Is Moderate Alcohol Drinking Good for your Cardiovascular Health?

The answer, of course, is more complicated that everyone thinks. For many years, we have been told, (and as a physician I have told people) that drinking alcohol in moderate amounts is good for the cardiovascular health. This is based on  studies that indeed show a decrease in cardiovascular events (heart attacks, strokes and death) in people who drink alcohol moderately compared to non-drinkers or to heavy drinkers. The basis seemed to be an increase in the HDL “good” cholesterol.

Today, with the availability of genetic testing, scientists have been able to identify a subset of people (15-20% of the population) that may get a huge cardiovascular benefit from drinking alcohol moderately. According to one study, they can reduce the risk up to 80%. What this means is that if someone does not belong to this group, drinking alcohol in moderate amounts probably does nothing to the cardiovascular risk.

What are the potential lessons from this information? The first lesson is that Medicine is an evolving science. As knowledge increases, we physicians will be able to practice better and serve patients better. The second lesson is that individualized care is extremely important. Nowadays we tend to look for “fit-for-all” solutions. The reality is that we are all built differently. 

Marco A. Ramos MD

3 Reasons to Obtain a Second Medical Opinion

Healthcare is complicated. Specially if we are talking about complex situations like chemotherapy, dialysis, surgery or advanced procedures. The decisions made between the doctors and the patient will always involve the body of the patient. 

First, a second medical opinion is a way to reassure the patient regarding the course of action its healthcare is taking. There might be many doubts concerning a proposed surgery, for example. A second medical opinion would provide the patient the peace of mind necessary to minimize anxiety associated to the procedure.

Second, a new opinion rendered by a specialized physician would complement and supplement the information that the patient already has. A problem with the current healthcare system is the lack of time physicians have to provide the necessary data that patients need to make informed decisions

Third, a second medical opinion may broaden the options a patient can have. Specialized physicians looking specifically into the patient’s case can provide new insights withe respect to the case and when doing this, alternative therapies can emerge as possibilities when they were not considered initially.

A second medical opinion is a tool that all patients should consider, specially when the the proposed treatment strategies are complex and involve a certain level of risk for the life or wellbeing of the patient.

Marco A. Ramos MD

3 Pieces of Advise if You or Your Relative are Hospitalized

Hospitalization is a reality. It will happen to most of us, for one reason or another. It gets more common as age increases. The hospitalization process can be risky. There are specialized medications being given and invasive procedures performed. Regardless of the training and capabilities of the physicians and the watchful eyes and caring hands of nurses there will be side effects that might threaten the life or well being of a patient.

The first piece of advise is never to be confrontational with the hospital staff. In many occasions healthcare workers are working at the limit of their capabilities. Adding more stress to an already stressful situation by nature (which the hospitalization is) will only create negative feelings towards the patients and families. Healthcare workers are human beings and although they have been trained to be non-judgmental and to treat everyone equally, they are also human beings and have emotions of their own.

A second piece of advise is to make sure that all information about the hospitalization process is understood and that decisions are made together with the doctor. Patients and families sometimes fail to answer the questions because “the doctor already rounded and we missed him or her”.  It is the physician’s duty as the one ordering the treatments to inform the progress to the patient’s and/or families. Nurses know how to locate physicians and they will do it upon patient’s or family’s request.

Last, but not least, what do you do in case, in spite of multiple efforts to comprehend what is going on in the hospitalization process, things are not understood? At this point, what is needed is the intervention of the primary care provider (or even a third party physician patient advocate). Nowadays, there are more and more hospitalist services and the primary providers are staying away from the hospital scene. The primary provider or a private physician patient advocate would be able to interact with the hospital personnel and explain the issues to the patient and family afterwards.

The hospitalization process is complicated, but communication is key to a successful outcome. Barriers to effective communication can convert an already difficult situation into a worse one.

Marco A. Ramos MD

3 Reasons to be Careful with Genetic Testing

Nowadays, it is possible to obtain access to one’s genome data easily and relatively cheap. There are several companies offering this information and together with interesting information regarding ancestry they provide medically relevant data.

The first reason to be careful with is the meaning of the data by itself. The majority of diseases are multifactorial in origin, meaning that not one, but many genes could be involved in their genesis. In addition, the environment is also important, meaning that if even if the “defective genes” are present, a healthy diet and physical fitness can ameliorate the effects. An adequate interpretation of the data has to be performed by a physician and if further questions arise this should be followed by a second medical opinion of a physician with training in genetic counseling.

A second reason to be cautious is the abundance of information in the internet about certain conditions and the recommendations provided by well intentioned, non-medically trained people. We always have to keep in mind that we are unique and that the combinations in our genetic material probably do not repeat in another person. Therefore, the recommendations have to personalized. Again, as in the previous paragraph, your physician has to be in charge of starting a necessary treatment or reassuring the patient if necessary.

Finally, what would happen if an insurance company obtains someone’s personal information? Would they use to raise premiums if they know that you are at risk for a certain condition? Would a person become uninsurable? Privacy of course has to be a key factor here. Even if you disclose information to your personal doctor and he or he makes it part of the medical record, the insurance company might have access to it.

Genetic testing, now widely available and cheap can provide medically relevant information. However, there are risks associated with obtaining it. The primary physician should be in charge of guiding the interpretation and possible therapies associated with it and also has to be instrumental helping you keep the privacy of the information. Also, we cannot underestimate the importance of a second medical opinion.

Marco A. Ramos MD

3 Situations to be Careful if Taking Diuretics

Taking diuretics has become one of the cornerstones of the treatment of hypertension and heart failure. Although it has benefits, it has risks too. Here are 3 situations that any person taking diuretics has to be watchful for.

People usually follow the doctor’s recommendations and take the diuretics faithfully once, twice or thrice a day. However, if the person taking the diuretics develops, diarrhea, vomiting or loses its appetite, he or she runs the risk of developing low blood pressure for volume loss in the vascular system. This can cause dizziness, syncope (passing out) or kidney failure.

Diuretics always carry the side effect of losing potassium and/or magnesium though the increased urine production. The best way to avoid this is to have a balanced diet or to take supplements. Low potassium or magnesium can cause dangerous cardiac arrhythmias or muscle weakness.

A low sodium concentration in the blood is also a potential consequence of the use of diuretics. This can happen if the person taking this type of medication drinks too much water while replacing the losses through the urine. Low sodium concentration in the blood can cause headaches, loss of balance, and if severe, lethargy, seizures and death. All diuretics can be associated with low sodium concentrations, however, the thiazide type of  diuretics are more commonly  related to this problem.

All medications cause side effects. Always talk with your doctor regarding these when starting a new one.

Marco A. Ramos MD

The Three Most Common Causes of Kidney Failure

The kidneys are very important organs in the human body. They perform many functions other than just make urine (see my blog post published on October 23, 2014). The kidneys can lose 80-90% of their total function and there could not be any symptom, however, if more than that is lost, dialysis or kidney transplantation are needed in order to survive. So, what causes kidney failure? The list is long, however, the three most important causes are as follows:

The number one reason for people requiring dialysis is diabetes mellitus. 38-45% of all cases of kidney failure are caused by this condition.

The second cause for kidney failure is hypertension (elevated blood pressure). 25-28% of the people who require renal replacement therapy have hypertension as its main mechanism. We have to keep in mind that many diabetics are hypertensives too.

The third cause for kidney failure is glomerular diseases in general. Many of these conditions are autoimmune and have long and complicated names and can only be diagnosed accurately by a kidney biopsy. 10-15% of dialysis cases are from these conditions.

These three causes account for about 85% of all reasons for going into dialysis. There are other situations like genetic conditions,
medication reactions or toxicity from herbal “remedies” that can also cause the kidneys to fail. Since kidney dysfunction rarely produces symptoms until it is too late, it is important to undergo yearly physical examinations that include basic laboratory workup that would detect that the kidney is failing. 

Marco A. Ramos MD

How to Correctly Rehydrate a Person

How to Correctly Rehydrate a Person

Dehydration can occur due to many reasons. The most common reasons to become dehydrated are vomiting, diarrhea and lack of oral intake. Doctors prefer to use the term “intravascular volume depletion”, however, it sounds too long and complicated. For the sake of simplicity I will consider “dehydration” and “intravascular volume depletion” equivalent terms.

Many people believe that drinking water or beverages like juices or tea are good to rehydrate a dehydrated person. The problem is that when someone becomes dehydrated he or she loses salts together with water. The content of salts in the above mentioned solutions is minimal. As a consequence of that, the body loses salts and water and gets back water. The sodium (the main electrolyte in the extracellular fluid) becomes diluted. Too much sodium dilution can cause problems like headaches and lack of balance. Severe sodium dilution can cause seizures and death.

In addition to what I have just mentioned, when the body is dehydrated, there is a hormone called anti-diuretic hormone (ADH) which is secreted. This hormone does not allow water to leave the body. This can have the effect of diluting further the sodium in the body. This is why, we need the right amount of salts when rehydrating.

There are over the counter solutions available can can help with the rehydration process. A good salty broth can also do the trick. However, if the dehydration is severe and vomiting does not allow proper oral rehydration, you might need to go to the closest emergency department before there is kidney failure or before you collapse

Marco A. Ramos MD