March 13, 2021 • 40 mins
Does your bladder really burst if you hold your pee for too long? Will you get kidney stones if you do not drink two liters of water a day? These are just two of many questions that Urologist Dr. Chun Ko Chan (Kiki) answers in our “Re(n)al Talk” Round of the Life-Sparring Podcast.
The urinary system is likely the organ we know the least and have the worst misconceptions about. Reason enough to dedicate an episode to the topic and talk to a re(n)al expert.
Will Dr. Kiki Chan be able to address Fabian’s Childhood trauma of kidney stones and bursting bladders? Listen in to Round 6 of Life-Sparring.
Show notes and more at Life-Sparring.com/podcast
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Thomas Latter (00:10):
In the blue corner, with a specific gravity
indicating moderate dehydration,from Hong Kong your host Fabian
Gruber. In the red corner, theonly guest to get away with
rescheduling a show to perform akidney transplantation, also
(00:31):
from Hong Kong, Dr. Chun KiChan.
Fabian Gruber (00:44):
Today we have another Life-Sparring round with
a health focus. So it'simportant to start with the
usual disclaimer. This podcastis for information and
entertainment purposes only. Bywe discuss medical topics, we
are not providing medicaladvice. And if you're facing a
health scare of any kind, seeyour local health care
professional without the delayand do not rely on information
(01:06):
from the internet. With that outof the way, welcome to
Life-Sparring, Dr. Chun Ki Chan.
So this podcast has been a whilein the making. And we actually
had a session scheduled a fewweeks earlier. And then you
asked me to cancel due to akidney transplantation. And I
mean, I haven't run this showfor very long. But I'm pretty
sure that this is already a verystrong candidate for the best
(01:29):
postponing reason ever. So itwill be very difficult to ever
top this. I hope the patient isrecovering very well...
Dr. Kiki Chan (01:40):
sorry for last minute cancellation to to make
things feel better for us, thepatient is doing great.
Fabian Gruber (01:46):
No, absolutely not. That's there is no better
reason for sure. So seriously,I'm very grateful that you are
taking the time to talk with meabout renal health today. So I
think the urinary system is ofall our major organs, possibly
the one that gets the leastattention. And there may be also
the most knowledge gaps andmisconception about and I'm
(02:07):
pretty sure that you are able toclear this out a little bit. You
have been practicing urologistsand the Hong Kong public
hospital system for more than adecade, you train other doctors
on surgical procedures. Andyou're also involved in billing
information database on renalcancer. So yeah, there is no
better person to talk to aboutthis topic. And yeah, that your
(02:29):
fellow HKUST MBA graduate, ofcourse, makes things even more
fun. So I can't wait to quizzyou. But as I usually like to
do, I really would start at thevery beginning. So how did you
get into medicine in the firstplace? Kiki,
Dr. Kiki Chan (02:44):
first of all, thank you for having me. A
pleasure is all mine. How did Iget into medicine? I think I'm
not sure how familiar you arewith the Hong Kong TV drama. But
back in the old days, there werefew fairy hit medical dramas
like ER, and then there's thiscounterpart produced in Hong
Kong. So I sort of justassociated that, like this
(03:07):
medical professions is somethingthat's super refined, chill, a
bit heroic and very meaningful.
So I sort of just know, this issomething that I want to do
thinking back, I think there'salso this influence from an
Asian family, that being aprofessional is the way to go.
So I think in like in my highschool years, I was just sort of
(03:27):
No, this is what I'm I want todo and I actually haven't given
much thought to other degrees.
So we just naturally became amedical school for me.
Fabian Gruber (03:39):
So you didn't come from a long line of medical
professionals or are there anyother doctors in your family?
Dr. Kiki Chan (03:45):
I have a line of family friends, close family
friends who are amazing,well-known doctors in Hong Kong.
So I've been under theirinfluence ever since when I was
a kid. But most of my familymembers are actually interested
in Chinese medicine than Westernmedicine. Yes, so I think that's
a good thing that I sort ofappreciate the good things from
(04:08):
both Chinese and Easternmedicine but yeah, no, didn't
come from a long line ofmedical practitioners.
Fabian Gruber (04:15):
Yeah. And then of course, I have to ask the
question, so why urology I thinkthe more lTV drama-like
specialization are heartsurgery, brain surgery. How did
you become a urologist?
Dr. Kiki Chan (04:28):
That was a total accident. It was unexpected. I
mean, it just so happens thatafter I graduate medical school,
my first rotations as in houseofficer and as a medical
officer, was in the urologydivision. And not to mention the
amazing urologist who are now myclose friends that I've met and
(04:50):
who were my mentors at thattime. What changed me was a
kidney transplant. So I saw myfirst kidney transplant as my
first year of medical officerand then I just knew It was
something that I really want todo, though, I get asked this
question a lot, this is thefirst time I get to give this
long answer.
Fabian Gruber (05:08):
So how's your job these days? So you like having
this this double function right?
On one hand, you're stillpracticing, I guess. And then
you have consultant roles. How'sthat balance? How is your your
normal work day.
Dr. Kiki Chan (05:21):
So basically, what I do from on a day to day
basis is to manage patients witheither stone or infection or
cancers of the urologicalorgans. So basically, kidney or
bladder, or prostate, and a lotof my time is divided into
either surgery or outpatientclinics. So when I'm doing
(05:41):
surgery, either I do some of themajor surgeries myself such as
like removing kidney cancers, orprostate cancers. And other
times, I would train mycolleagues, my trainees to do
surgeries, and other times, itwill be in outpatient clinics.
So seeing some of the patients.
And yeah,
Fabian Gruber (05:59):
and did COVID have a big effect on your daily
job. I mean, I can imagine that,in general, like being in the
medical sector is even harder,like those, there's one and a
half years than it ever hasbeen. How did this affect you?
Dr. Kiki Chan (06:15):
This is so true.
Actually, we had quite a wave ofpatients not willing to come
back for outpatient clinics,visits because of COVID. And now
that the COVID seems to beimproving a little bit, they're
all rushing back. But all inall, I think you are very right
at the beginning saying that theneurological system is one of
the more so called neglectedones. It's really amazing how
(06:37):
the COVID has hit us by thefourth wave by now. And we just
didn't really have to cancel oursurgeries, because we have so
many patients with neurologicalcancers and serious diseases. So
these are the diseases and thesurgeries that we continue to
do, even in the middle of COVID.
(06:58):
And it's just a bit overwhelmingand amazing to look at the fact
that we didn't really have tocancel our list at all, because
just there are so many patientswith serious urological
diseases.
Fabian Gruber (07:09):
And do you think that the reason is that people
are just kind of too late toactually find out that they
have, for example, bladdercancer also, is it the just the
lack of awareness leads to laterdiagnosis? or Why do you think
this it's so common?
Dr. Kiki Chan (07:24):
Actually, I think the public awareness is
improving, because there's moreregular checkups. So we're
picking up cancers at an earlierstage. I think the public sort
of not realize that a lot ofmale and female, especially when
they start to age can haveurological diseases, and the
number is as under estimated.
Fabian Gruber (07:46):
Good. So I think we should take a little step
back. And maybe you could justdescribe in the most simplest
way how the whole you want topress practice working like how
does the whole renal systemwork? Can you just describe the
main functions? And maybe alsoif you if you have one on top of
your head? What is there thatmost people get completely wrong
(08:08):
about the Renal System?
Dr. Kiki Chan (08:10):
Well, I think to begin with the Urological system
is we have this upper urinarytract and the lower urinary
tract. My special interest isactually the upper urinary
tract, which is the same acrossall genders. So it's basically
the kidneys and the ureters. Andthe bladder. And once we get to
the bladder is sort of dividesinto a lower urinary tract. So
(08:32):
bladder and the urethra andprostate and it's all a holistic
call a at the neurologicalsystem. common misconceptions. I
think you got one that while wewere sharing, if you drink too
much water and you don't go topee, does that hurt your kidney?
Or does the bladder rupture? Iget asked this quite a lot too.
(08:54):
It doesn't under normalcircumstances. But I've seen
cases of ruptured bladder, butit's not like a normal thing
that someone can hold until thebladder ruptures. So what
happened during those two caseswas the patient got very, very
drunk. I think she had too muchbeer. So at the end, the bladder
was too full, but she was toodrunk to pass and then she
(09:17):
tripped and hit her lower tummyand the bladder just ruptured.
I've seen it twice, but it's Idon't think it's a normal
circumstances.
Fabian Gruber (09:24):
Yeah, that sounds scary enough for me. I mean,
that that's, that's not helpingto ease my childhood traumas
inflected by Auntie's...
Dr. Kiki Chan (09:35):
beer drinking
Fabian Gruber (09:36):
I am German, after all. Yeah, but I think not
to that extent. So I have a fewmore of those myths. Maybe we
can just do a little mythbusting round. How about kidney
stones? Is it really related tolack of hydration or is there
not really any relationshipbetween both?
Dr. Kiki Chan (09:54):
Lack of hydration is definitely a factor for
kidney stones formation, but Ithink It's not the only factor.
Sometimes we also have to take alook at whether there's like a
genetic predisposition, ifthere's a family history, and
whether or not the patients orthat individual has any
underlying predisposition, likeif there's underlying disease,
(10:15):
that predisposes excretion ofsome of the stone forming agents
like calcium, then no matter hownormal the water intake is, then
that individual may or may be athigher risk of having kidney
stones. But definitely in anormal circumstances, lack of
hydration or not having enoughwater intake is a risk factor.
Fabian Gruber (10:36):
And when we are talking about water intake, so I
mean, there are so many rules,right? two liters a day. What's
the scientific basing aboutthis? Is there really something
where like there's scientificconsensus or medical
practitioner consensus around oris this all kind of very
difficult.
Dr. Kiki Chan (10:55):
For the general public, we usually advertise
having eight glasses of waterper day, because I think that's
more easy for Public to follow.
It's just easier to gauge witheight glasses by for people with
a history of stones or peoplewho are currently having stones,
I would actually recommendhaving water so much so that the
urine output per day is over 2.5liter. So I think it's one thing
(11:18):
to know how much you drink. Butsometimes we have different
lifestyles. So for someone whois very active physically, or
may sweat a lot, so the waterintake may need to be even
higher, because that person willsweat. So what we count is not
the water that has been taken,but instead the water that
eventually passes through thekidney, and is able to be
(11:41):
excreted. So if we are beingextremely strict and
scientifically based, then itwould be urine output more than
2.5 liters per day. But thatwould be for people who have
stones. So for general public, Ithink somewhere around two
liters per day of intake wouldbe sensible. But it's also
different in terms of theindividual, how active he or she
(12:05):
is how much he or she sweat. Andif there's any underlying
medical diseases, like forsomeone who has a bad heart
function, I wouldn't recommenddrinking that much.
Fabian Gruber (12:16):
I mean, I'm still thinking how to measure I'm a
quantified self guy. So likeoutput measurement, of course,
is maybe a challenge for the mynormal daily routine. But yeah,
Challenge accepted. How aboutsupplement consumption? Is there
any anything that that you seecritical, like in terms of like
(12:36):
those searches? Or, for example,bodybuilders who take a lot of
protein powder? Is thereanything that is a problem from
a renal perspective?
Dr. Kiki Chan (12:45):
Yes, I think I totally agree that nowadays, we
all like a lot of us who resortto taking supplements. I do
think that there on one side, Ithink supplements are good,
especially if it compensates forthe lack of intake in our normal
diet. But I think we have tohave a clear mind of why we take
certain supplements to me, Ithink supplements mainly are
(13:07):
taking for two reasons. One isyou believe that you cannot have
adequate intake from your normaldiet. So that's why the
supplements help to gap theinsufficiency. Right? And the
second one is if you believethat certain supplements help to
either prevent or cure a certaindisease. So in the first group
meaning to compensate thedietary insufficiency, I think,
(13:31):
first of all, the first questionwe have to ask is whether or not
is really impossible to takethat certain nutrients through a
normal diet. Let's say vitaminC, like a lot of us will take
vitamin C supplements. But Ithink having enough vitamin C
for our daily intake usuallyjust takes like five servings of
(13:51):
fruits and vegetables. So it'snot entirely impossible when you
come to think about it. So Ithink it using this as an
example, I think it reallydepends on whether you think you
cannot intake in your normaldiet. So before you decide that
you really need that supplement.
And there has been I think therehas been also cases which that
overdosing on certainsupplements, indeed hurts the
(14:13):
kidney function. So again, it'svitamin C is also a very common
examples, taking too muchvitamin C actually may cause
some urinary problems or maycause kidney stones. So that's
why I always tell my patientslike if you think you need a
certain supplement, do you thinkthat the why you need it, and if
it's due to a lack of normaldiet, let's try our best to see
(14:36):
if we can use normal likenatural food to overcome that
the lack. So yeah, so that's thefirst part of my stance on
supplementation. But on theother hand, I do believe that
there are some supplements thatmay have to be taken, let's say
like vitamin B 12, which mightbe needed in case if someone is
vegetarian, right. So I think atthe end, we have have to go back
(14:59):
to our lifestyles and see ifcertain supplements are really
necessary. And if it is, then Ithink wich dose is beneficial
for health. Just like everythingwe just don't overdo it and, and
use it. Because it's absolutelynecessary.
Fabian Gruber (15:17):
We covered kind of the basic myths that I had
kind of on my mind. But for you,as a practitioner are the
biggest health concerns when itcomes to regional health, what
are kind of the biggest healththreats and when for me, it
seems like especially kidneyfunction seems to be quite a
complicated thing, because it'snot the on off thing, right? So
kidney function and kind ofdeteriorate slowly it works and
(15:41):
sudden doesn't work like likewhat you can have like a heart,
I don't know, if you have aheart attack, then then you have
a heart attack, right? So itshuts down the complete system.
And it seems like for kidneyfunction, for example, is more
like a gradual decreasepotentially. And now maybe you
can go like a little bit intointo what what you see as the
main health problems that youdeal with also professionally,
(16:01):
and, and maybe what what arelike the things to really to
look out for,
Dr. Kiki Chan (16:06):
From what I see what really hurts to kidney
health, in my daily practice isdiabetes and hypertension, which
are the two most common causefor renal failure for kidney
failure. So I think the reasonwhy people think that the kidney
will fail with old age isbecause most of the time with
aging, many of our populationwill have some metabolic
(16:27):
disease. So mainly hypertension,diabetes, or high cholesterol.
And little do we know that ifthey remained very poorly
controlled, eventually thekidney would suffer. So I think
in the first thing to reallypreserve our kidney functions,
it's actually not difficult, butit's difficult to do, especially
for busy Hong Kong people arebusy city life people is to just
(16:51):
have a good health and diet,right? So have a good habit of
regularly exercising, drinkplenty of water and have a very
healthy and nutritious basedfood. And if you do it
persistently, then perhapschances are the lowers the risk
of metabolic disease and thekidney will not suffer at the
end.
Fabian Gruber (17:11):
And when it comes kind of to renal-specific health
data, is there anything inparticular, we all know this
kind of classical renal panelthat you get when you're doing
your annual health check? Likelocusts? It's nutria like nature
is pH like what are those thoseitems where you normally kind of
(17:31):
specifically look for and whatwhat do they sing?
Dr. Kiki Chan (17:35):
I think in the general workup, kind of setting
like an annual health check kindof setting, we will look at the
mainly the leukocyte if there isany white blood cells, so
indicates if there's anyinflammation or infection. And
also we will look at if there'sany red blood cells. So if
there's any microscopic or hintsthat hematuria. And most common
(17:56):
other things that we look atwill be if there's any protein,
and any glucose. But all in all,if I think that urine analysis
which the multistep panel serveas a very preliminary test, so
it can be done in an officesetting, or it can be done at
home. But either way, I thinkwhat's important to know is that
the panel is very sensitive, butnot very specific. Meaning that
(18:20):
it can pick up a lot of things,but sometimes it can miss a lot
of things also. And sometimes ifit's comes back to be positive
or abnormal, it might not beentirely a disease. So the
purpose is served is to mainlyfor increased awareness of when
you should go find your familydoctor.
Fabian Gruber (18:39):
I mean, I think I've mentioned in the podcast
before and I mean, I definitelymentioned it to you, I recently
bought some piece of Chinesemedical technology to actually
do a renal panel at home. Soexactly like you described at
some at the end. It's it's asystem like where you use a
multi strip that measures 11items at once you dip it into
(19:01):
your morning urine and then yourun it through the machine and
the machine basically reads thestrip for you decodes the color
coding and presents it indigital form. So is that
something I mean that for you asa practitioner is something that
you think is is not a bad idea?
Because what I always think islike I have this kind of
quantified self perspective onit. So on one thing is like
doing a health check once peryear. It's It's good. It's
(19:24):
better than nothing. But it's avery, it's a snapshot. I mean,
it's it's a snapshot of of yourhealth net particular moment.
But it's also because you do itso rarely, it doesn't really
establish base values, it's verydifficult to see kind of changes
because they are the timeframeis so, so big. So that's why I
kind of think that when it'srelatively it's not very
(19:46):
expensive, and it's notrelatively complicated to do
this kind of measurements athome by not doing them like once
in a while just to also kind ofsee a little bit is there
something that that is changingover time, so but Do you think
about this kind of gadgets? Andis that something you would like
people to use more? Or do youthink leave it to the doctors,
Dr. Kiki Chan (20:08):
I'm quite open minded in this aspect, I think
it's difficult, very difficultto prove whether home monitoring
device is useful or not, becausemost of the people who do home
monitoring devices are areeither those with with a disease
that we would recommend them tomonitor at home or the other
segment would be those who arelike you Fabian and like,
(20:29):
totally healthy, but very healthcautious. So they want you want
to know more about your healthand and catch anything has a
very early stage, right. So Ithink for this segment of
individuals, it will be verydifficult to prove that the test
is not useful or useful, becausechances are, you will likely
remain to be healthy for quite along time. So I think instead of
(20:51):
saying that, no, like, Don't doit, you're wasting your time,
leave it to Doctor, I think it'sgood that the individual has a
increased awareness on on thehealth, and is trying to see if
there's anything that promptshim or her to go to a doctor
earlier. So I think it's okay todo it. As long as we understand
that for every test, even bloodtests, or even test that we do
(21:14):
in a hospital, there is somefalse positives, some false
negative. So if a test comesback to be positive, go ask your
family doctor if any otherinvestigation is needed. And do
you understand that some of thetests can be negative falsely,
and just be mindful that it'snot 100% accurate, but I think
there's no harm in it, becauseit's not an invasive test to
(21:36):
begin with. So I think I do havea very open mind. And I think
usually what what it means bylike, for individuals like you
who do test at home, I think itjust means that you are very
aware of your health. And it'sdefinitely a good thing.
Fabian Gruber (21:50):
I mean, I sometimes have the feeling that
there's still quite a gapbetween kind of the medical
sector and this kind of devicesthat are going more into the
medical area, I have a Garminwatch. So the Garmin watch in
the meantime, records Sp02,during my sleep, it has all the
heart rate measurement, cat ratevariability, ecetera. But like a
few times when I was actuallylike consulting a doctor for
(22:14):
medical issue, I mean, I alwaysoffered my records and says, oh,
by the way, I also have kind ofseven years of heart rate data
if you're interested. But Ithink it's simply so far. I
mean, I've never had like adoctor who said, Oh, yeah,
that's interesting. Let me letme have a look at least even
though I think the quality ofthe data that is the mean time
(22:34):
kind of gathered by thosedevices most likely is quite
good. I don't think that theSpO2 measurements from my Garmin
is necessarily way off from thenormal finger, fingertip devices
that that are used in thehospital, because the technology
is exactly the same, the sensoris the same. And Garmin makes so
many more of those sensors thatthey possibly learned more in
(22:56):
the process than the medicalsector. But I think it's still
it seems to be still some kindof like kind of a chasm between
the medical sector, the medicalprofessionals and this kind of
home use devices. But do you seethat?
Dr. Kiki Chan (23:09):
I think home use devices is actually the way to
go. Like, I think it's not or nomatter what we think as medical
professionals, I don't think weare stopping this trend. Because
just like you said, there's aGarmin, there's Apple, my dad
just got a new handheld ECGmeasuring device. And I
absolutely love it. I mean, iffor people who have underlying
(23:31):
diseases, let's say underlyingheart rate problem, I would
actually absolutely love that ifthey have home monitoring
records for me to to know moreabout their heart rates in the
six or three or six months thatI didn't get to see them, right.
So I think it's absolutelyuseful, especially for those
(23:51):
with an underlying medicalcondition. For other people who
are healthy, like maybe let'ssay, let's use you as an
example. I don't believe thatsomething would be wrong with
your heart rate or your Sp02.
But I think it's not somethingbad to have like it for one
thing is if you're feelingunwell maybe you have like a
chest palpitation, there'salways this home device that you
(24:13):
can go to instead of rushing toa busy in a public set or busy a
new department and wait severalhours but not get your checked
promptly, right. So I thinkthese are home monitoring device
is the way to go. And I dobelieve that we should learn to
embrace it. Because it justgives us so much more
information.
Fabian Gruber (24:34):
I really believe that this at the end it should
work hand in hand, right? Itdoesn't mean that like we're not
trusting the doctor's diagnosisis just about kind of providing
more information right andpotentially helpful information.
Dr. Kiki Chan (24:46):
Another thing I think is to understand what the
device can do for you. And notof course not rely on it overly
just like my father's case. ITold him Yes, the ECG the
handheld ECG device can tell ifyou're having a abnormal
heartbeat. But it doesn't changethe fact that you have to have a
(25:10):
healthy lifestyle in order toprevent it from abnormal test to
come up, right. So doing aregular test does not means the
disease will not come by, itjust comes hand in hand with a
healthy diet and a healthylifestyle, though is something
like part of the package.
Fabian Gruber (25:27):
Perfect. I want to go back like a few things
from my kind of homemeasurements I'm specifically
interested in one thing that I'mjust curious about is pH value.
How important is that? Thatreally, I've always always get a
six. So pretty much exactly inthe in the range, or in the
average range that that'sexpected? Like is there is this
(25:48):
a common issue that pH valuesget out of whack? And what would
that normally mean, if it goestoo high or too low?
Dr. Kiki Chan (25:55):
I think the pH really depends on on your
general health condition. Ifit's related to something very
serious, like someone with avery bad infection, then the pH
level can, it can be veryimportant. But in a general
setting, the pH level is a less,it's more or less like a
(26:16):
reference, I would normally useit for my kidney stones patient,
because the pH definitelyreflects the food that the
individual intake. And also ifthe kidney is excluding too
acidic urine, because that wouldlead or stone formation. So I
think doing a pH checkdefinitely helps, especially if
(26:36):
there's an underlying condition,that a very bad pH or very
acidic pH is not favorable.
Fabian Gruber (26:42):
Interesting. So I have measured now quite a few
times, I've never had anyvariation. So I'm always kind of
pretty much exactly the same 6.0value,
Dr. Kiki Chan (26:51):
I think that's that sort of maybe signify that
you have generally a verypersistent lifestyle, or the
diet and also your water intakeis quite consistent, or average,
I think because that's that'sthe other topic.
Fabian Gruber (27:04):
That's the other web I wanted to dive in. Because
I mean, I struggled basically mywhole life with proper
hydration. And that's, that'ssomething that already as a
child, where with all thosetraumas come from with like, you
will get kidney stones, becauseeven as a child, I sometimes
drink like two glasses of watera day or so. And that's it. And
even now there is it's I try, ofcourse consciously to kind of
(27:27):
resume your hydrating here verywell while I'm talking to you.
But overall, it's like if I getobsessed with something, if I'm
working on something, I caneasily forget it. And then like
three hours later, I realized,Oh, I haven't had a cup of
water, like for quite quite sometime. So that's something I'm
really interested in. And thatwas also one of the main reasons
why I got kind of into thiswhole topic of renal health,
(27:47):
etc. So what I was interested inthis kind of home panel was the
specific gravity measurements.
So also there, I'm relativelystable, but always at the higher
end, like I always get 1.03,which is kind of would be an
indicator for at least milddehydration, right?
Dr. Kiki Chan (28:05):
Yes, well, I think again, each parameters has
a false positive and falsenegative, and there can be
underlying medical conditionthat interferes with the
reading. So before we interpreteach of the parameter, we have
to make sure there's nocondition that interferes but
but with those aside, you'reright that as high specific
gravity will indicate thatyou're mildly or moderately
(28:28):
dehydrated. But sometimes Ithink Fabian, we sort of can
tell even without the paneltelling you, I'm not sure if you
had this experience, likefeeling dry around your mouth,
or like a bit of a headache.
Sometimes I think these aresigns of dehydration that our
body's trying to tell us. So Ithink while on one thing is good
to have this objectiveparameters like specific gravity
(28:50):
to tell you whether you'rehydrating or not. But the other
thing is just go back to yourlifestyle and, and count, like
how many glasses of water have Itaken and gradually built the
habit. And especially I thinksometimes when you have symptoms
that you don't relate withhydration, like if you're
getting grumpy, if you'regetting headache, they might be
early signs of dehydration,though you feel like I'm having
(29:13):
this headache. And I might bedehydration rather than your
colleagues.
Fabian Gruber (29:20):
I get that part.
And of course also I was notkind of trying to use like
specific gravity now like as amomentous check in the middle of
the day and say, Oh, let mecheck if I'm dehydrated. That
was I did my kind of my panel inthe morning basically first
things after getting up justkind of normally I go to toilet
first and then afterwards I stepon a scale and measure my body
fat. I was kind of running thispanel and I was just kind of
(29:41):
interested to see if I could seefluctuations. For example, like
if I did a longer trail run theday before I ran like 20
kilometers or something and thenext morning like see a
difference. So that's and I mustsay that on specific gravity,
like an opposite to pH where Ibasically never see any
difference. I definitely sawdifferences, even though they
were like, yeah, most of thetime, I was like at 1.0 to 1.03.
(30:03):
So definitely a little bit toohigh for my taste or for for
what's recommended.
Dr. Kiki Chan (30:11):
I'll be very interested to see your specific
gravity in the middle of theday. Yeah, because normally
first thing in the morning,we're we're most dehydrated,
because after a long trip, wehaven't replenished the fluid.
So it will be very interestingto see if you could do it in
other times of the day. And ifit changed, because it might not
your hydration status is mightnot be best reflected or first
(30:33):
thing in the morning. You mightbe a very well hydrated person
throughout the day.
Fabian Gruber (30:38):
Okay. No, I mean, that's, that's another idea.
Okay, I will use one of my homeoffice days,
Dr. Kiki Chan (30:44):
You can get back to us in your future episode.
Fabian Gruber (30:48):
Now, that's why I like to talk to real experts,
you get new ideas, and you learna lot. So yeah, I think one one
more question regarding ketones.
So I used it also to measureketone levels, because at least
in January, this year, I waspretty much the entire January
in ketosis. And previously, Iwas prick my finger and blood
ketone measurements, but that'srelatively expensive. And also
(31:10):
Yeah, it's slightly annoying toprick your finger five times a
day and you until you getcalluses on your finger. So I
bought, I bought another cheapmedical device like a ketone
breath, monitor, as a nun. Andas a way to kind of measure the
levels. And because I know theyare not as reliable as the blood
(31:30):
ketone values, that's why I wasvery interested to measure that
I have two ways to measure itturns by urine measurement. And
by by breathalyzer, and I was Iwas, I was pretty positively
surprised that they alignedquite well. So it was not too
far off on most days, which thenkind of made me quite positive
about my relatively cheap toollie Express purchases here.
(31:53):
But what I wanted to ask you andin general, is if there's
anything in terms of kind of,like ketone levels, in the urine
that you have came across thatwould, from a renal perspective,
say it's negatively associatedto any to kidney health or
anything like it. I mean, I'venever found anything but I'm
(32:14):
just curious as to diet getsalso more widespread, and I
personally enjoy like being inketosis, like at least kind of
in periods, not it's maybe notsomething I can I can do through
the complete year, especiallynot if I don't want to end a
lonely divorced man, as my wifelikes to bake a lot. But yeah, I
mean, it's just curious if youhave ever heard anything about
(32:36):
it.
Dr. Kiki Chan (32:39):
Okay, regarding keto diet, in terms of like, the
evidence level is not strong,like it's not level one or level
2x level. So I think there ifyou search hard enough, you'll
eventually find something thatsupports it. And something that
says that is not useful is notto go against it. And for me, I
think a keto diet is somethingthat I don't see a lot of harm
(33:02):
in it. But I think definitely,we have to do it with a level of
consciousness that first of all,we don't overdo it. And second
of all, we have to make surethat there's no underlying
medical conditions that goagainst a keto diet. But in
general, I still believe that awell balanced diet is a way to
go in terms of like a lifelongjourney. So for me, I can't give
(33:27):
like a medical recommendation,whether one should do it or not,
I think
Fabian Gruber (33:30):
you don't have to, you don't have to.
I'm not putting you on the spot.
Dr. Kiki Chan (33:34):
I think it's okay to try as long as we are very
cautious about over restrictingor over ingestion of certain
food, it's not good. So ingeneral, the goal is for us to
have a well balanced diet. Butketo diet is not something that
I would absolutely recommendagainst, because there's just no
evidence to say that it's asuper bad thing. But I just for
(33:54):
now, I on the other side, Idon't see like a level one
evidence saying that is anabsolutely the best thing to do.
Fabian Gruber (34:00):
But what I always find fascinating about the keto
diet is that it is a metabolicstrategy that you can really
objectively measure, right? Soyou have a way to measure if
you're in ketosis or not. Whilethere is not really a way how to
kind of measure what your weightwatchers meal just did to you or
something that you just ate.
Right. So that's kind of that'ssomething that I always found
fascinating. I think most of myquestions that I had kind of
(34:23):
prepared to answer, but I thinkI want to give you like maybe a
chance also to say what what youthink people should be more
aware of what would make yourjob easier? And is there
anything really I mean, I thinkwe covered kind of balanced
diets and generally a healthylifestyle. But is there anything
else that we that we missed out?
Dr. Kiki Chan (34:44):
I think now that we're speaking of doing home
monitoring and also measuringwhile our diet is doing to us, I
think maybe you're inspiring meto know that the general public
is actually more concerned andmore conscious about their
health. The Sometimes, asdoctors imagine, and I think
it's it's a wonderful idea, Ithink we also be responsible for
(35:07):
our health. And I think it'ssometimes I do get patients
coming to me with a lot ofsearch results from Google's
say, like, I think you shouldgive me this medication, or I
think you should treat mydisease this way. And I learned
to appreciate the effort. And Ithink for us, like for me, I
will absolutely love to see thatour patients is very concerned
(35:31):
and very cautious about the dietand the lifestyle. And the only
message that I would love toemphasize is that there's with
every home measurement, andevery every test, even that we
do in the hospital, there is acosine and downside. So as long
as we're aware of the positiveand the negatives to that test,
(35:51):
I think it's absolutely okay forus to, to do any measurements we
want to do. So it's basicallyknow what you're doing, and know
the good side. And downside, thesame thing for supplements, I
think supplements is not a badthing. Definitely supplements
can be very good, especially forpeople who have a restrictive
diet or with an underlyingmedical condition. So as long as
(36:13):
we know that, we have to why weneed that supplement, and
whether if there's any harmregarding that supplement, it's
absolutely fine to do it. So Ithink it's just just like
everything in life, right? Beingwell balanced, know, the pros
and cons. And we're good.
Fabian Gruber (36:29):
And I think we helped a little bit to spread
some knowledge today. Especiallyyou did really as insightful as
I was hoping hoping for finalquestion. Do you have any social
media presences or anythingwhere people can reach you? Or
should they just send a followup question my way, and I
forward them to you? Is thereanything that you want to share?
Or?
Dr. Kiki Chan (36:49):
Yes, I can be fine on LinkedIn. I think that's
how we met. And it's perfectlyfine. If they fire you with all
the questions, and then you giveit to me. It's which is
perfectly fine. Yeah.
Fabian Gruber (37:01):
Perfect, then, yeah, I have a link to your
LinkedIn account, I think in theshow notes. And if anybody else
has questions, just they canalso email me and I will forward
to you and we will do a followup. Lovely. Thank you very much
Kiki I was was really awesome.
And I think you erased my titletrauma a little bit even though
you scared me now even moreabout ruptured bladder. So that
(37:22):
was we I'm not sure. If I mightdream of
Dr. Kiki Chan (37:28):
actually I do. I do want to bring up one point,
the reason why I emphasize somuch on knowing the pros and
cons to everything is becauseI've seen some individuals got
really scared on a homemonitoring test. So I think,
what why am I so so affected byis because being a doctor for
(37:48):
over a decade, I really believewhat we think. And our emotions
affect our health more than weimagined. So I think as good as
some tests may tell us, ifthere's any minute problems with
our with our body, I think wealso have to take a positive
mindset on how these gadgets arehelping us and not over worrying
(38:08):
about them. Because overworrying a test, which might be
fascinating, positive,eventually may hurt our body
more than the test is meant todo to us. So I think that's why
I really emphasize because I'mreally big on holistic health,
like mine, healthy mind, healthybody. And yeah,
Fabian Gruber (38:26):
I mean, I think it's an absolutely fair point. I
think it's like some peoplemeasure simply to just find
something right. And that's, ofcourse, not the attitude you
should approach. Right? I mean,for me, it's more like about
trying also to establish abaseline to understand my body
with better and to understand,okay, if my pH value normally is
six, if it suddenly is seven,yeah, then there's something
happening. Right? And that's,that's what I'm mostly
(38:48):
interested in.
Dr. Kiki Chan (38:49):
Yeah, I think for like for your type is perfect,
because you're trying to use aqualitative measurement to see
if there's any situations thatdeviates from your baseline. But
I think that's perfect. Andthat's how I think that's how
most of the gadgets should beused.
Fabian Gruber (39:05):
Perfect. Thank you very much. I think that's a
very good closing line and veryencouraging thing for all
quantified self people outthere. And I think in the
meantime, I think a lot ofpeople who listen to this
podcast and to read the blog,possibly among them, so yeah,
one more time. Really. Thank youvery much, Vicki. And yeah, it
was a pleasure and it's alwaysnice to talk to fellow alumnus
(39:28):
from high school. Yes,
Dr. Kiki Chan (39:30):
thank you so much for having me. I really enjoyed
it.
Fabian Gruber (39:36):
This was Life-Sparring Round 6
talk was Dr. Chun Ki Kiki Chan,hosted as always by me, Fabian
Gruber. As mentioned at thebeginning of this episode, this
podcast is for the purpose ofinformation entertainment only,
and does not provide medicaladvice. If you suspect that you
have a medical problem. pleaseseek a local medical
professional without delay.
(39:59):
Life-Sparring is Produced byThomas Latter, intro and outro
beat are by my Markezi producer.
More info about Life-Sparringand this episode, including all
links, gadgets resourcesmentioned in the show, you can
find atLife-Sparring.com/podcast . If
you enjoyed the show, pleasesubscribe and leave like
wherever you are getting yourpodcast. I hope you'll join us
(40:20):
again for the next round ofLife-Sparring. Until then, stay
healthy, keep your hands up andprotect yourself at all times.
In the blue corner, with a specific gravity
indicating moderate dehydration,from Hong Kong your host Fabian
Gruber. In the red corner, theonly guest to get away with
rescheduling a show to perform akidney transplantation, also
(00:31):
from Hong Kong, Dr. Chun KiChan.
Fabian Gruber (00:44):
Today we have another Life-Sparring round with
a health focus. So it'simportant to start with the
usual disclaimer. This podcastis for information and
entertainment purposes only. Bywe discuss medical topics, we
are not providing medicaladvice. And if you're facing a
health scare of any kind, seeyour local health care
professional without the delayand do not rely on information
(01:06):
from the internet. With that outof the way, welcome to
Life-Sparring, Dr. Chun Ki Chan.
So this podcast has been a whilein the making. And we actually
had a session scheduled a fewweeks earlier. And then you
asked me to cancel due to akidney transplantation. And I
mean, I haven't run this showfor very long. But I'm pretty
sure that this is already a verystrong candidate for the best
(01:29):
postponing reason ever. So itwill be very difficult to ever
top this. I hope the patient isrecovering very well...
Dr. Kiki Chan (01:40):
sorry for last minute cancellation to to make
things feel better for us, thepatient is doing great.
Fabian Gruber (01:46):
No, absolutely not. That's there is no better
reason for sure. So seriously,I'm very grateful that you are
taking the time to talk with meabout renal health today. So I
think the urinary system is ofall our major organs, possibly
the one that gets the leastattention. And there may be also
the most knowledge gaps andmisconception about and I'm
(02:07):
pretty sure that you are able toclear this out a little bit. You
have been practicing urologistsand the Hong Kong public
hospital system for more than adecade, you train other doctors
on surgical procedures. Andyou're also involved in billing
information database on renalcancer. So yeah, there is no
better person to talk to aboutthis topic. And yeah, that your
(02:29):
fellow HKUST MBA graduate, ofcourse, makes things even more
fun. So I can't wait to quizzyou. But as I usually like to
do, I really would start at thevery beginning. So how did you
get into medicine in the firstplace? Kiki,
Dr. Kiki Chan (02:44):
first of all, thank you for having me. A
pleasure is all mine. How did Iget into medicine? I think I'm
not sure how familiar you arewith the Hong Kong TV drama. But
back in the old days, there werefew fairy hit medical dramas
like ER, and then there's thiscounterpart produced in Hong
Kong. So I sort of justassociated that, like this
(03:07):
medical professions is somethingthat's super refined, chill, a
bit heroic and very meaningful.
So I sort of just know, this issomething that I want to do
thinking back, I think there'salso this influence from an
Asian family, that being aprofessional is the way to go.
So I think in like in my highschool years, I was just sort of
(03:27):
No, this is what I'm I want todo and I actually haven't given
much thought to other degrees.
So we just naturally became amedical school for me.
Fabian Gruber (03:39):
So you didn't come from a long line of medical
professionals or are there anyother doctors in your family?
Dr. Kiki Chan (03:45):
I have a line of family friends, close family
friends who are amazing,well-known doctors in Hong Kong.
So I've been under theirinfluence ever since when I was
a kid. But most of my familymembers are actually interested
in Chinese medicine than Westernmedicine. Yes, so I think that's
a good thing that I sort ofappreciate the good things from
(04:08):
both Chinese and Easternmedicine but yeah, no, didn't
come from a long line ofmedical practitioners.
Fabian Gruber (04:15):
Yeah. And then of course, I have to ask the
question, so why urology I thinkthe more lTV drama-like
specialization are heartsurgery, brain surgery. How did
you become a urologist?
Dr. Kiki Chan (04:28):
That was a total accident. It was unexpected. I
mean, it just so happens thatafter I graduate medical school,
my first rotations as in houseofficer and as a medical
officer, was in the urologydivision. And not to mention the
amazing urologist who are now myclose friends that I've met and
(04:50):
who were my mentors at thattime. What changed me was a
kidney transplant. So I saw myfirst kidney transplant as my
first year of medical officerand then I just knew It was
something that I really want todo, though, I get asked this
question a lot, this is thefirst time I get to give this
long answer.
Fabian Gruber (05:08):
So how's your job these days? So you like having
this this double function right?
On one hand, you're stillpracticing, I guess. And then
you have consultant roles. How'sthat balance? How is your your
normal work day.
Dr. Kiki Chan (05:21):
So basically, what I do from on a day to day
basis is to manage patients witheither stone or infection or
cancers of the urologicalorgans. So basically, kidney or
bladder, or prostate, and a lotof my time is divided into
either surgery or outpatientclinics. So when I'm doing
(05:41):
surgery, either I do some of themajor surgeries myself such as
like removing kidney cancers, orprostate cancers. And other
times, I would train mycolleagues, my trainees to do
surgeries, and other times, itwill be in outpatient clinics.
So seeing some of the patients.
And yeah,
Fabian Gruber (05:59):
and did COVID have a big effect on your daily
job. I mean, I can imagine that,in general, like being in the
medical sector is even harder,like those, there's one and a
half years than it ever hasbeen. How did this affect you?
Dr. Kiki Chan (06:15):
This is so true.
Actually, we had quite a wave ofpatients not willing to come
back for outpatient clinics,visits because of COVID. And now
that the COVID seems to beimproving a little bit, they're
all rushing back. But all inall, I think you are very right
at the beginning saying that theneurological system is one of
the more so called neglectedones. It's really amazing how
(06:37):
the COVID has hit us by thefourth wave by now. And we just
didn't really have to cancel oursurgeries, because we have so
many patients with neurologicalcancers and serious diseases. So
these are the diseases and thesurgeries that we continue to
do, even in the middle of COVID.
(06:58):
And it's just a bit overwhelmingand amazing to look at the fact
that we didn't really have tocancel our list at all, because
just there are so many patientswith serious urological
diseases.
Fabian Gruber (07:09):
And do you think that the reason is that people
are just kind of too late toactually find out that they
have, for example, bladdercancer also, is it the just the
lack of awareness leads to laterdiagnosis? or Why do you think
this it's so common?
Dr. Kiki Chan (07:24):
Actually, I think the public awareness is
improving, because there's moreregular checkups. So we're
picking up cancers at an earlierstage. I think the public sort
of not realize that a lot ofmale and female, especially when
they start to age can haveurological diseases, and the
number is as under estimated.
Fabian Gruber (07:46):
Good. So I think we should take a little step
back. And maybe you could justdescribe in the most simplest
way how the whole you want topress practice working like how
does the whole renal systemwork? Can you just describe the
main functions? And maybe alsoif you if you have one on top of
your head? What is there thatmost people get completely wrong
(08:08):
about the Renal System?
Dr. Kiki Chan (08:10):
Well, I think to begin with the Urological system
is we have this upper urinarytract and the lower urinary
tract. My special interest isactually the upper urinary
tract, which is the same acrossall genders. So it's basically
the kidneys and the ureters. Andthe bladder. And once we get to
the bladder is sort of dividesinto a lower urinary tract. So
(08:32):
bladder and the urethra andprostate and it's all a holistic
call a at the neurologicalsystem. common misconceptions. I
think you got one that while wewere sharing, if you drink too
much water and you don't go topee, does that hurt your kidney?
Or does the bladder rupture? Iget asked this quite a lot too.
(08:54):
It doesn't under normalcircumstances. But I've seen
cases of ruptured bladder, butit's not like a normal thing
that someone can hold until thebladder ruptures. So what
happened during those two caseswas the patient got very, very
drunk. I think she had too muchbeer. So at the end, the bladder
was too full, but she was toodrunk to pass and then she
(09:17):
tripped and hit her lower tummyand the bladder just ruptured.
I've seen it twice, but it's Idon't think it's a normal
circumstances.
Fabian Gruber (09:24):
Yeah, that sounds scary enough for me. I mean,
that that's, that's not helpingto ease my childhood traumas
inflected by Auntie's...
Dr. Kiki Chan (09:35):
beer drinking
Fabian Gruber (09:36):
I am German, after all. Yeah, but I think not
to that extent. So I have a fewmore of those myths. Maybe we
can just do a little mythbusting round. How about kidney
stones? Is it really related tolack of hydration or is there
not really any relationshipbetween both?
Dr. Kiki Chan (09:54):
Lack of hydration is definitely a factor for
kidney stones formation, but Ithink It's not the only factor.
Sometimes we also have to take alook at whether there's like a
genetic predisposition, ifthere's a family history, and
whether or not the patients orthat individual has any
underlying predisposition, likeif there's underlying disease,
(10:15):
that predisposes excretion ofsome of the stone forming agents
like calcium, then no matter hownormal the water intake is, then
that individual may or may be athigher risk of having kidney
stones. But definitely in anormal circumstances, lack of
hydration or not having enoughwater intake is a risk factor.
Fabian Gruber (10:36):
And when we are talking about water intake, so I
mean, there are so many rules,right? two liters a day. What's
the scientific basing aboutthis? Is there really something
where like there's scientificconsensus or medical
practitioner consensus around oris this all kind of very
difficult.
Dr. Kiki Chan (10:55):
For the general public, we usually advertise
having eight glasses of waterper day, because I think that's
more easy for Public to follow.
It's just easier to gauge witheight glasses by for people with
a history of stones or peoplewho are currently having stones,
I would actually recommendhaving water so much so that the
urine output per day is over 2.5liter. So I think it's one thing
(11:18):
to know how much you drink. Butsometimes we have different
lifestyles. So for someone whois very active physically, or
may sweat a lot, so the waterintake may need to be even
higher, because that person willsweat. So what we count is not
the water that has been taken,but instead the water that
eventually passes through thekidney, and is able to be
(11:41):
excreted. So if we are beingextremely strict and
scientifically based, then itwould be urine output more than
2.5 liters per day. But thatwould be for people who have
stones. So for general public, Ithink somewhere around two
liters per day of intake wouldbe sensible. But it's also
different in terms of theindividual, how active he or she
(12:05):
is how much he or she sweat. Andif there's any underlying
medical diseases, like forsomeone who has a bad heart
function, I wouldn't recommenddrinking that much.
Fabian Gruber (12:16):
I mean, I'm still thinking how to measure I'm a
quantified self guy. So likeoutput measurement, of course,
is maybe a challenge for the mynormal daily routine. But yeah,
Challenge accepted. How aboutsupplement consumption? Is there
any anything that that you seecritical, like in terms of like
(12:36):
those searches? Or, for example,bodybuilders who take a lot of
protein powder? Is thereanything that is a problem from
a renal perspective?
Dr. Kiki Chan (12:45):
Yes, I think I totally agree that nowadays, we
all like a lot of us who resortto taking supplements. I do
think that there on one side, Ithink supplements are good,
especially if it compensates forthe lack of intake in our normal
diet. But I think we have tohave a clear mind of why we take
certain supplements to me, Ithink supplements mainly are
(13:07):
taking for two reasons. One isyou believe that you cannot have
adequate intake from your normaldiet. So that's why the
supplements help to gap theinsufficiency. Right? And the
second one is if you believethat certain supplements help to
either prevent or cure a certaindisease. So in the first group
meaning to compensate thedietary insufficiency, I think,
(13:31):
first of all, the first questionwe have to ask is whether or not
is really impossible to takethat certain nutrients through a
normal diet. Let's say vitaminC, like a lot of us will take
vitamin C supplements. But Ithink having enough vitamin C
for our daily intake usuallyjust takes like five servings of
(13:51):
fruits and vegetables. So it'snot entirely impossible when you
come to think about it. So Ithink it using this as an
example, I think it reallydepends on whether you think you
cannot intake in your normaldiet. So before you decide that
you really need that supplement.
And there has been I think therehas been also cases which that
overdosing on certainsupplements, indeed hurts the
(14:13):
kidney function. So again, it'svitamin C is also a very common
examples, taking too muchvitamin C actually may cause
some urinary problems or maycause kidney stones. So that's
why I always tell my patientslike if you think you need a
certain supplement, do you thinkthat the why you need it, and if
it's due to a lack of normaldiet, let's try our best to see
(14:36):
if we can use normal likenatural food to overcome that
the lack. So yeah, so that's thefirst part of my stance on
supplementation. But on theother hand, I do believe that
there are some supplements thatmay have to be taken, let's say
like vitamin B 12, which mightbe needed in case if someone is
vegetarian, right. So I think atthe end, we have have to go back
(14:59):
to our lifestyles and see ifcertain supplements are really
necessary. And if it is, then Ithink wich dose is beneficial
for health. Just like everythingwe just don't overdo it and, and
use it. Because it's absolutelynecessary.
Fabian Gruber (15:17):
We covered kind of the basic myths that I had
kind of on my mind. But for you,as a practitioner are the
biggest health concerns when itcomes to regional health, what
are kind of the biggest healththreats and when for me, it
seems like especially kidneyfunction seems to be quite a
complicated thing, because it'snot the on off thing, right? So
kidney function and kind ofdeteriorate slowly it works and
(15:41):
sudden doesn't work like likewhat you can have like a heart,
I don't know, if you have aheart attack, then then you have
a heart attack, right? So itshuts down the complete system.
And it seems like for kidneyfunction, for example, is more
like a gradual decreasepotentially. And now maybe you
can go like a little bit intointo what what you see as the
main health problems that youdeal with also professionally,
(16:01):
and, and maybe what what arelike the things to really to
look out for,
Dr. Kiki Chan (16:06):
From what I see what really hurts to kidney
health, in my daily practice isdiabetes and hypertension, which
are the two most common causefor renal failure for kidney
failure. So I think the reasonwhy people think that the kidney
will fail with old age isbecause most of the time with
aging, many of our populationwill have some metabolic
(16:27):
disease. So mainly hypertension,diabetes, or high cholesterol.
And little do we know that ifthey remained very poorly
controlled, eventually thekidney would suffer. So I think
in the first thing to reallypreserve our kidney functions,
it's actually not difficult, butit's difficult to do, especially
for busy Hong Kong people arebusy city life people is to just
(16:51):
have a good health and diet,right? So have a good habit of
regularly exercising, drinkplenty of water and have a very
healthy and nutritious basedfood. And if you do it
persistently, then perhapschances are the lowers the risk
of metabolic disease and thekidney will not suffer at the
end.
Fabian Gruber (17:11):
And when it comes kind of to renal-specific health
data, is there anything inparticular, we all know this
kind of classical renal panelthat you get when you're doing
your annual health check? Likelocusts? It's nutria like nature
is pH like what are those thoseitems where you normally kind of
(17:31):
specifically look for and whatwhat do they sing?
Dr. Kiki Chan (17:35):
I think in the general workup, kind of setting
like an annual health check kindof setting, we will look at the
mainly the leukocyte if there isany white blood cells, so
indicates if there's anyinflammation or infection. And
also we will look at if there'sany red blood cells. So if
there's any microscopic or hintsthat hematuria. And most common
(17:56):
other things that we look atwill be if there's any protein,
and any glucose. But all in all,if I think that urine analysis
which the multistep panel serveas a very preliminary test, so
it can be done in an officesetting, or it can be done at
home. But either way, I thinkwhat's important to know is that
the panel is very sensitive, butnot very specific. Meaning that
(18:20):
it can pick up a lot of things,but sometimes it can miss a lot
of things also. And sometimes ifit's comes back to be positive
or abnormal, it might not beentirely a disease. So the
purpose is served is to mainlyfor increased awareness of when
you should go find your familydoctor.
Fabian Gruber (18:39):
I mean, I think I've mentioned in the podcast
before and I mean, I definitelymentioned it to you, I recently
bought some piece of Chinesemedical technology to actually
do a renal panel at home. Soexactly like you described at
some at the end. It's it's asystem like where you use a
multi strip that measures 11items at once you dip it into
(19:01):
your morning urine and then yourun it through the machine and
the machine basically reads thestrip for you decodes the color
coding and presents it indigital form. So is that
something I mean that for you asa practitioner is something that
you think is is not a bad idea?
Because what I always think islike I have this kind of
quantified self perspective onit. So on one thing is like
doing a health check once peryear. It's It's good. It's
(19:24):
better than nothing. But it's avery, it's a snapshot. I mean,
it's it's a snapshot of of yourhealth net particular moment.
But it's also because you do itso rarely, it doesn't really
establish base values, it's verydifficult to see kind of changes
because they are the timeframeis so, so big. So that's why I
kind of think that when it'srelatively it's not very
(19:46):
expensive, and it's notrelatively complicated to do
this kind of measurements athome by not doing them like once
in a while just to also kind ofsee a little bit is there
something that that is changingover time, so but Do you think
about this kind of gadgets? Andis that something you would like
people to use more? Or do youthink leave it to the doctors,
Dr. Kiki Chan (20:08):
I'm quite open minded in this aspect, I think
it's difficult, very difficultto prove whether home monitoring
device is useful or not, becausemost of the people who do home
monitoring devices are areeither those with with a disease
that we would recommend them tomonitor at home or the other
segment would be those who arelike you Fabian and like,
(20:29):
totally healthy, but very healthcautious. So they want you want
to know more about your healthand and catch anything has a
very early stage, right. So Ithink for this segment of
individuals, it will be verydifficult to prove that the test
is not useful or useful, becausechances are, you will likely
remain to be healthy for quite along time. So I think instead of
(20:51):
saying that, no, like, Don't doit, you're wasting your time,
leave it to Doctor, I think it'sgood that the individual has a
increased awareness on on thehealth, and is trying to see if
there's anything that promptshim or her to go to a doctor
earlier. So I think it's okay todo it. As long as we understand
that for every test, even bloodtests, or even test that we do
(21:14):
in a hospital, there is somefalse positives, some false
negative. So if a test comesback to be positive, go ask your
family doctor if any otherinvestigation is needed. And do
you understand that some of thetests can be negative falsely,
and just be mindful that it'snot 100% accurate, but I think
there's no harm in it, becauseit's not an invasive test to
(21:36):
begin with. So I think I do havea very open mind. And I think
usually what what it means bylike, for individuals like you
who do test at home, I think itjust means that you are very
aware of your health. And it'sdefinitely a good thing.
Fabian Gruber (21:50):
I mean, I sometimes have the feeling that
there's still quite a gapbetween kind of the medical
sector and this kind of devicesthat are going more into the
medical area, I have a Garminwatch. So the Garmin watch in
the meantime, records Sp02,during my sleep, it has all the
heart rate measurement, cat ratevariability, ecetera. But like a
few times when I was actuallylike consulting a doctor for
(22:14):
medical issue, I mean, I alwaysoffered my records and says, oh,
by the way, I also have kind ofseven years of heart rate data
if you're interested. But Ithink it's simply so far. I
mean, I've never had like adoctor who said, Oh, yeah,
that's interesting. Let me letme have a look at least even
though I think the quality ofthe data that is the mean time
(22:34):
kind of gathered by thosedevices most likely is quite
good. I don't think that theSpO2 measurements from my Garmin
is necessarily way off from thenormal finger, fingertip devices
that that are used in thehospital, because the technology
is exactly the same, the sensoris the same. And Garmin makes so
many more of those sensors thatthey possibly learned more in
(22:56):
the process than the medicalsector. But I think it's still
it seems to be still some kindof like kind of a chasm between
the medical sector, the medicalprofessionals and this kind of
home use devices. But do you seethat?
Dr. Kiki Chan (23:09):
I think home use devices is actually the way to
go. Like, I think it's not or nomatter what we think as medical
professionals, I don't think weare stopping this trend. Because
just like you said, there's aGarmin, there's Apple, my dad
just got a new handheld ECGmeasuring device. And I
absolutely love it. I mean, iffor people who have underlying
(23:31):
diseases, let's say underlyingheart rate problem, I would
actually absolutely love that ifthey have home monitoring
records for me to to know moreabout their heart rates in the
six or three or six months thatI didn't get to see them, right.
So I think it's absolutelyuseful, especially for those
(23:51):
with an underlying medicalcondition. For other people who
are healthy, like maybe let'ssay, let's use you as an
example. I don't believe thatsomething would be wrong with
your heart rate or your Sp02.
But I think it's not somethingbad to have like it for one
thing is if you're feelingunwell maybe you have like a
chest palpitation, there'salways this home device that you
(24:13):
can go to instead of rushing toa busy in a public set or busy a
new department and wait severalhours but not get your checked
promptly, right. So I thinkthese are home monitoring device
is the way to go. And I dobelieve that we should learn to
embrace it. Because it justgives us so much more
information.
Fabian Gruber (24:34):
I really believe that this at the end it should
work hand in hand, right? Itdoesn't mean that like we're not
trusting the doctor's diagnosisis just about kind of providing
more information right andpotentially helpful information.
Dr. Kiki Chan (24:46):
Another thing I think is to understand what the
device can do for you. And notof course not rely on it overly
just like my father's case. ITold him Yes, the ECG the
handheld ECG device can tell ifyou're having a abnormal
heartbeat. But it doesn't changethe fact that you have to have a
(25:10):
healthy lifestyle in order toprevent it from abnormal test to
come up, right. So doing aregular test does not means the
disease will not come by, itjust comes hand in hand with a
healthy diet and a healthylifestyle, though is something
like part of the package.
Fabian Gruber (25:27):
Perfect. I want to go back like a few things
from my kind of homemeasurements I'm specifically
interested in one thing that I'mjust curious about is pH value.
How important is that? Thatreally, I've always always get a
six. So pretty much exactly inthe in the range, or in the
average range that that'sexpected? Like is there is this
(25:48):
a common issue that pH valuesget out of whack? And what would
that normally mean, if it goestoo high or too low?
Dr. Kiki Chan (25:55):
I think the pH really depends on on your
general health condition. Ifit's related to something very
serious, like someone with avery bad infection, then the pH
level can, it can be veryimportant. But in a general
setting, the pH level is a less,it's more or less like a
(26:16):
reference, I would normally useit for my kidney stones patient,
because the pH definitelyreflects the food that the
individual intake. And also ifthe kidney is excluding too
acidic urine, because that wouldlead or stone formation. So I
think doing a pH checkdefinitely helps, especially if
(26:36):
there's an underlying condition,that a very bad pH or very
acidic pH is not favorable.
Fabian Gruber (26:42):
Interesting. So I have measured now quite a few
times, I've never had anyvariation. So I'm always kind of
pretty much exactly the same 6.0value,
Dr. Kiki Chan (26:51):
I think that's that sort of maybe signify that
you have generally a verypersistent lifestyle, or the
diet and also your water intakeis quite consistent, or average,
I think because that's that'sthe other topic.
Fabian Gruber (27:04):
That's the other web I wanted to dive in. Because
I mean, I struggled basically mywhole life with proper
hydration. And that's, that'ssomething that already as a
child, where with all thosetraumas come from with like, you
will get kidney stones, becauseeven as a child, I sometimes
drink like two glasses of watera day or so. And that's it. And
even now there is it's I try, ofcourse consciously to kind of
(27:27):
resume your hydrating here verywell while I'm talking to you.
But overall, it's like if I getobsessed with something, if I'm
working on something, I caneasily forget it. And then like
three hours later, I realized,Oh, I haven't had a cup of
water, like for quite quite sometime. So that's something I'm
really interested in. And thatwas also one of the main reasons
why I got kind of into thiswhole topic of renal health,
(27:47):
etc. So what I was interested inthis kind of home panel was the
specific gravity measurements.
So also there, I'm relativelystable, but always at the higher
end, like I always get 1.03,which is kind of would be an
indicator for at least milddehydration, right?
Dr. Kiki Chan (28:05):
Yes, well, I think again, each parameters has
a false positive and falsenegative, and there can be
underlying medical conditionthat interferes with the
reading. So before we interpreteach of the parameter, we have
to make sure there's nocondition that interferes but
but with those aside, you'reright that as high specific
gravity will indicate thatyou're mildly or moderately
(28:28):
dehydrated. But sometimes Ithink Fabian, we sort of can
tell even without the paneltelling you, I'm not sure if you
had this experience, likefeeling dry around your mouth,
or like a bit of a headache.
Sometimes I think these aresigns of dehydration that our
body's trying to tell us. So Ithink while on one thing is good
to have this objectiveparameters like specific gravity
(28:50):
to tell you whether you'rehydrating or not. But the other
thing is just go back to yourlifestyle and, and count, like
how many glasses of water have Itaken and gradually built the
habit. And especially I thinksometimes when you have symptoms
that you don't relate withhydration, like if you're
getting grumpy, if you'regetting headache, they might be
early signs of dehydration,though you feel like I'm having
(29:13):
this headache. And I might bedehydration rather than your
colleagues.
Fabian Gruber (29:20):
I get that part.
And of course also I was notkind of trying to use like
specific gravity now like as amomentous check in the middle of
the day and say, Oh, let mecheck if I'm dehydrated. That
was I did my kind of my panel inthe morning basically first
things after getting up justkind of normally I go to toilet
first and then afterwards I stepon a scale and measure my body
fat. I was kind of running thispanel and I was just kind of
(29:41):
interested to see if I could seefluctuations. For example, like
if I did a longer trail run theday before I ran like 20
kilometers or something and thenext morning like see a
difference. So that's and I mustsay that on specific gravity,
like an opposite to pH where Ibasically never see any
difference. I definitely sawdifferences, even though they
were like, yeah, most of thetime, I was like at 1.0 to 1.03.
(30:03):
So definitely a little bit toohigh for my taste or for for
what's recommended.
Dr. Kiki Chan (30:11):
I'll be very interested to see your specific
gravity in the middle of theday. Yeah, because normally
first thing in the morning,we're we're most dehydrated,
because after a long trip, wehaven't replenished the fluid.
So it will be very interestingto see if you could do it in
other times of the day. And ifit changed, because it might not
your hydration status is mightnot be best reflected or first
(30:33):
thing in the morning. You mightbe a very well hydrated person
throughout the day.
Fabian Gruber (30:38):
Okay. No, I mean, that's, that's another idea.
Okay, I will use one of my homeoffice days,
Dr. Kiki Chan (30:44):
You can get back to us in your future episode.
Fabian Gruber (30:48):
Now, that's why I like to talk to real experts,
you get new ideas, and you learna lot. So yeah, I think one one
more question regarding ketones.
So I used it also to measureketone levels, because at least
in January, this year, I waspretty much the entire January
in ketosis. And previously, Iwas prick my finger and blood
ketone measurements, but that'srelatively expensive. And also
(31:10):
Yeah, it's slightly annoying toprick your finger five times a
day and you until you getcalluses on your finger. So I
bought, I bought another cheapmedical device like a ketone
breath, monitor, as a nun. Andas a way to kind of measure the
levels. And because I know theyare not as reliable as the blood
(31:30):
ketone values, that's why I wasvery interested to measure that
I have two ways to measure itturns by urine measurement. And
by by breathalyzer, and I was Iwas, I was pretty positively
surprised that they alignedquite well. So it was not too
far off on most days, which thenkind of made me quite positive
about my relatively cheap toollie Express purchases here.
(31:53):
But what I wanted to ask you andin general, is if there's
anything in terms of kind of,like ketone levels, in the urine
that you have came across thatwould, from a renal perspective,
say it's negatively associatedto any to kidney health or
anything like it. I mean, I'venever found anything but I'm
(32:14):
just curious as to diet getsalso more widespread, and I
personally enjoy like being inketosis, like at least kind of
in periods, not it's maybe notsomething I can I can do through
the complete year, especiallynot if I don't want to end a
lonely divorced man, as my wifelikes to bake a lot. But yeah, I
mean, it's just curious if youhave ever heard anything about
(32:36):
it.
Dr. Kiki Chan (32:39):
Okay, regarding keto diet, in terms of like, the
evidence level is not strong,like it's not level one or level
2x level. So I think there ifyou search hard enough, you'll
eventually find something thatsupports it. And something that
says that is not useful is notto go against it. And for me, I
think a keto diet is somethingthat I don't see a lot of harm
(33:02):
in it. But I think definitely,we have to do it with a level of
consciousness that first of all,we don't overdo it. And second
of all, we have to make surethat there's no underlying
medical conditions that goagainst a keto diet. But in
general, I still believe that awell balanced diet is a way to
go in terms of like a lifelongjourney. So for me, I can't give
(33:27):
like a medical recommendation,whether one should do it or not,
I think
Fabian Gruber (33:30):
you don't have to, you don't have to.
I'm not putting you on the spot.
Dr. Kiki Chan (33:34):
I think it's okay to try as long as we are very
cautious about over restrictingor over ingestion of certain
food, it's not good. So ingeneral, the goal is for us to
have a well balanced diet. Butketo diet is not something that
I would absolutely recommendagainst, because there's just no
evidence to say that it's asuper bad thing. But I just for
(33:54):
now, I on the other side, Idon't see like a level one
evidence saying that is anabsolutely the best thing to do.
Fabian Gruber (34:00):
But what I always find fascinating about the keto
diet is that it is a metabolicstrategy that you can really
objectively measure, right? Soyou have a way to measure if
you're in ketosis or not. Whilethere is not really a way how to
kind of measure what your weightwatchers meal just did to you or
something that you just ate.
Right. So that's kind of that'ssomething that I always found
fascinating. I think most of myquestions that I had kind of
(34:23):
prepared to answer, but I thinkI want to give you like maybe a
chance also to say what what youthink people should be more
aware of what would make yourjob easier? And is there
anything really I mean, I thinkwe covered kind of balanced
diets and generally a healthylifestyle. But is there anything
else that we that we missed out?
Dr. Kiki Chan (34:44):
I think now that we're speaking of doing home
monitoring and also measuringwhile our diet is doing to us, I
think maybe you're inspiring meto know that the general public
is actually more concerned andmore conscious about their
health. The Sometimes, asdoctors imagine, and I think
it's it's a wonderful idea, Ithink we also be responsible for
(35:07):
our health. And I think it'ssometimes I do get patients
coming to me with a lot ofsearch results from Google's
say, like, I think you shouldgive me this medication, or I
think you should treat mydisease this way. And I learned
to appreciate the effort. And Ithink for us, like for me, I
will absolutely love to see thatour patients is very concerned
(35:31):
and very cautious about the dietand the lifestyle. And the only
message that I would love toemphasize is that there's with
every home measurement, andevery every test, even that we
do in the hospital, there is acosine and downside. So as long
as we're aware of the positiveand the negatives to that test,
(35:51):
I think it's absolutely okay forus to, to do any measurements we
want to do. So it's basicallyknow what you're doing, and know
the good side. And downside, thesame thing for supplements, I
think supplements is not a badthing. Definitely supplements
can be very good, especially forpeople who have a restrictive
diet or with an underlyingmedical condition. So as long as
(36:13):
we know that, we have to why weneed that supplement, and
whether if there's any harmregarding that supplement, it's
absolutely fine to do it. So Ithink it's just just like
everything in life, right? Beingwell balanced, know, the pros
and cons. And we're good.
Fabian Gruber (36:29):
And I think we helped a little bit to spread
some knowledge today. Especiallyyou did really as insightful as
I was hoping hoping for finalquestion. Do you have any social
media presences or anythingwhere people can reach you? Or
should they just send a followup question my way, and I
forward them to you? Is thereanything that you want to share?
Or?
Dr. Kiki Chan (36:49):
Yes, I can be fine on LinkedIn. I think that's
how we met. And it's perfectlyfine. If they fire you with all
the questions, and then you giveit to me. It's which is
perfectly fine. Yeah.
Fabian Gruber (37:01):
Perfect, then, yeah, I have a link to your
LinkedIn account, I think in theshow notes. And if anybody else
has questions, just they canalso email me and I will forward
to you and we will do a followup. Lovely. Thank you very much
Kiki I was was really awesome.
And I think you erased my titletrauma a little bit even though
you scared me now even moreabout ruptured bladder. So that
(37:22):
was we I'm not sure. If I mightdream of
Dr. Kiki Chan (37:28):
actually I do. I do want to bring up one point,
the reason why I emphasize somuch on knowing the pros and
cons to everything is becauseI've seen some individuals got
really scared on a homemonitoring test. So I think,
what why am I so so affected byis because being a doctor for
(37:48):
over a decade, I really believewhat we think. And our emotions
affect our health more than weimagined. So I think as good as
some tests may tell us, ifthere's any minute problems with
our with our body, I think wealso have to take a positive
mindset on how these gadgets arehelping us and not over worrying
(38:08):
about them. Because overworrying a test, which might be
fascinating, positive,eventually may hurt our body
more than the test is meant todo to us. So I think that's why
I really emphasize because I'mreally big on holistic health,
like mine, healthy mind, healthybody. And yeah,
Fabian Gruber (38:26):
I mean, I think it's an absolutely fair point. I
think it's like some peoplemeasure simply to just find
something right. And that's, ofcourse, not the attitude you
should approach. Right? I mean,for me, it's more like about
trying also to establish abaseline to understand my body
with better and to understand,okay, if my pH value normally is
six, if it suddenly is seven,yeah, then there's something
happening. Right? And that's,that's what I'm mostly
(38:48):
interested in.
Dr. Kiki Chan (38:49):
Yeah, I think for like for your type is perfect,
because you're trying to use aqualitative measurement to see
if there's any situations thatdeviates from your baseline. But
I think that's perfect. Andthat's how I think that's how
most of the gadgets should beused.
Fabian Gruber (39:05):
Perfect. Thank you very much. I think that's a
very good closing line and veryencouraging thing for all
quantified self people outthere. And I think in the
meantime, I think a lot ofpeople who listen to this
podcast and to read the blog,possibly among them, so yeah,
one more time. Really. Thank youvery much, Vicki. And yeah, it
was a pleasure and it's alwaysnice to talk to fellow alumnus
(39:28):
from high school. Yes,
Dr. Kiki Chan (39:30):
thank you so much for having me. I really enjoyed
it.
Fabian Gruber (39:36):
This was Life-Sparring Round 6
talk was Dr. Chun Ki Kiki Chan,hosted as always by me, Fabian
Gruber. As mentioned at thebeginning of this episode, this
podcast is for the purpose ofinformation entertainment only,
and does not provide medicaladvice. If you suspect that you
have a medical problem. pleaseseek a local medical
professional without delay.
(39:59):
Life-Sparring is Produced byThomas Latter, intro and outro
beat are by my Markezi producer.
More info about Life-Sparringand this episode, including all
links, gadgets resourcesmentioned in the show, you can
find atLife-Sparring.com/podcast . If
you enjoyed the show, pleasesubscribe and leave like
wherever you are getting yourpodcast. I hope you'll join us
(40:20):
again for the next round ofLife-Sparring. Until then, stay
healthy, keep your hands up andprotect yourself at all times.
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