San Antonio Express-News (Sunday)
The body keeps a tight rein on electrolytes
Q: Can you explain electrolytes? How can we make sure we keep our electrolytes in the normal range within our body? Are we wasting our money purchasing bottled water that says, “includes electrolytes“? I came across an electrolyte powder that can be added to water. Is this the best way to keep electrolytes in the normal range? How can we tell if we are taking too much electrolytes?
A.R.
A: Chemicals that dissolve in water are called electrolytes when they break into charged particles called ions — they conduct electricity, hence the name. The most important electrolytes in the body are sodium, potassium, chloride, bicarbonate (the ionized form of carbon dioxide, dissolved in the water), magnesium, calcium and phosphate.
These are regulated by the body very carefully through wonderfully complex systems and are kept in perfect balance most of the time. We get the overwhelming majority of our electrolytes from food. Most people need never worry about their electrolytes, nor do anything special to keep them regulated.
All water, except purified laboratory water such as distilled, contains some electrolytes. But when you pay for “electrolyte water,” there are a lot more electrolytes than in tap water. Most of the time, this is a waste of money, since your body regulates the electrolytes well through what you get in through food.
However, there are a few exceptions. One is athletes who are exercising at high intensity or for a long time, particularly in hot or dry weather. This can cause loss of electrolytes (especially sodium) through sweat, so endurance athletes need to consume more sodium, a positively charged electrolyte in its dissolved ionic form. It must always come with a negative ion, especially chloride (sodium chloride is table salt) or bicarbonate (sodium bicarbonate is baking powder). Athletes can buy powdered versions (usually packaged with a fair bit of sugar) or a premixed drink. Gatorade is an early example of an electrolyte drink.
Most people who don’t exercise at high amounts will do just fine drinking water. Drinking when you are thirsty, even while exercising, is safer. While we’re on the subject of drinking water, I prefer tap to bottled water, as there are no significant benefits to bottled water beyond taste in almost all of the U.S. and Canada.
Another example of people who need to pay attention to their electrolytes are those whose body systems are out of
kilter, especially people with kidney disease or those who are vomiting or who have diarrhea. These groups often experience electrolyte disturbances. In a hospital, doctors spend a lot of energy correcting electrolytes by adding the appropriate supplemental electrolytes to a person’s intravenous fluids or orally. One of my professors always said, “The kidney is smarter than 10 interns,” since the kidney regulates electrolytes very well.
It is hard to get in too much electrolytes, but I occasionally see it. I know one person who drank an entire jar of pickle juice and felt really ill. But unless you have kidney disease (where excess potassium can literally be deadly), the body is smart enough to keep things in balance.
Q: What is dissociative identity disorder? There are a lot of movies and TV shows about it.
Anonymous
A: Most people will be more familiar with dissociative identity disorder’s former name: multiple personality disorder. DID is a complex psychiatric disorder that has been frequently mischaracterized in the media. The hallmarks of the disorder are memory problems
(gaps in recall of personal events or information) and two or more distinct personality states, which are sometimes called “alters.” The different personalities are very seldom dramatically different from each other in the way the media frequently portrays.
However, the different personality states are often perceived by the person or by others as having different abilities and behaviors, and sometimes include perceived age, gender and sexual orientation differences. Still, the different personalities in a person with DID are better thought of as different facets of the person than as different people living in the same body. It is uncommon but not rare; estimated to occur in about 1 percent of the population.
The majority of people with DID have a history of abuse during childhood, especially sexual or physical abuse. But it can be some other type of severe trauma during childhood, usually before the age of 6.
A person with DID frequently experiences hourslong gaps in their memory. During this period of time, others may report a marked change in mood or behavior, including angry outbursts. DID is frequently misdiagnosed or never diagnosed, and this is more confusing
because many people with DID may also have other psychiatric illnesses, such as posttraumatic stress disorder or borderline personality disorder.
Depression, sometimes with suicidal behavior, is common in DID. However, the media portrayals of a person with DID as being violent are incorrect and unfair. People with DID are not more likely to be violent than anyone else.
Dissociative identity disorder is a complex condition that is difficult to diagnose, resulting from severe trauma. People with this condition need compassion from friends and family, and skillful care from knowledgeable practitioners, who can be hard to find.
You can read more about dissociative disorders here: isst-d.org/public-resourceshome.
Q: My problem is canker sores. I have had them occasionally in the past, but now I have one or two in my mouth constantly. This has been going on for the past year or more. I have seen my dentist, cardiologist, dermatologist and my family physician. I’ve gotten no real help except for pain control (“magic mouthwash” and Chloraseptic). I gargle a salt solution every three or four hours. My question: Is there a doctor that I should be seeing that covers mouth canker sores? This condition has caused eating and sleeping problems.
L.P.
A: Canker sores are known technically as aphthous ulcers. They are completely different from cold sores, which are caused by herpes simplex viruses, although an exam by an experienced doctor is sometimes needed to tell them apart. It’s not clear what causes them. They may be related to abnormalities in the immune system. Stress can trigger them.
Many people note an association between canker sores and a common toothpaste ingredient called sodium lauryl sulfate. And if your toothpaste has that, stopping it in favor of an SLSfree toothpaste may dramatically help your symptoms. Lysine (an amino acid) supplements are often advised but have poor data supporting their use. However, many of my readers have told me it’s effective for them.
Steroid creams (such as Kenalog) applied on the sore speed healing. A dermatologist often has expertise in this problem.
Q: In 2015 I had my mitral valve replaced with a pig valve. By going this route, I realize it is not a permanent fix. How long should I expect this valve to last before requiring replacement? I’m a 70-year-old male. The recovery from the open-heart surgery was brutal, so I am not looking forward to doing it again.
D.B.
A: You can plan on living a long time, since more than 50 percent of bioprosthetic valves (like the porcine valve you have) are still working fine after 20 years. Only about 20 percent of people with a bioprosthetic mitral valve need replacement after 15 years.
In those much younger than you, the risk of deterioration of the valve is higher, so a mechanical valve is usually recommended for those younger than 55 at the time that they need a new valve. A mechanical valve is expected to last a lifetime, but even these, very rarely, develop mechanical faults.
A relatively new procedure, called a transcatheter mitral valve implantation, may be an option for people who are older or who have a higher risk for traditional surgery. Transcatheter valve replacement is already a very important treatment for aortic valve replacement, and may be adopted more commonly with the mitral valve in the future.