Salt and water regulation derailed by SIADH
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.