47⬅ Donald Trump: Amyloidosis Doubts and Loose Ends

But first, a lesson on medical diagnosis

The immensely insightful English physician, Richard Asher, told this story 3a:

When I tried to teach the art of medical diagnosis to students, I often used to ask them this riddle... "What runs about farm yards, flaps its wings, lays eggs and barks like a dog?... Have you guessed it? The answer is `a hen!'"

To the inevitable follow-up question "Barks like a dog?" Asher would respond: "That was just put in to make it difficult." He would then explain that "Patients so often produce an egregious or distracting symptom in addition to the symptoms they ought to have."

One could add that "has feathers" was omitted from the riddle, making the riddle more difficult still, and teaching that patients will often lack major findings that they ought to have.

And so it is with Donald Trump. It would be nice, and considerably easier on my nerves, if all the elements of his medical history aligned perfectly with a single disease. But that is a vain hope in any patient.

And do not forget...

The idea here is not to diagnose Donald Trump with amyloidosis. This website is about saying he should be tested (and the results disclosed) because there is a strong suspicion.

Loose end: Amyloidosis subtype

"Amyloidosis" is the name for hundreds of different diseases arising from abnormally behaving proteins that infiltrate organs. A complete diagnosis of amyloidosis includes deciding which of these hundreds of amyloidosis sub-types the patient has, down to the molecular level.

That is normally done with lab tests, but the broad strokes can sometimes be deduced by looking at which organs are involved, because different sub-types of amyloidosis have different patterns of organ involvement.

This leads to two loose ends with Trump's medical state: first, his pattern of organ involvement is uncertain (for example, are the kidneys involved?), and, second, it is not clear which sub-type his pattern (whatever it is) matches most closely.

That second statement is not entirely true. Trump's pattern of organ involvement seems to well match the "AL" type of amyloidosis, but he is unlikely to have that sub-type, for non-medical reasons. Specifically, the treatment for AL amyloidosis is sufficiently demanding that he would need to drop of out sight for a time, which he hasn't done. He could elect to forego treatment, of course, but that seems not only uncharacteristic, but the disease moves fast enough that his currently observable decline would be much worse had he opted out of treatment.

Elements of his organ pattern match some of the genetic "TTR" sub-types of amyloidosis. That would point a finger at his ancestors, but too little is known of Tump's family medical history to be helpful.

Overall, his pattern of organ involvement and pattern matching are not worth worrying about at this stage: they are dogs and feathers that our meager knowledge of his actual symptoms cannot resolve, not to mention the fact that we would have to understand in detail the clinical behavior of hundreds of sub-types of amyloidosis, which is beyond the limit of today's medical knowledge.

And so, regardless of our ignorance on those two counts, he still needs definitive testing. If the testing is negative, then we can look back and say "Aha, the warning signs were here because his organ pattern didn't fit perfectly with a common pattern," but it would be a grave medical mistake to withhold testing on that basis.

Loose end: Not amyloidosis

Other diseases besides amyloidosis could account for several of Trump's medical findings. Severe liver disease, for example, can cause bruising, swelling, and low blood pressure. Only three liver-related measurements have been disclosed for Trump in 2025-2026, not sufficient to rule out liver disease.

I hope the information collected on this website helps anyone who wants to fashion a list of non-amyloidosis possibilities and analyze them. I would applaud such efforts. Based on a friend's work, a beginning is presented in the Appendix, below.

APPENDIX

A differential diagnosis

After first encountering the website (sans pathology index), a very wise and experienced internist friend constructed the following list of possible causes for Donald Trump's ails.

1. Fatty liver disease, with late hepatic decompensation. Tends to be quite silent for years.

2. Recent onset heart failure from atherosclerotic disease — his decades long diet would make this likely

3. Diastolic dysfunction from the same cause, or as you suggest, infiltrative process

4. Myxedema

5. Nephrotic syndrome

6. Scurvy

7. Lymphedema

8. Drug complications, from NSAIDS, calcium channel blockers, testosterone, steroids, etc.

9. Sleep apnea

10. Multiple myeloma

11. Chronic leukemia, lymphocytic or myeloid

She added:

"All this would be a partial differential. Patients will always surprise you. Diagnosis is like solving a crime, in that it's arrived at by the scut work of collecting way too much information and weeding out suspect diagnoses. Deciding ahead of time what (or who) you think the culprit is will sometimes lead to brilliant diagnoses, and more often make you embarrass yourself."

This is a gentle admonition that she would prefer a different approach to the medical analysis of Donald Trump than the one this website is taking.

And that's completely fair.

But is it practical?

Back where we started

Think about the first item on the internist's differential: liver disease. Trump's medical report offers only three datums about the liver: normal AST and ALT, and normal abdominal imaging of some unknown kind. It is impossible to exclude liver disease with that amount of information, so immediately we are dead in the water if we try to follow the conventional technical medical approach.

But we're not completely dead, because non-medical information can be applied with a reasonable degree of certainty. Here is how I responded to the internist's differential. It builds to the last paragraph.

Any condition that responds well to treatment can be crossed off, because I think that at least one of the 22 docs that he saw would be able to pinpoint what's happening and get him on effective treatments. So, that would rule out pre-cirrhotic fatty liver, non-end-stage cardiac ischemia, myxedema, scurvy, drug complications, and obstructive sleep apnea. Cushingism probably belongs on the list, too (but blood pressure wrong, so maybe not), but that's amenable to treatment as well.

I don't think Trump would surrender to disease even if the treatment were harsh, so that also rules out myeloma and leukemia/lymphoma. Of course, if he has multiple myeloma complicated by amyloidosis, that would be part of the systemic amyloidosis diagnosis.

Cirrhotic liver disease, fatty or otherwise, could surely produce edema and bruising and relative hypotension. But this requires years of missed diagnosis and missed treatment during the very long lead-up to the cirrhotic stage. I don't think his docs are so incompetent as to miss something this big for that long. Through the years he has certainly had all the blood tests and liver imaging necessary to point a finger at the liver, if not make the diagnosis outright. My reading of his personality is that if his docs told him, "you must lose weight or this scarring in your liver will progress and not just kill you, but torture you as it progresses" ... I think he would moderate his diet and accept medication, including a GLP-1. And if they put him on one of the new medications for MASH, I am sure he would take it -- by all accounts he takes his hypocholesterolemic medications.

Same reasoning for end-stage cardiac ischemia. I think they would have found it long ago and stented him up the wazoo. He truly does love to play golf, so if over the years he had a correctible form of exercise limitation, I think he would be eager to have it fixed. And if he'd had an infarct at any time, my read of his personality again is that he'd happily go into the hospital for treatment rather than accept a higher risk of death by gritting through it at home. He did finally surrender to a covid hospitalization.

He might have a component of lymphedema. I don't know enough about its natural history and its differential to understand whether it can account for the late onset, semi-rapid progression, and magnitude of his swelling, and whether there are systemic associations that could account for other features of his presentation.

I actually think that some of his lab and imaging info can be trusted. I don't think his docs make up numbers, because in their most recent report they contorted themselves to adjust the normal range for hematocrit rather than simply alter the hematocrit. But I do not trust them to faithfully report subjective findings. I think they'll color the results in various obfuscating ways without wholesale lying.

But you are 100% right that the web site needs to foot stomp that my goal is to find a single unifying explanation rather than provide exhaustive differentials for each one of his abnormalities. This is admittedly not the way to approach a sick patient, but the proper approach that you've rightly put forward is going to be stalled at every step by the absence of data, and the only way forward is going to be intersecting the differentials for each abnormality to look for the unifying explanation that appears on all the individual differentials... which is exactly where we are now. Some diseases, the "great masqueraders" like amyloidosis and lupus, have inherent advantages in searches like this, because they are seemingly on the differential for everything. But that is all the more reason to make sure they have been excluded.

The message of the last paragraph brings us back to the basic goal of the website: finding one disease that fits as many clinical findings as possible.

If such a disease is found, then it is fair for the physician community to ask the people medically responsible for the president whether that disease has been excluded by nonpublic data. And that is indeed where all of this started.