Social Worker (3:58)

Frequently, the person with dementia doesn't know they have dementia. Their memory is fine. There is nothing wrong with their thinking. Everything is fine. What are you. They are not even aware sometimes that they need physical help. No, no, I can do this by myself. I'm fine. And then when you insist, they get angry. But it's a very important one to remember is that the person with the dementia truly believes that there is nothing wrong. And yes, they do remember what they had for breakfast, and they certainly remember that they didn't have any breakfast, even though you were the one that gave them breakfast and they ate it all. And 50 minutes later, they're telling you, no, I didn't have breakfast. Where's my breakfast?

Ben (Interviewer/Host) (4:41)

Wall Street Journal just came out with an article. As signs of aging emerge, Trump responds with defiance. Strange headline right there. But when you go into this article, I mean, it has a lot of things that are concerning. Trump says that he bruises easily because he takes 325 milligrams of aspirin each Day and has rejected his doctor's advice to take less. They say aspirin is good for thinning out the blood. I want nice, thin BL pouring through my heart, not thick blood. I don't want that thick blood. Does that make sense? Is what Donald Trump said to the Wall Street Journal. He also says that some of the reason you see these bandages on his hand is this is a direct quote. He applies makeup to his hands after he gets whacked again by someone. I have makeup and that's, you know, easy to put on. It takes about 10 seconds. I put it on when I get whacked again by someone. When you get whacked again by someone, what does it even you get whacked? He says that he's not sleeping on camera when we see him sleeping, but that's him blinking. Sometimes they catch the blink. He says that's just the blink they catch. Then in terms of his diet, they talk about him eating French fries and McDonald's Quarter Pounder, hamburger, Big Mac and filet of fish all in one sitting. And there was another part here where Trump and his doctor in this journal article, then thereafter, are saying that he didn't get an mri, but he got a preventative CT scan of the abdominal area. Remember before they talked about advanced imaging and they said it was an mri. I mean, we heard clips from Caroline Levitt saying, it's an mri. Trump says, it's an mri. It's an mri. It's an mri. Got an mri. Did you want me not to get the mri? It's an mri. People said, what part of the body? He goes, I don't know. But then they had a doctor's note that said abdominal advanced imaging, and now they're saying it's a CT scan. None of this is making sense to me. I want to bring in Dr. Vin Gupta, who leads Midas Health about all of this new data and new information. Doctor, what do you make of this all?

Dr. Vin Gupta (6:45)

Well, you know, Ben, we've been talking about this now for the last several weeks, and I was stunned that the President's position, just top line, wasn't clear on the type of advanced image that he got. What is the point of having a physician, a personal physician to the President of the United States, if you don't know the tests that that person, the President, is undergoing? So the fact that. And it's not hard in any way to confuse an MRI with a CT. These are very different modalities. One takes 45 minutes in some cases, the other takes 45 seconds. And so the fact that there's any confusion on the part of the president, much less his own physician, really flies in the face of what they keep talking about, which is radical transparency. When you and I had this conversation a few weeks ago on December 1, when they issued that memorandum, I remember feeling very strongly, then just release the actual report. We don't want the summarized manicured note on their letterhead because it was hard to trust that. And it proves that. Actually, the last four weeks it proves out that we were right to question whether they're being totally transparent because they got a CT and an MRI supposedly mixed up on the substance of what was put in the Wall Street Journal report. A few things. One, it never made sense that they released the results of an MRI of your torso, arguing in the doctor's letter on December 1st that somehow this is something you do for long term prevention or health prevention as you age. That's not true. Yes, there's this fad of MRIs, full body for those that can afford it. Fine, let's just leave that aside. Nobody gets an MRI just of the torso. And so when you and I had this conversation for our listeners, the question was, are they just releasing the abdominal and cardiac findings and somehow hiding other findings, like what's happening in the brain, for example, Just didn't make sense. So now they're saying it's the ct, a CAT scan of his heart and maybe of his abdomen. Again, why are they getting this? As we age, sometimes we get a CT of your coronary arteries. Coronary calcium scan, which he actually had in 2018. According to his prior doc, Ronnie Jackson, at the time in 2018, there was some evidence of calcifications in his coronary arteries, which is not abnormal as we age. Pretty much happens to all of us now. Suddenly it's completely normal. That doesn't make a lot of sense. 1, 2. His doctors are right to tell him that he shouldn't be using aspirin, 325 milligrams every day. They're correct. It should be a baby aspirin every day. If this is for prevention of, say a stroke or a heart attack. And so the fact that he's doing 325, there's no medical justification for that. There's really very few indications for 325of aspirin long term, some childhood indications, some short term indications for it in an adult, say, that might have had a heart attack or a cardiac procedure, you get 325 maybe for a few days at most, if not just a one time dose and then quickly start 81. And yes, it can cause bruising, absolutely can cause skin bruising.325 of aspirin. But this notion that it causes some of these other potential sort of bleeding of the skin when Pam Bondi gave him a handshake, that feels a little speculative and a little unclear. I'll lastly say there's the issue with his imaging. How could they possibly confuse or mix up ct, mri? I look directly at his physician when I say that that is not something any personal physician should be confusing or misinforming the public on, especially when it comes to the president's health disaster issue. Doesn't make a lot of sense and his doctors are right on that to call him out. Then lastly, if you really look at his what they're sharing in this Wall Street Journal article about his cardiovascular health, he doesn't exercise. He says he doesn't want to exercise because he finds it boring. So he doesn't really do aerobic activity. He walks on the golf course. That's the most that he does. And two, he eats frequent hamburgers and french fries, according to this article, which if somebody has a personal chef, as he does, and he can eat anything in the world that he so desires and that specific person is not reliant on fast food and yet he's eating something that one sitting with a hamburger and french fries, that's 80% of your sodium intake, up to 80% of your saturated fat intake just in one sitting, one meal. That's not healthy. So when you take together the aspirin dosing, the questions about his prior CT scan in 2018 versus now his current CT scan, the fact that you it was previously abnormal, now it's normal, doesn't make a lot of sense. And the fact that they're just obfuscating, I'm not surprised it's causing everybody to ask questions because they're creating these problems for themselves.

Ben (Interviewer/Host) (11:51)

And then there's just the way that Donald Trump presents to the public. When you go through medical records, as I did when I was a litigator, the doctors also make observations how the patient presents and their appearance. Did they show up physically looking a certain way? And was their physical appearance in contrast to their words or were their words steady? Were they rambling? How did they literally present during the checkup? And when Donald Trump here again says that he doesn't know the difference between a CT and an MRI or if it is an mri, he doesn't know which part of the body an MRI was performed on and when Donald Trump goes and says that my hand got whacked, it's whacked. That's not a thing that exists. What is it even referring to? Your hand gets whacked and then you need bandages. That's not a. Like, he's not speaking in complete sentences. And so for me, I view this as totally non political. And I just try to look at a sentence where I go, I don't think he's speaking in sentences that have beginning, middles and ends. He's not completing thoughts. And that raises alarms just in and of itself, considering this is a guy who has access to the nuclear codes.

Dr. Vin Gupta (13:12)

You know, something that keeps coming up, and we've talked about this, and he keeps citing it, is this constant passing of the Montreal Cognitive Assessment Test, moca. And you know, just for everybody out there, this is not a test. This is a screening tool for mild cognitive impairment. Say if you're having memory issues, just sort of linear thought is difficult. You're not able to kind of put basic thoughts together. As we age, this is something that we utilize in medicine all the time for basic screening of mild cognitive impairment, mild dementia, in other words. He keeps talking about that, and I think in doing so, he's confusing the public because this is not a tool that the general public should be utilizing with that level of frequency. Unless. Unless there's a reason to do it, which is, in other words, to assess and monitor the evolution of mild dementia or mild cognitive impairment. If that's what he's been diagnosed with, then sure that's an indication to do these serial tests. Absolutely. But if he's not been diagnosed with that, or if they're trying to, again, it's hard to know now what they're being transparent on since they're fundamentally walking back Connecticut MRI these findings. Hard to trust anything now from his personal physician, but especially now, the question here is why does he keep citing this cognitive tool and the results from it? I suspect he's doing it despite his doctor's best advice. This is where I'll get his doctors and his medical teams back here is, I'm sure many of them are saying, don't talk about this, or this is not something that we're actually saying we want to administer with this level of frequency. Perhaps this is him just doing what he thinks is best, but it's not. Again, the flex that he thinks it is. Passing this assessment proves nothing. It proves nothing. And if anything, it raises more questions.

Ben (Interviewer/Host) (15:09)

While I got you on here, I want to just change topics, just briefly because there's so many of our subscribers who are very worried right now that they haven't been able to afford a health care plan on the Affordable Care act exchanges. Now they don't have health care and they don't know what to do. Or maybe they have a family member who's now been kicked off of their ACA plan because without the subsidies they can't afford it. And I know we've gotten so many comments. What can we do? What can we do? So what's your guidance to people right now who have been thrown off their health care plans because of Trump and the Republicans refusing to have this vote to extend the ACA subsidies now?

Dr. Vin Gupta (15:49)

Ben, thank you for that tee up critical topic. And as you pointed out, we've gotten a lot of outreach from Midas Touch Midas Health listeners and viewers on can we do something here to just put good information out. As everybody knows, January 1st, first day where the lack of subsidies to make healthcare affordable for those 24 million Americans who get their health insurance on the Affordable Care act exchanges throughout the country. January 1st, yesterday was that first day where these prices are taking effect. These are having real world impacts on people and families. So what can you do if your health insurance premium now is unaffordable? In many cases, we think for at least 5 million people, they're going to go uninsured. Many more underinsured with the type of plan that's going to be high deductible will basically just cover catastrophic health care expenses, but difficult to really afford anything else. What should you do? I should say none of these pieces of advice substitute for federal action on just extending the subsidy. So I hope that happens and I hope this guidance ultimately proves unnecessary. But what can you do? 1. Go to healthcare.gov if you're in this situation with unaffordable healthcare premiums, you can still go to healthcare.gov it might seem counterintuitive, but there's a special enrollment period where you can look and compare for so called bronze level plans. These are plans that tend to be high deductible, are less generous in terms of what you can get, but the premiums tend to be lower. In some cases the premiums for the bronze level plans will still exceed what somebody say in the silver level plan got in 2025, but it's something to at least look out for. And you have 60 days after saying say you didn't really enroll in coverage, you have 60 days in the special enrollment period. So through March 1st to switch to say a bronze level plan. So that's something to consider. One, you might be newly eligible for Medicaid then. And so whenever there's a premium redetermination, if premiums increase, people might now be newly eligible for Medicaid. And I should emphasize Medicaid is has a year long enrollment period. It's not open enrollment just for say six weeks towards the end of the year, which is typical of most health insurance plans. Medicaid, you can enroll at any point in the year. So something to keep in mind, maybe you can actually qualify for Medicaid. A question to ask your physician, your clinic's social worker, if you don't know where to go, do you now qualify for Medicaid? Number three federally qualified health centers across the country, FQHCs for short. Ben. These are places bedrocks of care in communities across the country that essentially provide care to those on Medicaid, those that are underinsured, those that have no insurance. And usually the price of that care is tied to their ability to play to pay. The price of that care is tied to their ability to pay. So if you haven't ever looked at an FQHC and you're in this position where their health insurance has become unaffordable, perhaps now is the time to look to your federally qualified healthcare center in your community and there's usually one not far from where everybody that's listening to us is living. Go and consider that. And usually they tailor their fees to ability to pay. So something to look at. And lastly, medications. I get a lot of questions Ben, from folks wondering, well gosh doc, I'm worried about my meds. What should I do about my meds? One thing you can do is ask to switch from a 30 day refill on your meds, your chronic meds, your inhalers, your blood pressure medications, your diabetes medications to a 90 day that tends to actually save money going from 30 to 90. So you can do that. There's a lot of generic alternatives for branded inhalers. I'm a pulmonologist, ask for a generic alternative. Ask your prescriber, your medical provider, can they prescribe a generic that might do the same medical benefit as a branded medication. And then usually I look at cost plus drugs, I look at entities like Amazon Pharmacy. These entities, Walmart now have cash pay options that don't utilize insurance spend for chronic medications that tend to actually be lower for medications than somebody's co pay. So now actually circumnavigating around your insurance and just paying cash for your blood pressure medications, your diabetes medications, your asthma inhaler, frankly, in many cases through Mark Cuban's Cost Plus, Amazon Pharmacy, Walmart, other entities like this can save you money than applying your insurance. So something to consider, I think all.

Ben (Interviewer/Host) (20:34)

Very important practical advice. I mean, it's shameful that we're here where that advice has to be, you know, given, but it's, it's stuff that people can really take with them into the new year and, and implement in their day to day life. Dr. Vin Gupta, thanks for sharing all your knowledge. Thanks for leading Midas Health. We appreciate you.

Dr. Vin Gupta (20:54)

Thank you.

Ben (Interviewer/Host) (20:55)

And everybody hit subscribe here. Let's get to 6 million subscribers. Want to stay plugged in? Become a subscriber to our substack at midasplus.

Host/Announcer (21:02)

Com.

Ben (Interviewer/Host) (21:02)

You'll get daily recaps from Ron Filipkowski ad free episodes of our podcast and more exclusive content only available at midasplus.

Host/Announcer (21:10)

Com.