Dr. Sumit Sharma

Dr. Sumit Sharma

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FAQs

My Kidneys Are Not Functioning Well. What Can I Do?


The Rate At Which Both The Kidneys Filter The Blood Is Called As Glomerular Filtration Rate (GFR). Normal Glomerular Filtration Rate Of Both The Kidneys Is Around 100, 50 Being The Contribution From Each Kidney. The Most Common Blood Test That Is Performed To Evaluate Kidney Function Is Serum Creatinine Level. The Serum Creatinine (S Cr) Level Remains Normal Till GFR Is Around 60. Once GFR Goes Lower Than This Level S.Cr Starts Rising. So, If Your S.Cr Level Is High 40% Has Already Been Lost. To Prevent Further Damage To Kidneys Follow Following Steps:

1. Remain Well Hydrate

2. Exercise Regularly

3. Keep Weight In Healthy Range

4. Control The Underlying Reason For Renal Dysfunction. Control Blood Pressure, Blood Sugar.

5. Seek Prompt Treatment Of Any Ailments Like Diarrhoea, UTI. Avoid Dehydration.

6. Stop Smoking, Drinking

7. Decrease Salt Intake To Minimum, Avoid Junk Foods.

8. Keep Haemoglobin In Normal Range. Take Iron And Calcium Supplements With Vitamin D.

9. Get Blood Tested For Haemoglobin, Urea, SCr, Electrolytes, Urine Microscopy And Ultrasound Examination Every 3-6 Months.

10. Get An Arteriovenous Fistula Made If The SCr Level Is More Than 4 Mg%.

Once The Kidney Function Falls Less Than 10%, The Blood Needs To Be Filtered In Machine (Called Haemodialysis) Or Kidney Transplant Is Required.

What Should I Do To Ensure That My Kidneys Function Well?


Follow Following Steps:

A. Maintain A Healthy Lifestyle. Eat To Live And Not Live To Eat. Take A Platter Of Food And Salads Daily. Ensure A Good Bowel Evacuation Daily. Avoid Junk Food, Excessive Salt And Sugar.

B.  Remain Well Hydrated. Observe The Colour Of Urine And Try To Ensure That The Colour Of Urine And Tap Water Should Be Same. If The Urine Is Yellow It’s A Reminder To Drink 2 More Glasses Of Water.

C. Do 6 Monthly Health Check If You Are More Than 50 Years Of Age And Annual Health Check If You Are Less. In Particular Check For Blood Pressure And Diabetes And Keep Them Normal.

D. Exercise Regularly. Give 45 Minutes Each Day To Yourself And Exercise. Best Forms Are Running, Swimming, Brisk Walk In That Order. 

E. Meditate Daily And Try To Control Stress And Anxiety. As One Prospers There Are Entities That Rob You Of Your Well Being.

F. Maintain Haemoglobin In Normal Range.

G. If There Is Already Some Kidney Dysfunction, Ensure You Don’t Overburden Them With Excess Proteins. Avoid Health Supplements Like Creatine, Proteins, And Testosterone Injections.   

H. Avoid Excessive Use Of Medications. Popping A Pill Even For Insignificant Ailments Especially Pain Killers Can Damage The Kidneys.

I. Maintain A Healthy Body Weight. A Rough Estimate Of Ideal Adult Body Weight Is: Height In Cms – 100. Keep The Body Weight Around This Figure.

J. Avoid Smoking. 

How Do I Know My Kidneys Are Functioning Well Or Not?


The Symptoms Of Kidney Dysfunction May Not Appear Early In The Course Of Disease. Therefore It Is Recommended To Screen The Kidney Functions Using Blood Test Periodically And Looking At The Kidneys Using Ultrasound Scan. The Earliest Symptom Of Kidney Failure Is Inability To Fall Asleep And Lack Of Diurnal Rhythm. Since The Function Of Kidney Is To Eliminate Excessive Water From Body, Once Dysfunctions Sets In Water Accumulates In Body Leading To Swelling Around Eyes And Legs. Vitamin D Activation Doesn’t Not Occur Leading To Decreased Strength Of Bones And Muscles Causing Body Ache, Joint Pain. The Production Of Haemoglobin Decreases Leading To Anaemia, Weakness And Easy Fatigability. The Skin Gets Dry And Itchy. There Is Loss Of Appetite And Nausea. The Appearance Of Such Person Would Be Bloated And Pale. 

What Is The Function Of Kidneys In Body?


Kidneys Are A Pared Organ That Lies In The Upper Part Of Back By The Side Of Backbone. The Basic Function Of Kidney Is To Produce Urine. Urine Is Complex Mix Of Water, Electrolytes, Urea, Creatinine And Many Other Solutes. The Purpose Is To Remove The Waste Products Of Metabolism Present In Blood And Excessive Water Through Urine. Kidney Also Cause Activation Of Vitamin D Making It Functional And Produces A Chemical Called Erythropoietin Which Is Essential For Production Of Haemoglobin In Blood. The Function Is To Some Extent Like That Of An RO Filter. It Has One Inlet And Two Outlets. One Outlet Giving Filtered Water And Another Draining Non Usable Water. Kidney Also Functions Like This.


Kidneys Play A Very Important Role In Maintaining A Normal Level Of Blood Pressure.

What Does A Women Want?


I Am Surprised By Level Of Ignorance Of Men Who Are Getting Married About What Follows. I Am Not Going To Talk Much About The Intellectual Part Of It And Would Try To Focus On The Physical Part. First And Foremost The Question To Be Asked Is “Am I Upto It”. 

Congratulations You Are Getting Married And If You Have Had Sex In Past Without Any Problem, Then Possibly There Is Nothing To Worry. Things Will Be Well. But If You Have Not Had Sex, Ensure That The Foreskin Of Your Penis Goes Slides Back Exposing The Glans (Cap Of The Penis) Effortlessly And Without Any Discomfort. If That Has Never Happened If Your Life, You Need To Consult A Urologist. Sometimes The Foreskin Can Be Tight And It Might Not Be Possible To Pull It Back, A Condition Called Phimosis. It Might Be Painful To Pull It Back. However, During Intercourse The Sensation Of Pleasure Is So Overwhelming That One Doesn’t Feel The Pain And The Skin Slides Back And Can Get Stuck In The Groove At Proximal End Of Cap (Called Corona). It Is Imperative That After Sex You Bring The Foreskin Back To Its Usual Location. It The Skin Is Not Coming Back, Boy You Are In Trouble. This Condition Is Called Paraphimosis. Visit A Local Doctor And Get The Skin Back To Its Normal Position. If This Is Not Done In A Reasonable Amount Of Time, The Blood Supply To The Cap Gets Cut Down And It Gets Damaged.

I Treated One Patient Who Came With Severe Paraphimosis. His Skin Had Been Stuck For Past 5 Days. Upon Asking Why He Didn’t Come Earlier, He Revealed That He Had Gone For Honeymoon Abroad. While Having Sex For The First Time, His Foreskin Got Stuck. He Showed To A Local Doctor Who Was Unable To Diagnose It. He Couldn’t Have Sex For The Rest Of Honeymoon And Remained Suffering With Pain. After He Came To Me, I Reduced The Foreskin And The Swelling Subsided. So Ensure That To And Fro Movement Of Foreskin Is Free And Effortless.

Making The First Impression

I Am Sure If You Have Got Married, You Are Able To Achieve Prompt Hard Erection Upon Getting Excited Or Else You Would Have Visited A Sexologist Already. When A Man Has Sex For The First Time, He May Get Disappointed With Himself As Men Initially Tend To Come Too Soon. God Has Created Women More Powerful In This Area Where Man Lacks Strength That He So Much Desires. To Add To The Embarrassment God Has Physiologically Added Some Refractory Period To A Man’s Sexual Cycle. That Means Once A Man Has Had His Orgasm, Erection Will Not Happen Immediately. It May Take 15 Minutes To 2-3 Hours. The Period Varies From Person To Person. After This Period One Will Be Ready For Another Session. If Someone Wants To Make A Good First Impression, There Are Certain Dietary Interventions, Exercises And Safe And Effective Medicines To Increase Sexual Stamina. The Medicines Are Harmless And Not Habit Forming.

What A Woman Wants?

I Don’t Know Frankly. The Honeymoon Is First Socially Acceptable Trip For Sex. That Being The Highlight, Spend Some Quality Time Together, Discuss Your Past Experiences, Families, Life, Future Or Anything That Is Your Common Interest. As Far As Women’s Sexual Desires Are Concerned Let Megive You Some Tips. Do You Know How A Female Masturbates? Most Of The People Think It Is Done By Poking Some Object Or Finger Into The Vagina. It May Be True For Some Female But Majority Of Them Achieve Orgasm By Rubbing The Clitoris. Do You Know What Is Clitoris? In A Male Body There Are Remnants Of Female Body Parts Albeit Rudimentary. You Have Something That Corresponds To Female Vagina, Uterus. Similarly In Females Body The Part That Corresponds To A Man’s Penis Is Clitoris. It Is A Highly Sensitive Tissue Very Rich In Nerves. 


As You Can See The Clitoris Is Away From The Vagina. During Sex One Penetrates The Vagina With Penis And Strokes. During This Act There Is Minimum Stimulation Of Clitoris. Almost 75% Of Females Are Unable To Achieve Their Orgasm With Normal Penetrative Sex. It Doesn’t Matter How Long You Do It, Or How Well Equipped You Are. So, During Sex To Make Your Partner Happy, Stay Long Enough And Add Variety To Her Sexual Stimulation. Don’t Jump To Penetrative Sex And Spend A Good Time In Foreplay. During Sex If You Feel That You Are  Going To Come And Partner Has Not Finished Yet, Take The Penis Out And Do Some Stimulation Of Vagina Which May Involve Touching, Putting A Finger And Stroking, Rubbing The Clitoris. While Doing This Ensure That Your Nails Have Been Trimmed And Filed So That There Are No Sharp Edges. Ensure Good Lubrication And Apply Gentle Pressure On Clitoris While Rubbing And Don’t Press It Too Hard. If You Are Not Averse To Oral Sex You Can Perform Oral Sex Also By Kissing The Inner Thigh, Vagina And Gradually Proceed To Rubbing The Clitoris With Your Tongue. Once Your Partner Is Satisfied You May Also Proceed To Finish. Ask Her What She Likes And Dislikes And Act Accordingly.

The Sexual Frequency Is Tailored According To Need And Desires Of Couple And There Is No Minimum Frequency At Which You Should Engage In Intercourse.

The Time For Which Each Act Lasts Also Varies From Person To Person. Important Thing Is To Make The Time When You Engage In Coitus Count. There Are A Few Tricks To Make The Act Last A Bit Longer. They Include:

Decrease Sensitivity Of Glans: This Way The Stimulation Decrease. It Can Be Done By Applying Some Desensitising Creams On Glans Or By Wearing Long Last Condoms During Sex.

During Sex Don’t Contract Pelvic Muscles Too Hard. Just Penis Has To Remain Hard And Rest Of Body Should Be Relaxed.

During Sex, Follow The Technique Of Stop Start. During Sex If You Feel You Are Going To Ejaculate, Stop Stroking. Take A Pause And Start Stroking Again Once You Feels You Can Hold On. During Pause You May Withdraw The Penis And Engage In Foreplay.

If You Feel That Now You Can’t Stop The Ejaculation From Happening, Withdraw The Penis From The Vagina And Squeeze The Cap Of Penis Hard. Keep The Pressure For A Few Seconds. Once You Think That You Are Under Control, After Pause Of A Minute Start Again. With This Technique, You Would Be Able To Stop Ejaculation 50% Of Times.

Diversion: That Means During Sex The Body Is Engaged In Sex, But The Mind Should Be Diverted Away From It. So, Think Of Something Else During Sex That Is Mentally Engaging.

So You Are Getting Married And Thinking What Crap Is This? It Is So Unnatural. Well Remember It’s Not Just About You, We Are Discussing What A Woman Wants.

Try To Follow This In Day To Day Routine:


A. Get Up Early And Start The Day With 3-4 Glasses Of Luke Warm Water. Consume 1-2 Garlic With Warm Water. Consume 1-2 Amla If Possible.

B. Minimise Intake Of Salt And Sugar.

C. Have A Platter Of Fruits And Salad Daily. Good Things To Consume Are Beet Root, Carrot, Watermelon, Oranges, Apple.

D. Maintain Good Level Of Hydration And Consume At Least 3-4 Liters Of Water In A Day (For A Person With Normally Functioning Kidneys). Observe The Colour Of Urine. It Should Always Be As Clear As Drinking Water. If It Is Yellow, Go Drink 2 More Glasses Of Water.

E. Avoid Consuming Water For 90min After Meals.

F. Take Luke Warm Water To Drink, Its Healthier.

G. If You Are Non-Diabetic, Take Some Jiggeryafter Meals.

H. Ensure To Consume At Least 1 Fruit In A Day.  

4. Fourth Is Regular Physical Exercise. If Your Body Is In Decent Shape, Byfar The Best Exercise One Can Do Is Running. If There Is Problem With Legs, Joints Next Best Will Be Swimming. Brisk Walking Is Also Very Healthy. Well It Doesn’t Just Mean Walking Fast. One Has To Walk Fast Enough To Cause Pain In Legs, Despite The Pain The Pace Should Not Come Down. At End Of 30min Brisk Walk One Should Be Sweating Irrespective Of Weather.

5. Fifth And Most Important Component Is Mental. Have You Heard The Term Psychosomatic Complaints? That Means, Actually There Is No Biochemical Imbalance In Body. However, Due To Stress Or Past Trauma, The Mind Makes You Perceive Physical Symptoms That Actually Are Not There. Here The Individual Has To Control The Mind. Have You Heard The Term Pseudo-Pregnancy? If No, Hear The Story That Follows Carefully: In Young Girls When They Go To Hostel For The First Time Leaving The Family, Some Of Them Get In Relationships And Get Boyfriends. They Start Having Sex With Their Partners And A Fear Of Pregnancy Creeps Into Their Mind. They Start Believing They Are Pregnant. They Start Puking And Miss Their Periods. The Belly Starts Growing. This Girl Doesn’t Share The Ordeal With Friend, Family Or Teachers Due To Embarrassment Till They Reach Nine Months And Go Into Frank Labour. She Reaches The Doctors Clinic And Now Tells The Doctor That She Is Pregnant. Tests Are Conducted To Confirm Pregnancy. To Her Surprise It Comes Negative. Since She Believed She Is Pregnant, The Mind Produces All The Physical Changes That Happen In Pregnancy.

If A Belief Can Produced Such Pronounced Physical Changes, What Happens If We Direct This Mental Energy Into Producing Beneficial Physical Changes Or Reverting The Biochemical Aberrations? Therefore, Understand The Reason For The Medical Problem You Are Having, Its Physiological Basis,  Take Appropriate Medications And At Same Time Feel The Problem Fading Away, Imagine The Problem Reversing (Practically Visualise It In Your Mind) Help The Mind To Heal The Body.

Have You Read The Book Called Secret? The Crux Of The Content Of The Book Is This That Whatever You Think Happens. It May Be A Positive Or Negative Thought. If A Person Is Constantly Thinking “I Might Not Fail In Exam “The Nature Doesn’t, Or For That Matter The Brain Doesn’t Understand “Not”. Hence, There Is A Probability That One Might Suffer An Accident. Even If You Don’t Want A Thing To Happen, You Are Thinking About A Negative Outcome Only. The Message Is “Think Responsibly”. Avoid Thinking About Negative Outcomes And Think Only Positive. 

The Point The Author Is Trying To Make Is Harnessing The Power Of Mind. An Individual Uses Only 10 % Of The Power Of Mind. If We Increase If By A Few Percentage And Direct It Positively Towards Process Of Healing, It Can Help.

What Advice Would You Give To Prevent Ailments And Remain Heathy?


Any Ailment Or Deficiency An Individual Suffers From Is A Because Of A Biochemical Imbalance In The Body. The First Step To Treatment Is Correcting This Imbalance In Body. Follow Following Steps:

1. First Thing One Has To Counteract Is The Bad Air That We Breathe. I Don’t Mean One Has To Install Air Filters In Home. We Have To Get Rid Of Compounding Factors Over And Above The Normal Level Of Pollution That We Endure. So, Stop Smoking And Do Regular Breathing Exercise. Running/ Jogging Daily In A Park With Lots Of Trees Go A Long Way In Correcting The Biochemical Imbalance Of Body.

2. Second Is To Maintain A Good Level Of Water Intake. Take 3-4 Glasses Of Warm Water In Morning Helps To Detoxify The Body, Maintain A Good Hydration Status, Ensures A Good Bowel Evacuation. It Is Important To Have A Good Bowel Movement At This Time Of Day. At Same Time Ensure Good Hydration Level Throughout The Day. Drink At Least 4 Liters Of Clean Water In A Day (Not If You Have Kidney Failure). Keep Observing The Colour Of Urine. It Should Be As Clear As The Water You Drink. If At Any Point The Colour Of Urine Is Yellow, Drink 2 More Glasses Of Water At That Time. Idea Is To Ensure Good Hydration Status Throughout The Day.

3. Third Important Component Is The Food You Eat. It Should Be Clean, Hygienic. Avoid Added Salt And Sugar Both Irrespective Of The Fact That You May Not Have High Blood Pressure Of Diabetes. These Things Just Add To The Taste And Don’t Have Health Benefits. So Preferably Avoid Them Whenever You Can. Add Salads And Raw Vegetables To Diet. They Add 2 Important Components. Antioxidants And Fibers. Antioxidants Are Most Important Component For Detox And Fibers Ensure A Good And Regular Bowel Movement. At Least One Platter Of This Without Added Salt Can Be Consumed As Evening Snack.

Advice For Patients With ED/PME


1. Start The Day By Drinking 4 Glasses Of Warm Water.

2. Freshen Up And Do Running For 45 Minutes.

3. Do Kegel Exercise 10 Min Session 3 Times A Day.

4. Eat 4 Walnuts In Morning After Workout.

5. Meditate For 15 Minutes And Try To Control The Mind And Prevent It From Wandering. Anxiety Decreases The Chance Of Getting Erection.

6. Remain Hydrated Throughout The Day And Ensure That The Colour Of Urine At All Times Should Be As Clear As Drinking Water. If It Is Yellowish, Drink 2 Glasses Of Water More. This Helps To Maintain Blood Viscosity And You Understand If The Blood Is Less Viscous, It Flows Better.

7. Take A Platter Of Salad And Fruits Daily. Increase Intake Of Beet Root And Water Melon

8. Drink A Glass Of Fruit Juice Without Salt Daily. Best Juice Would Be Beet Root.

9. Keep Body Weight In Check (Ideal Adult Body Weight Is Height In Cm-100)

10. Reduce Intake Of Salt. There Should Be Minimum/No Salt Intake In Between Meals.

11. Omit Smoking

12. Social Drinking Is Allowed.

13. Take A Glass Of Warm Milk With Half Teaspoon Of Organic Turmeric And 4 Pinches Of Black Pepper In The Night Before Sleeping Daily. 

If You Like The Advice And Are Benefitted, Please Let Us Grow. Google Drsumiturologist. On Right Hand Side You Will See The Business Page. Scroll Down Along It And Write A Review. God Bless You.

How To Treat Erectile Dysfunction?


Treatment Involves Evaluation The Underlying Cause. It Will Require A Few Blood Tests. After Finding The Underlying Anomaly, It Can Be Corrected With Medications. Needless To Say It Requires Your Participation. Follow The Underwritten Advice Religiously. Don’t Be Fearful Of Failure Leading To Aborted Attempts Of Coitus. Understand That If The Signal Doesn’t Descend Down The Mind, Medications Are Less Likely To Work. Adopt A Healthy Lifestyle. Have A Detailed Understanding Of How Erection Happens, Imagine It And Believe In Yourself. Imagine Yourself Getting Better. Think Positive. Mind Is A Very Strong Influence On The Body And It Starts Producing Changes You Believe Or Want. So Think Positive And Remain Positive. 

What Cause Erectile Dysfunction?


It May Be Difficult To Gain Erection Under Following Situations;

1. There Is Low Level Of Testosterone Or High Level Of Prolactin.

2. The Mind Is Disturbed Because Of Stress, Anxiety (Can Be Performance Anxiety As Well), Tension, Depression Or Some Personal Or Family Tragedy.

3. The Nerves That Carry Signal From Brain To Back (Spine) And Beyond Are Not Well Nourished. (Can Be Due To Deficiency Of Certain Vitamins)

4. These Is Some Backbone Problem (Can Be Slipped Disc Of Infection Of Back Bone) Leading To Compression Of Exiting Nerves.

5. These Is Low Level Of Argentine Leading To Low Levels Of Nitric Oxide (Less Coal To Burn Hence Less Heat)

6. The Nitric Oxide Gets Metabolized Too Quickly. (Fire Gets Doused Too Soon)

7. There Is Some Narrowing Of Tubes (Called Arteries) Carrying Blood Into The Penis. Hence, Even If They Open Up, Not Ample Blood Flows In. This Can Happen Especially In Patient With High Cholesterol, Diabetes.

8.  The Tubes That Carry Blood Out Of Penis Fail To Get Compressed And Hence Outflow Continues. (This Is Analogous To Inflating A Tyre That Is Punctured. One Will Achieve Erection But It Will Not Last.)  

There Are 4 Stages Of Erection:


Stage 1: Penile Blood Flow Increases And It Leads To Enlargement Of Penis. However It Is Not Rigid.

Stage 2: There Is Pooling Of Blood In Penis Leading To Mild Rigidity. It Will Be Difficult To Penetrate The Vagina If It Is Not Well Lubricated. However, If The Vaginal Is Well Lubricated One Will Be Able To Penetrate The Penis In By Supporting And Directing It Using Ones Hand.

Stage 3: In This Stage All The Tubes Carrying Blood Out Of Penis Get Completely Occluded. The Penis Becomes Hard And Doesn’t Buckle. Weather The Vagina Is Lubricated Or Not, One Will Be Able To Penetrate In This Stage.

Stage 4: This Happens At Time Of Orgasm. The Penis Fills To Its Maximum Capacity. There Is No Inflow Of Outflow Of Blood In This Stage. The Penis Is Hardest In This Stage.

Stage 5: After Orgasm, All The Changes Get Reversed And Penis Becomes Flaccid Again. It Will Remain Flaccid For A Variable Time Period Called Refractory Period. In This Period It Is Impossible To Gain Erection Again.

How Does Normal Erection Occur?


Erection Is A Very Dynamic And Multistep Process. The Sexual Desire Is Caused By Normal Level Of Testosterone And Prolactin Hormones In Blood. Low Level Of Testosterone And High Level Of Prolactin Can Decrease Sexual Desire.

When One Gets Sexually Excited By Stimuli Which Can Be Visual, Touch, Sound Some Biochemical Changes Happen In Brain Which Indicate To The Brain That The Individual Is Sexually Excited. If The Brain Is Disturbed Because Of Any Reason, It Rejects The Stimulus And Erection Will Not Be Achieved. This Can Happen If The Individual Is Under Stress, Depressed, Anxious Due To Prior Failures To Achieve Erection Or If Individual Is Mourning. 

If The State Of Mind Is Sound, Then It Assesses The Situation, If The Situation Is Conducive For Sex Then The Brain Send Signal To Backbone Through A Network Of Nerves That Can Be Considered Akin To Electrical Wires. From The Back, The Signal Is Taken To Penis Through Cavernosal Nerves. If There Is A Back Problem Like Slipped Disc, These Nerves May Get Compressed And May Affect Erection. Once The Signal Reaches The Penis, The Amino Acid Argenine (This Can Be Considered Analogous To Coal) Is Burned To Produce Chemical Called Nitric Oxide (Think Of This As Fire That Is Being Produced By Burning Coal). Once The Concentration Of Nitric Oxide Increases In Penis It Causes Some Changes In Blood Flow To Penis.

There Are 2 Types Of Tubes In Penis Carrying Blood In And Out Of Penis. Under Influence Of Nitric Oxide, The Tubes Carrying Blood Into Penis Open Up And More Blood Flows Into The Penis. At Same Time The Tubes Carrying Blood Out Of Penis Compresses. There Is More Inflow And Less Outflow Of Blood, Leading To Penile Engorgement, A Process Called Erection.

What Is Erectile Dysfunction (ED)?


It Is Inability To Either Achieve Or Maintain A Sustained Erection Sufficient Enough For A Penetrative Intercourse.

Dr. Sumit Sharma information on Health Beyond Insurance (HBI) platform is intended for consumers to connect with Dr. Sumit Sharma, and to provide helpful information to consumers regarding providers' products and services. HBI does not endorse, guarantee, or warrant the products or services of Dr. Sumit Sharma, and HBI is not an agent, or representative of, or otherwise responsible for or on behalf of, Dr. Sumit Sharma. HBI never makes any medical decisions for you or on your behalf, nor does HBI ever take any medical action in response to information transmitted or received by the Dr. Sumit Sharma. HBI does not take part in any medical diagnoses, procedures, or recommendations, or in any medical, prescription, service.