There’s no harm in soaking in a hot Epsom salts bath
Q: In the winter, I enjoy an occasional soak in a hot bath, especially when my muscles ache after a hard day, and I often add a cup or more of Epsom salts. These seem to make the bath even more soothing and therapeutic, and I feel especially clean afterward.
Am I crazy, or is there something to this? I’m wondering about the chemistry. Are these salts absorbed through the skin, and if so, isn’t a cup of salt rather harmful? And can they cause kidney stones? I had one of those last year and wonder if this had anything to do with it.
A: Magnesium sulfate (Epsom salt) is used by many people as a soak and for purported health benefits. Many people feel that they make the bath especially relaxing. While magnesium is a critically important salt, we get the magnesium we need through food nearly all the time, while magnesium supplementation is necessary on occasion, such as in people taking certain diuretics.
However, although there may be some small absorption, magnesium is not at all wellabsorbed through the skin, so there is neither harm nor benefit to soaking in Epsom salts. A cup is a commonly recommended amount of Epsom salt to add to a bath.
Sodium chloride (table salt) definitely increases the risk of kidney stones when taken by mouth, but magnesium does not. You can enjoy your Epsom salt bath without fear.
Q: At 63, I’m familiar with age-related loss of elasticity, most noticeably with my skin. I’ve assumed that it was occurring all throughout my body. I hadn’t really worried about having to urinate three or four times a night; I had just assumed that my bladder didn’t stretch like it used to. I have been trying to hydrate more, as I do during the day with meals. I thought it was just my body continuing to process fluids into the night. Is three or four times a night really a red flag?
A: Urinating frequently at night is common and can have several different reasons, only some of which are concerning.
Inability of the bladder to stretch is not a common cause.
In men, it can be a symptom of prostate enlargement. Since the urethra, which empties the bladder, goes straight through the prostate, enlargement of the prostate can slow down urinary flow and make it more difficult for men to empty their bladder. Urinating small to medium amounts of urine several times a night is classic for prostate enlargement that isn’t due to cancer. Severe prostate enlargement can obstruct the kidney enough to cause damage on occasion, so it’s worth an evaluation.
In both men and women, overactive bladder (an involuntary spasm of the muscles in the bladder) can cause frequent urination, both during the day and at night. The symptoms for OAB are many small voidings, and it sometimes may cause incontinence. OAB and prostate enlargement can be hard to tell apart in men.
Men and women who have many large voids at night are getting rid of excess fluid. This could be because you just drank a lot of fluid before bed, so don’t do that. I recommend to stop drinking at 5 or 6 p.m. It can also be due to diabetes and sometimes kidney or heart failure. There are less common causes, so it really is worth speaking to your doctor about this issue.
Q: I am having significant issues with my hip replacement that was performed 10 years ago. It can get quite painful after kneeling, lifting heavy objects or sitting in some chairs for extended periods. My MRIs show no issues. C-reactive protein tests and sedimentation rates are within the normal range, so my doctors are not sure what is causing the pain.
I was tested for heavy metals a year ago in anticipation of replacing the prosthesis. My cobalt levels were high, but not toxic (3 mcg/L). Due to unforeseen circumstances, I had to delay surgery. I was recently retested and now have a level of 6 mcg/L, which I understand to be toxic. My
physicians don’t seem to want to address this issue, but I am greatly concerned. I suggested chelation, dialysis and even having periodic units of blood withdrawn, which were all refused.
Is there anything I can do to reduce these levels and prevent damaging my cardiovascular and nervous systems!
A: Cobalt toxicity is not common. By far, the most common time I see elevated levels of cobalt is in people who have a hip replacement that is wearing out and failing. Very occasionally, the cobalt is high enough to cause symptoms of toxicity, such as heart or nerve symptoms; thyroid issues; smell, hearing and taste loss; rashes; muscle weakness; and fatigue.
When a metal-on-metal prosthesis wears out, the cobalt in the prosthesis can enter the blood. A level above 10 mcg/L suggests that the prosthesis has excess wear. Even though yours is still below that, the fact that the number is rising in the last year, along with the symptoms you have, strongly suggest that your hip may indeed be in need of replacing.
Exactly what cobalt levels should bring concern is a topic that there seems to be uncertainty about. Some sources say that systemic symptoms are unlikely at a level below 100 mcg/L, but several wellrespected authors have suggested that a level above 20 mcg/L might be enough to cause local symptoms, such as the pain you are experiencing around your hip. Your levels are unlikely to cause symptoms.
Since, in your case, it is virtually certain that the cobalt is coming from the hip wearing out, the correct treatment is not chelation or dialysis, but removing the source of the cobalt — your prosthesis. These levels indicate it is wearing out, but are not high enough to be considered an emergency.
Q: Do people with dementia who are starting to lose touch with things (names, places, etc.) realize it? Are they in denial, or do they not even know that there is a problem?
A: Every person is different and the different types of dementia behave very differently. In people with Alzheimer’s dementia, the most common type, memory loss is among the earliest symptom, but different types of memory are affected distinctly. A person with early Alzheimer’s may be able to recall events of the distant past or memorized facts very well, but have great difficulty recalling exactly what happened at a particular time and place, especially in the recent past.
My experience with patients (and loved ones) who have Alzheimer’s is that at the beginning, they are often aware they are losing their functions and abilities. However, as the disease progresses, the awareness fades as well, which may be more painful for family, but less painful for the person with dementia. Behavioral issues and personality changes may also occur as the dementia progresses. You can read much more at alz.org.