time now for "sunday house call." >> welcome as always. joining us mark siegel, professor of medicine and author of the inner pulse, unlocking the secret code of sickness and health. >> and chairman and professor of lenox hill hospital. he's joining us live from new orleans. he's attending the annual dwatherring of the american your logical association. good to see both of you. >> nice to see you. >> we're going to start with the horrific tragedy of the amtrak

crash. as you know eight people were killed during that. more than 200 injured. many still in the hospital. now they face a tough road to cover. let's start with dr. siegel. what's ahead for them when you have such a traumatic experience and have to deal with this? >> that's a great question. i want to start by saying that the lack of seat belts on trains has a lot to do with what happened. the way that injuries occur isn't what people expect. it's people flying around car and hitting off of each other and windows. if you're sitting forward, you could hit the table in front of you and end up with an abdominal injury. there's a very major ens dents of peopling with haunted for years after this if they were in one of these cars. the physical injuries, i've gone over some of what they are. broken bones, broken ribs, there are spinal injuries that we're

seeing in the hospitals. you have to give a hats off to the emergency responders in the city of philadelphia and also the medicare care in philadelphia. it's lucky this occurred near such a major city. in the past, and there's a study that looked at over 500 of the accidents that occur on trains. it's always been dictated by houchz the emergency responders work and how calm the people are on the train. it looked like both of those things were working. >> dr. siegel, you bring to mind broadening beyond this train crash here. it makes me think of people traveling over the summer and taking road trips and many times throwing things in the back window or things that are not locked down in the car that could become projectile. >> that's a great point, and that's reportedly may have even been happening here, some projectile issues but it's a reminder that you're never totally safe when you're moving. in planes we're supposed to be

seat belted. what about in the car? what's johnny doing in the backseat? is he scream are you distracted? >> i think we have to get that to happen. it hasn't happened. i think we need a federal law to make it happen. we this seat belts on planes. they're not on school buses. >> i've never understood. >> you'd have a different kind of injuries. here's another thing, one last thing. the trains are going faster and faster. that's another point. if they're going to go over 100 miles per hour, you'd better be seat belted in. >> what are you thoughts on this top snick. >> i think if you look at what happened, the responders did an amazing job. usually all the surgeons are on an emergency call. whether you're a yourologist or cardiac surgeon, we all get a

call to respond and get to the hospital. this accident happened around a major hospital and many hospitals. they all responded extremely fast, and the mechanism to reach the sickest patient first was critical, and it worked really well. obviously a lot of injuries. happened to the head trauma and spinal injuries but you also worry about a lot of organs. liver lalacerations, bladder perforations, but they were able to save a lot of people. eight people died. you're right that an accident like this, when it happened, passengers become a moving target, and they can hit themselves around to the cabin and also a lot of suitcases and other things can affect them. so from cuts and bruises to fractures of the ribs, punctures of the lungs, we're all waiting in emergency rooms when the

passengers come. they get an immediately blood test and examination and x-raies. the ones that have to go to the operating room, they can handle immediately, and we can save their lives. >> and because we're broadening this out to many road trips that are taken this sum evemer, what about the hidden injuries that we take for granted n. it's a fender bender. i'm not going to bother getting it checked out. >> these patients, you're right. these patients have to be followed up carefully. the first 24 to 48 hours, they may be fine but it's important for them that if they have any kind of headaches or any confusions, pains that they don't expect, that it appears, they need to go back for a follow up. let's talk about the emotional aspect that we've always spoken about. the emotional stress. they relive the emotion over and over again.

images of the accident may come back. they need to be under surveillance and need to have psychiatric evaluation at some point in the future. hats off to the doctors and surgeons that responded to this. i still think that the trains are safe. we need more than one kconducto. make sure they didn't fall asleep. this kind of train works well in europe. whether you need seat belts or not, they need to look into that. >> hidden underneath the rib cage are your spleen and liver. we worry about that if abdominal trauma. we put a line in because if somebody is bleeding and we don't know it, we want to replace at least the fluids. and you talk to the patient and find out if they're awake and alert, and you find out if they're disoriented. on the scene they'll strap anybody on a body board that they think might have a spinal injury. these are key points.

>> people sometimes want to move but you shouldn't. >> absolutely, and last point. the post-traumatic stress for this kind of an accident is among the worst. people are haunted for years. >> good points. well, there is a new warning for millions of type 2 diabetes patients. they're raising red flags about a newer class of drugs used to treat the disease. i love making sunday dinners. but when my back hurt, cooking all day... forget about it. tylenol was ok, but it was 6 pills a day. but aleve is just 2 pills all day. and now, i'm back! aleve. "checking my free credit score at credit karma." "i have great credit" "when was the last time you checked? "you da man!" banter "that's a lot of cheddar. we gotta check your credit score.

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the fda warning about a new class of diabetes drugs used by thousands of patients saying they could lead to some serious side efgts. you mention the word side

affects, and i want to know if they're through a prescription only. >> we were so excited about this medication. they are called sgtl inhibitors. these are a kind of medications that can help with your diabetes, lower blood pressure and help you lose weight. they found out in the last year about 20 patients ended up going to the emergency room because they are what we call diabetic koe toes a doe sis. this means these are the kind of medications that inhibit reabso reabsorb, of sugar. if you can get the suge fwar, then you have to burn the muscle and fat and you end up having a lot of acid called ketoacidosis. you can end up in the emergency room. the big question for mark is how do the medications make it to the market and why aren't they

going through stricter regulation. people and patients taking these medications, they are making these pills. they seem to be working but they have patients have to be careful to monitor their glucose very carefully. if you have an infection or low volume and kidney failure, you may be at risk. a big warning out there for people with diabetes. >> we're looking for any mechanism we can in people, especially who are overweight who have type 2 diabetes. if we're stuck with medication, there's different ways to do it but there's not a million ways. one is you push the pancreas to make more insulin. a third way is a drug that usually is my first line drug, that actually gets the liver to decrease the amount of sugar it

puts in your bloodstream. you there's a new one called sglt 2. it works on the level of the kidney. now, david brought up a great point that i want to answer his question. you know why this side effect is occurring? >> when you do this in clinical trials, you're only testing this on 1,000. in the marketplace, it's hundreds of thousands of patients. you might find a side effect you didn't know about. meanwhile, drug reps are hyping this and telling people to use it. it's a good lesson for doctors to not news drugs so fast when they first come out. stick with what works before you go to the new kid on the block without knowing all the side effects. you may miss something in a study. >> i also want marc to mention something about ja noef ya.

that's an important medication. you can sensitize the insulin receptors and another mechanism. i think this is going to become more popular. >> it's great. i agree with that. i use that on a lot of patients. it preserves the precursor to insulin, and our body is trying to get rid of it all the time, but this medication keeps it around. the more it's around, the more it helps you to metabolize your diet. if you aren't that heavy but you just keep binenige eating all t time, it helps a lot. >> you make a good point. i'm always under the impression that type 2 diabetes or associated with overweight people but there are people who are small who have it.

>> genetics. obviously the more you weigh, the more of a problem it is. >> can you doctor ask your doctor for januvia? >> yes. >> for type one diabetes, that's when we see a lot of ketoacidosis. you're right. the sugar is basically being wasted and they can't use it. this is one incident that use of medication can give you this kind of side effect. that's an important point you brought up. >> i'm pressed with you bringing up januvia. >> i do my work. everyone thinks i'm in new york just drinking. arthel is right. the night life here is just amazing. >> new orleans has incredible food, and you know about that. >> i won't tell you about what i ate when i was home. >> did you give him recommendations? >> i did. >> what if you eat too much salt in your food. the doctors are saying how bad

too much salt can be. what if you don't get enough? the doctors are back with that when we come back.

call." in our segment should we work, a segment where we talk about everything that worries us. one viewer writes a few weeks ago you discussed low potassium levels. i would like to hear about low sodium levels. you discussed a lot about the dangers of too much salt but what about too little? >> it's an important topic and i'm glad the view every brought it up. there's a lot of things that can cause your sodium to be low.

ha heart failure, liver failure. >> fluid pills. >> i was going to get to that. it's the most important in my mind. sometimes it medications. doctors need to think outside the box more. i had a patient with low sodium. i said you're drinking too much water. you can dilute your sodium. >> repeat that. >> if you drink a lot of water, and just plain water, and you drink glass after glass after glass, you can end up with low sodium from that alone. that's called poly genic poly dipsia. >> how do you know if you have low sodium? >> your doctor has to test you. before you can feel fatigued and get nauseous and vomiting and have muscle aches and the most important thing, by the way, it happens very quickly. you can get seizures. >> there is a possibility of drinking too much water that you would dilute your sodium levels.

so what do you drink instead and do you use electrolytes or what do you do to stay hydrated? >> i think what this patient has is -- he has controlled high blood pressure. i'm assuming he's probably taking some blood pressure, and one of the diuretics is the one you can use a lot of salt and that can be one of the reasons why this patient has low salt. what should be your salt level? somewhere between 135 to 145 is normal, lower than 135, you can take your blood test, if it is lower than 135 you have to be warned. also, there are other things such as something called siaph. you may have a hrmt where yormou absorb a lot of water. there can be adrenal problems where your hormones -- you're not absorbing enough salt.

you're losing a lot or not absorbing or diluting it. in this particular patient, if your salt is low, you're going to get muscle weakness, you'll have possible seizures and eventually a lot of problems and abnormalities and heart problems and end up in the emergency room. >> the diuretics, i think other than drinking too much water, it is the number one cause. you're right to be suspicious that this patient was on blood pressure medicine, probably on a diuretic. i want people to know, you're thinking that diuretic is getting rid of water for you, but it is also getting rid of salt at the same time. that may lead you to have a low salt in your blood, dangerous. >> by the way, for a lot of people out there, i know you work out a lot and, eric, a lot of athletes, with the summer coming up, you may be sweating or you may have just losing a lot of water, but you would lose a lot of salt also and be

careful with that. keep hydrated. >> how do you know if your body needs the salt, if you're craving salt. how do you know it is not just a tasting or your body is craving, needs the salt? >> well, i think depending on what goes on, if you're an anti-diuretic, work out a lot and saw this coming down, you're going to be fatigued, you'll have abdominal pain, muscle weakness, you'll have symptoms. and once you go to the doctor, they'll check and it will show up. the first lab we get is something called sma 7 and your sodium will be low. as a urologist, we used to see this when we did prostate surgery and post operative. we used to see this. we don't see that anymore. >> can i just eat salt? >> you don't just eat salt. you don't want to replace this loss with pure water. you want to drink something with electrolytes. >> the best treatment for this

is to -- not to take a lot of water. it is to restrict your fluid. that's the treatment first. >> how much water? how much water? >> it is not so much how much water, you slow down the water intake until you bring your salt up. if you replace the salt rapidly, what you can do is you can cause adema in the brain and you can actually kill somebody. so you have to do it very gently and if you cannot restrict the fluid, you can give a very slow amount of salt gradually and this has to be done in the icu under control -- >> if it is a severe case, you do this with -- >> if i may, i think this is exciting and we're going to hold this topic over to the next break. stick around, we'll have more on this. if you have any questions, tweet us.

i love making sunday dinners. but when my back hurt, cooking all day... forget about it. tylenol was ok, but it was 6 pills a day. but aleve is just 2 pills all day. and now, i'm back! aleve. we're back now talking about what low sodium levels will do to the body. dr. siegel, take it away and tell us how do you know what are the symptoms if you don't have enough sodium in your body. >> be on the lookout for confusion, nausea, headache, muscle aches, and memory problems. you're not thinking clearly. you're very, very fatigued. those are the key issues. fatigue, muscle aches,

headaches, nausea and vomiting. now, if we think this is severe enough, and you're not dehydrated, we're going to restrict the amount of fluid that you take in, to two leit s e ers a day. we don't want you to be diluting your blood further. your sodium goes down further and you may have a seizure. >> i think it is important to really know exactly what the diagnosis is. not only you look at this sodium, but have to understand whether it is as the result of too much fluid or whether you're losing salt. each one of them have completely different kind of treatments, and a good endocrine and good internist can tell you whether we need to restrict the fluid. if you need to, fix it. the response is always done very slowly. if you fix it too fast, you're going to get absorption of fluid, along with salt. and you can get great edema and cause a lot of harm. >> key here is knowing the cause and addressing it directly. can be dehydration or too much.

>> summer. big issue. >> get salt in your margarita. an active storm system batters the nation's heartland, bringing tornadoes, hail, high winds and flash flooding and it is not over yet. millions of americans under the threat of severe weather as that system pushes east. we'll get the latest forecast on the fox news extreme weather center. we're learning new details about the daring special forces raid against isis. delta force commandos went hand to hand as they tried to capture the terror group's chief financial officer. is this the beginning of a new strategy against the islamic state. will he or won't he? louisiana governor bobby jindal on whether he'll jump into the white house race and his efforts to protect religious