Dear Dr. Roach: My husband was hospitalized with congestive heart failure. He returned home, grew weaker, and after three days was diagnosed with severe dehydration and passed away the following day. How can that happen so quickly? Can medication be a factor? Please explain how the body organs are affected by severe dehydration.
M.M.
Congestive heart failure isn鈥檛 a single disease: It鈥檚 a syndrome that can be caused by many conditions. The hallmark of CHF is the inability of the heart to pump as much blood as the body needs. As the condition worsens, the pressure of the blood before it reaches the heart goes up. (We call this 鈥渇illing pressure,鈥� and it is not the blood pressure measured in the arm.) This causes pulmonary edema (fluid inside the lungs) when considering the left side of the heart, and causes swelling in the legs when considering the right side of the heart. Many people have both left-sided and right-sided symptoms. Both fatigue and shortness of breath are common symptoms.
One treatment for heart failure is medication to remove excess salt and water through the kidneys. Sometimes the dose of the diuretic in the hospital to remove the excess is more than is needed at home to keep the balance where it is, and the body gets below the normal level. (We call this volume depletion, not dehydration, since both salt and water are deficient.) A normal heart can adapt to lower-than-normal fluid volume levels; a heart with CHF often can鈥檛. When the heart is unable to provide the blood to the kidneys, liver, brain and the heart itself, the result is catastrophic organ failure.
I can鈥檛 be sure what happened to your husband. People with CHF also are highly prone to arrhythmias, abnormal heart rhythms. It is possible that your husband had a sudden heart rhythm that caused him to pass away. What we can learn from what happened to your husband is how important it is to have a checkup soon after being discharged from the hospital for conditions such as severe CHF, which require careful monitoring.
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Dear Dr. Roach: I take Aleve or extra-strength ibuprofen as needed for back pain. My doctor told me that if I were taking them regularly, I鈥檇 need to take them with food. As the pain occurs during the night, I was wondering how much food I need to take with them. A full meal, a cracker or what? I am having therapy to strengthen the back muscles and, I hope, prevent the pain.
M.N.
Anti-inflammatory medicines like ibuprofen or naproxen (Aleve) can cause irritation of the lining of the stomach. The symptoms can be reduced by taking the medication with food.
I would choose either ibuprofen or naproxen. Taking both increases risks of side-effects. Both are good, so choose the one that works best for you. Naprox-en tends to last longer than ibuprofen for most people.
I would take the medication you choose with either a meal or a snack before bed. I don鈥檛 advise taking medication in the middle of the night on a regular basis.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible.
