Trump: Predecessors left North Korea to a president ‘that scored the highest on tests’

Washington (CNN)Fresh off a White House doctor declaring his health excellent, President Donald Trump swiped at his predecessors on North Korea, while saying he “scored the highest on tests.”

Discussing the issue of North Korea’s nuclear ambitions in an interview Wednesday with Reuters, Trump took a swing at his predecessors, former Presidents Barack Obama, George W. Bush and Bill Clinton, for their approaches to the rogue nation.
“I guess they all realized they’re going to have to leave it to a president that scored the highest on tests. What can I tell you?” Trump said.
    White House physician Ronny Jackson told reporters on Tuesday that he had screened Trump for neurological impairments at the President’s asking during a yearly medical exam last week, and that Trump had scored 30 out of 30 on the cognitive test.
    Jackson said he “found no reason whatsoever to think the President has any issues whatsoever with his thought processes.”
    Jackson declined during his question and answer session to compare Trump’s health to that of other presidents, and he described Trump as in good health outside of needing to lose weight and to exercise.
    Trump said in the Reuters interview that he already gets exercise.
    “I mean I walk, I this, I that,” Trump said. “I run over to a building next door. I get more exercise than people think.”

      Trump’s heart health in focus after doctor’s briefing

    CNN chief medical correspondent Sanjay Gupta said Jackson’s information indicated that the President, like most men of his age, has a common form of heart disease.
    Trump has bragged in the past about his health and energy as well as his IQ score, which he said in 2013 is “one of the highest.”
    Since becoming President, Trump has continued making similar claims, offering that he could score higher on an IQ test than Secretary of State Rex Tillerson and claiming earlier this month that he is a “genius.”

    Read more: http://www.cnn.com/2018/01/17/politics/donald-trump-medical-exam-interview/index.html

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    President Trump has common form of heart disease

    (CNN)Like most men of his age, President Donald Trump has a common form of heart disease, relatively easy to address if he increases the dose of his cholesterol-lowering medication and makes necessary lifestyle changes. Without those changes, the President has a moderate risk of having a heart attack in the next three to five years, according to the Mayo Clinic.

    On Tuesday, White House physician Dr. Ronny Jackson disclosed Trump’s basic labs measurements, physical exam results and the conclusion of a cognitive exam, known as the Montreal Cognitive Assessment. Additionally, the President had an echocardiogram of his heart, as well as a stress test, both described as normal. Although it was not part of the official medical records that were released yesterday, after further questioning, Jackson also revealed that Trump underwent a coronary calcium CT scan as part of his routine physical exam.
    His score is 133, and anything over 100 indicates plaque is present and that the patient has heart disease. According to Trump’s official medical records, in 2009 his coronary calcium score was 34. In 2013, it was 98.
      Most people might have not heard of this test, also known simply as a heart scan or calcium score. It is a CT scan, a specialized X-ray that takes high quality pictures of the heart, looking for calcium-containing plaque in the blood vessels that feed the heart, known as the coronaries. With this information, doctors can then calculate the risk of having a heart problem in the future. In the case of Trump, a new score of 133 reveals there has been a steady build-up of plaque in his blood vessels, indicating moderate heart disease. Also concerning are Trump’s total cholesterol levels and his LDL (“bad” cholesterol), as both increased significantly over the last year, despite being on a statin drug known as Crestor or Rosuvastatin.
      Trump, 71, is not too different than most Americans his age. After the age of 40, most men in the United States have some evidence of heart disease, and the President’s score places him squarely in the mid-risk range for a man of his age. Because the President doesn’t smoke or drink and “appears to have good genes,” according to Jackson, he has been able to avoid the classic symptoms of heart disease.
      “His score is 133 and he is 71 years of age, which puts him in the 46 percentile,” said cardiologist Dr. Rachel Bond of Lenox Hill Hospital in New York. “What does this indicate? Yes, he certainly has coronary artery disease because calcium is present. But this is also common for someone his gender, race and age.
      “When I compare him to other males who are 71 and white, only 46% of others have a better score than him.”

      See the latest news and share your comments with CNN Health on Facebook and Twitter.

      Bond added this is not something to be taken lightly.
      A coronary calcium score below 100 reduces the risk of heart attack to moderate.
      Jackson has already increased the dosage of the Trump’s cholesterol-lowering medication and recommended a low-carbohydrate and low-fat diet, along with an exercise regimen.

      Read more: http://www.cnn.com/2018/01/17/health/trump-heart-disease-gupta/index.html

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      Why Trump’s Heart Report Isn’t A Clear-Cut Diagnosis

      Donald Trump is the oldest person to become a U.S. president, which may be why he and his team feel they have to frequently boast about his health. Over the course of his first year in office, his administration has also had to combat questions of potential cognitive decline, following erratic behavior on social media, and calls from doctors to evaluate his mental health

      Trump may have hoped that the release of the results of his first official White House exam would put an end to those questions, but some of his numbers are still raising concerns among voters and members of the press. 

      For instance, Dr. Ronny Jackson, the White House physician, proclaimed Trump to be in excellent overall health Tuesday, saying that he enjoyed “significant long-term cardiac and overall health benefits” thanks to abstaining from alcohol and tobacco. 

      But the next day, Dr. Sanjay Gupta, CNN’s chief medical correspondent, said that Trump already has heart disease. Gupta based that on the president’s rising coronary calcium scores over the years. The measurement, which can predict the likelihood of having coronary artery disease, looks at the amount of plaque present.  

      The dispute left viewers confused and suspicious of both Jackson’s initial assessment and Gupta’s diagnosis based on Trump’s health report, turning cardiac health into a partisan debate. But unlike politics, the science is clear: Experts are siding with Dr. Jackson’s initial assessment of Trump’s heart health. The president’s test results do not reveal heart disease.  

      A misunderstanding of the coronary calcium test and what its score means lies at the heart of this controversy. 

      The coronary calcium score is a non-invasive heart scan that allows doctors to identify calcified plaque in the arteries. The more calcified plaque there is, the higher one’s score — and the higher one’s risk of heart attack and stroke. On the CNN segment, Gupta noted that in 2009 Trump scored a 34, which means there was evidence of mild coronary calcification. In 2013, that number rose to 98. Then, by 2018, that number had risen to 133. A score of more than 100 means that there is a moderate amount of plaque in the coronary arteries and that there is a moderate to high risk of having a heart attack. 

      In contrast, President Barack Obama underwent the scan in 2010 and scored zero — no evidence of coronary artery disease. President George W. Bush also had the scan while in office and scored 24 — what would be characterized as “minimal” or “mild” plaque.

      While Trump’s rise may seem alarming, it’s actually pretty typical of what happens when people start statin treatment to lower their cholesterol levels, explained Dr. Richard Chazal, immediate past president of the American College of Cardiology and medical director of the Heart and Vascular Institute at Lee Health in Florida. 

      While Chazal didn’t want to comment directly on Trump’s numbers, he did point out that after the first coronary calcium scan, doctors generally don’t tend to continue performing the test. This is because as statins start to work, the calcified plaques begin to grow, shrink and then heal in the arteries. This process makes the calcifications seem even larger, thus leading to an elevated coronary calcium score. Trump has been on some kind of statin since at least 2016.

      “This is a case where the marker goes up but the risk goes down,” Chazal explained. 

      After a patient begins statins, heart doctors generally look at other biomarkers, such as cholesterol levels, or the presence of symptoms like chest tightness or shortness of breath to see if heart disease risk is going down. 

      “There are more complicated tests that could be done to look for progression, but coronary calcification is not a good way to follow the success, or lack thereof, of statin therapy or any preventive care,” he concluded. 

      No, a high calcium score does not automatically mean heart disease

      Besides the fact that Trump’s coronary calcium score may be artificially elevated, there is also the fact that he doesn’t exhibit any symptoms of heart disease.

      Heart disease, or cardiovascular disease, is an umbrella term that describes several problems affecting either the heart or its blood vessels. These include coronary artery disease, heart attacks, strokes, heart failure, arrhythmia or heart valve problems. 

      When it comes to coronary artery disease specifically, which is what the calcium score measures, doctors can disagree about what measures qualify for actual heart disease. To Gupta and other experts HuffPost spoke to, a coronary calcium score over 100 by definition qualifies as coronary artery disease.  

      But to Dr. Michael Blaha, director of clinical research for the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins, a coronary calcium score of 133, absent any symptoms, doesn’t rise to the diagnosis of heart disease. 

      “In my view, a clinical diagnosis of coronary heart disease refers to coronary arteries with blockages, or to patients with symptomatic complaints suggesting coronary disease,” Blaha said in an email to HuffPost. “A coronary calcium score of 133 is suggestive of mild to moderate coronary atherosclerosis, which is different than coronary heart disease.”

      Atherosclerosis is a term that describes the buildup of plaque in artery walls, and it can lead to heart attack or stroke

      Blaha also pointed out that Trump’s coronary calcium score places him at around the 50th percentile for other men his age, as the condition is extremely common.

      “Unfortunately, this is a commentary on American society ― the average male patient of this age has mild to moderate plaque in their arteries.”

      Cardiologist Robert Segal, founder and medical director of LabFinder.com, echoed Blaha’s assessment and said that because Trump did well on his physical stress tests, his heart prognosis is good. Segal also said that Trump was in good hands when it came to medical treatment — unlike many Americans who are at risk for heart disease. 

      “President Trump is getting excellent medical care, and he’s being appropriately screened for heart disease,” Segal said. “The main issue for many Americans is that they aren’t aware that they have heart disease. I would recommend that everyone be aware of their cholesterol numbers and consider screening for heart disease as they approach middle age.”

      Heart disease is the leading cause of death for both men and women in the U.S., linked to an estimated one in four deaths every year. About 49 percent of all Americans have at least one of three key risk factors for heart disease, which are hypertension, high LDL cholesterol and a smoking habit. Other risk factors include diabetes, a sedentary lifestyle and a body mass index of over 25. 

      While Trump doesn’t smoke, he does have several of these risk factors. He has a BMI measurement of 29.9, according to Jackson’s recent assessment, and a total cholesterol level of 223, which is borderline high. He also reportedly believes that exercise is bad for you and loves eating cheeseburgers in bed

      CORRECTION: A previous version of this story incorrectly said that heart disease killed one in four Americans every year. In fact, heart disease is linked to one in four U.S. deaths every year. 

      Read more: http://www.huffingtonpost.com/entry/trump-heart-disease-question_us_5a5fcab7e4b0ccf9f1213f5b

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      Donald Trump’s health: What we know so far

      (CNN)What the world knows about President Donald Trump’s general health is not much as of now — and what the public learns about his health after a medical exam on Friday might not be much, either.

      Trump, 71, is scheduled to undergo his first formal physical exam since taking office.
      “We’ll only learn what he wants us to know,” said Arthur Caplan, a professor and founding head of the Division of Medical Ethics at NYU Langone Health in New York.
        “A physical is forward-looking and almost, really, an examination of your biochemistry. We’re going to look at your blood and your urine, and we’re going to take a look at your heart electronically,” said Caplan, who was one of 75 health professionals who signed a letter urging Trump’s doctor to evaluate his neurological health (PDF).
        Presidents historically will “release general information on things like cholesterol, is there any problem with emerging diabetes or the president’s heart. … It won’t solve or settle any of the controversies about his competence,” he said. “The president has the same right to privacy as you or I would if we went to get a physical. No one has the right to know what the results are. There’s no legislation, there’s no requirement that he tell us anything.”
        Trump’s physical will be performed at the Walter Reed National Military Medical Center in Maryland and conducted by the White House physician, Dr. Ronny Jackson, who also performed President Barack Obama’s last several physicals while he was in office.
        The White House has said it will provide a readout of the exam on Tuesday, but until then, here is what we know about Trump’s health.

        Trump’s weight and cholesterol

        Dr. Harold Bornstein, the president’s personal physician at the time, released a letter in 2016 detailing Trump’s key stats, including his body mass index, blood pressure and even testosterone level.
        The letter noted that at 6-foot-3 and 236 pounds, Trump had a body mass index of 29.5, which made him overweight, according to the National Institutes of Health’s online BMI calculator.
        “Overweight and obesity increase the risk for diabetes, heart disease and high cholesterol,” said Dr. Ranit Mishori, professor of family medicine at Georgetown University School of Medicine who was not involved in the president’s care.
        “I would focus on lifestyle modifications, diet changes and exercise,” she said. “Come up with a plan for incorporating exercise and/or dietary changes into the daily routine, recommend a healthy diet — Mediterranean, lots of fruits, and vegetables, little red meat — and likely perform a blood test for diabetes, in addition to cholesterol levels.”
        Trump had a total cholesterol level of 169, “good” HDL cholesterol of 63, “bad” LDL cholesterol of 94 and blood pressure of 116/70, according to the letter.
        Blood pressure levels less than 120/80 are considered “normal.”

        Trump’s blood and heart health

        The letter also indicated that Trump’s blood sugar level was 99 milligrams per deciliter, and his triglycerides, which are a type of fat found in the blood, were 61 mg/dL. For a fasting blood glucose test, which measures sugar, a level between 70 and 100 mg/dL would be considered “normal.”
        Trump takes a statin, called rosuvastatin, to treat high cholesterol and triglyceride levels, and he takes a low-dose aspirin, according to the doctor’s letter.
        The letter also indicated that Trump was screened for prostate cancer, which resulted in a low score, meaning there was no evidence of cancer. He had a colonoscopy in 2013 and a transthoracic echocardiogram to examine his heart in 2014. Both tests appeared to be normal.
        The letter also mentioned that Trump’s testosterone level was 441.6.
        A testosterone test measures the amount of the male hormone in the blood, and normal measurements for these tests typically are 300 to 1,000 nanograms per deciliter among men and 15 to 70 among women, according to the US National Library of Medicine.
        “From the scientific perspective, it would be interesting to see what kinds of tests he’s had,” Mishori said. “My guess is that he’ll have what’s called a VIP or ‘executive’ physical: a very thorough and lengthy affair with multiple specialists” and manytests, such as EKG, carotid artery ultrasound, urinary test, PSA test and more.

        Trump’s mental health

        That 2016 doctor’s letter noted that “Mr. Trump is in excellent physical health.”
        Yet since taking office, Trump’s mental health has become a topic of public interest.
        A review of the past five presidents’ physical exams shows only brief mentions of mental health, and none included a readout of mental health tests.

        See the latest news and share your comments with CNN Health on Facebook and Twitter.

        “Although cognitive screening is not recommended in every individual older than 65 years because of a current lack of evidence for or against screening, the US Preventive Services Task Force advises clinicians to look for early signs or symptoms of cognitive impairment, such as problems with memory or language,” Mishori said.
        “They are not generally considered routine parts of the physical. The task of recognizing changes in memory, thinking and other cognitive functions and distinguishing whether such symptoms are due to normal aging or are signs of early dementia is not an easy one,” she said.

        Read more: http://www.cnn.com/2018/01/12/health/donald-trump-health-explainer/index.html

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        Gupta: ‘Competent’ or ‘crazy’ misses the point of presidential mental health

        (CNN)The discussion around the health of President Trump has reached a new level of urgency this week because he will be an outpatient at Walter Reed Medical Center today, undergoing a battery of tests to determine whether he is “fit to lead,” a colloquial term many use but with little clinical basis.

        Almost everywhere I go, including the hospital where I practice, nearly everyone wants to weigh in about the mental health of Trump, and perhaps because I am a neuroscientist and medical reporter, I have become a repository of these opinions (though I will tell you the mind is a much more difficult thing to probe than the brain).
        Some of the opinions have been cringeworthy, like the time a fellow physician asked whether I thought the president was “crazy” in a crowded elevator full of patients, any one of whom could be suffering from debilitating mental illness. Many of the armchair diagnoses have been misguided, even if well-intentioned, and all have been thus far unsubstantiated.
          Particularly bothersome is the commingling of the president’s questionable behavioral traits with serious mental illness. It is, as Dr. Allen Frances, the chairman of the DSM-IV task force that defines the criteria of various mental conditions, said, an insult to the mentally ill.
          The point is, there can be major pitfalls with these sorts of distant diagnoses.
          For starters, they are typically wrong.
          An accurate diagnosis of mental illness is a serious and laborious undertaking. Many patients see at least three mental health care professionals over several months to arrive at any diagnosis.
          Even after sustained contact with a patient, most responsible psychiatrists will follow up with family members and close acquaintances to gather as much information as possible. They want to be as certain as possible, as any doctor would be with the diagnosis of, say, cancer or a stroke. Unlike those diseases, though, mental illness has no particular brain image or blood test that can easily make the case. It takes time and expertise by someone who has been trained to find the clues and avoid the traps — and that excludes the vast majority of us, including me.

          Trump’s ‘diagnosis’

          Frances doesn’t believe that Trump has narcissistic personality disorder, a popular amateur diagnosis on the internet. This is particularly important because Frances also happens to be the Duke University professor who wrote the criteria defining the disorder.
          I have often responded to those sharing their opinions with a smile and a shrug when approached by people wanting to have the “Trump is crazy” discussion. It is not out of lack of interest but because, after the umpteenth time, I know that the discussion often sadly leads to worsening misconceptions about the mentally ill.
          Point is, even if Trump was diagnosed with a mental illness, that is not necessarily a barrier to holding a job or even higher office. It was in 1972 when Thomas Eagleton was dropped as a Democratic vice presidential candidate after it was revealed that he had been hospitalized for depression. We seem hardly enlightened since then.
          Fully half of US presidents between 1776 and 1974 had clinical evidence of mental illness during their lifetimes (half of them while in office), according to a 2006 study in the Journal of Nervous and Mental Disease. Half of those were depressed, including James Madison, Dwight Eisenhower and, perhaps most famously, Abraham Lincoln, who also suffered from psychosis. Lyndon Johnson, Theodore Roosevelt and John Adams were among the fifth of US presidents with bipolar disorder. And another fifth were alcoholics, including Richard Nixon, whose staff, according to an NPR interview with one of the study’s authors, had to make sure he didn’t make important decisions in the evening.
          A separate study in the Journal of Personality and Social Psychology from 2012 took it a step further when it concluded that John Kennedy was a psychopath but added that “certain features of psychopathy are tied to successful interpersonal behavior.” In particular, it was the trait of “fearless dominance” — a brashness accompanied by a compulsion to dominate social situations, a higher willingness to take risks and an immunity to anxiety — that was “associated with better presidential performance, leadership, persuasiveness and crisis management,” according to the study authors.
          Fearless dominance. When you consider the qualities of a good leader, trust, intellect, curiosity, empathy and discipline probably come to mind, but “fearless dominance” is a frightening term these experts think should be added to the list.
          Terms matter when we talk about mental health.
          When Dr. Bandy X. Lee, a Yale psychiatrist, briefed mostly Democratic members of Congress in early December, she raised a different term: “dangerousness.”
          It is not a true psychiatric diagnosis but one that has been medicalized nonetheless. According to J.C. Segens’ “Dictionary of Modern Medicine,” it is “the state of being dangerous and possibly causing mental or physical harm to others.”
          Based on “public records, tape recordings, video tapes and his own public speeches, interviews and ‘tweets,’ ” Lee told congressional members, it is “obvious” Trump meets the criteria for dangerousness. And she feels compelled to inform the public. She is the organizer of the Duty to Warn conference and has written a book, “The Dangerous Case of Donald Trump.”
          That makes many of her colleagues uncomfortable, because they abide by the 1973 Goldwater Rule, which prohibits psychiatrists from opining about the mental health of an individual they have not personally examined. Lee, and a handful of other psychiatrists, instead seem to take cover under a separate professional guideline, the controversial Tarasoff Rule of 1976, which obligates psychiatrists to notify potential victims if they believe their patient is a real threat. It is that “duty to warn,” Lee told me over the phone, that has motivated her to break from the rank-and-file psychiatrists.
          In this case, she is claiming that the patient is Trump and the potential victims are everyone else on the planet.
          Of course, Trump is not Lee’s patient, and she has never examined him.
          For its part, the American Psychiatric Association offered a rebuke to Lee and others who continue to diagnose from afar. “A proper psychiatric evaluation requires more than a review of television appearances, tweets and public comments. Psychiatrists are medical doctors; evaluating mental illness is no less thorough than diagnosing diabetes or heart disease,” it said in a statement this week.

          What presidents are tested for

          When Trump is examined today for his annual physical, he will undergo a battery of tests. There’s no guarantee which ones they will be and no requirement that results be released.
          Most presidents have released one- to two-page summaries including height and weight, blood lipid levels and even running speed. George W. Bush, we were told, smoked occasional cigars and ran 3 miles 4 times a week. Only candidate John McCain released his full medical records in 2008, and he invited me to review them in a secure room for a few hours. While McCain’s records included detailed reports around his mental health, virtually none of the others I have seen in the past 16 years of reporting on presidential health made mention of the cognitive or mental health of the presidential patient. The current White House has telegraphed that mental health testing is probably not something the president will even undergo.
          If his doctors want to probe the brain and mind of Trump and he agrees, a few useful tests could be performed.
          The Mini-Mental State Examination is a five- to 10-minute validated exam that has been around since 1975. It consists of 11 questions that focus on five specific areas of cognitive function: orientation, registration, attention and calculation, recall, and language. A low enough score could indicate that the patient is cognitively impaired.
          A neuropsychiatric evaluation is much more thorough: up to eight hours, with many cognitive-based questions. The goal is to investigate any changes in the brain that might impact behavior. It can also help identify the early stages of dementia and make clear if a patient is able to conduct the normal activities of daily living.
          And although a brain scan, such as a CT or an MRI, would not be able to diagnose a mental illness, it would probably uncover an organic problem such as a tumor, hydrocephalus or types of dementia including vascular or frontotemporal dementia, which in certain locations can greatly impact the behavior, memory and judgment of a patient.
          Lee believes Trump should also have a capacity exam, by force if necessary. Capacity, a medical term, is mostly synonymous with the legal term competence. A capacity exam is not precisely defined, but it is one of the most common reasons a doctor like me, a neurosurgeon, will consult with a psychiatrist: I want help in determining whether a patient has the ability to provide consent for an operation.
          The question I am typically trying to answer: Can the patient make an informed decision about having surgery? The question Lee is hoping to answer: Can the president make informed decisions about the welfare of the population?

          See the latest news and share your comments with CNN Health on Facebook and Twitter.

          At no other time in US history has a group of mental health professionals been so collectively concerned about a sitting president’s dangerousness, according to Lee.
          But other than a clear-cut diagnosis of dementia, it’s difficult to see how a mental health diagnosis leads to removing a president from office, no matter his fearless dominance or perceived dangerousness.

          Read more: http://www.cnn.com/2018/01/12/health/presidential-mental-health-gupta/index.html

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