thanks to my panel and especially to all of you for watching. see you right here next week. pa. and thank you for watching. pa. hope to see you right here next week. time now for "sunday house call." >> welcome as always. joining us mark siegel, professor of medicine and author of the >> welcome to unlocking the secret code of sickness and health. >> and dr. david somati, the chief of robotic surgery, he's doing his live from new orleans, where he's attending the annual gathering of the american you're logical association. good to see both of you doctors. >> good to see you. . >> going to start with the horrific tragedy of the amtrak crash as you know.

eight people were killed during that incident. more than 200 were injured, many still in the hospital. now they face a really tough road to recovery. let's start with you. how do you best -- what do they do? what's ahead for them when you have such a traumatic experience and have to deal with this, whether it's a psychological or physical trauma? >> that's a great question. the lack of seat belts on trains had a lot to do with what happens. the way that injuries occur isn't what you expect. it's people flying around cars, hitting off of luggage rackings, hitting off of each other. if you're sitting forward, you can hit the table in front of you and end up with abrosimova domal injury. if you're sitting backwards, you can get rip lash.

tough they're lucky this occurred in such a major city. they looked at the accidents that occur on trains. it's always been dictated by how fast the emergency responders work and how calm the people are on the train. it looked like both of those things were working here. that's why we're seeing so few fatalities. >> and you bring to mind, broadening wond beyond this train crash here, it makes me think of people traveling over the summer, taking road trips. and many times, throwing things in the back window, having gulf clubs and various thing things that are not locked down in the car that could become projectiles. >> that's a great point. and that reportedly may have been happening here, some projectile issues. it's a reminder you're never totally safe wn you're moving. what about in the car?

what's johnny doing in the backseat? is he screaming? how distracted are uh as a driver? what causes crashes is often that kind of a thing. >> what about the seat belt issue on trains? that's a great point. >> i think we have to get that to happen and it hasn't happened. i think we need a federal law to make that happen. we don't have them on school buses either. >> i never understood that. you have different kind of injuries. one last thing, these trains are going faster an faster. that's another point. if they're going to go over 100 miles an hour, you better be seat belted in. the responders did an amazing job. whether you're a you're rolgts or a neurosurgeon or card yeah surgeon, we get a call to respond and get to the hospital.

thf accident happened around major hospitals, jefferson and many other hospitals. temple hospitals. they all responded extremely fast. and the triage mechanism to reach the sickest patient first what absolutely critical. you have to worry about a lot of organs, liver lacerations, bladder per forrations and on and on. but they were able to really save a lot of people. unfortunately eight people died as a result of this. you're right, an accident like this happens, passengers become they hit themselves around to the cabin. from cuts and bruises to fractures of the ribs, punctures of the lungs. they were all waiting in the

emergency room, they will get an immediate 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. what about the hidden injuries that we take for granted. >> these patients have to be followed up very carefully because the first 24 to 48 hour, they may be fine. bit's important for them, if they have any kind of headaches or any confusions, pains that they didn't expect, to go back to the emergency room and get tested. there's a follow-up injury that's unnoticed in the first visit. let me talk about the emotional aspect of this. ptsd and emotional stress that comes, relives this emotion

again and again. they need to have psychiatric and emotional stress in the future. i still think that the trains are safe. we need more than one conductor. and make sure that they didn't fall asleep behind this whole thing. let me emphasize a couple of points. hidden behind your rib cage with the spleen and the liver. i worked in the emergency room for ten years. the first thing we do is put in a large intravenous line in. if somebody is bleeding and we don't know it, we want to replace at least the fluids. as david just said, you talk to the patient, you find out if they're awake and alert. on the scene, they'll strab anybody to a body board who they think has had a spinal injury.

>> that's so important to say that. people want to move but you shouldn't. >> absolutely. and last point, the post traumatic stress disorder for this kind of an accident is among the worst. >> there's a new warning for millions of type two diabetes patients. why the fda is raising flags about a newer class of drugs who commonly use the disease.

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the fda warning about a new class of diabetes drugs used by thousands of patients saying >> the fda warning oof a new drug that can lead to serious side effects. you mentioned the work side effects, i want to know what sort of side effects? and are thee the types of drugs

you're going to get through a prescription only? >> we were so excited about these medications. thr called sglt inhibitors. they're the kind of medications that can help with diabetes, lower blood pressure and lose weight. can you imagine one pill that can do all of this? what the fda found out is that in the last year, about 20 patients ended up going to the emergency room because they what we call diabetic ketoacidosis. what does it mean? these are the kind of medications that inhibit reabsorption of sugar from the kidney. you get rid of the sugar, that's how you control the diabetes. but sugar is important and it's great for energy for every cell. if if you can't get the sugar, you have to burn the muscle and fat and end up having a lot of acid called ketoacidosis. it can give you fatigue and muscle sorness or coma.

why do these medications make it to the market and not going through stricter regulation? people who are taking these medications, eli lily, johnson & johnson are making this pill. they seem to be working. but patients have to be careful to monitor their glucose very carefully. if you have an infection, if you have low volume, and if you have kidney failure, you may be at risk for this diabetic ket ketoacidosis. so it's a big warning for people with buy beet tease. >> we're looking for any mechanism we can for people with diep 2 diabetes. we say lose weight, exercise more, better diet. but there's different ways we can do it, but there's not a million ways. one is you push the pancreas to make more insulin. another is you get the body to be more sensitive to insulin when it's in the bloodstream. a third way -- and there's a great drug called metformin out there. that gets the liver to decrease

the amount of sugar it puts into your bloodstream. now there's a new one called sglt 2. s is for sodium, g is for glucose. you no why this side effect is occurring? because when you do this in clinical trial, you're only festing on 1,000, maximum 2,000 patients. but when you get out to the marketplace, hundreds of thousands of people are taking it and you might find a rare side effect, a very significant one, that you didn't know about. all the drug reps are hyping this, going to every doctor's office, jews it, use it, use it. it's a good lesson for doctors out there to not use drugs so fast. stick with the tried and true. what really works, before you go to the new kid on the block without knowing for sure what all the side effects are. you can do every study on the sun and you may miss something. >> i also want mark to mention something about genovia. it's a very important medication that i want you to make a

comment. because this is your line of work, where you can actually sensitize the insulin receptors in another mechanism and not this way. and i think this medication is going to become more popular given the kind of information that we have about this sglt 2 inhibit inhibitors. >> it's great, i agree with that. it preserves a hormone called incritit, that's a precursor to insulin. our body is trying to get rid of that hormone all the time. but genuvia keeps it around. it works well for people who don't eat right. in other words, if you aren't that heavy, but you just keep binge eating all the time, genuvia helps a lot. >> you make a good point. i'm always under the impression that type 2 diabetes is associated with overweight people. but there are people who are small that have it, correct?

>> obviously the more you weigh the more of a problem it is. >> so the point that you're bringing up is very important. for type 1 die bheet tease, that's when we will see a lot of ketoacidosis. because the sugar is being wasted and they can't use it. but this is one incident where the use of medication can give you these kinds of side effects. that's a very important point that you just brought up. >> david, i'm very impressed with you bringing up genuvia there. very smart. >> i do my work. everyone thinks i'm in new orleans just drinking. the night life over here is just amazing. >> new orleans has incredible food. you know all about that. >> i won't tell you all the stuff i ate when i was just home. >> what if you eat too much salt in the food or the food that you make at home? the doctors have been saying how

bad too much salt could be. what if you don't get enough salt? the doctors will be back with that advice soon. enough? the doctors are back with that when we come back. my name's lou, and i quit smoking with chantix. i had tried to do it in the past. i hadn't been successful. quitting smoking this time was different because i got a prescription for chantix. along with support, chantix (varenicline) is proven to help people quit smoking. the fact that it reduced the urge to smoke helped me get that confidence that i could do it. some people had changes in behavior, thinking or mood, hostility, agitation, depressed mood and suicidal thoughts or actions while taking or after stopping chantix. some people had seizures while taking chantix. if you notice any of these, stop chantix and call your doctor right away. tell your doctor about any history of mental health problems, which could get worse while taking chantix or history of seizures. don' take chantix if you've had a serious allergic or skin reaction to it. if you develop these, stop chantix and see your doctor right away as some can be life-threatening. tell your doctor if you have a history of heart or blood vessel problems, or develop new or worse symptoms. get medical help right away if you have symptoms of a heart attack or stroke. decrease alcohol use while taking chantix. use caution when driving or operating machinery.

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>> even and back now on our segment "should i worry?" one viewer write, a few weeks ago, you discussed low potassium levels. i would like to hear about low sodium levels. i am 75 and have controlled high blood pressure. so dr. siegel, you discussed the dangers of too much salt, but what about too little? >> you know, it's a very important topic. i'm glad the viewer brought it up. there are a lot of thins that can cause your sodium levels to

be low. being on certain medication, anti-depressants -- >> fluid builds. >> that's another most important in my mind. sometimes it shows that doctors need the most important in my mind.the most important in my sometimes it shows that doctors need to think outside the box more. i had a patient a couple weeks ago with a low sodium saying you're drinking too much water. you could dillute your sodium. but he said to me -- >> repeat that. >> drinking glass after glass after glass of water you can end up with low sodium of that alone. we have to warn people about this. >> how do you know if you have low sodium? >> your doctor has to test you and part of a regular examination. now -- >> do you feel anything? >> fatigue, nauseous and vomiting and muscle aches and most important thing is happens very quickly, you can get seizures. >> doctor, he's saying there's a possibility of drinking too much

water that you would dilute your sodium levels. so what do you drink instead? do you use electrolytes? >> you should ask him if i answer this question and i get it right whether i get the honorary internist diploma. i think the patient has controlled high blood pressure and assuming he's probably taking blood pressure and one of the diuretics is the one that you can lose a lot of salt. 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 and you can check your blood test. lower than 135 you have to be worried. also, there are other things such as something called sisdh. you may have a hormone to absorb a lot of water and dilute your salt. there will be adree nal problems

where your hormones, you are not absorbing enough salt and losing a lot or you're not absorbing or you're diluting it. in this particular patient, if your salt is low, you are going to get muscle weakness, possible seizures. and eventually you can have a lot of problems and electrolyte abnormalities and heart problem and end up in the emergency room. how did i do over there? >> you get the award on the diuretics. other than drinking too much water, number one cause and very right to be suspicious that this patient who's on blood pressure medicine is probably on a diuretic an i want people to know you're thinking that the diuretic is getting rid of water for you but it's also getting rid of salt at the same time and may lead to a low salt in the blood and very dangerous. >> 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 may have just losing a lot of water but you would be losing a lot of salt,

also. >> good point. >> be careful with that. always keep hydrated. >> how do you know if your body needs the snaalt? how do you know it's not a taste thing but your body craving, needs is salt? somebody? >> well, i think, you know, depending on what goes on, on these diuretics or work out a lot, you're fatigued, you will have ab nominal pain and symptoms and the doctor will check your blood and will show up. the first lab to get is something called sma-7 and sodium is really low. as a urologist, years ago we used to see this doing prostate surgery and post-operative see this and we don't see it anymore. >> can i just eat salt? >> you don't just eat salt and david is getting at this. don't replace the loss with pure water. drink something with electrolytes.

something like gatoraide. >> the best treatment is to restrict your fluid. that's the treatment first. >> how much water, doctor? we have to go they're saying. how much water a day? >> not so much how much water. slow down the water intake to bring the salt up. if you replace the salt rapidly, what you can do is you can cause edema in the brain and you can actually kill somebody. so you have to do it very gently and if you cannot restrict fluid you can get a very slow amount of salt gradually and this has to be done in the icu under control. >> if it's a severe case. you do it with fluid. >> if i may jump in, because i think this is exciting and we are going to hold this topic over to the next break. stick around and have more on this. if you have questions, tweet us. r

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we're back now talking about what low sodium levels will do we're back now talking about what low sodium levels will do to the body. take it away and tell us how do you know, what are the symptoms if you don't have enough sodium in your body? >> confusion, nausea, headache, muscle aches, and memory problems. you're not thinking clearly. very, very fatigued. those are the key issues.

fatigue, muscle aches, headaches, nausea and vomiting. if we think this is severe enough we restrict the amount of fluid to 2 liters or 1.5 liters a day. we don't want you diluting the blood further. then the sodium goes down more and you might end up having a seizure. >> it's important to really know what the diagnosis is, not only look at the sodium but you have to understand if it's as a result of too much fluid or whether you're losing salt. each one have completely different kind of treatment and a good internist can really tell you whether we need to restrict the fluid and if you need to fix it, again, the response is always done very slowly. if you fix it too fast, you're going to get absorption of fluid along with the salt and you can get brain edema and cause a lot of harm. >> very curious.

>> the key is knowing the cause. dehydration or too much. >> we are heading into the summer. we are heading into the summer. it's a big issue. >> doctor, get a salt-rimmed margarita. that will help. while you're in nola. >> that's how i get my salt. >> thank you for watching. a fox news alert. a dire situation. the battle for ramadi and it appear that is isis has won. iraqi official now saying the provincial city has, quote, fallen to the terror group. earlier homicide bombers killing 15 iraqi troops as battles rage only. reports now some 8,000 civilians have been displaced. iraqi prime minister ordered security positions not to abandon their position after some forces retreated amid the isis threat. this apparent isis victory gives them a hold in the vital anbar