golf, etc.
That is why Admiral Jackson’s examination and opinion are important to the entire country, and there will be a summary report to assure the country of Trump.45’s good health and effective management of any health conditions or illnesses requiring it.
Observations Before the Event
Health Observation at a distance is difficult, and suggestions or conclusions should be offered cautiously indeed. But such external comments are not automatically without value or merit wither. In Trump.45 we have the most extensive visual, auditory, and print record of any one ever holding the office of President, staggering in scope and variety.
Partly this is because Trump.45 has been a public figure since at least 1974 (for more than 40 years), with an exceptionally high visibility and media coverage, and deliberate intensive seeking of exposure for his various business ventures, hotels, golf courses, spas, clubs, books, TV appearances, and personal events.
So there is an unparalleled body of background material, millions of pictures, and hundreds of hours of video footage to guide an interested bystander.
Watch the Hands
A classic Trump.45 gesture, seen hundreds of times is his peculiar Thumbs-Up sign. He uses it liberally when meeting world leaders, posing for photographs, attending political rallies, walking towards airplanes, or his private club entrance, or the White House, or pretty much anytime, anywhere a camera is present. Thousands of thumbs up shot have been taken and a large fraction of them have survived, freely available on the internet, even to a casual searcher.
And there is something just a bit off about his gestures. His classic thumbs up shows an abnormal alignment (bent crooked) of his distal thumb joint and a larger than expected swelling at the base. It is present bilaterally. It has been present for some times (at least a couple of years), and may be getting worse over time
Here are some Trump Thumbs Up Shots to illustrate.
For contrast, here is what a ‘normal” thumbs up shot looks like on another politician from 2008, during a happy time.
Trump.45’s Thumbs Are a little Odd, So What?
Here’s the so what. Trump.45’s thumbs (both of them) appear quite consistent with the abnormalities (deformities) frequently affecting male patients with early to moderate arthritis. In particular, they closely resemble examples of those with Rheumatoid Arthritis.
Here is a drawing of a Rheumatoid Thumb. Compare and Contrast, if you will.
Trump.45’s thumbs appear to demonstrate both an enlargement of the MP joint on both his thumbs, and a developing boutonnière deformity in the IP joint, causing the bowing (hyperextension) observed in his off kilter thumbs up gesture in both hands.
Rheumatoid Arthritis (RA) in Men
Many folks think of this medical condition as primarily an affliction of women, and it is more common among their gender. However, men can be equally affected. The significance of Rheumatoid Arthritis is that it is an autoimmune disorder, which means that the body is partly fighting against itself, and the disease is usually progressive, but at a variable rate. It is chronic, but it can be treated and managed, and there are good diagnostic tests and tools available to be certain of an accurate diagnosis in proper hands.
Here are some basic facts about Rheumatoid Arthritis
From the Mayo Clinic website:
Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.
An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues.
Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don’t involve the joints. Rheumatoid arthritis can affect many non-joint structures, including:
- Skin
- Eyes
- Lungs
- Heart
- Kidneys
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
From the Journal of Prolotherapy:
As a disabling, systemic, inflammatory disease—rheumatoid arthritis can severely restrict and deform any joint in the body, including those in the hand and fingers. Rheumatoid arthritis occurs in about 1.5% of the population of the United States and is three times more likely to affect women than men. When rheumatoid arthritis occurs in the thumb, it limits both grip strength and pinching ability, which can severely limit activities of daily living. Rheumatoid arthritis can also lead to joint subluxation or dislocation, which occurs when the ligaments around the joint weaken. Thumb deformities are commonly classified using the Nalebuff classification system, which includes six deformities and their respective pathological mechanics. Boutonniere, or type 1, is the most common deformity.
A rheumatoid thumb can make basic tasks of daily living, such as opening doors, writing, gripping, and typing infinitely more difficult, if not impossible, to execute. At the point that activities of daily life are compromised, medical intervention is necessary.
Is There Other Evidence Trump.45 Might Have RA
There is additional video evidence that could be related. On two or three occasions since the summer, Trump.45 has tried to drink some water during a public speaking appearance, and had some difficulty: opening a water bottle, holding the bottle clumsily with both hands, or apparently having some trouble holding a glass of water.
The first time I recall was the day after he returned from his extended Asian trip in November (November 15). At first I thought while watching the video that after a very long non-stop flight from the Philippines (14-15 hours), flying West to East, he was suffering from jet lag and some dehydration on the flight. At 71 years of age, he was likely tired, with less than a normal amount of sleep in an unfamiliar bed on Air Force One, and perhaps had not heeded the expected sound advice from the flight crew about maintaining good hydration during the flight.
Trump.45 was roundly criticized for his water bottle stumbles during his statement, as others recalled and invoked his merciless ribbing and ridicule of Marco Rubio, who botched a water break while responding to Obama’s State of the Union Address in 2013.
Turn about is fair play , and all that.
But Trump.45 shortly had another awkward water pause or two, with a peculiar two handed grip issue. In one the fingers of his left hand formed sort of a bent at an angle set (ulnar deviation) from the base of the hand which can be seen in arthritic patients.
Trump.45 appeared to have some grip control issues as well, as though he was not steady and confident in grasping the bottle or glass, and was using both hands to maintain fine motor control to raise the container to his lips.
In two other instances, it appeared Trump.45 was slurring his words, and he reached for some water to clear his throat.
Also, on reflection it seemed out of his pattern that after nearly two years on the political campaign trail where Trump.45 seemingly never needed for water during a speech or rally, suddenly he was shown doing so at least three times in a short span of a few weeks.
The White House officially dismissed any potential concerns by saying Trump.45 just had a dry mouth, no speech slurring, and what’s the big deal anyway. Stick to important stuff. FAKE NEWS
Some Cardinal Characteristics of RA
From the Healthline website:
Arthritis is an umbrella term used to describe inflammation of the joints. However, there are different kinds of arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA).
Although RA and OA both affect the joints, they’re very different forms of the same broader condition. RA is an autoimmune condition, while OA is primarily a degenerative joint condition.
RA is an autoimmune disease, which means your body attacks itself. In people with RA, the body interprets the synovium, the soft lining around the joints, as a threat similar to a virus or bacteria and attacks it. This attack causes fluid to accumulate within the joint. The fluid buildup causes swelling, pain, stiffness, and inflammation around your joints.
Both types of arthritis are more common in women than men. OA and RA are more prevalent in older adults, but RA can develop at any age.
People who are overweight, suffer from joint deformities, diabetes, or gout are more likely to develop OA. RA can run in families.
Many of the basic symptoms of RA and OA are the same, including:
painful, stiff joints
limited range of motion
warmth or tenderness in the affected area
increased intensity of symptoms first thing in the morning
Each kind of arthritis also has its own unique set of symptoms. RA is a systemic disease, which means it can affect the entire body, not just the joints. Early signs of RA can include low-grade fever (in children), muscle aches, and excessive fatigue.
People in advanced stages of RA may notice hard lumps underneath the skin near joints. The lumps, called rheumatoid nodules, can be tender.
RA usually begins in the smaller joints of the body. You’re likely to have pain, stiffness, and swelling in the finger joints. As RA progresses, symptoms can develop in the larger joints such as the knees, shoulders, and ankles.
RA is a symmetrical disease. That means you’ll experience symptoms on both sides of your body at the same time.
From another Healthline article:
Early Signs of Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disorder that causes chronic inflammation of joints. Rheumatoid arthritis (RA) tends to begin slowly with minor symptoms that come and go, usually on both sides of the body, and progress over a period of weeks or months. Symptoms of this chronic disease vary from person to person and can change from day to day. Bouts of disease activity are called flare-ups, and inactive periods are called remission.
- Fatigue
- Morning stiffness
- Joint stiffness
- Joint pain
- Minor joint swelling
- Mild inflammation of the joints is typical early on, causing your joints to appear bigger than normal. This swelling can also cause joints to feel warm to the touch.
- Fever
- Numbness and tingling
- Decrease in range of motion
Other early symptoms of rheumatoid arthritis
- general weakness or a feeling of malaise
- dry mouth
- dry, itchy, or inflamed eyes
- eye discharge
- difficulty sleeping
- chest pain when you breathe (pleurisy)
- hard bumps of tissue under the skin on your arms
- loss of appetite
- weight loss
Observations About Trump Consistent with Symptoms of RA (November 15, 2017)
Trouble Removing Water Bottle Cap
Difficulty Gripping the Water Bottle with Both Hands
Problems Moving the Water Bottle Smoothly to His Mouth
Peculiar Position of Hands Holding Water Bottle
Dry Mouth
What About Trump?
The observations described above are each consistent with the hypothesis that Donald J. Trump may be exhibiting signs of a systemic illness, Rheumatoid Arthritis.
Is this a diagnosis? Absolutely not. By no means. No Way Trump. It is, however, suggestive visual evidence that warrants proper consideration and evaluation by the White House Physician on behalf of the nation.
With a thorough medical history, physical examination, and laboratory testing, Admiral Jackson can make a diagnosis or rule it out, in proceeding to a determination of current medical fitness for this President, and in order to assure his fellow Americans of the President’s continued good health and ability to perform his constitutional duties as best he can
Medical examination, not speculation or affirmation.
What Else?
There has been quite a furor in the past week about whether or not Tryump.45 has lost a step, or shown evidence of mental decline or disability in office. The White House steadfastly denies it, and takes umbrage to boot.
If Trump.45 should turn out to be suffering from RA, there is a further consideration for this discussion. There is medical evidence that 30-70% of established RA patients may exhibit cognitive impairment, or a form of cognitive fog.
From a US News & World Report June 2017 article:
“Wait, why did I walk into this room? What was it I was looking for?”
If you have rheumatoid arthritis, you might often ask yourself similar questions, or you could have trouble recalling names, appointments, birthdays or other important dates. You may even find it difficult to remember how to perform routine tasks at work, and you could have a tough time making simple decisions.
If this sounds like you, you may be suffering from cognitive impairment, or brain fog.
“Brain fog is a widely used, nonmedical term that is often applied to describe a person’s inability to think clearly, remember things, concentrate or easily carry out day-to-day mental tasks,” says Dr. Mark Swain, who is a professor of medicine and head of the Division of Gastroenterology and Hepatology at the University of Calgary in Canada.
“People suffering from chronic inflammatory conditions, including RA, often complain of brain fog,” he says. “In one study, roughly 30 percent [of people with RA] were found to be cognitively impaired,” Swain says.
Dr. Robert G. Hylland, a rheumatologist with Mercy Health in Muskegon, Michigan, says the percentage may even be higher.
“Studies suggest that 30 to 70 percent of RA patients have cognitive impairment,” he notes.
This wide range of estimated prevalence is likely a reflection of the fact that there has been little research into the subject.
“There aren’t many [relevant, high-quality] studies on cognitive impairment in RA” says Patricia Katz, a psychologist and professor of medicine and health policy at the University of California, San Francisco. But those that have been done have “generally found that people with RA either performed more poorly at a range of cognitive assessment tasks than healthy controls, or performed at a level below age norms,” she says.
In addition, patients may not complain to their rheumatologists about memory problems and the inability to concentrate. “In my experience, [patients complaining of] cognitive deficits and brain fog are relatively uncommon,” says Hylland, who is also an assistant clinical professor of medicine at the Michigan State University College of Osteopathic Medicine. Moreover, “physicians frequently don’t ask about them, and questionnaires used to obtain patient information rarely contain such inquiries,” he adds.
According to Hylland, when patients do voice such concerns, they usually associate them with poor sleep, which is “not usually independently evaluated in the studies reporting on brain fog,” he notes. Cognitive impairment in people with RA may indeed be tied to poor sleep, which is a common complaint because pain can cause insomnia or make it difficult to get restorative sleep. Lack of good-quality sleep causes fatigue, which impairs functioning.
“There is some literature on ‘cognitive fatigue’ in RA,” Katz says, “which some have identified as a unique state.”
“Non-restorative sleep, chronic stress and pain independently alter cognitive function and together contribute to secondary fibromyalgia, a disorder in which brain fog is almost universal,” Hylland adds.
Summary
Close External Observation is not diagnosis. That is Admiral Jackson’s current assignment. Undoubtedly, as an experienced and well trained Naval officer and physician he will perform his duty with a high degree of skill.
We expect that and hope he will be able to issue a clean bill of health for our President. Regardless of any partisan political divide over specific issues, the fact is that America has only one President at a time,
In January 2018, that person is Donald J Trump.
Let the facts speak for themselves. We all want out President to be as healthy as possible. We don’t need and can’t abide empty sloganeering or whiffle piffle for effect in this matter.
Admiral Jackson, we await your report.
Just One More Thing
If, unluckily for him, DJT should find out he has RA, there is a potential slice in the medical news.
There is some evidence that gold may cause arthritic injuries in the hands, and that frequent play could exacerbate the adverse hand effects in anyone who already has RA.
Trump.45 is a right handed dominant golfer. See a 10 plus minute analysis here of his golf swing.
I have heard Trump.45’s swing referred to elsewhere as a very unusual, but quite effective stroke. I am not a golfer and the technical content of the video narrator is well beyond my competence to assess, but the narrator sure seems completely confident in his description and break down of Trump.45’s swing mechanics.
If the narrator isn’t a golf swing expert, he sure sounds like one to a novice viewer. And he has 10 minutes of actual slo-mo video to demonstrate his stuff.
Here are two sports medicine citations that show a right handed golfer is most likely to injure his lead (left) wrist. (For what it’s worth, Trump.45’s November 15 water stumble seems to show his left wrist with the most prominent ulnar deviation.}
An article from the Sports Injury Bulletin states that a frequent site of golf injuries in right handed players is ulnar deviation in their leading (left) wrist.
A study among elite European golfers shows:
Up to 67 % of wrist injuries occur in the ulnar aspect of the lead wrist, (the left wrist in a right-hand dominant golfer). The extensor carpi ulnaris (ECU) tendon is involved in the majority of ulnar sided injuries. Typical ECU tendon pathology includes subluxation, dislocation, tendonopathy, and tenosynovitis.
Now that really would be a dreadful pisser. Can you imagine? What in the world would Trump.45 do if he had to curtail golfing on doctor’s orders?
I sure wouldn’t want to be in attendance at that meeting while Trump.45 was being a VSG (Very Stable Genius). No siree.