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Heart failure and fluid retention – a word of advice…

Posted Aug 23 2012 10:23am

Received wisdom says take your diuretics and limit your fluid intake to control oedema. Fair enough, that works, but I, like many other heart failure patients, simply felt very ill from dehydration. And dehydration also worsens drug-induced constipation, a remedy for which  you’ll find two posts ago.

In addition, as time passed (18 months), my diuretic, Furosemide (Lasix), became  increasingly ineffective, so if this is happening to you, read on.

I also found, on occasional trips to the pub, that my constant and severe thirst would overcome prudence, and I’d wind up shovelling down an absurd amount of beer, only to be drunk and dehydrated, as booze is a diuretic too. So much so that the following morning I’d be several pounds lighter.

First of all, if you’ll allow me a small but relevant digression, I got so tired of being nauseous, something that’s been present pretty much ever since I moved to Wirral permanently in 1985, and which I’d always put down to my ME. I long ago exhausted the anti-emetic pharmacopoeia, tried and dismissed herbal remedies, and found the only things that had any effect at all were crystallised ginger (which I love, so when I needed it, it had already been eaten!), and ginger wine.

A couple of months ago, though, I did what I’d been toying with for years – bought a Brita filter jug, mainly because, in this flat, the cold tap never runs truly cold. In days, my nausea had gone. A little still lingers, but barely noticeable and not totally disabling as it often was before – I suspect what’s left is really ME, and the worst of it was caused by the water supply. And my last bottle of ginger wine is still unopened.

The filter jug changed my pattern of drinking to little and often (I keep a glass in the fridge), as the water is so extremely cold it’s impossible to drink a lot (my fridge is no more than a degree or two above freezing, and sometimes dips below** – frozen yoghurt, anyone?), and half a glass is plenty, probably about 150ml.

**It’s frost-free and cooled by circulated, frigid, air – put anything too close to the air vents and it’ll freeze.

Which was when I noticed that if I had a small drink, I’d quite quickly pee 2 or 3 times the amount, and one drink might well keep me peeing for an hour or two. The logical deduction, then, is that the state of  dehydration that results from going by the book actually does, in fact, inhibit urination,** even when taking diuretics – something you really don’t need with oedema on the scale I have it. My legs and feet have been so swollen for the past couple of weeks that I could barely bend my knees or toes. Somewhat better now, but still can’t get my boots on, so not going out any time soon.

**Whether this is so in every case I couldn’t say, but it certainly is in my case, and I have no reason to suppose I’m unique.

So my conclusion, based on experience, is that seriously restricting your fluid intake can be damaging (bearing in mind that water is all I drink at home – I’m not a 12 cups of tea a day person, and don’t drink booze at home in any quantity – maybe 1 bottle of beer or cider a week), causing dehydration and impairing urine production, but a sensible, and still low (under 2 litres a day), intake will encourage urination and reduce oedema. The proof lies in the fact that over 4 days I have lost 8lb in retained fluid (and am on my way to shedding even more), and am able to walk better than the shuffle which is all I’ve been capable of for a fortnight or more.

It’s worth bearing in mind that one-size-fits-all medicine, with its standard  advice, is often not a good thing, simply because people, themselves, are not standardised. We’re all different.

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