3 Reasons Why “Weight Loss Challenges” May Be Unsafe

Weight loss challenges have become a popular way to lose weight. People who consider themselves to be overweight sometimes gather as a group and engage in them in order to lose the extra pounds they consider they have. On some occasions, these activities are promoted by gyms and “fitness” centers. They may consist on exercise routines that may be extreme and in dietary regimens that may be unhealthy. Here are 3 risks that any person participating in these challenges may be exposed to.

1. Risk of muscle injury. Muscle injury (rhabdomyolysis) is a condition that may happen if muscles which have not been subject to exercise regularly are suddenly exposed to it. The main problem with muscle breakdown (besides the pain) is the release of muscle enzymes into the bloodstream. These enzymes are known to be toxic to the kidneys and are known to cause kidney failure.

2. Risk of low sodium concentration. Low sodium in the blood (hyponatremia) can occur in people when they lose body salts through sweat from exercise and drink pure water or low salt-containing fluids. The body, when dehydrated, tries to retain fluid and when a dehydrated person drinks water most of it stays in the body, diluting the remaining sodium concentration. If sodium becomes too low, it can precipitate seizures .

3. Risk of low potassium concentration. Low potassium in the blood (hypokalemia) is known to happen when someone has a prolonged decreased food intake. The main risk of hypokalemia is the development of cardiac arrhythmias that can cause a person to collapse and even to have a cardiac arrest. 

There are other risks of performing unusual physical activity coupled with severe restrictions of food intake. The ones presented in this post are ones that are known to happen and that may pose a risk to a person’s health. Whenever there is a health related issue that needs to be addressed, the primary physician is the best suited professional that can guide a person through the process. He or she should be able to create the best approach for losing weight

Marco A. Ramos MD

3 Common Ways Kidneys Get Damaged Acutely

The kidneys are very delicate organs. As it can be seen in a previous post, they are in charge of many different functions and need to have a good supply of blood at all times in order to perform appropriately. 

1. The most common reason the kidneys get damaged is when the blood supply decreases. This happens when an individual loses fluids through diarrhea, vomiting and does not replenish its fluids with salt-containing fluids. 

2. Certain pain medications, can affect the internal blood flow of the kidneys. If these medications are taken and the body is not adequately hydrated the blood flow to the kidney cells can severely decrease and cause kidney damage. The type of pain medications belong to a category called non-steroidal anti-inflammatory drugs. Common examples of them are ibuprofen, naproxen and ketorolac. Other medications, taken when the body is not well hydrated can also damage the kidneys these include diuretics and blood pressure medications called ACE-inhibitors (examples: captopril, lisinopril, enalapril) and angiotensin receptor blockers (examples losartan, valsartan, irbesartan).

3. Finally, the kidneys can get damaged by a substance that is necessary for certain diagnostic procedures. The use of radiocontrast for coronary angiograpahies or CT scans can damage the kidneys if they are already chronically damaged or if the patient is not adequately hydrated.

There are other causes for acute kidney damage. The post concentrates in the common ones.

All these causes are usually temporary and the faster they are corrected, the better the chances of avoiding longer damage. Whenever there is a change in the level of fluids a body, the balance has to be restored. Do not hesitate to talk to your doctor or go the the closest Emergency Department if you feel at risk.

Marco A. Ramos MD

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