Ronak 0:00 On today’s episode we have Dr. Michaela Mocanu. Dr. Mocanu attended Carol Davila University of Medicine & Pharmacy in Romania, where she received her medical degree. She completed her Internal Medicine residency at Georgetown University Hospital and her Nephrology fellowship at the University of Pennsylvania. Dr. Mocanu, welcome to the show.Dr. Michaela Mocanu 0:19 Thank you so much for having me here. I'm super excited to be here and talk to you.Ronak 0:23 Awesome. Yeah, so just jumping right in, explain what Nephrology is and what you do, and what inspired you to choose a specialty.Dr. Michaela Mocanu 0:32 So, nephrology is the branch of medicine that focuses on taking care of the kidneys. And the kidneys are vital organs. As you know, they help us control our bodily fluids, they help us control our blood pressure, detoxify our bodies, control our electrolytes, and we really could not live without them. So as a nephrologist, what I do is I help people live longer, healthier lives by improving their kidney function, or slowing down the progression of their kidney disease, or controlling their blood pressure, which lowers their risk of stroke or heart disease in itself. Let alone the risk of progression of kidney disease and also something that people don't know is I can also help prevent kidney stones. So as a nephrologist I am surprised that most of my patients don't know that a nephrologist can help prevent kidney stones, as well as the urologist will help manage the complications of kidney stones that take out the kidney stone. And as a nephrologist, I carefully look at the urine and the risk factor somebody has for forming kidney stones and I can help with lifestyle interventions and new medications for. Ronak 1:51 So like, what are some common ways people get kidney stones? And do they come to you when they're in pain? Or just tell us a little bit more about that.Dr. Michaela Mocanu 2:03 Thank you for asking that. Most patients who come to me for kidney stones have passed several kidney stones throughout their lifetime, or they have been referred by the urologist or by a friend. So what we do in situations like that, we take a very thorough medical history to kind of get a sense of what their risk factors for forming kidney stones might be. And then we look at objective data such as we collect 24 hours to 48 hours, the first set of urine that we collect the best is to collect 48 hour urine. So it improves with accuracy. And we look at various substances in their urine that put them at higher risk for forming kidney stones. And that's how we can tailor treatment individually to every patient because every patient is different based on the risk factors or their family history, and their lifestyle habits in themselves.Ronak 3:13 Yeah. So Dr. Mocanu, tell us a few ways that people can prevent kidney stones.Dr. Michaela Mocanu 3:18 Yeah, so I think that general principles that would apply to everyone would be one is to stay very well hydrated when we have a history of kidney stones and when someone has passed several kidney stones in their lives. Number two, limit salt intake is very important. And surprisingly, don't avoid calcium in your diet. Unlike the general thought that calcium leads to kidney stones in that when taken in the diet, it actually is quite the opposite. Normal intake of calcium is advice for patients with kidney stones, and just eat your fruits and veggies to keep a healthy microbiome. In general, this would be like the minimum things that anyone can do even without having tailored lifestyle interventions or tailored treatment for kidney stones and just doing that can prevent kidney stones in general.Ronak 4:23 Does exercise have any role in this? Or is it 100% diet?Dr. Michaela Mocanu 4:27 Well, exercise may have a role in this if we get very dehydrated and don't drink enough.Ronak 4:31 Okay. Got it. And how does diabetes and high blood pressure impact kidney function?Dr. Michaela Mocanu 4:37 Diabetes has, and thanks for that question because the majority of my patients suffer from both diabetes and high blood pressure. Both are big offenders of the blood vessels. So diabetes affects primarily the small vessels in the kidney. And you may recall from school that the kidney has his tiny filters called glomeruli. And they're formed by very, very tiny blood vessels. So diabetes affects those tiny filters that help us absorb reabsorbed protein back in our body. So first it filters the protein out, and then it reabsorbs it in our body. And with time, people with diabetes tend to lose protein in their urine. And this protein that is lost in the urine can be very toxic to the kidney, leading to inflammation and scarring. And that's how overtime it leads to kidney disease. Now, high blood pressure as opposed to diabetes tends to affect larger vessels. We don't typically see so much protein in patients affected by high blood pressure alone. But both of them are lead causes of chronic kidney disease in this country. Ronak 5:58 Got it, got it. So you started your private practice in our King of Prussia location just a few months ago, what's your experience been like so far?Dr. Michaela Mocanu 6:10 So far, I love it. So let me tell you a little bit more about my practice first and foremost. So you understand because I have a different setting in my practice than most nephrologists in this area and in the country altogether. I run a direct care, hybrid model of practice. What that means is that I accept patients that are covered by Medicare Part B. And all the rest of the patients in the practice follow that direct care concept, which is nothing but concierge without paying that membership monthly fee. So what that means is that I have the advantage of having more time to dedicate to my patients, I spend more time with my patients, my patients have direct access to me via a HIPAA compliant line. So if they have burning questions, let's say they can just reach out to me directly without any intermediary to answer their question. And it gives me there are the biggest advantage to me, as a physician of running this practice is that it makes me feel like I'm really practicing medicine the way I imagined that medicine should be practiced, I dedicate enough time to every one of my patients, I get to learn more about my patients, I have a fewer patient population. So I get to learn all about them. And I get to know them very well. And the biggest advantage to the patient is that their physician actually dedicates them more time. I can get to learn about all their conditions. And I feel that we have a better patient to physician relationship, and we can establish that trust relationship that sometimes is impossible to achieve when you're in the traditional setting where you have to see, let's say, four to five patients an hour. So overall, I'm very happy with how this new model I wouldn't say new, it's not a new model. But how this model works. For me and my patients right now. It's very rewarding as a physician.Ronak 8:42 So you said you don't do a monthly model. So are you just charging hourly?Dr. Michaela Mocanu 8:45 For patients, yes. So for that question, yes, I'm charging right. I have a special fee for the initial visit and a special fee for a follow up visit. But for my patients with Medicare, I don't charge anything extra. I just go by the Medicare fee. Ronak 9:04 Okay, okay. Make sense. Yeah, I know this is a novel thing where just concierge care in different specialties is popping up more and more. But I can't imagine it being like, easy to educate and to get new patients. So what's, how do you market your practice? What are you doing to get your name out there?Dr. Michaela Mocanu 9:26 First and foremost, I have websites. And I have a blog on my website. I would recommend that people check out my blog. It is focused on kidney disease, hypertension and weight loss.Ronak 9:45 What's the website?Dr. Michaela Mocanu 9:46 www.weightkidneycare.com. And on my website, I also have a special page dedicated to helpful education materials that are free for patients to use. And I gathered those from different conferences at which I participated. And I use them frequently to educate my patients. For instance, I had a patient just the other day, their question was, okay, so how much protein is good for me? And to give them a very adequate answer, of course, this is a special situation with chronic kidney disease, when you follow the key legal 2024 guidelines for that, then I gave them the answer for that. But then the patient had a visitor with him. So the daughter had a question, how much protein should I have? And you know, it's rude not to answer. So I actually had to look up information for that. I found that on the Harvard nutrition website, and there's one of the listed education materials on my website, the health, my healthy plate, and the Harvard nutrition source. Ronak 11:06 So that must take up a lot of time to write, to research, to write, and then to post everything.Dr. Michaela Mocanu 11:14 I enjoy it. I feel like it gives me the opportunity to learn more. And it also gives me the opportunity to kind of prepare for my patients to kind of find a way of better explaining to them what their condition is and how I can help them best. So it's a win-win for everybody. Ronak 11:38 And I know you're a physician affiliated with mainline health, how does that help with your marketing?Dr. Michaela Mocanu 11:45 It helps a lot because I am on them. I mean, easily to be found on the Main Line Health website as one of the Nephrology and obesity medicine providers there, as well as it allows me to connect with the primary care physicians within Main Line health.Ronak 12:08 Very nice. And, going back and talking about the conferences, I know you're always on the top of new research. Are there any advancements in nephrology that you're most excited about?Dr. Michaela Mocanu 12:20 Oh, yes. So thank you for asking that question. Because I couldn't be more excited at probably every single nephrologist in this country. Literally the past five years, in nephrology have meant so much there are so many advances nephrology has changed all together. It's only like two weeks, about two weeks and a half ago, a new study was published in one of the most prominent medical journals in the world, the New England Journal of Medicine, and it was about how the newer weight loss medications such as ozempic, though people know it as ozempic magnetite, but how it can actually help with improvement in kidney, diabetic disease, it can prevent further decline, kidney function and progression to dialysis. And it can help patients live longer altogether they can help your cardiovascular risk when on ozempic. One of the biggest scares for nephrologists is having protein in the urine. As I was mentioning previously, it can be toxic, it's like drain on the renal tubules. It can be corrosive and toxic and causes a lot of inflammation to the kidney. So by just a lower dose of the magnetite, which people commonly know as ozempic, according to this new research study, which was extremely well done, it can lower protein in urine by as much as 40%. That was amazing information. Now, there are other medications also that came up within the past five years. And there are medications that we found out that not only do they help with diabetes, but they also improve cardiovascular risk in patients with chronic kidney disease or in patients with heart failure. People may know them as flozins dapagliflozin empagliflozin. And I don't want to get too technical here. But overall, in nephrology, the past five years, meant a lot. Not only do we have newer medications for using chronic kidney disease, but we have newer medications for using glomerular diseases, one of the most common of which is IGA nephropathy, there are two new medications that we can employ there in the guidelines that have changed altogether too. So the future looks bright in nephrology, and I hope that more people want to go into nephrology, because there is hope that we can do more for our patients that we couldn’t do 10 years ago when I graduated. Ronak 15:12 So drugs like ozempic and manjaro are taking up a lot of headlines, I would say. So now the mainstream knows about these drugs? What are some of the side effects, because you also, for your practice, help with weight loss for patients. So what role do these drugs play in that?Dr. Michaela Mocanu 15:37 So let me explain to you how I put it to my patients, so they better understand. You see, we call them drugs, but in reality, they're nothing but analogues of hormones our body naturally produces. And it is possible that with changes in environment, exposure to fast food, with age, maybe our bodies are less able to produce these hormones that have an essential role in maintaining happy and healthy brain gut access and keeping our weight under control. So some people may need a little bit of these hormones to help them achieve weight loss, and they're very effective for achieving weight loss. But I don't really like to think of them in terms of drugs simply because they are literally analogues of hormones our body make, and yes, they are drugs, but so is synthroid or levothyroxine, which we use for hypothyroid. So is insulin that we use for diabetes. So they're in the same class in the sense that they work in a similar way of restoring hormonal balance in our bodies that help us achieve a healthier weight. So of course, it's every medication that we use, they can have side effects, but I also believe that the side effects are coming from the fact that your body needs time to adjust to having that hormone back within the body. Because what research shows is that the side effects are typically dose dependent. And it also happens that when we take, say, a certain dose of this medication, and we maintain the patient at the same dose, with time, the side effects go away. So their body gets used to the medication and then is when they don't feel the side effects. Like the most common side effects of this class of medications are GI side effects, because that's where they primarily they work in the brain, but they control how fast our gut moves, what they do is they they make you feel less hungry, they help you have fewer cravings, but they also slow down the motility of your gut, so that you may feel fuller, making a full after eating, let's say half the amount of your plate the plate in front of you, instead of eating the whole plate. So you feel like okay, I don't need to eat any more, I'm already full, I don't need more and you also work on the metabolism they improve our insulin resistance in our body. So they really tackle different mechanisms to help people achieve weight loss. And as I was saying the main side effects or GI related side effects like you may feel a bit nauseous if you eat too much. And you know it takes time for the brain to realize how much you ate. There's a lag of about 20 minutes so we eat, eat, eat and then we don't realize oh 20 minutes later it's like oh I was full maybe a while ago and I kept eating. So one of the main side effects is nausea. Some people have, surprisingly, diarrhea, people may experience constipation. Some people may experience nausea. Some people may experience small reflux as the gut motility slows down. So the most dangerous side effects, I shouldn't say side effect, but rather association with this medication would be pancreatitis, and in rodents, they they found that very large doses of this medications have been linked with a higher number of a certain type of thyroid cancer, but the “no no” of taking this medication to be acute pancreatitis when, especially when we think it's related to the drug. A certain type of thyroid cancer medullary thyroid carcinoma not every type of thyroid cancer. And of course, we don't give it to pregnant women because we haven't started pregnant women. So we don't want to risk complications. And there is it's hard to enroll pregnant women in the studies, nobody would want to try, you know, they are doing studies, where women, you've may have heard of the ozempic babies, right? So women can get pregnant easier after being on this medication, because when losing weight, the hormonal balance in the body reestablishes, and then they get pregnant easier. So far, we do not know of major side effects of these medications on children, babies, but it's a subject I can talk more about, because we really don't have enough data. Yeah, we're waiting for data.Ronak 20:49 Yeah, no, but this was a good synopsis. And I know a lot of people are interested in learning more about ozempic, manjaro, and as it relates to weight loss.So with your practice-Dr. Michaela Mocanu 21:04 If I may add more. So these medications are not just weight loss medications, they literally improve a lot of health problems. Medicare has recently approved semaglutide, also known as ozempic, for cardiovascular risk protection, because people have fewer strokes or heart attacks. And you know, we've learned that chronic kidney disease protection, fatty liver disease protection.Ronak 21:34 You mentioned diabetes, as well, right? Dr. Michaela Mocanu 21:36 Yes, especially diabetes, they were actually designed for diabetes. And then we've seen that patients with diabetes with these medications had so many benefits, such as that started with weight loss, but then we've learned they have fewer strokes, fewer heart attacks, improved sleep apnea, improved GERD, and a lot of things. So really, I like to think of them more than just medications. I like to think of them, like replacing a missing link in your body such as giving back your body, a teeny bit of the hormone that your body is missing, in order to reestablish that balance that was lost. Ronak 22:18 Makes sense. And a really good synopsis and I apologize if my questions are a little basic here. You're the expert here. So where do you see the field of nephrology heading in the next decade?Dr. Michaela Mocanu 22:35 Oh, as I said, I'm super excited because there are a lot of advances in nephrology. Nephrology is a very complex field. And there are many factors that can affect kidney function or from diabetes, hypertension, but there are autoimmune diseases that affect kidney function. And there is polycystic kidney disease. There are kidney stones, there are lots of factors. And every single one of these field's transplantation, in nephrology, every single one of these fields has seen significant advancements. You may have heard, just because I just mentioned transplantation, you may have heard of xenotransplantation being on the pages of the magazines recently, right. So there have been advances that they're working on an artificial kidney they're working on or optimizing these machines that provide dialysis at home. And, of course, in terms of medication. Our hope, as nephrologists, is to have sufficient medications, to postpone progression of chronic kidney disease or to improve our patients chances of healing from a specific disease to keep the patient in remediation. And here there have been tremendous advances and there are new medications. I can think of at least five of them right this moment. And we hope that with more research and better research being conducted right now, we will learn more about how to best help our patients. And of course there is AI and I have no idea how AI will change the nephrology world and will be contributing to changing nephrology as well as entire medicine. We would be better at diagnosing diseases with AI, hopefully. Ronak 24:52 Right, changing the world. Can you share a memorable patient's story that significantly impacted you? Dr. Michaela Mocanu 25:00 Sure. I'll share a story of one of my first patients in this practice, many memorable patient stories, whether being here or at the hospital, but this was one of my first patients seen at this practice, a very, very young man in his 30s, who came to me for uncontrolled elevated potassium levels. And as a nephrologist, one of the scariest electrolytes besides sodium is potassium, because potassium can kill somebody when it's very high. Literally, it causes this abnormal heart rhythm, and somebody can die from it. So there was a big concern, his primary care had to be concerned because this man was young, he was on medication to lower his potassium level. And every single time he would take his levels by having a normal kidney function, his potassium was high, he had to go to the hospital to the emergency department, he was sent a couple of times to the emergency department for high potassium, he had seen like, at least two nephrologists, before coming to see me and at least two endocrinologists. And after several visits to the ER, he was very worried that, you know, young men can die from high potassium. So I took a very thorough history, and I couldn't really find any cause of high potassium in his particular case. And I looked at all his labs, repeated the labs, and then I looked at his physical exam, and this is a body builder. So what happens is that potassium is an electrolyte that tends to stay inside the cells. And bodybuilders have a lot of muscle mass. So what he was doing, he was very nice as a very nice bodybuilder, he would pump his fist repeatedly when going to the lab to help the phlebotomist, the lab tech, draw blood and find a blood vessel for him. And by just doing that he would cause his potassium shifts from inside the cells outside the cell, which is what we were measuring in the blood. So I simply had to advise, hey, when you go there, just don't do that. Be relaxed. Don't pump your fists, don't contract your muscles. Even before you go there, no need to fast and then his potassium, you know what they have? And it was absolutely normal. So he was taking medication. Fortunately, he was not very adherent to taking that medication. He was keeping it. He was not taking it as prescribed. Because he could have been dangerous to him if taken as prescribed because he actually had a normal potassium level. He hasn't had high potassium in a year. They haven't bothered him yet at all for it. He was very happy. At least this stress went away. And let me share another happy story because that belongs to my weight loss patient group. So I have this patient who had terrible back pain and she was scheduled for surgery, neurosurgery for her back. And she was scheduled for surgery a month ago, and she called me to tell me. Hey, Dr. Mocanu, I lost so much weight, I went to see my neurosurgeon. They said that I don't need surgery anymore. I was very happy. I'm very happy about that. Ronak 28:19 That's amazing and like two success stories! So I know you mentioned your website before. So can you just repeat it so patients can find you?Dr. Michaela Mocanu 28:27 Yes, they can look me up on my name, or they can find me on the Main Line Health page, provider page. Dr. Michaela Mocanu and they can also look for my website at www.weightkidneycare.com. I know it's kind of a long website. Ronak 28:50 But it's simple. www.weightkidneycare.com. Perfect, thanks for joining!Dr. Michaela Mocanu 28:54 Thank you so much for having me here. Very nice talking to you! Ronak 28:57 Awesome. Thanks.
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