Dr. Kevin Most: Wearable devices

Dr. Kevin Most

Remember the good old days, when the Fit Bit was so cool because it would track our steps? Then it would do our heart rate, then it would track our sleep pattern. Well the world of wearable devices is changing so quickly now it is difficult to keep up. There are a few new ones that are worth discussing as they could impact our health from a simple thing like sun exposure all the way to a complex heart issue and a bunch in between.

The foundation of these devices has moved from a simple data point ( steps walked) to a concept of Prevention, prediction, management and in some cases diagnosis. The advancements that have been made in just a short period of time only leads us to believe that the tools we think are pretty cool now will be laughed at and obsolete in a short time. That being said we do have some that are pretty cool and cutting edge.

THERMOMETERS

The health of our children is probably the most important concern parents have. When very young, the infant with an infection can’t share with us how they feel, so we look for other signs. The most obvious sign we look for is fever. Many of you listening may remember the old mercury thermometers that you had to hold under your tongue for a minute, and then trying to read these very small numbers on the thermometer was nearly impossible, or better yet a Grandmother who could simply place her hand on your forehead and detect if you had a fever.

Fortunately those days are gone and we now have digital thermometer that read quickly and are designed to be user friendly. The very fast and accurate, under the tongue thermometers are still used in doctors’ offices, the forehead roller is becoming more popular, as is the ear unit, for its ease of use. Each of these are great and accurate but the downside is they are a single point of data and taken sporadically. This sporadic measure often results in poor timing of giving Tylenol or Motrin to correct a fever, and may miss the temperature spike that is of concern for us

Now we have technology that is a wearable continuous thermometer for an infant. It is a simple patch that is applied to the skin, the monitor tracks and measures the child’s temperature and sends results to your cell phone, and alerts you when a set temperature has been hit. Why is this important? Do we really need to awake a child who is sleeping just to take their temperature? Would it not be nice to only use medication for fever control when we actually need it. As physicians we often want to know how high a temperature was and when it occurred as it may aid in a diagnosis. For the working parent knowing their child’s temperature when ill, is being monitored is reassuring, what is more reassuring is that you can see the results right on your phone and not rely on the babysitter or day care facility to call you with the results.

Now this is not for everyday use, this is for the child who has been seen by a doctor and has been diagnosed with an infection and monitoring and treating the fever is appropriate. Using this on a routine basis is not cost effective as the cost is about $20 a patch and it lasts for 24 hours. Letting a child sleep thru the night and knowing you are monitoring continuously is probably worth the $20 once or twice a year. It is worth a discussion with your pediatrician during an illness with a young infant.

SKIN Protection

How about some technology that can and will impact all of us. We discuss each year the importance of wearing sun screen to help us minimize our chances for skin cancer in the future. We talk about the SPF, we talk about the need to reapply, we guess on our exposure as we may be under trees and in shade for part of the time we are out. ( Think Cochran playing golf often not in the sun as trees produce a shade). In all honesty, how many of us reapply sunscreen and more importantly reapply at the right time? It is not that we are against reapplying sun screen it is that we don’t remember. Time flies by and we don’t reapply and then at night we try to understand why we are sun burnt. By that time the damage has been done to the skin.

Well now there are a few wearables that actually measure the amount of UV rays we are exposed to in real time and remind us based on real data to reapply or remove yourself from the sun. There are some that clip on your clothes and there are actually some that are a small patch that applies to your skin or nails and it changes colors based on the amount of exposure. The patch monitor works with a color change that prompts you to reapply sunscreen. L’Oréal gave out a million of these as attest and showed that 34 % of people used more sunscreen and 37% moved out of the sun into the shade based on the results. The wearable monitor actually tracks the amount of UV exposure and tells you how much time you have to get out of the sun before skin is damaged by the sun.

So when we talk about sun exposure, these new wearables take it to the next step of actual measurement which allows for prevention by reminding us to reapply or better yet get out of the direct sunlight. If these catch on they will make an impact, industries with employees in sun exposed positions may consider providing these as part of a wellness plan. We know that early sun exposure causes cancer and problems in the future so caring for your skin now may prevent cancer in the future.

DIABETES

We have talked about diabetes and the impact it has on our heart, our circulation, our kidneys and our eyes. It is a terrible disease that not only shortens the lives of diabetics but also impacts their quality of life. We know that control of blood sugar is key, the high levels of blood sugar is what allows for inflammation and damage to all of the organs.

If you know someone with diabetes you know the pain they go thru as they monitor their blood sugar levels. The problem with Type 1 diabetics is their pancreas has decided to stop or slow down the body’s production of insulin. We need insulin to move glucose (sugar) from our blood stream to the cells in the body that need it. Because of that issue, we need to replace insulin.

Now for the rest of us, when we eat a big meal or some sugar laden food, our body is able to measure how much sugar we have ingested and we release the amount of insulin needed to keep our blood sugar level at the correct level. The body is able to take the big swings in blood sugar that we throw at it. When we don’t eat the body is able to remove stored sugar from the liver and put it to use. Diabetics do not have that functioning monitoring system.

Because of that inability to change the insulin levels, diabetics have to stop thru the day and measure their blood sugar. They do this by sticking their finger and taking a drop of blood and running it thru a monitor. They find out what their blood sugar level is and then adjust how much insulin they need to take. So most diabetics are sticking their fingers 2-3 times a day and adjusting their insulin based on these spread out numbers thru the day.

Well now we have a new monitor that attaches to the skin and it is able to measure and record your blood sugar continuously, without having to stick your finger, without having to carry a monitor around. It allows diabetics to know when their sugar is too high or too low by simply looking at their phone. The skin monitor is able to measure the blood sugar level thus allowing diabetics to measure whenever and where ever they are without a finger stick.

When the rolled this out in Europe they showed that diabetics who used to measure 2-3 times a day were now measuring an average of 16 times a day and they also noted that the diabetics had much tighter control of their blood sugar. Time will tell the impact on these individuals as they are now able to keep their blood sugar at levels closer to non-diabetics.

HEART Monitoring

If you have ever had a heart issue or know someone who has, you know it can be scary and in some cases as the work up is being done, very inconvenient. The use of monitors that individuals wear around that allows for the continuous monitoring are called Holter Monitors. It would not be unusual for a patient to be given a Holter monitor for 24-48 hours. This would be attached to their chest and also to a box they would carry around. They would then bring in the box and the recording would be taken out of the box and read by a cardiologist. It would show them what you heart rate and rhythm was over the past day or two. Unfortunately it would tell you after the fact. Recent technology has allowed for the Holter monitors to be smaller and blue tooth readings allow for real time readings. This technology is used in all hospitals so we are able to monitor 100’s of patients at one time with technologists sitting in a room monitoring the tracings and looking for abnormalities.

Well now we have a simple stick on monitor that sits on your chest that you can wear outside of the hospital. No longer do you need the cords and box, this is a patch that will monitor your heart rate and EKG rhythm as well. There are a few companies that have now designed a small patch that can be worn for up to 14 days that tracks your heart activity. The beauty of this technology is that you can wear it while doing all of your daily activities. This monitor tracks your heart thru out the day and as it is a patch you have nothing to carry around, no wires to worry about. This allows for an easier way for patients and doctors to track your heart activity easier, longer and for less expense. This is a wearable that not only can aid in a diagnosis but also help in the prevention of strokes.

DEHYDRATION

Every year whether it is around the marathon or just a run of very hot and humid days, we discuss dehydration. We talk about the signs and symptoms, what to look for to tell you that you are dehydrated, like losing your ability to sweat or your rapid heartbeat. We then discuss how to treat dehydration, and we talk about what to do to prevent it on very general terms. Now we have wearable technology that will monitor your sweat and give you real time feedback. This is another wearable device that is helping us prevent something common from happening and keeping us safe. Monitoring and telling us based on our body what we need to do in real time.

Before going into a hot or rigorous activity environment we would “guess” or “estimate” how much fluid one would need to stay hydrated. But as you all know, we each cool and sweat at different rates. Now we have a wearable monitor that tracks our sweat content and informs us of when we are approaching a state of dehydration. We have said in the past that when you get to the point of being thirsty you are on your way to dehydration. Many of you may be thinking, who really needs this technology. How about the child who is at an all-day soccer tournament, what about the firefighter working a fire or anyone who is outside for extended period of times. Keeping our hydration up allows for the bodies cooling system to continue to function and keeps us safe as dehydration can have life threatening implications.