Salt and water reg­u­la­tion de­railed by SIADH

Prince Albert Daily Herald - - OPINION - Keith Roach

as I did not re­al­ize how im­por­tant sodium is to nor­mal func­tion­ing. And even though I have heart is­sues, the proper sodium level must be main­tained while, at the same time, the blood pres­sure is con­trolled. -- D.L.

AN­SWER: I believe that you had a con­di­tion called SIADH (syn­drome of in­ap­pro­pri­ate anti-di­uretic hormone), pos­si­bly in re­sponse to your or­tho­pe­dic surgery (there are other causes, in­clud­ing lung and brain dis­eases, but sometimes we never can find a cause), which was ex­ac­er­bated by the water they gave you to en­cour­age uri­na­tion. SIADH is a prob­lem with the kid­neys’ abil­ity to get rid of water. Thus, al­though salt is sometimes used to treat SIADH for short pe­ri­ods of time, the key to un­der­stand­ing and con­trol­ling this con­di­tion is man­age­ment of free water (water with­out salt).

With ex­cess ADH (also called va­so­pressin), the urine is very con­cen­trated, and this leads to re­ten­tion of water in the body, di­lut­ing and low­er­ing sodium. The kid­ney re­sponds to the ex­cess water by elim­i­nat­ing more sodium, which leads to fur­ther re­duc­tion in the blood sodium level.

Tolvap­tan blocks the ef­fect of the ex­cess ADH, al­low­ing the body to get rid of water. It must be used very cau­tiously, since rais­ing blood sodium level too much too quickly can cause per­ma­nent brain dam­age. I was taught never to raise the sodium by more than 10 points in a day.

Salt re­stric­tion is ab­so­lutely ap­pro­pri­ate for most peo­ple with high blood pres­sure and heart dis­ease. How­ever, SIADH is more com­mon than you might think, and the key to its treat­ment is re­strict­ing drink­ing water, rather than in­creas­ing di­etary sodium.

DEAR ABBY: I am in a long-dis­tance re­la­tion­ship with a man who lives halfway across the coun­try. Be­cause he’s very wealthy, he ar­ranges for all the air­fare. I am a sin­gle mother and I have lim­ited fi­nances.

“Bruce” owns a suc­cess­ful busi­ness and, through his busi­ness, racks up mil­lions of credit card points. He never pays out of pocket for any va­ca­tion ex­penses -- ho­tels, car, air­fare, cruises, etc.

Be­cause I have been fly­ing so of­ten to see him, I have been bumped sev­eral times from my flights and re­ceived travel cred­its on the air­lines, which I was ex­cited to get be­cause now I have the abil­ity to fly with my chil­dren some­where.

The prob­lem is, Bruce in­sists I use the vouch­ers only to see him since they were ob­tained on his points.

I ar­gued that they were my vouch­ers for giv­ing up my seats. He says, yes, the seats HE “bought.”

Get­ting air­fare is ab­so­lutely no skin off his nose -- he has mil­lions of dol­lars and mil­lions of points! Am I out of line here? -- BUMPED IN KANSAS

DEAR BUMPED: I don’t think so. How­ever, you are get­ting an in­sight into Bruce -- who ap­pears to be un­will­ing to sub­si­dize any travel that in­cludes your chil­dren.

If you haven’t al­ready no­ticed, that should be a big red flag if you’re con­sid­er­ing a future with this mil­lion­aire.

DEAR ABBY: My three best friends over the last four years re­cently de­cided to start a busi­ness to­gether. They said I was more than wel­come to join them, but fi­nan­cially I wasn’t able to swing it. I work part-time, so I have been help­ing them when I can.

When we get to­gether for din­ner once a month, most of their con­ver­sa­tion fo­cuses on their busi­ness. But re­cently they dis­cussed a shop­ping trip they took to­gether. They went on a day I could have gone, but I was not in­vited.

Should I take this -- and other sim­i­lar in­ci­dents -- as a hint that our friend­ship has run its course? -- FEEL­ING LEFT OUT

DEAR FEEL­ING LEFT OUT: Talk­ing about the shop­ping trip in front of you was in­sen­si­tive.

How­ever, you may not have been in­vited be­cause your friends were afraid you might be em­bar­rassed it you could not par­tic­i­pate in the shop­ping. You men­tioned that their busi­ness ar­range­ment is re­cent. They may be dis­cussing busi­ness be­cause that’s what is on their minds.

Don’t write them off or with­draw just yet. You can al­ways do that. Wait to see how things play out.

DEAR ABBY: Help! I’m a 67-year-old man be­ing re­lent­lessly chased by a 68-year-old woman. I have told her I want to date other women and will be moving out of the coun­try at the end of the year. De­spite this, she is con­stantly try­ing to ma­neu­ver me into an ex­clu­sive re­la­tion­ship, prob­a­bly end­ing in liv­ing to­gether.

I don’t want to hurt her, but I’m at a loss as to how to get her to back off. -- HAP­PILY UNCOMMITTED

DEAR UNCOMMITTED: Here’s how. Tell her you can’t han­dle the pres­sure she’s putting on you and end the re­la­tion­ship NOW.

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