President Donald Trump, the oldest President elected in US history at the age of 70, underwent his first presidential physical last January. He used it as an opportunity to quiet critics who questioned both his physical health and mental acumen.
As part of last year's physical Trump requested then-White House physician Dr. Ronny Jackson to do something quite unusual, He asked him to administer a cognitive exam.
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These types of exams are not a routine part of a standard physical. Jackson, who was also the physician to President Barack Obama, said it was the first time he was aware of any president taking any sort of cognitive test.
"He actively asked me to include that, so we did," Jackson told reporters, including myself, who attended a press conference revealing the results of the exam. Jackson said Trump received a 30 out of 30 on the Montreal Cognitive Exam, a quick screening assessment for mild cognitive impairment and early Alzheimer's disease but not a diagnostic tool.
Whether it will be administered again this year, Jackson said, at the time, would be up to the President. He saw no indications it was necessary, he said, but "if the President wants to get one done next year, then we'll do another one next year."
The press conference itself was also unique, as it was one of only a few held by a White House physician to go over the results of a physical.
Dr. William Lukash, President Gerald Ford's physician, was known to address the press about the results of the exam, but traditionally results of the commander in chief's physical are released as a document to the press. As both a reporter and a physician I don't ever recall covering a press conference where the president's physical exam was discussed.
From last year's exam, we learned Trump's blood pressure was normal but there was concern regarding both his cholesterol and weight. In fact, his then reported 239 pounds put him just shy of being obese, according to the US Centers for Disease Control and Prevention's guidelines.
What we know about President Trump's health
His lipid panel indicated that his HDL (or "good") cholesterol level of 67 mg/dL was within the desired range of 60 mg/dL or above. Both his total level of cholesterol and LDL (or "bad") cholesterol, however, had climbed from previous assessments.
In 2016, his total cholesterol was 169 and his LDL was 94 mg/dL. The most recent tests from last year found his total cholesterol to be 223, and his LDL was 143 mg/dL, both considered to be borderline high. A total cholesterol level of less than 200 is desirable, and a LDL level less than 100 is considered optimal.
While Trump isn't unique in having high cholesterol, it's definitely a health concern. We know that high cholesterol increases risk for heart disease.
Both Jackson and the President's previous physician, Dr. Harold Bornstein, reported Trump had already been taking a low dose statin for several years to help lower his cholesterol. During last year's press conference, Jackson said he had recently increased the President's daily statin dose of 10mg of Rosuvastatin, commonly sold as Crestor, but did not say by how much or how often.
We also learned that in addition to the statin, Trump was taking a daily multi-vitamin, Propecia for hair loss, a daily aspirin for cardiac health, and a cream for Rosacea. a skin condition characterized by persistent redness in the face.
Jackson said he hoped to work with a nutritionist to help improve the President's diet as well as prescribe him an exercise regime. It isn't clear if the President -- who is well known for avoiding exercise and calls McDonald's Big Macs one of his favorite meals -- has followed any of the doctor's recommendations.
In the official readout of the physical exam the White House did not reveal that Trump also had a coronary calcium test done. Upon questioning, Jackson told reporters the President had undergone the heart scan and scored 133 on the test. According to the Mayo Clinic, "a score of 100 to 300 — moderate plaque deposition — is associated with a relatively high risk of heart attack over the next three to five years." Previous medical records indicate that in 2009 his coronary calcium score was 34, and in 2013 it was 98.
"Some people have just great genes"
Despite these factors, Jackson was quite optimistic about the health of the President.
He pointed out in his report that the First Patient did not have a family history of heart disease and credited the President's history of "a lifetime of abstinence from tobacco and alcohol" as key to mitigating the concerns of heart disease. Trump has been known to take a rare sip of wine here and there, but generally doesn't drink.
At the conference, Jackson told reporters: "It's called genetics. I don't know. Some people have just great genes." Jackson effusively added, "I told the President that if he had a healthier diet over the last 20 years, he might live to be 200 years old."
Trump's records mention that he had a colonoscopy in 2013 that showed no signs of abnormal tissue growth or cancers. A colonoscopy was not performed during last year's exam, but Jackson said one was expected to be performed this year.
Jackson also told reporters he was prepared to work hand in hand with the First Family to encourage the President to eat better and exercise more. "His daughter, Ivanka, and Mrs. Trump are both proponents of eating healthier and exercising. So they'll be partners of mine in working this out," Jackson told us.
Later in the spring of 2018, Trump tapped Jackson to run the Veterans Administration. He eventually withdrew his nomination, after becoming embroiled in the politics of the confirmation process. Since then, it has been unclear who was in charge of overseeing the President's health.
As of last year, Dr. Sean Conley took over for Jackson as head of the White House Medical unit overseeing a medical team that see and treat the president. That role traditionally serves as physician to the president.
Stress and health
There is no question that the job of President is stressful. A 2015 study in the British Medical Journal found elected presidents and officials typically live three fewer years and had a 23% increased risk of premature death, compared to their runners-up. That discrepancy can be amplified in Presidents who suffered from pre-existing chronic disease, which is not the case with Trump.
Jackson had been enthusiastic to return to the podium to share this year's upcoming physical and lab results, but it's not clear if Conley, or anyone from the White House, will be doing the same this year.
At the press conference last year, Jackson was prescriptive. "We'd like to get the LDL down below 120, so that's what we'll be shooting for," he said. He added that he would like to see the President lose 10 to 15 pounds. Considering that the President's weight and cholesterol appear to be the biggest concerns, these are the right goals. As a physician, I agree.
Jackson increased the dosage of his statin -- even though we don't know how much, or how frequently. And he was right to focus on diet and exercise. But the question now is not how to get there.
The question now, as we await possible news of a second annual physical, is how willing of a patient was the President?