 and welcome to the latest episode of Tell Health in Hawaii. My name is Vikram Acharya. I'm the Chief Executive Officer of Cloudwell Health, Hawaii's only all physician founded telemedicine healthcare delivery organization. This month is kidney awareness month. And to learn more about our kidneys, to learn more about kidney awareness is an aphrologist, a kidney doctor, Dr. Ari Gans. Dr. Gans, how are you today? Good, good, thank you, thank you. Hi everybody, and thanks so much for having me today. Thanks for the invite, especially in this special month about the kidneys, yeah? Thank you. Thank you for being on the show, Dr. Gans. We appreciate your time. To get things started, so you're a practicing kidney doctor in Hawaii. Tell me a little bit about your background, where you're from and what brought you to Hawaii. Oh, for sure. Well, it's very interesting last few years. I'm originally from El Salvador in Central America. I went to do my residency and fellowship in New York State, different programs over there. So I lived there for about almost eight years. And when I finished my training, I was looking at a few options and thank God, to be honest, we came to Hawaii and it's been great so far. I mean, the weather is amazing. I'm sure you know that already. And it's just so much like home. Very family oriented, the weather, everything is great. Actually, so very happy to be here. Now, you're a nephrologist, so you specialize in taking care of people's kidneys, and it being Kidney Awareness Month, can you talk to me a little bit about the role of the nephrologist in managing the kidneys, what they do, how they work with other doctors to make sure someone is as healthy as possible? For sure, so we love it. So basically, so kidneys starting from the beginning will be basically, we have two of them, and their main job is to clean our blood. They clean our blood, they get rid of toxins, they control our water balance, and our body, our metabolism. They do a lot of other things, but those are why they are most commonly known. And we as kidney doctors, we see such a vast, disease in the kidney that is only originating at the kidney, or that is simply affected from any other medical problems. And kidneys, they're very strong, but I want to say very sensitive to major changes of our organism, and it just unfortunately so happens that when there's a lot of other problems going on, that maybe I'm not originated at the kidney, the kidney can get hurt. So that's when we, especially for the kidney, we focus on trying to see how we can, one, find out if there's a kidney problem. Two, how can we protect the kidney? And three, how we can get that kidney in better shape. And as a fourth option, I would probably add how we can treat whatever problem is going on as well. In the way we do that is having a close connection, basically working side by side with your primary care provider, with other specialist cardiology, I would say it's very common. Also rheumatology, autoimmune disease doctors and such. So we have a lot of, there's a lot of, in nephrology, there's a lot of bread and butter happening with the kidneys, kidney failure is so common. And there's a lot of issues why that can happen, but basically we like to stay in touch with the primary care doctor. We get a lot of help from them by identifying when there's a kidney problem and when it's a good time to come to us so we can start doing some changes for the better. Yeah. Now, what types of tests or scans are done to check the kidneys? If I come to you and say, and my primary care doctor is concerned that I may have problems with my kidneys, what kinds of things would I expect when I see you and your team? All right. So essentially the first step is say when you're going to see your regular doctor, he can identify any decrease in your kidney function by a, at the beginning of a medical, of the kidney problem by a blood test. All right. And this blood test it's usually done on a routinely basis on almost all of the patients by the primary care provider on a basically every three months or every six months, at least once a year. It gets automatically done. It's part of the workup or monitoring the patient's health. So your primary care doctor can identify that from the first day. And the issue is how severe that medical problem is and then if it's very early, we are primary care providers specifically in Hawaii, they are very capable on handling and trying to identify what's going on and how to treat it. But then of course, when it becomes or it's a very serious problem, then they refer you to us. And then at that point, it's very important for us to identify a lot of respect. And if anything, I think we all should be aware as patients, what are the risk factors that I have in my life that could actually hurt my kidneys? It can go from very serious things, say very bad high blood pressure, very bad blood sugar, diabetes, very bad cholesterol or obesity has now in the last few decades I've been associated with having kidney problems as well to the other side of simply taking too many paintings, like ibuprofen, naproxen and all those type of pills. And so once we identified the risk factors, we try to separate, okay, is there something that we can do to make that kidney not continue to get injured or not to continue to get pain? So we go through a detailed history with the patient, we try to find out all the medications that have been going on, we try to find out previous records from the patient. And it's very interesting because you can find a lot of information that it's actually, people think, oh yeah, it's okay. I just took a few ibuprofen every now and then, but then when you look back, it's actually like 10 per month. So definitely can hurt the kidney. So we like to go through different stages of when a patient comes to us. One is identifying those risk factors. Two, we like to modify those risk factors. And three, we like to start making interventions on a treatment plan to improve that kidney function if possible. But one of the main goals is, if your kidney function has deteriorated, is to avoid the progression of that chronic kidney disease. And when I mentioned chronic kidney disease, I mean chronic kidney disease is just the term that we say there is a kidney problem. And that chronic kidney disease could be for it could be from multiple reasons. It doesn't say why is your kidney failing. It's just saying that you do have chronic, but you have kidney failure and you have kidney problems. So yes. Yeah, it does start though, it sounds like with that first test though, the importance of going to a primary care doctor and getting that kidney function test to start to really evaluate the baseline health of the kidney. Really it starts with that, it sounds like. Correct, correct. It's so crucial because as you can go to your regular doctor just for a common cold or feeling tired or checking your vitamins or your cholesterol, that test will get done almost, I would say almost 90, above 99% of the times that you go and see your doctor, they will likely already discuss. And it's very important that as patients we also ask, hey, how is my kidney doing? Is everything okay? And your doctor will go over with you through all those results and there's any kidney problems for sure. Then it is definitely advisable to find out how serious it is. Do you need to be seen by a kidney doctor and so on. So the first step, exactly what you mentioned is identifying is there a kidney problem. Once we know, then we can start the workup. We can start finding out what's going on. We can figure it out, can we fix it? Can we treat it? Can we cure it? And that's very important. That's definitely the first step becomes your second point. Thanks. Now in Hawaii, are rates of kidney disease potentially higher compared to other states? Or is, and if so, why is that? Why is those rates potentially higher? Correct. So it's very, very interesting what happens in Hawaii. We have a lot of different, the population, the community that we treat, it comes from different backgrounds. We have Asian background, we have native Hawaiians, we have Pacific Islanders that come from all islands of the Pacific, and it's very interesting to see that mixed population here because all of them, they have a different percentage of the community, and all of them they have, it seems that they seem to be very sensitive on the kidney waste. Before there had been a lot of epidemiologic studies throughout the whole world, United States and in Hawaii as well, and it has been the true prevalence of chronic kidney disease. It's very difficult to put a number into that. It has, there's no growth number, how many patients and such per year. But in Hawaii, it is being reported, there was a analysis of native Hawaiians with Pacific Islanders, which was published in 2019 or 17, I believe, in which according to the data, public records data analyzed at that time, they said that from native Hawaiians, including Pacific Islanders, the ratio of kidney problems could be up to eightfold versus Caucasians and other communities. So it's very impressive. And one of the things that he was, and we know that in the United States, one of the first cause of having kidney problems is diabetes. It actually, it seems that diabetes, the prevalence and incidence in Hawaii, it's very high. And that is what we believe is one of the main factors. Of course, we all love our food. Food in the island, it's amazing. And it has something to do with our dietary habits as well, our predispositions of these medical problems, which it seems to be more sensitive on native Hawaiians and Pacific Islanders as well. I see. Now, in the world of telehealth, if I needed to see you as a nephrologist, could I have a very good medical visit just like the way we're talking now? And is that possible? It's a great question, especially through COVID times. And we found out in our office that we had to provide and obviously continue to provide kidney care to our patients here in Hawaii. And through COVID, one of the silver lining of the situation was that we were putting ourselves up to speed with the technology and everything that we have available nowadays to provide that care. Even if it wasn't a face-to-face visit, being in the same room, which we all love and like and miss still, office was able to run on almost above 90, 95% of all of our visits were run through telemedicine. Excellent, wow. Actually up until now, since that last wave of COVID was happening, I would say more than 75% of our visits are still telemedicine. One of the greatest impacts in telemedicine was that patients could be, there's some parts of Hawaii that are very remote and access is very limited from other islands. Sometimes people used to travel just to O'ahu, just to have a sit-down with us. Although we enjoy sitting with people and just talking about it and finding out face-to-face what's going on, you know, and you build more report, I feel that we still have the capability of building up our relationship. And through telemedicine, it's been great because we are able to discuss, I'm able to meet not only with the patient, but also with their loved ones, their family members side-by-side, and we can all be in the same room together, no matter where they are. Talking and going through each of the medical case, through the medical records, all the labs and coming up with a treatment plan for that patient. And so the great thing is that I feel like with telemedicine, we'll be able to reach more patients than that they were not easy to get because they couldn't get to that doctor to see him at the office. No, with telemedicine now, we can have that access in just a matter of connecting through your phone, through your tablet, through your computer. If the patient has trouble doing it, we have maybe a niece, a nephew, an uncle, or somebody at home who also knows how to operate the devices, and we can easily come in. We got them on the habits of, hey, can you check your blood pressure before we need it? So while we're sitting with them, so we can check those vital signs, we can examine, how are they feeling, how are they doing? So it's been an amazing breakthrough for healthcare. I believe telemedicine has definitely given us so many more options. And I think it's something that for sure is here to stay. So it's been good. So our office is on full swing, able to tailor the patient needs if it is in-patient, face-to-face visit. We also have those patients that come in and we see them. And we also are completely ready to do a lot of telemedicine at the office. So yes. That's wonderful that you're able to provide care so seamlessly between an in-person setting, the traditional setting, but also the virtual setting. Because I would think that if I were able to get my labs drawn before the visit, and those labs results are sent to you, then you will know all that when you see me, and it just makes it for a very productive visit. All right, it makes it very effective, to be honest, very effective. We can share educational links with the patients through the chat box when we're doing telemedicine. I can actually share my screen, show them the graph, how their kidney function is doing, up or down, or what it is that we can show. We can show them their chart, all their labs, not only by me talking to them about it, but I can actually show them. So it's been very nice, very useful. Now, if I wanted to make my kidneys healthier, what are some steps that I can take right now to make my kidneys healthier? Great, great question. So definitely there's a lot of things that we can, and everything starts with us individually. Yeah. And what I mean by that is, having that simply hitting us on a better health. And what we focus is, what I tell my patients is definitely, if you have to know your medical problems, you may not have any medical problems, you may have a pressure cholesterol or whatever that is, but there's a few things that you can do. One of the most common things, and I keep mentioning this because it's very, very common, over 15, 20 million people in the United States, even more out there to say they use pain medications. And it's really an issue because I have seen so many types of kidney failure by simply taking too many pain tubes. And that is something that whatever medication you take, even if it's over the counter, you should be aware not to do the excess. If there's something that is bothering you too much, definitely you should touch base with your doctor after, hey, is this medication safe and okay for me to take regarding my kidneys. So watching the medications that you buy over the counter, it's important, not all of them, all of them are safe if you use them in an appropriate manner, but the excess of them might bring kidney problems. Second, I would say also, run down through the medications that your primary doctor has been providing. All of the medications in medicine do have side effects, but we always, your primary care doctor will always be checking your kidneys, making sure some of them are being well, but just to make it clear, all of the medications in medicine can have side effects, not all of them have kidney side effects. So just to make that distinction clear. Now proper hydration, it's fundamental for your health. Our body composition is a lot of water in it and definitely if you're running dry on your tank, basically you will be dehydrated, especially if you spend, you will be surprised how many liters you can spend working under the sun. I have a lot of elderly patients who love to do their gardening outside, especially when the sun is hitting so strong, make sure you're drinking water to their families, make sure you guys are getting water to your elder and the family, making sure they're drinking enough water. How much water you should drink? Well, it really depends on the body size and so on, but as a general rule, you could say at least drinking about 32, probably even more, like maybe 45 to 55 ounces per day, it's a good amount of liquid. So hydration, very important to keep your kidneys healthy. Verify that the medications that you're taking are not causing any damage or could cause any damage. Three, I would say, how to keep your kidneys healthy? Know your problems. If you have high blood pressure, slow down on salty food, you know that low salt diet not only will help the blood pressure, but it also will help to preserve your kidneys from getting any damage if blood pressure goes high. Number four, this has not been a solid proof, but there's been signals that high sugar content drinks may be an issue also with kidney failure. Also, lose weight. I say this, so the kidneys are like the ones who do the cleaning in our house, yeah? They clean our whole body. So the bigger the body, the more cleaning they have to do. So if we wait, it does help. So- I like that analogy. That's a good- Yeah. That's good. So yeah, so there's, at least I would say, staying well hydrated, watching your diet, including a lot of vegetables, it's very fundamental. That has also signal to try to preserve kidney function on patients who have kidney disease and avoid certain medications that could cause the problems as well. Then very important, make sure you have your regular checkups with your primary care doctor who can detect any early signs of kidney problem. Yeah. It's funny. Today is doctor's day. And I want to thank you. Happy doctor's day. It's very hard to be a physician every day. And especially through the COVID-19 pandemic and the challenges on our healthcare system and our providers, this must have been very challenging for you and your team. And what it sounds like with telemedicine, it made it much more seamless, much easier for you to still talk to your patients. And it really does sound like telemedicine is pretty much the same as a regular visit. It's very effective if patients get to access care that they need, much easier without taking a plane to Oahu and so on. And I'm sure there's plenty of places in the mainland as well that are benefiting from it. And thank you so much for inviting Doctor's Day. I feel blessed. I really have to thank God for how he has support us through all of this. And we're very happy to help. And hopefully we can continue to help everybody in Hawaii as they need it. And for sure. The first thing of everything is education. So thank you so much, Vikram, for allowing me to share a little bit about what chronic kidney disease and kidney is. Everybody should be aware and everybody should know that there are kidney specialists to assist. And if it's not a face-to-face visit, telemedicine is always available. Yeah, I know. Thank you, Dr. Gans. It's just a real pleasure having you on the show. Your knowledge of the kidneys, being a physician on the front lines, treating all the residents in the state of Hawaii. Happy Doctor's Day. Happy Doctor's Day to you. Happy Doctor's Day to all your colleagues. And we appreciate you very much. Thank you for taking care of our Ohana. Thank you very much. Thank you. Have a wonderful day. Thank you, you too. Thanks, bye. Bye-bye. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.