NPR asks Dr. Thomas Maldonado, a vascular surgeon in Nyu Langone Health, on the diagnosis of chronic venous insufficiency of President Trump and what the public can learn from it.
Michel Martin, host:
In the United States, up to 30% of all adults have a form of chronic venous insufficiency. So let’s learn more about it. We called Dr. Thomas Maldonado for this. He is vascular surgeon at Nyu Langone Health in New York. Hello, Dr Maldonado. Thank you for joining us.
Thomas Maldonado: Hello. It’s good to be here.
Martin: So what are the first indicators for this? What should people are looking for?
Maldonado: Well, you know, it’s a progressive disease, so there is a range of symptoms and signs. And, you know, very early, it is something that can have a soft swelling. Often people feel a certain heaviness, itching in their legs, believe it or not. And then the varicose veins are in a way what is the common presentation. People come with a kind of unsightly veins.
They want to be more beautiful in summer. They want those treated. But it is actually a warning that there is a problem with the veins and venous traffic.
Martin: You know, the White House published the results of the president’s last physics in April, which is about three months ago. He showed that there was, “a normal blood flow and no swelling,” unquil, in its ends. So, is it possible that this condition has arrived quickly in just a few months?
Maldonado: Well, probably unlikely. I mean, there is – it is a chronic disease and it is – so the name of chronic venous insufficiency. So this really happens during a lifetime, although it is more common, as we know, in the elderly, especially women. But the best way to understand this is that circulation is a really simple plumbing. You know, we have a pump, heart. It propels blood through the arteries which deliver it to the organs, the ends and the veins refer it.
And these veins, over time, while we fight on gravity every day of our life, can become weak. You know, the valves that live in the veins, these delicate little valves can fail, and this really happens over the years, so unlikely that this has happened overnight.
Martin: I was just wondering, how or why are his doctors so sure that it is a vascular problem and not a heart problem? For example, why is it the plumbing problem and not the heart problem? Who finishes …
Maldonado: Yes.
Martin: … Specter, right? Like, it’s …
Maldonado: Correct.
Martin: … Is it a problem up to bottom or an upward problem? They seem convinced that it is an ascending problem, but why are they so sure?
Maldonado: Well, you know, there is an assessment that takes place. Whenever you see someone with swelling, you will assess their heart. If they have heart failure, their liver insufficiency can also, you know, increase your total body water, if you want and renal failure in the same way. There are therefore a number of different systemic reasons for which people can swell.
And these are excluded with various exercises, so I’m sure he had an echocardiogram. This is how you get a complete assessment of other systems. But common things happen fluently, and certainly, you know, chronic venous insufficiency is a very common disease.
Martin: I read that women are statistically more inclined to develop this condition. Can you just amplify this? Like, why? And are there any differences in the way she presents herself in men or women?
Maldonado: Yes. Well, women – pregnancy, for sure, and repeat, you know, more pregnancy can add risk factors to develop chronic venous insufficiency. And there are several reasons for this. But the symptomatology or the way people present are the same. It is swelling, pain, heaviness. And again, in the most serious cases where we have changes in skin fibrosis, degradation of the skin, as you have heard, with ulcers and an infection that can develop. It is therefore not so benign, in fact, especially in the last stadiums.
Martin: So – and just another thing about the president. The White House doctor has attributed bruises on the president’s hands to, quote, “trembling by hand and the use of aspirin, which is used to prevent cardiovascular disease”. I’m sure a lot of people do that, take a little aspirin per day. What do you do with this explanation?
Maldonado: Yes. I think it’s plausible. I mean, aspirin is one of these drugs which can be very important for people’s vascular health, but can also give you these skin manifestations, where you have a kind of murderer or what we call an easy capillary rupture of ships, and certainly of any type of local trauma, whether, you know, a bracelet or a watch, sometimes you see people who have people in the skin
Martin: So, before you let you go, are there things that people-ordinary people as we should do to prevent this or to take care of this?
Maldonado: Yes. I think early recognition, like most things. You want to catch this early so that you can prevent progression, you know, compression stockings, elevation of the legs, exercise, weight loss, more, you know, obesity is one of the significant risk factors. So look at your health, stay healthy and wear compression. You know, you want to recognize these things early so that they do not progress at the stages of more serious chronic problems.
Martin: OK. All right. It’s Dr. Thomas Maldonado. He is vascular surgeon in Nyu Langone Health. Dr. Maldonado, thank you very much for sharing these ideas with us.
Maldonado: Thank you.
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