To Your Good Well being: Too many toilet journeys in a single day is a quality-of-life problem | Columnists

DEAR DR. ROACH: I’m a 69-year-old lady in good well being. For a few years, I’ve had rising bother sleeping due to having to rise up through the night time to urinate. It’s now 4 to eight occasions per night time. I’m cautious to not drink a lot after early afternoon. I’ve a nutritious diet and get loads of train. My major doctor handled me for overactive bladder, which didn’t work. I’ve seen two urogynecologists. They each instructed me that I’m producing approach an excessive amount of urine at night time as a result of my antidiuretic hormone ranges are very low. Additionally they instructed me that the remedy usually given for that can’t be given to folks over 65 as a consequence of cardiac uncomfortable side effects. Do you have got any concepts? Ought to I see a kidney specialist? That is critically affecting my high quality of life. I really feel that if I’ve to reside with this for the remainder of my life, it could be a brief one. — A.E.S.

ANSWER: The physique has a number of methods in place to permit folks to sleep by way of the night time with out having to rise up to urinate. One among these is a hormone known as arginine vasopressin, additionally known as antidiuretic hormone. It’s normally at a excessive stage at night time. Sadly, this technique does not work so effectively in lots of older folks, and may generally invert totally in order that the degrees are low at night time, and folks must urinate extra. One remedy for that is to present the hormone in a type known as desmopressin, usually abbreviated DDAVP. It’s given by injection, or through nasal spray or oral pill.

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The facet impact your urogynecologists are involved about is low sodium ranges (hyponatremia), which is extraordinarily frequent in folks over age 65 when taking this remedy, and most consultants is not going to prescribe it for older folks. Ladies are at even greater threat than males. The Meals and Drug Administration has a black field warning, the very best stage of concern, that DDAVP is acknowledged to “trigger hyponatremia” and that “extreme hyponatremia might be life-threatening, resulting in seizures, coma, respiratory arrest, or loss of life.” Even in research with individuals who have been fastidiously monitored and the place decrease doses have been tried, members nonetheless developed critical hyponatremia at a price that was regarding (as much as 30%).

Different choices embody utilizing a dose of a diuretic within the afternoon, so your physique is as “dry” as it may be earlier than mattress; sleeping medicines; and a more recent remedy known as posterior tibial nerve stimulation.

DEAR DR. ROACH: I used to be hospitalized and placed on IV antibiotics two weeks in the past, and adopted it up with one other week of oral antibiotics, amoxicillin. Since getting this remedy, I’ve had diarrhea. Is that this a results of the antibiotics? — Ok.M.B.

ANSWER: The diarrhea may be very more likely to be associated to the antibiotics. Antibiotics destroy a lot of your wholesome micro organism residing within the colon, which frequently results in diarrhea. More often than not, the traditional micro organism will come again after ending the antibiotics, and the diarrhea goes away.

Diarrhea with fever or blood, or that persists, ought to immediate analysis for a critical an infection, Closteroides dificile, which wants pressing remedy. C. diff is immune to most antibiotics, so just about any antibiotic predisposes to this harmful an infection, because the C diff take over the gut after the wholesome micro organism have been killed off by the antibiotics.

Many individuals will deal with antibiotic-associated diarrhea with probiotics (wholesome micro organism), both as meals (reminiscent of yogurt) or as a complement. It isn’t clear how efficient that is.

Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column each time doable. Readers could e mail inquiries to [email protected] or ship mail to 628 Virginia Dr., Orlando, FL 32803.