It’s not uncommon for people to put off seeking medical care. The process can be stressful, especially if you feel your health care provider doesn’t really understand you and your special concerns. That can be even more true for some patients, such as those in the LGBTQ+ community.
In this Q&A, Barbara Warren, PsyD, Senior Director for LGBT Programs and Policies in Mount Sinai’s Office for Diversity and Inclusion, explains how to find a provider with specific experience in LGBTQ+ health issues, how that can help alleviate stress and improve health outcomes, and details Mount Sinai’s approach to offering compassionate care. Dr. Warren, who leads Mount Sinai’s implementation of lesbian, gay, bisexual, transgender and gender diverse (LGB/TGD) culturally and clinically competent health care, is also an Assistant Professor of Medical Education at the Icahn School of Medicine at Mount Sinai.
What are some of the biggest health challenges for the LGBTQ community?
One of the biggest challenges for LGB/TGD consumers is finding a provider and finding a health system that is both LGB/TGD clinically and culturally competent, and being able to go anywhere in that system, to any provider, to any setting, and feel safe, to feel that you are being treated both effectively and with compassion. This is something that we have taken lots of strides to make possible throughout the Mount Sinai Health System.
Why is it important to find a provider who has experience with LGB/TGD health issues? What can they offer?
One of the things that LGB and TGD patients should look for is a provider who understands their needs. Being lesbian, gay, bisexual, transgender and gender diverse isn’t a health problem in itself. But many LGB/TGD people have health issues that are related to something we call “minority stress.” Minority stress is any kind of stress that people can undergo that affects us both psychologically and physiologically—when we either have experienced or anticipate experiencing discrimination, bullying, or even violence. This is something that many people in the LGB/TGD community live with. Even if they themselves have had not had personal experiences, they know that there is a possibility of discrimination, and of misunderstanding by health care providers. This can create anxiety. When sustained over time, this anxiety can create health problems, not just psychological or health behavior issues.
“It is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects,” says Barbara Warren, PsyD.
Can You Give an Example?
Sometimes if we are experiencing many stressors, we may overeat, or drink more alcoholic beverages, or not get enough rest or sleep. Increased and sustained anxiety in response to stressors can interfere with decision-making, memory, and effective functioning. Sustained stressors create a physiological response that leads to increased levels of cortisol in our bodies. Cortisol is known as the body’s stress hormone. It governs key body functions but too much cortisol can lead to a number of health problems, for example increased cardiovascular risk. It is important to note that stressors may be personal or interpersonal in our lives in terms of our current life circumstances like the loss of a loved one, or loss of a job or housing.
Recent threats to LGB/TGD safety and equity across many states in the form of legislation to deny gender-affirming care, banning books and public education inclusive of both racial and LGB/TGD history and representation, banning drag or any other behaviors that don’t conform to rigid and outdated binary gender stereotypes, have all been recent sources of what we are calling “minority stressors.” They have had the effect of increasing rates of depression, anxiety, and suicidality, especially among LGB/TGD young people. So it is more important than ever that for those looking for an LGB/TGD affirming and knowledgeable health care provider, the provider understands that these stressors can affect an LGB/TGD patient’s experience of illness and recovery and work with that patient to understand and mitigate those effects.
How do you find a provider who has this experience?
At the Mount Sinai Health System, we have a number of ways. First we have web pages that give you information and resources, including our LGBT web page. There are a number of other organizations that can help, including the Gay and Lesbian Medical Association and the World Professional Association for Transgender Health. You can email us at LGBTinfo@mountsinai.org, and we will answer your email and make a direct referral to providers around the Mount Sinai Health System that have special expertise.
In addition, we have a number of programs and a number of practitioners specializing in certain aspects of LGBT health. For example, our Institute for Advanced Medicine, which started as our HIV/AIDS program to serve the large gay and bisexual population, specializes in some of the health care issues that are facing LGB/TGD people. There are five locations throughout the city. Our Center for Transgender Medicine and Surgery is a national model for services to support undergoing a gender transition and TGD affirmative primary care. We take LGB/TGD health very seriously at Mount Sinai and offer ongoing training for all of our providers, our front-line workers—everybody from our security guards to our surgeons to create a safe and welcoming environment for our LGB/TGD patients, families, visitors, and employees.
Hearing loss is a common condition that affects millions of people worldwide. In the United States, one in eight people over age 12, and more than 65 percent of individuals over 60 years old, experience hearing loss, according to the National Institutes of Health.
The impact of hearing loss is not limited to difficulty hearing; it is also linked to other health issues such as cognition, dementia, social isolation, and depression. Maura K. Cosetti, MD, Director of the Ear Institute at New York Eye and Ear Infirmary of Mount Sinai, explains why taking steps to prevent hearing loss can be so important, and how hearing loss can lead to other complications, including a potential decline in your memory and thinking.
“Treatments for hearing loss are very effective at improving the clarity of speech, and recent data has also shown that they improve cognitive function as well,” she said.
Here are five important facts you may not know about hearing loss:
Individuals with hearing loss are at higher risk of dementia
Many studies have shown that hearing loss is associated with dementia. Adults with hearing loss are at a greater risk of dementia than those without hearing loss. Results from many studies, including one published in JAMA: The Journal of the American Medical Association, found that the risk was related to the amount of hearing loss. Specifically, adults with mild hearing loss were at twice the increased risk, while those with moderate and severe hearing loss were up to three to five times more likely to develop dementia. Overall, moderate to severe hearing loss has been associated with a 60 percent increased risk of developing dementia compared to those without hearing loss. This relationship is believed to be due to the brain’s increased effort to process sounds, which leads to cognitive overload and mental exhaustion.
To book an appointment with Maura K. Cosetti, MD, call 212-979-4200 or 212-241-9410.
Hearing loss can lead to depression and social isolation
Difficulty hearing can significantly impair communication, and those with hearing loss often limit their interactions and relationships with others, leading to isolation and loneliness. Many research studies have shown a close relationship between hearing loss, social isolation, and depression. Hearing loss is based on how loud sounds need to be for you to hear them, as measured in decibels. For every 10 decibel decrease in your ability to hear, the odds of social isolation increase by 52 percent. Many studies have shown that individuals with hearing loss are more likely to experience depression than those without hearing loss.
Hearing loss is not a normal part of aging and should be treated
Age-related hearing loss is common, often gradual, and may not be easily recognized. Signs of hearing loss include:
Struggling to understand conversations in noisy environments, such as restaurants, parties, or other crowded places.
Turning up the volume on your phone or television.
Ringing in the ears.
Asking people to repeat themselves or thinking others all speak quietly.
Misunderstanding words or phrases.
Some types of hearing loss can be associated with physical obstruction, such as ear wax or fluid in the ears, and can be easily treated. Other types, such as sensorineural hearing loss that occurs from damage to the inner ear, may benefit from amplification, such as hearing aids. Individuals who are experiencing these symptoms should speak to their doctor and seek evaluation for hearing loss.
If you are a hearing aid user but do not get much benefit from your hearing aids, speak to you doctor about other options that may be available, such as cochlear implants.
Treating hearing loss can improve cognition
Treatments for hearing loss are very effective at improving the clarity of speech, and recent data has also shown that they also improve cognitive function. Both hearing aids and cochlear implants are safe and highly effective treatments for hearing loss—and both have shown to improve cognition. Studies show that older adults who use hearing aids have better cognitive function than those with hearing loss who do not use hearing aids. Numerous studies on adults with more severe hearing loss show that cochlear implantation leads to improved cognitive function, and decreased risk of dementia over time. Data suggests that all treatments for hearing loss, including both hearing aids and cochlear implants, improve social engagement, reduce depression, and significantly improve quality of life.
There are many steps you can take to prevent hearing loss
Prevention is one of the most important things we can do to limit hearing loss. While some factors that contribute to hearing loss, such as genetics and aging, are beyond our control, there are many steps you can take to prevent or reduce the risk of hearing loss.
Protect your ears from loud noises. Avoid or limit exposure to loud noises, such as concerts, sporting events, and power tools. If you must be in a noisy environment, wear earplugs or noise-cancelling headphones to reduce the impact of loud noises on your ears.
Maintain good ear health. This includes avoiding the use of cotton swabs or other objects to clean your ears, as this can damage the delicate structures inside the ear.
Seek treatment for any ear infections or other conditions that could affect your hearing. Certain medications, such as some antibiotics and chemotherapy drugs, can cause hearing loss or damage. If you are taking any medications that could affect your hearing, be sure to discuss this with your doctor and take any necessary precautions to protect your ears.
Stop smoking. Exposure to cigarette smoke, either when you smoke or to second-hand smoke, significantly increases your risk of hearing loss.
Take care of your general health. Both uncontrolled diabetes and untreated high blood pressure are risk factors for hearing loss. Follow your doctor’s guidance for treatment of these conditions.
Mammograms have been in the news lately, and it can sometimes be a bit confusing. But the guidance from Mount Sinai doctors remains unchanged and simple: You should start getting mammograms at age 40 and continue yearly.
In this Q&A, Elisa Port, MD, FACS, Chief of Breast Surgery and Co-Director of the Dubin Breast Center, explains why changing guidelines from groups such as the U.S. Preventive Services Task Force have not altered the recommendations of doctors like herself to urge women to start mammograms at age 40 and have them every year. She also explains why this longstanding recommendation for annual mammograms starting at age 40, based on extensive data, is critical for Black women, who are more susceptible to an aggressive form of breast cancer, and why new regulations from the Food and Drug Administration on breast density are also important.
Elisa Port, MD, FACS
What is the latest advice on the age that people should start getting regular mammograms?
The age that women should start getting mammograms has never changed from the perspective of health care professionals. There is tons of data and research that has shown that starting at age 40 and yearly thereafter is the best way to detect breast cancer early and gives women of all those age groups the best chance of survival if they do develop breast cancer that is found through early detection. What has not been consistent is that, starting in 2009, and then again in 2016, a number of groups, such as the American Cancer Society and the U.S. Preventive Services Task Force, started putting out guidelines that differed from that. These were basically prioritizing different factors, and taking into account such things as the anxiety of patients, false positives, and cost. But doctors have known all along that the optimal way to screen women for breast cancer, with the highest chance of survival, is starting at age 40 and continuing yearly thereafter.
What is the U.S. Preventive Services Task Force?
The task force is an independent, volunteer panel of experts on prevention and evidence-based medicine that provides guidance to primary care physicians about preventive services such as screenings and counseling services. It is one of several leading sources of guidance to physicians.
What are the reasons for the new guidance from the task force to start mammograms at age 40?
One of the reasons for the change in its guidance on mammograms was newer data, very disturbing, showing that Black women—who we know can develop cancers younger—are more at risk for developing a particularly aggressive kind of cancer called triple negative breast cancer that can grow more rapidly. The death rate in Black women who get breast cancer is substantively and unacceptably higher. So this change in recommendation is a limited response to that data, saying one thing we can do to address that is revert back to starting screening at a younger age. But they did not go far enough.
How is the risk for Black women different?
One of the biggest issues specific to Black women is that breast cancer is not just one disease. Breast cancer involves multiple different subtypes. Each of these different subtypes is treated differently, has a different pathway, and behaves differently. One of these subtypes, called triple negative breast cancer, is the most aggressive kind of breast cancer and also one of the most difficult to treat. We know that of all breast cancers, triple negative makes up only about 15 percent. However, there are certain groups that have a higher chance of developing triple negative breast cancer and are at high risk for developing that subtype. Black women are one of those groups. When they develop breast cancer, there is a 30 percent chance it will be triple negative, not 15 percent. So it is much higher. As a result, they may need to be screened earlier, and with greater frequency.
Should people be concerned if they cannot afford a mammogram?
At Mount Sinai, we feel very strongly that women should keep to our guidelines, and we accept all insurance. We will do everything within our power to make sure that all women, even those without insurance, regardless of their ability to pay, get the care they need.
Are there any exceptions for the guidance that mammograms should start at age 40?
One of the things that we have made so much progress on, and that I’m so proud of, is there is not a one-size-fits-all approach. There are groups where we might even start screening earlier. Women with a family history of breast cancer, particularly at a young age, may start screening earlier and add other adjunctive tests like ultrasound or MRI—these are all considered in our high-risk populations. For example, if your mother was diagnosed with breast cancer at age 45, we typically advise starting screening about 10 years younger than the youngest family member diagnosed with breast cancer. Doctors might recommend starting at age 35, and recommend that you seek personalized advice and guidance regarding screening.
The FDA recently updated its regulations to require mammography facilities to notify patients about the density of their breasts. What does this mean for patients?
The density notification is a very important step because it tells women and their providers if they might be at higher risk for having a cancer missed, and potentially should be adding screening tests, like ultrasound and MRI, to close the gap in case mammograms are missing something. What is most important is that knowledge is power—women should be empowered to know more about their bodies. It does not automatically mean everyone needs an ultrasound or an MRI. It is a very nuanced discussion with one’s doctor, but it is a data point that can factor heavily into making these decisions. Breast density can only be determined one way, and that is based on a mammogram. We cannot tell breast density from the physical exam, or age, or family history. Based on that mammogram, one can then have an educated conversation regarding whether any additional imaging is appropriate
Will this new regulation produce any changes for Mount Sinai patients?
Many states, including New York, already had laws regarding breast density notification before the FDA’s action. So here at Mount Sinai, patients are already learning about their breast density, without the new FDA notification. Now all states, including New York, will need to do this in a uniform way. So there may be some small change for us in the notification language we send to patients.
What should I do if I have any questions or concerns about mammograms?
Primary care providers and gynecologist are the ones who order most of these tests. Their role is to customize and personalize any kind of cancer screening based on the individual, her family history, age, and other medical issues. That is what a good doctor does: takes all these considerations and puts it all together in a thoughtful approach for the individual.
Healing from an injury or chronic orthopedic condition can be challenging, and many patients are unsure about their options for recovery. For example, will your condition require physical therapy or surgery, and when is it necessary to see a specialist?
Melissa Leber, MD
In this Q&A, Melissa Leber, MD, Associate Professor Orthopedics, and Emergency Medicine at the Icahn School of Medicine at Mount Sinai, explains the different options patients have to relieve their pain. Dr. Leber is also Director of Player Medical Services at the US Open and Director, Division of Emergency Medicine Sports Medicine.
If I have a chronic orthopedic condition or injury, when should I see a specialist?
If you’re developing pain, whether it’s your knee or shoulder or another body part, you can try a course of anti-inflammatories, rest, and activity modification. If your pain is really debilitating—for example, if it’s greater than a three or four out of 10 on a pain scale, or it’s starting to affect your everyday life and the things you love to do—that’s when you should see a specialist.
When is physical therapy the best option, and when is surgery called for?
After evaluating the patient, we decide on whether to recommend surgery or non-operative treatments. Most of the time, we can present the patient with various options and decide on what is best for that particular patient. It depends on age, medical history, and their goals. Occasionally, surgery is 100 percent necessary to get you back to your normal function, but most of the time, surgery is elective. It’s not a black and white answer on whether you have to do surgery or have to do physical therapy. It may depend on whether you’re an athlete, how quickly you want to return to normal activity, whether you’re okay functioning at 80 percent versus 100 percent, and some of that is a personal discussion between you and your physician.
Are my age and general health important factors in choosing surgery versus physical therapy?
Your age and general health definitely affect whether we might recommend non-operative treatments versus surgery. Some of that depends on what your goals are for return to activity, and on what other conditions you may have: diabetes, high blood pressure, heart conditions, etc., Some medical problems may make you less fit for surgery. Sometimes it’s not really a choice, because, in the case of a hip fracture, for example, you may never be able to walk again without surgery. It depends on the condition.
If my orthopedist recommends surgery, what questions should I ask?
What will the recovery time look like?
Should I expect to be in any kind of a brace or a sling after the surgery?
How much physical therapy will I need to return to normal?
When should I expect to be at 80 percent functioning versus 100 percent functioning after the surgery?
What is the success rate of this surgery? Is it a 100 percent success rate, 80 percent success rate?
What are the risks of this surgery?
Is it possible that I may come out of the surgery having continued pain?
What would you do or recommend if I were your sibling or parent?
You will weigh the pros and cons of the surgery based on how much discomfort you’re in now and how much it’s affecting your everyday life. For example, a patient with knee pain may have knee arthritis as well as meniscus tearing, and we have to choose which patients we recommend for surgery, in which case we might say, “Okay, let’s focus on the non-operative treatments for now.” If you’re not doing well, we might recommend you consider surgery later. Some of that depends on how much arthritis is in the knee, and that’s a much more in-depth conversation.
What are some of the common misconceptions patients have about orthopedic surgery?
One of the biggest misconceptions we hear from patients is that they prefer not to see an orthopedic surgeon because they automatically think they’ll be recommended to have surgery, and that’s not true. Most of the time, the orthopedic surgeon will try non-operative treatments or conservative treatments rather than jumping straight into surgery. It really is a case-by-case situation. In general, you shouldn’t be afraid to go to see the specialist, because they may have great advice and ideas regarding the non-operative treatments that may help you—interventions such as injections and even platelet rich plasma and other things that we can offer.
What else should people know about physical therapy and surgery?
Going into physical therapy takes time and patience, but in general, you can work on functional correction using strength training, balance, stretching, and all the modalities that physical therapy can offer. Most of the time, physical therapy can work wonders. If you’re willing to put the time and effort in, you really can do great things with physical therapy and rehab. Try to find a therapist who you trust and connect with as physical therapy will go better. You can always switch to a different physical therapy clinic if you don’t love the place you are going. Ask your doctor for recommendations on which physical therapist or physical therapy location would be best for you.
Should I try taking medications at home?
Many patients come to see us having not tried taking any over-the-counter medications at home. Taking a few doses of anti-inflammatories known as NSAIDs—non-steroidal anti-inflammatories—can help considerably. Naprosyn or ibuprofen are different types of NSAIDs that can help a lot, even just two or three doses. Of course, check with your primary care doctor if you aren’t sure whether it is safe to take NSAIDs given your other medical problems and medications.
If my doctor tells me I need to rest, does that mean I can’t do anything?
When a doctor recommends rest after you’ve had an injury or an area of pain, it doesn’t mean complete rest. It just means sometimes doing more low impact exercise or trying to avoid over stressing that area of pain or that joint. If you have an injury or an area of pain, ask what exercises you can do, because many times there are a lot that you’re able to do to stay active. As you get older, if you stop exercising completely, you get deconditioned quite quickly, and that can hurt your recovery and your performance. I recommend trying to stick with activity but alter that activity to do something slightly different so you’re not injuring that area further.
How much strength training versus cardio should I do?
Patients shouldn’t focus on cardio 100 percent of the time. I often see patients coming in with knee or hip pain, and they walk 10,000 to 20,000 steps a day, or they run three to five miles every day. Sometimes it’s actually best to focus on resistance and strength training more than cardio. As patients get older, strength training becomes more and more important. When someone is 20 years old, they could do 80 percent cardio, 20 percent strength training. When they’re 80 years old, it should be the opposite, where they do 80 percent strength training and 20 percent cardio. If you have the capability, getting a personal trainer can be extremely helpful towards maintaining a healthy and pain-free life. They can watch your technique and help avoid injury while also making you stronger.
Your kidneys are vital organs that keep your blood clean and free of waste. When something goes wrong with your kidneys, you can develop serious health problems, which is why it is important to take steps to stop kidney disease before it develops.
In this Q&A, Dinushika Mohottige, MD, Assistant Professor of Medicine (Nephrology) at the Icahn School of Medicine at Mount Sinai and at the Institute for Health Equity Research, explains the many symptoms of kidney disease and how you can prevent it.
What causes kidney disease?
The key causes of kidney disease in the United States are diabetes and high blood pressure (hypertension). It’s important to recognize that these factors are the most common causes of kidney disease, because we can treat these conditions, and slow, or halt the progression of disease.
How can I prevent kidney disease?
Here are some of the most important things that you can do to prevent kidney disease:
Speak with a primary care physician or whomever you see for your primary care needs about whether you have any of these common risk factors, and then address them, either through medications or changes in the way that you are living your life. Think about things like diet, and the role of certain types of foods that might influence both diabetes and hypertension.
Make sure that if you have kidney disease, you are aware of medications and their kidney-related risks. This includes medications purchased over the counter, such as high doses of non-steroidal anti-inflammatory drugs.
Think about your physical activity. This doesn’t have to mean going to a gym. Even fairly vigorous walking can be incredibly important. Think about opportunities to make sure you’re eating foods you like, but that are not necessarily going to accelerate the risk of kidney disease. The National Kidney Foundation and other patient organizations have a lot of resources on how one might do this.
Recognize whether you have a family history of kidney disease. Have other people in your life been affected by kidney disease? Have they been on dialysis or gotten a transplant? These are some important things that you might want to know before having a conversation with your provider or health care team about your own risk for kidney disease.
When should someone see a doctor?
One of the toughest things about handling or managing kidney disease is that kidney disease often presents silently. Although there are about 37 million people in the United States who are living with chronic kidney disease, less than 10 percent, in many studies, have been found to know that they actually have kidney disease. That is because the symptoms of kidney failure are often silent until a person has already lost a substantial amount of their kidney function, and this is important. One of the things that you can do is have a conversation with your physician or health care provider regarding what your kidney function is. That can be measured in blood tests, including the serum creatinine, and that can be assessed also by looking at your urine to see whether you are having an abnormal amount of protein spilling from your urine or whether you have red blood cells, which shouldn’t be coming through your urine. If you are also noticing changes in urination—more difficulty emptying your bladder, swelling, and other changes—these are all important alerts to see a health care provider immediately.
What resources are available?
The National Kidney Foundation is an amazing resource. There are several other resources for people living with kidney disease that offer everything from educational materials about what kidney disease is and how it might influence your life, to the types of foods to cook that are more kidney-friendly, to resources and support as you transition into perhaps needing dialysis or thinking about a transplant.
What are some symptoms of kidney disease?
There are a few symptoms in the context of kidney disease, such as being more fatigued or having less energy, and having a harder time concentrating or doing the things you typically do. This can also include difficulty sleeping. This can include changes in your urination—urinating less, urinating more often, seeing blood in your urine, which are all concerning, as is noticing foamy or “sudsy” urine and developing swelling. Other symptoms a person who has pretty advanced kidney disease might begin to experience include but are not limited to:
swelling around the feet and the ankles; new shortness of breath
cramping in your muscles, fatigue, or having less energy
a poor appetite overall or feeling less inclined to eat; food tastes differently, such as metallic tasting
swelling in other parts of the body, including around the eyes
changes in your skin, such as drier or itchy skin
Each of these might represent some symptoms that your kidneys are not working as well.
What are some of the latest advancements in kidney disease treatment and management?
Fortunately, due to the efforts of the kidney care community broadly, there have been multiple advancements in the treatment and management of kidney disease in the United States. There’s an important deliberation occurring now, which is regarding whether kidney function should be assessed as a preventative screening opportunity by the U.S. Preventive Service Task Force. Many kidney care organizations are advocating for this. This would mean a more universal opportunity to screen people for kidney disease detected earlier, and therefore, intervene earlier.
For those living with kidney failure, many organizations are advocating for more equitable care in terms of access to transplant and dialysis you can conduct at home.
There are also new medications being tested for specific types of kidney disease, including those with genetic underpinnings. Be sure to speak with your doctor about your options, including possibilities to enroll in clinical trials that may help you advance newer therapeutics that could help.
What therapeutics are available?
In the last several years, we have seen the opportunity to intervene and reduce the risk of kidney disease among individuals because of multiple classes of new therapeutics. One of the most important is called SGLT2 inhibitors. These medications can now be used in individuals with and without diabetes to slow the progression of kidney disease. Along with this, there are several new agents, including GLP-1 agonists, used to treat diabetes and other conditions, which have important effects in terms of reducing the risk of kidney disease progression and poor heart-related outcomes, which are often linked to having kidney disease. These are just two examples of the types of disease-modifying therapies that have given us opportunities to slow disease progression, particularly among people who have diabetes-related kidney disease, but also in individuals who do not.
How does kidney disease affect a patient’s overall health and well-being?
It is important to think about kidney disease as one of the many things in a person’s life that might impact how they feel, how well they’re doing, and what risks they have for other diseases and concerns, particularly those impacting the heart. Unfortunately, kidney disease increases your risk for heart disease, and also plays a key role in regulating your fluid balance, blood cell production, and bone health. One of the most moving things is hearing from the people that I’m fortunate to take care of about how their kidney disease has impacted them. There are many symptoms—from loss of sleep, fatigue, and appetite to swelling and fatigue—that are influenced by kidney disease. These get in the way of people working, enjoying their hobbies, and truly feeling like they have the best quality of life. Therefore, we have to collectively pour energy into treatments that help us detect, prevent, and slow kidney disease. We also need to make sure the best treatments are made available to all who need them, regardless of ability to pay and other factors. It is critical to recognize that on a day-to-day basis, kidneys are doing a lot of work for our bodies—they keep many other organ systems in balance.
What happens when the kidneys reach an advanced stage of kidney failure?
When individuals reach the stage where there is kidney failure and they require some replacement of their kidney function that is not in the form of a transplant—for example, dialysis—many people describe a lot of challenging symptoms. Even though dialysis is a life-saving therapy that replaces kidney function, it often comes with the burden of having to undergo this treatment several hours per day, several times a week, three times a week. Although there are opportunities to do this therapy at home, it still comes for many patients with additional symptoms—feeling fatigued after the treatment, having less time to spend with family, and in some instances, it can influence your mental health, as well, leading to depression or anxiety. Some also describe this having a significant impact on their sense of freedom, being able to work, and feeling fatigued.
What should I do if I experience these symptoms?
There are many types of symptoms, both physical and mental, that can arise due to kidney disease. As such, it is important to feel empowered to speak with your health care team early and often about whether you have kidney disease. You might say—“How are my kidneys?” or “I just want to make sure I have all the information I need to protect my kidneys.” You can also engage with excellent resources, including those through the National Kidney Foundation. If you are told you have kidney disease, you should advocate and speak with peers and support organizations to ensure that you get answers about causes of the disease, additional tests, and the best strategies to intervene and slow disease progression.
What advice do you have for those living with or at risk for kidney disease?
The most important advice that I have for people at risk for kidney disease—people who have high blood pressure or diabetes—is to start to have a conversation with your health care team and health care providers about what things you can do to manage that risk or control those conditions on your own. Ask them for help, ask them about how your kidneys (and other conditions) are doing, and lean on them as a team to identify the medications and other supports that can help slow the disease or reduce your risk of developing kidney disease. Identify resources in the community that can talk to you about social support and other things that you might want to know about kidney disease.
What do you want people who are already living with kidney disease to know?
One of the most important things is to feel empowered to remember that you know your body better than anybody else. If something does not feel right, or you are concerned about a rapid change in your kidney function, engage with your health care team and ask for answers about what is going on. People living with kidney disease should also remember there are multiple options for treating kidney failure. Particularly once you get to the stage of having kidney failure or requiring kidney replacement therapy, there are multiple options that your providers and your health care team should be speaking to you about. Dialysis is not the only solution. Transplants, including living kidney donation (the best treatment for kidney failure), should be options you discuss with your team. Some individuals might want to hear about conservative options for care, as well as options for doing dialysis at home.
When is it necessary to get a transplant?
Getting a transplant is a long process that requires many, many steps, as well as certain criteria to be eligible. Asking about transplantation early and often from your health care team is important. Having a person with you at your visits to take in some of the information about what your options are, what treatments are like, and to be there to support and help you is also important for managing what can be a complex and challenging process. We—your clinicians and members of your care team—are here for you to partner with you in making those decisions. Our job is to get to know you and your goals and values, so we can make sure we discuss options and develop plans with you that align with your goals and values.
Taking a walk is an easy way to move your heart to better health. Some studies recommend walking as many as 10,000 steps a day; however, this may not be realistic for everyone. How many steps should you walk each day for optimal heart health, and what are some alternatives?
In this Q&A, Mary Ann McLaughlin, MD, Associate Professor of Medicine (Cardiology), and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, explains how much you need to walk each day to keep your heart beating strong. Dr. McLaughlin is also Director of Cardiovascular Health and Wellness, Mount Sinai Heart, and Co-Director of the Women’s Cardiac Assessment and Risk Evaluation Program at the Mount Sinai Health System.
Do people need to walk 10,000 steps a day for optimal health? And if so, why? There are studies showing that overall risk of death or heart attacks is reduced in people who walk at least 10,000 steps a day. More recently, in the Journal of the American Medical Association, there was an article looking at those who walked 8,000 steps or more, and it showed that in 3,000 adults followed for over 10 years, those who exercised at least 8,000 steps a day had reduced death rates. They found that even exercising 8,000 steps or more just one to two days a week had a significant reduction in dying from cardiovascular disease or dying period. This study supports that idea that you can—by step counting—have very good effects on cardiovascular health.
Is there a lower number of steps people can aim for that would still allow them to achieve good heart health? We now know that 8,000 steps a day actually is very effective, even just one to two times a week. In addition, being active at least five hours a week does have health benefits. Anything more than being a true couch potato definitely can incrementally improve cardiovascular health, and those people who work very long hours during the week and are weekend warriors, those who exercise vigorously on weekends alone, can still reduce their risk of cardiovascular bad outcomes. You don’t have to do 10,000 steps a day, per se. Any bit of exercise is better than none at all.
What are the cardiovascular risks of being too sedentary, and how does walking reduce these risks? When we look at the risk of heart attack, we look at some major risk factors. Diabetes is one; hypertension is another; high cholesterol is another; family history of premature coronary disease is another. When we look at what exercise does, it improves the vascular health—the blood vessels are more effectively exchanging oxygen to the muscles and to the brain; it reduces obesity and the effects of diabetes on the heart. Both of those—by reducing excess weight and sugar—can improve the risk of cardiovascular disease.
What walking speed should I aim for to get the best cardiovascular health results? When we look at intensity of exercise, we actually have different scales that we use in cardiac testing. We know that two and a half to three miles per hour is considered moderate intensity—that’s what we say is equivalent to three metabolic equivalents of exercise, or three “mets.” When people are walking more vigorously—up to four miles per hour—that’s considered vigorous exercise
What other exercises will give me similar health results? If you don’t particularly love to walk all the time, things like bicycling at 6 to 12 miles per hour can reduce cardiovascular events; jogging around seven miles per hour; swimming 50 yards per minute; tennis, especially singles tennis, pickleball, and even doubles tennis, can be very vigorous exercise.
What are some other health benefits of walking? Recently, the Journal of American Medical Association—Neurology, showed that those who had a higher number of steps at 9,000 steps per day, had a lower risk of dementia. For those who dislike exercise, when we talk to them about what the real benefits are—prolonging life, reducing risk of heart attacks and now, dementia—that will have a very big impact.
How many minutes per week should I be walking or exercising? The American Heart Association guidelines have recommended at least 150 minutes per week of moderate intensity exercise, or 75 minutes a week for vigorous aerobic activity for those who want to be weekend warriors. We also recommend adding resistance or weight muscle strengthening. For overall health, that helps balance, reduces risk of falls as we age, and anything that reduces time sitting is important. Many people are using standing desks, and that is actually shown to be a little healthier than sitting all day. Anything that gets everyone off the couch has excellent health benefits.
What else can I do to improve my heart health? The other important part of that is eating healthy. You want a healthy diet, one that’s lower in saturated fat, higher in vegetables, more of a plant-based diet, with healthy meats, including fish and chicken, less of the red meat and saturated fats. I hope you found this helpful and go out and take a good walk this weekend.
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