Lawler's Theories on Hydration/Dehydration, Lung Fluid, and CHF

Lawler's Theories on Hydration/Dehydration, Lung Fluid, and CHF

Records Kept
I keep daily records of the following: official daily weight (taken at 6 am daily), weight range over day (several times per day), fluid intake, urine produced, times of bowel movements, salt intake, blood oxygen, blood pressure, and pulse. I also note any ICD-heart thumps or problems, sweating during the day, work done each day, how I feel, injuries, and any lung fluid (I use a stethoscope).

Taking these records keeps me on the right track to stay healthy daily, to exercise daily, to sweat daily, and to practice breathing daily (deep and pursed-lip). I also keep my mind active by writing articles almost daily.

I walk on my farm, doing various things, a total of 2 to 7 miles daily. I try to keep my salt intake below an average of 1500-1800 mg per day (usual range is 750 to 2500 mg per day). I do almost everything I did before ICD implant except use my left arm in extensive movements or heavy lifting much due to discomfort from ICD movement in chest flesh during arm movement.

History
I have two heart conditions: a weak, damaged heart (caused by unknown) that can lead to CHF (twice thus far), and third degree heart block, probably caused by medications. Symptoms of a weak heart were first really noticed January 20, 2001, when I had difficulty breathing, and then stopped smoking. My EF has varied from 11 to 16%; it has not been measured since ICD implant, but I feel better. I had an ICD-pacemaker implanted 28 Oct 2011 to keep me alive. A heart cath in December 2011 showed NO blocked heart arteries. I had loop-diuretic induced gout starting 13 March 2012.

I am constantly trying to figure out ways to keep on living. The theories discussed herein are a result of my latest thinking/experimenting. My responsibilities as a scientist are to report anything I think may benefit others. From my own experiences, and observations on a friend (now dead from CHF at 89), I came up with several theories about hydration, dehydration, lung fluids, and CHF, as follows:

Hydration

---Theory: Water as a Diuretic

Dorland's Illustrated Medical Dictionary. Diuretic: 1. increasing the excretion of urine. 2. an agent that promotes the excretion of urine.

Stedman's Medical Dictionary. Diuretic: 1. Promoting the excretion of urine. 2. An agent that increases the amount of urine excreted.

The fear of too much fluid in lungs translated to me that I should avoid too much fluids, so I did not, wrongly, drink enough fluids. Since I got gout on 13 March 2012 I increased fluids initially just to try to avoid another episode of painful gout. I noticed I was urinating more frequently and producing more urine; I had more kidney activity. I was still on furosemide. With the more frequent urination and greater volume, I decided to stop furosemide as a diuretic and use water to try to stimulate more fluid removal.

Fluid intake prior to gout ranged from 300 ml (10 oz)(winter) to 1200 ml (40 oz), after gout I have been drinking 1050 ml (35 oz) to 3000 ml (100 oz) of water per day, depending on how much I work outside and sweat. These fluid numbers are in addition to the fluids I get from the foods I eat daily.

Various references list various natural foods as having diuretic qualities. Some listed are: watermelon, lettuce, celery, parsley, cranberry juice, juniper berries, dandelion, brussels sprouts, oats, garlic, asparagus, tomatoes, lemon juice, carrots, cucumber, cabbage, onions, watercress, beets, green tea, apple cider vinegar, nettle, fennel, artichokes, horseradish, any natural foods with a high water content, etc.

All in previous list are similar in that they have a high water content, which translates for some as water is a diuretic. After getting loop-diuretic induced gout and seeing my kidney function (creatinine and BUN got worse) get worse, I decided I should get off furosemide, and try water as my diuretic (See definition of diuretic above.). I believe it is always better to use something natural than a medication, if possible.

Since getting gout 13 March 12, I have been drinking 1050 ml (35 oz) to 3000 ml (100 oz) of water per day, depending on how much I work outside and sweat. In March 12 my weight ranged from 125.4 to 128.6 (gaining), April 127.2 to 129.4 (gaining), May 128.0 to 130.2 (gaining), June 130.2 to 128.2 (losing), July 128.8 to 126.4 (losing), August 127.8 to 125.0 (losing), and September 126.8 to 124.4 (losing). After increasing my water intake I still gained water weight while on furosemide.

On 15 May 2012 I decreased my aspirin from 325 mg per day to 162 mg per day; on 6 June 2012 I decreased daily aspirin to 81 mg per day, which is my daily dosage now.

On 16 May 12 I reduced my furosemide to 10 mg per day; on 25 May 12 I stopped taking furosemide, and have NOT taken any since. After I stopped taking furosemide 25 May 12, I started losing water weight with my increased intake of water. I was also becoming more active due to gout being over and doing more manual labor and doing more sweating. So I have lost from 130.2 to around 124.4 (5.8 pounds in water weight) since increasing my water intake, going off furosemide, working harder, and sweating more. At present, this seems to be the winning combination for my body.

Daily urine output since stopping furosemide has ranged from 550 ml (sweating a lot) to 2450 ml. My body appears to rid itself of excess fluids during the night. Some nights I lost up to 2.4 pounds of water weight between 6 pm and 6 am the next morning.

My medications now are just carvedilol 12.5 mg twice a day, and 81 mg aspirin per day.

I am now keeping a constant weight of about 125-126 pounds, with less fluid retained after using water rather than furosemide as a diuretic. While on 20-40 mg/day furosemide my weight ranged from 123 to 131 pounds from March 2010 to 25 May 2012, except when fluids were expelled from my body during two hospital stays and I reached base weights of 120 and 122.2 pounds.

After the first CHF episode in March 2010 I lost fluids to 120 pounds, after the second CHF episode I lost down to 122.2 pounds. Thus, my base weight, with excess fluids removed, is 120-122 pounds. In the hospital they used furosemide IV drip to help reduce excess fluids.

My body is a biological machine. I am trying to find the best combination of things to keep it operating and going forward daily, although damaged.

While on furosemide I used to average carrying 5-8 pounds of excess fluids (weight of 127-130 pounds). Now on water as a diuretic I only carry about 3-4 pounds of excess fluids (weight of 125-126 pounds). It could be that the extra water I drink just forces the kidneys to work more efficiently to rid the body of excess water, so drinking more water might help avoid lung fluid.

Theory: The human body will try (through urination and sweating and exhaling water vapor) to maintain (without using medications) proper hydration if given enough water each day.

Dehydration
From my experience dehydration can lead to several weeks of painful gout. I believe it can also lead to episodes of CHF, as discussed below.

---Theory: Another Mechanism leading to CHF

-----Original:  The mechanism of getting CHF indicated by medical professionals is when one with a weak heart ingests too much sodium (mostly as salt), then the sodium retains too much fluid in the abdomen-lung area (with left hand heart weakness), and the fluid in the lungs prevents normal oxygen transfer to the blood and the body does not get enough oxygen.

In March 2010 I had my first recognized episode of CHF; I had been short of breath previously. I had 17 pounds (over 2 gallons) of fluids removed from me in the hospital. I lost weight from 137 to 120 pounds; thus my base weight at this time was about 120 pounds. This episode was definitely caused by too much salt and too much fluid. It had been building up; I thought my shortness of breath was due to exercise-induced asthma.

-----My theory: I believe there could be a second mechanism that can lead to CHF. This theory is based on my getting fluid in my lungs when I was actually losing weight from 128.4 pounds to 125.8, near base weight (with my then base weight in the area of 122 - 125 pounds) and partially dehydrated (from forearm skin folds not snapping back very fast) when I unexpectedly got CHF in December 2011. I lost fluids this episode to 122.2 pounds.

Also. when the father (89) of a friend of mine was dehydrated in part of his body, his lungs had fluid. He was then given more fluids to combat dehydration, and apparently some ended up in his lungs. He later died with too much lung fluid.

Theory: Maybe our bodies have a fail safe mechanism to protect the brain, heart, lungs, and other vital internal organs from dehydration as long as possible as a survival mechanism. This would be similar to the blood vessels near the body surface constricting during cold weather (or cold water) so more blood is used to keep vital organs warm and/or viable.

Maybe body fluids during the dehydration process are shunted/retained more to those vital organs needing fluids to stay viable, and increase our survival. We appear to dehydrate from the outside (skin) inwards; skin and skeletal muscle might be dehydrated first. It could be that lungs retain more fluid than needed during a body dehydration process. Or if fluids are shunted to the lungs (released by blood vessels in lungs) to maintain proper lung moisture content, sometimes excess fluid might be sent to the lungs, which could then be manifested as an episode of CHF during a general body dehydration process. This theory could then explain my getting CHF while losing water weight and being in a dehydration process.

Another possibility could be that the lungs get dehydrated during a body dehydration process, and the putting of fluids back into the body (via drinking or IV) to combat dehydration could lead to too much fluid being replaced in the lung area, leading to fluids in the lungs and CHF. 


Why is there a difference in hospital-induced dehydration to get rid of excess lung fluid in CHF cases and the body process which appears to lead to CHF lung fluid? The differences are mostly two: speed and natural vs unnatural (drug-forced) processes. In hospital dehydration the end result is drug-forced, unnatural, and is done fairly quickly overriding natural body processes. A general body dehydration that might lead to lung fluids is thought to be a natural body process (slower in progression than hospital-induced dehydration) which may allow body to be able to keep/get some organs hydrated more, as proposed previously.
 

I believe it is vital that weak heart patients stay properly hydrated (where all organs stay properly hydrated constantly; little variation up or down), and stay at a fairly constant level of hydration, and not start a dehydration process in the body, or vary body fluids so that one is changing from a hydration to dehydration state and back to hydration, which might lead to a CHF episode. Exercise and sweat also can help prevent a CHF episode based on my experience.

Properly hydrated means there is enough water in the body to keep organs at a steady level of sufficient hydration to operate correctly. Signs of this (in my case) are: 10-20 urinations per day (if there is no excessive sweating from work or exercise), light yellow urine, and no dehydration signs of forearm skin. If one does not urinate much, urine color is deep yellow to orange, and forearm skin does not return to prior shape quickly when pulled out, then there is a dehydration problem, and one should drink more water.

My theories could be proven, or not, by medical studies.

---Theory: Mouth breathing (a dehydration attempt?) during CHF
It could be that people with CHF start to breathe through mouth (and thus end up hyperventilating) because the body is trying to dry out lungs that have too much fluid by expelling more water vapor with open mouth breathing (open mouth exhale on a mirror and note water condensation on mirror). This could upset the carbon dioxide-oxygen levels in the body and lead to panic attacks and other anxiety problems. A friend's father (89) with apparently Lewy body dementia and a weak heart was almost constantly breathing through his mouth, and staying anxious. He was almost always in a state of hyperventilation, and low blood oxygen; he did not realize or comprehend what he was doing due to the dementia. I have had to catch myself, while working on farm, and clench my teeth together to breathe through my nose, rather than breathe through my mouth, which would lead to my feeling out of breath, and being anxious.

Comments
My personal solution (it may not work for another) to avoid loop-diuretic induced gout, kidney damage, and avoid episodes of CHF is to drink enough water so I stay constantly well-hydrated, avoid diuretic pills, and exercise enough to sweat out excess salt and fluid and strengthen heart. I am not a medical doctor, but a fish doctor; always check with your personal doctor before you do anything contrary to his directions.

Part (maybe all) of my theory may be correct because I continue to NOT retain much fluid even though I stopped taking furosemide 25 May 2012, and I have had no further episodes of CHF or high fluid retention or gout to date of this posting. But my living better and easier may be more due to better eating and drinking, or to more exercise, or to ICD, or to a combination of all I do to survive. My theories are not yet proven by research.

Each person is different in genetics, metabolism, physiology, environmental influences, immune system,  diseases, internal and external body microbiological population, motivation, mobility, kidney function. liver function, lung function, heart damage, heart EF, blood sugar, hydration, salt intake, foods eaten, weight, exercise, sweating, fluid intake, drug reaction/tolerance to medications, sleep, etc., so what works for one may NOT work for another. What works for me may NOT work for you. You have to be motivated enough to find the combination of everything you put into your body that works best to run your body at the best efficiency possible with a weak heart. One should not try things without first checking with his/her doctors.

I have to remember to drink more water, because there is not a feeling of being thirsty. or craving water if one is already well-hydrated.

A bad side effect of staying well-hydrated is that sleep is disrupted at night from more frequent urination, leading to a tired feeling some days.

When I see my heart doctors I briskly walk into the examining room without any support, while most of the others there stagger in, or use support from others, canes, crutches, walkers, wheelchairs, or scooters. My doctors say I'm a stage III heart failure patient, but I function as a stage I patient. My active livestyle keeps me going, and doing, better than similar patients. I am way off to the side of a bell curve of similar patients (noted by my nurse practitioner).

Since I see my heart doctors and ICD technicians only once every 3 months, I must know myself how to function in the best ways possible to stay active, avoid episodes of CHF, avoid more episodes of gout, etc..

My main heart doctor told me at a recent visit (July 2012) "Whatever you're doing, keep doing it. Your color is good. You look good."

I have found that exercise and sweating, or just sweating, does wonders for the body with a weak heart. Fluids are lost plus salt is sweated out, reducing the amount of salt in the body that can help retain fluids. I try to sweat daily, by exercise, by wearing too many clothes, by avoiding air conditioning, etc. A person with a weak heart will shorten his life by just sitting and doing very little. If I did not work on my farm daily, I'd probably be in much worse shape.

I plan on trying more and more things to increase my survival.

Main Conclusions for Keeping Me Going
1. Drink enough water to STAY well hydrated, at a constant level.

2. Keep mouth closed in breathing as much as possible.

3. Exercise well to sweat out excess salt and fluids and to strengthen heart.

Adrian R. Lawler, Ph.D. ,   (C) 2012 --


11 Oct 2012 ---- I went to the heart failure clinic this morning.  My weight was down 2 pounds since my last visit (a decrease in fluids retained), my readings were all right, and I have had no more episodes of lung fluid and thus no congestive heart failure since 3 Dec 2011.   Thus, my techniques and theories appear to be working for me.

The nurses at the clinic appeared skeptical of my methods, but could find no obvious signs that I was soon headed for another episode of congestive heart failure.

I have an advantage over the normal person with heart failure. I have been keeping plants and animals alive for over 60 years:  my father had a farm as I was growing up, I have worked with animals all my life, I have had a personal farm for 40 years, and in my jobs I kept various animals alive during  parasitology studies (since 1962), toxicity testing (10 years) , and running a public aquarium (15 years).  I have learned how to keep things alive, and hopefully can continue my health a few years longer even with a weak heart.

17 Oct 2012 --- Visit to heart Doctor. Doing well; all readings OK; stable.  Next visit in six months. No change in medications or other practices followed to stay out of a CHF episode.

25 Oct 2012-- I am still doing OK. My weight is up to about 127 pounds. I have to wear more clothes to sweat more to rid body of salt with the cooler fall weather. I also have decreased my water intake to 3-4 500 ml (16.9 oz) bottles of water per day because of less sweating out of fluids. I am still not taking furosemide.

They checked out my carotid arteries, and they were clear of obstructions. I am getting a very obvious beat on right side of neck just above collarbone; apparently it is blood going to the heart backing up in the jugular vein to that level because my EF is low. The beat is more obvious on right side of neck due (?) to my anatomy.

As long as I can stay thin and sweat I can keep fluids in lungs down and stay out of the hospital.

The heart doctor says I am doing so well I can go 6 months until the next check-up. My ICD technician is so satisfied he wanted me to come back in a year; I requested 6 months.      

26 Nov 2012 --- Still stable. Weight =  125.0 pounds this morning.   Drinking 32-48 oz of water per day in addition to fluid intake with food.  Still off furosemide.  Staying properly hydrated seems to help staying stable. 

   

Loop-diuretic Induced Gout

Loop-diuretic Induced Gout

I had no previous episodes of gout. On 13 March 2012 I enjoyed a casino buffet with a friend. I loaded up on proteins: shrimp, fish, and chili. That afternoon I worked around my farm and drank little fluids. I was sweating more than I thought. In the early evening my left big toe felt sore, like I had stubbed it. By mid to late evening I knew I had gout, with a very painful, swollen, throbbing, red big left toe.

I was taking 20-40 mg of furosemide per day, a loop-diuretic, to reduce fluid retention from a weak heart. After some internet research I found out that furosemide could induce gout.

On March 15 2012 I went to see my family doctor. He gave me some indomethacin to take, at 50 mg twice daily. After reading the dangers and side effects of this medication, and after the strong suspicion that lisinopril had given me third degree heart block and caused the implant of an ICD, and furosemide probably caused/helped cause my gout, I decided I could live better with the pain than with another potential side effect of bleeding ulcers. So I toughed it out. The gout was very painful for 3-4 days, then the pain decreased. It was painful to walk on, but I did.

My foot would get better, then worse, as I bumped the toe while working on my farm. I walked the whole time, as crutches banged against my ICD implant near my left armpit, which was not good. I cycled getting better, then worse, then better until 14 May 2012 when I went back to see the doctor to try to finally end the pain. I had read about a NSAID (voltaren gel) that could be rubbed into the toe area to help relieve the pain (I would not have to take it orally and chance getting bleeding ulcers.). I rubbed this medication three times daily into the big toe for a total of 55 applications until 2 June 2012 to finally get the gout episode to end.

So the gout was almost gone, except for a slight joint pain on 2 June 2012. The gout episode lasted about 15 weeks, and was quite bothersome. One should avoid gout if at all possible.

I have now quit taking furosemide because I did not want another bout of gout, plus I wanted to avoid possible damage to my kidneys (creatinine went from 1.5 to 1.9). I also drink more water (I stopped most of the soft drinks and went to mostly water). Further information on what I did with my medications, and why, and the results will be in a future post.

I have not had any more episodes of gout. Now when my toe starts to feel sore, I immediately drink some more water. I have learned.

Google the above title of this article, or "furosemide induced gout," to get references on the subject.

Adrian R. Lawler, Ph.D.,  (C) 2012 --