The Crippen Diaries 2007 (26)
The first patient arrived with one of my minor pet peeves.
A water bottle.
What is this modern affectation for walking round carrying a bottle of designer water? And not only was the patient carrying the bottle of water but, several times during the consultation, she unscrewed the top and took a little drink.
She was otherwise normal and there was no indication of psychiatric pathology. What is all this about?
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David is a 56 year old bus driver. A 56 year old bus driver with piles. Awful piles. Piles make most people laugh, until they get an attack themselves. David has had them for years but they have never been as bad as they are now. At times he has difficulty sitting down.
They were so bad at the weekend that he took himself to the A/E walk-in centre. He was given some cream and some co-codamol tablets and told to “see your GP and get him to refer you to a surgeon.”
In the old days, they would have done the referral themselves but the dictates of the NHS internal economy are such that the PCT is refusing to fund such referrals unless they come from the GP. This is supposed to empower the GP as the gatekeeper to the NHS and is said to be something about “the money following the patient.” And of course the hospital cannot offer David “choose and book” and a “choice” of hospitals.
This is, in reality, another barrier to health care, another layer of bureaucracy for the patient to conquer. Of course, I do the referral. Back to the local hospital. David has no interest in going anywhere else. I changed the co-codamol to an anti-inflammatory tablet. Codeine is not great for people with piles.
And I had to sign David off work. He really cannot sit down at the moment. The acute attack will subside over the next few days, but there will be another, and another. David will not get to outpatients for three months.
He may need more time off work before then.
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Tuesday 26th June
For most of us, home visits are not the highlight of the day.
There is no problem when it is an acute severe medical problem, and no problem when it is someone who is terminally ill. In fact, visiting the terminally ill remains, in my view, the most important part of the job.
Today, I had two visits. Both classical modern visits. Both entirely appropriate and reasonable and yet both deeply frustrating.
Two elderly ladies, both widows, both with children who do not live locally and both with a collection of minor medical problems.
The hip aches a little more. A dizzy turn. Run out of the red tablets. Not opened bowels for three days.
Alice, the first port of call, had not opened her bowels for three days. This happens to her occasionally and, for someone of her generation, is worrying. She quite genuinely cannot get to the health centre, and I am happy to see her at home. But I am not happy to do a rectal examination on her with no one else in the house.
So I lay a hand on her abdomen, which is soft and non-tender, and I try to reassure her. Take a couple of senna tablets tonight, and that will probably sort it out. And then she tells me about her granddaughter who, like one of my sons, is doing GCSEs and a few minutes later I leave worrying about the lack of an examination that many would say is essential.
Barbara is a little older than Alice and her short term memory is not so good. “I don’t know, doctor, I just don’t feel well…”
I spent twenty minutes trying to disentangle something tangible from the ragbag of minor symptoms, but nothing emerged. So I checked Barbara’s blood pressure, which was slightly higher than it should be. She seemed to feel much better for the “laying on of hands”. I drove back to the health centre wondering what, if any, action I was going to take on a blood pressure of 184/96 in a lady in her late eighties.
Not much, I suspect. And that is probably wrong too.
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Thursday 28th June
A new day, a new Prime Minister and a new Secretary of State for Health.
I really do feel better about it all. I am as cynical as the next man, probably more so, but even so I am prepared to give them a chance.
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I referred John to the ENT clinic a while ago for an assessment of his chronic snoring. He has finally had a sleep study. He does not have sleep apnoea and does not need CPAP. The ENT surgeon has suggested he buys a SNORBAN gadget.
The cost £45 so John would like me to prescribe one for him.
I cannot. They are not available on prescription.
But are the any good? The ENT surgeon who recommended it is a sensible guy. I looked at the website.
SnorBan is a revolutionary patented mouthpiece designed to stop snoring. It gently holds the lower jaw forward causing the windpipe to open. This position allows air to pass down without vibrating the tissues found there - the cause of the noise - putting an end to snoring.OK, that sounds reasonable. I have no experience of SnorBan. Their spelling is a tad worrying. "Eliviate"?
Use of the SnorBan mouthpiece improves oxygenation to the body and helps to eliviate day time fatigue.
But they say:
30 day unconditional 100% money back guarantee.
That sounds eminently reasonable, and gives me confidence. The only thing I do not like on the web site is the advert for a book
Download FREE e-book
'78 Ways to Live Forever'
(Just 4 stalks of celery a day will reduce your blood pressure)
NOW!
'78 Ways to Live Forever'
(Just 4 stalks of celery a day will reduce your blood pressure)
NOW!
Still, I suppose it is free, though I don’t much care for salary.
David asked me if I thought it was worth paying this money for a SnorBan. I was not able to help.
Has anyone tried one?
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55 Comments:
"It is vitally important to be seen to be doing something.....even what that something.... is in fact nothing"
Classic advice from one of our med school's orthopaedic consultants.
"several times during the consultation, she unscrewed the top and took a little drink."
perhaps nerves, the minor stress of the consultation with 'God' ?? :)
Rule 13: THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE?
Voltaire argued that ‘the role was to amuse the patient
whilst nature took its course’.
John if you want some justification for doing very little take a look at this.
Port, S., et al, Lancet 355:175, January 15, 2000
Port, S., et al, Lancet 355:175, January 15, 2000 http://idisk.mac.com/clarencest10-Public/port%20htn%20-%20lancet%201-00.pdf
I carry water around with me. We're all allowed our little oddities Dr Crippen! I do it because I used to get cystitus if I let myself get too dehydrated and it happened about 5 times. It was the most horrendous pain I've ever experienced and now I'm paranoid about getting dehydrated in case it happens again. Maybe she's the same? Of maybe she just gets a dry throat?
I don't know about "designer" water - the label on the bottle I'm using at the moment is co-op own brand and I refill it from the tap - but I tend to carry water around with me if I'm going to be out of the house for more than, say, half an hour. Especially in summer.
It's not to follow fashion - more to follow the advice to drink 8 pints a day in the hope of healthier kidneys and less headaches and clearer skin and all the rest. The idea is you just have a swig whenever you think of it.
That said, it IS a bit rude to keep doing it while in a conversation with someone, particularly someone you know you're only seeing for ten minutes.
Could you tell me why you didn't want to do a PR on the first patient without someone else being present?
Is the worry medicolegal ("Someone is going to think I am abusing this old lady"), or is there a potential medical risk in doing a PR?
Same as Mary for me. Though I do carry a "designer bottle" but only because that happened to be the last bottle I bought. I fill it up from the tap every day because it's a darn sight less expensive and time consuming than having to stop at a shop or cafe every time I feel a bit thirsty. As I'm on the go a lot of the time I can only rely on my water bottle for hydration!
In my profession it's practically a requirement to have water with you (unless you want to be one of those smelly-coffee-breathed teachers). Maybe it's rude for me to take a sip when I'm teaching but it's better than me foaming at the mouth and I certainly let the students have a discrete sip if they require it too.
I think drinking water is a generation thing. Whenever I go to my nan's house (or his gran's house) and ask for a glass of water I'm given incy wincy glass, whereas if I'm getting a glass of water for myself it's usually always at least half a pint.
Maybe you need a sign outside your door: "no chewing, no sipping"? ;)
I too sometimes carry a wee bottle of tap water. We used to as children, when we went adventuring, but then it was a TCP bottle, carefully washed and wrapped. A light plastic bottle is much more convenient.
How exhausting your life must be if you get peeved over something as minor as someone drinking water.
I nearly always carry water too, having worked out years ago how much enjoyment of various occasions I had lost through being uncomfortably thirsty and there being no water conveniently to hand. I probably wouldn't be drinking it whilst having a medical consultation though. Maybe she was dehydrated from alcohol the night before?
Maybe she was thirsty.
I remember taking a bottle of water into a consultation with my doctor, and taking swigs of it whilst talking to her. It was because I was just so thirsty all the time.
5 minutes later I was diagnosed as being diabetic.
Poor John, no sympathy today.
But, bloody hell, today one patient took two calls on his mobile phone during my 10 minute consultation. Grrrrr
Are you [i]sure[/i] it was water she was drinking?
John,
How odd that the majority of these responses focus on your trivial annoyance at the your polydipsic patient.
The frankly ludicrous situation of the poor bus driver and the colorectal surgical bureaucracy, or your home visit patient, who probably should have been PRd, but understandably you did not do so, due to a lack of a chaparone.
The NHS can get you down frequently - the slightest things often piss me off, where they pass over the heads of (less neurotic) colleagues.
The failure of many of y'learned commentators to raise an eyebrow at the inanity of your clinical observations is just rather depressing.
I too tend to carry a bottle of water around with me in the summer. I seem to be comfortable in a range of temperatures that is several degrees colder than most people, which means that I tend to suffer in the summer - I break out in a sweat if I just spend a couple of minutes sitting in the sun on a warm day (where warm means more than about 20 Celcius).
So I need to drink a lot more in the summer, so I tend to carry water. It's usually an old evian bottle that I bought at an airport once, and it's always full of tap water.
The only thing that would persuade me to sip at it during a chat with the doctor is if it was the only thing preventing me from throwing up...
I wonder was Dr Crip getting depressed...........afterall it's six days after the summer solstice & the nights are drawing in.
Try http://www.sad-lighting.co.uk/
ROFL
potentilla said...
How exhausting your life must be if you get peeved over something as minor as someone drinking water.
I nearly always carry water too, having worked out years ago how much enjoyment of various occasions I had lost through being uncomfortably thirsty and there being no water conveniently to hand. I probably wouldn't be drinking it whilst having a medical consultation though. Maybe she was dehydrated from alcohol the night before?
Wednesday, June 27, 2007 11:54:00 AM
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I get peeved at people ostentatiously carrying water bottle at inappropriate times. It is odd and gratuitous behavior. And drinking from it during the consultation is just downright rude.
But why DO people in the western word carry water bottles? We are not in the desert. I think they are making some sort of statement. Not sure what. Maybe something to do with being "right on".
I get peeved with people who come in chewing gum.
Finally, I don't find it is tiring, Potentilla. I find it somewhere between slightly annoying and slightly amusing.
I do believe that it is only a certain sort of person who is a "water carrier". I suspect there is a raft of underlying minor psychopathology. The very fact the so many people picked up on this rather tends to confirm that.
John
anonymous said...
Could you tell me why you didn't want to do a PR on the first patient without someone else being present?
Is the worry medicolegal ("Someone is going to think I am abusing this old lady"), or is there a potential medical risk in doing a PR?
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I could do a seminar on this. Lots of unspoken things that GPs do not normally talk about.
First, I would have done the examination had I thought it was essential.
Second, I am hard wired to belief that an examination of the abdomen is not complete without a PR. And yet, they are not done routinely.
Third, yes, I do worry about doing intimate examinations of women alone at home. Just because she is elderly does not mean that she is not entitled to medical courtesy. I would never do a PR on an elderly woman in the surgery without getting the nurse in; both to help and to chaperone.
Fourth, doing it at home presents difficulties. You really want her on a bed rather than the sofa so that means a difficult trip upstairs. And it is excruciatingly embarrassing for the patient.
And so you tend not to do these PRs.
There IS a medico-legal risk, albeit small. There are no particular dangers to doing a PR.
I don't think you would have been surprised to hear me say I would not do a vaginal examination at home. A rectal examination on a female is not much different.
If only patients would realise that part of the doctor's reluctance to do home visits is the difficulty of doing proper examinations in the home environment. Do a PR on an elderly lady, release a hard plug of stool, and you have diarrhoea all over the bed. Who is going to clear it up? How does the patient feel.
It's difficult. Often I drive away from a house thinking "I should have done a rectal examination".
I don't think I am alone. It is just that most people do not talk about it... and the hospital surgeons are not sympathetic. There are still some dinosaurs who insist on doing rectals on children with possible appendixes.
John
Thanks John for your comprehensive reply.
You make a good point that I would not have expected you to do a vaginal examination unsupervised.
As you say, ultimately you would have to do either unsupervised at a patient's home if the symptoms were such that there was no option (e.g. "there's blood on the paper").
Interesting. More posts about the things GPs don't talk about, please :)
Chris Eade - my apologies. I'm not a medic and so unless Dr Crippen describes a condition that is affecting myself or my family, how should I comment?
I also feel that the "underlying psychopathology" relates only to doing what one is advised to do. Eight pints of water, five-a-day fruit and veg, always use a condom, call 999 for chest pain... you can't blame us that it's worked!
Mary... I didn't mean to make you mad.
Although you have missed my point.
Even as a non-medic, one could feel aggrieved that the system is providing sub-standard patient
care. An NHS manager could even work that one through, perhaps...?
Your analogy amused me tho - I agree that condoms are wonderful preventers of pregnancy and disease, and people should be slapping them on more often.
However, would it be wrong to feel annoyed if a patient proceeded to put one on during my consultation?
C
Mary, don't worry, he doesn't really mean it about the psychopathology, he just put that bit in as a riposte to me.
Joking aside, John, it's actually quite an interesting question about individual variation in....water intake? rate of water intake? rate of throughput?
Do you only drink at mealtimes? If you are out for several hours, say shopping, do you feel no need to drink during that time, or do you stop at cafes? Presumably you carry lots of water when you are out in the Lakes? How much (approximately) would you carry for say 8 hours out on a summer day?
I was in the car for 2 x 2-hours trips today - would you not carry water were you to do the same?
(chris eades, you are considering too small a sample size)
8 pints ? Somebody hasn't listened to the message that well. It's 8 glasses or 2 litres. 8 pints would be 4.6 litres.
The message has also be completely muddled by TV "nutritionists", magazines and other sources, so that people think if they don't drink 2 litres of water a day they are doomed.
In fact nobody seems to be entirely sure where the 2 litres a day came from. http://www.netdoctor.co.uk/womenshealth/features/watermyth.htm
Not mad, not worried, and in full agreement that it was a bit rude of the patient... :)
Also, missing the point is what I'm best at, I'm practically a damn professional, but I've never pretended to be the brightest bulb in the box... I do get what you're saying, Chris - that we should be concerned about the bigger issues - but I've only got so much concern in me, I'm kind of more an "idle chitchat" person.
I get peeved at people ostentatiously carrying water bottle at inappropriate times. It is odd and gratuitous behavior. And drinking from it during the consultation is just downright rude.
Agreed, drinking during a consultation is rude (unless one is taking sips of water to prevent vomiting. It would be ruder to deposit my half-digested lunch on your desk, I think.)
(Incidently, I do find that if I'm feeling sick, taking small sips of cold water is a good thing. Is that psychosomatic, or is there a physical mechanism?)
I'm not really sure what you mean by "inappropriately carrying water" - it would be inappropriate to get married, or get an OBE or something with a water bottle clutched in one hand, but if I'm out doing some errands I'm likely to be carrying all sorts of junk. It might include some water.
But why DO people in the western word carry water bottles? We are not in the desert. I think they are making some sort of statement. Not sure what. Maybe something to do with being "right on".
Probably so that of they are thirsty, they can have a drink. Twenty years ago, I would have stopped at a cafe for a cup of tea if I was thirsty. Today, most of the cafes have been replaced by ghastly Starbucks franchises and the like, where getting a decent cup of tea is a decidedly shaky proposition. Also, these days I have less time, so am unlikely to want to stop for 20 minutes to drink tea by myself.
And I tend to carry a bottle of water with me if I think I will be thirsty because I flatly refuse to pay a pound or more to purchase a bottle of water from a shop when I have water that is every bit as good coming out of the tap in my house for free.
But why DO people in the western word carry water bottles? We are not in the desert. I think they are making some sort of statement. Not sure what. Maybe something to do with being "right on".
Probably so that of they are thirsty, they can have a drink.
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OK OK so, why don't they also carry a sandwich in case they are hungry and a plastic urine bottle in case they need a pee.
It is an affectation
John
I carry the water so I can stay well hydrated and avoid uncomfortable problems with my Chalfonts, John.
Not affectation. Self-preservation.
Rest assured, though, I wouldn't drink during a GP appointment. Being the age I am I would consider it rude.
1st patient : Diabetes insipidus? Or F40.1 Social phobia, F41.1 GAD, F42.1 Predominantly compulsive acts? Or drug induced (?iatrogenic, ?recreational)/RA/other xerostomia?
2nd patient : 3 months for first consult to then be on a list does make for grim news.
Patients 3 and 4 : a good case of The Doctor as the Drug, methinks. Sifting through the constellation of symptomatology and ascribing significance is arguably what GPs do best. With the likelihood of serious pathology being low, the gap between NNH and NNT presumably being modest, doing nothing (whilst safety netting) is what I'd have wanted for my nearest and dearest.
Patient 5, the new Health Secretary : not evidenced the diagnoses F60.2 Dissocial personality disorder and F62.0 Enduring personality change after catastrophic experience (of MTAS) that Patsy evidenced. Heartening signs.
Patient 6 : is he of mature years? Voluntary groups in our locale pay for items like these for over 65's including TENS machines and any similarly priced gadget or gizmo. The 30 day trial inspires confidance that it's less quackery, at least. Rough to give wise (valid) counsel to a bemused patient 'bout an intervention you're not familiar with, happens to me too often, guess either the ENT surgeon or Dr Google will have to assist.
It is an affectation
Are you seriously arguing that everyone who carries a bottle of water with them is doing so only as "an affectation"?
Or only that this applies to some subset of people who carry water? If so, define the subset?
I beseech ye in the bowels of Christ, consider that just becasue people do something that you personally don't do, they may not necessarily be wrong, or even suffering from minor psychopathology.
re the 8 glasses/2 litres of water per day, snopes.com isn't convinced - http://www.snopes.com/medical/myths/8glasses.asp
I wonder how many people would sip from a water bottle whilst talking to their boss, a client at work or at an interview?
Having said that, I wish I could carry a bottle of water around - six hour post-take rounds in an overheated DGH can be quite dehydrating. Not sure that the boss or the punters would be too impressed though.
(Renal has a *real* need to keep hydrated)
At the risk of the usual blasting for telling you what you already know, John, there seems to be plenty of review literature indicating the "oral appliances" have some usefulness in reducing snoring etc.
A bunch of refs come up on PubMed with:
Snoring AND "oral appliances" AND review.
Am taking an interest in this as Mrs PhD complains regularly about my snoring. Usually I just point out that I don't complain about hers. Married life, eh?
potentilla said...
It is an affectation
Are you seriously arguing that everyone who carries a bottle of water with them is doing so only as "an affectation"?
Or only that this applies to some subset of people who carry water? If so, define the subset?
I beseech ye in the bowels of Christ, consider that just becasue people do something that you personally don't do, they may not necessarily be wrong, or even suffering from minor psychopathology.
Friday, June 29, 2007 11:40:00 AM
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No, you have missed the point. As I am sure Oliver would have as well.
This tiny entry might be taken as a reflection on me and my minor foibles. I do think it is mostly an affectation but, whether or not it is, either way it irritates me.
I know some people who are irritated by Mahler.
Now THAT IS madness!
John
In defence of the water carrier ...
I once visited my GP in real fear of what I was going to be told, and my mouth was so dry that it made talking difficult. A quick swig from a water bottle could have helped a lot.
I also used to get cystitis, until I learnt that drinking plenty of water stops it happening. I've carried a bottle of (tap) water with me ever since in case I get thirsty.
However I also want to get the best from my GP. I am keen to avoid inadvertently distracting him from focussing his attention on my health, or by irritating him.
So thank you Dr C for risking negative reactions from your readers by letting us in on this "pet peeve".
Further insights into pet peeves, *** ideally balanced with things that patients do that cheer you up ***, would be welcome.
I know some people who are irritated by Mahler.
Oh? You surprise me, I would have thought Mahler was generally too vacuous to be irritating.
Anyway, if we could now call this trolling competition a draw, I am ACTUALLY quite interested in the underlying issue of whether there IS individual variation in the need for hydration or speed of processing water or something, in people in normal health. Hence my questions above. I had always vaguely assumed that the government advice about drinking 8 whatevers a day was fairly pointless, because too one-size-fits-all. Does anyone know of any research?
Renal - I would hazard a guess, as a frequent-flyer punter myself, that they would not care two hoots if you were carrying a bottle of water around. Your boss I can't speak for.
Mahler? Sole merit: in the shelf next to Mozart.
There was something on a BBC documentary recently debunking the 2 litres of water a day thing. I think it came from some obscure paper (yes, just the one) written decades ago that said a person should get about 2 litres of ater a day for optimum health. However, the paper also said that water from food (there's loads apparently - and not just in cucumber) and from other fluids counted towards that 2 litres. Conclusion was that most people got all they needed from their regular diet.
The programme also did an experiment on a set of twins re: how drinking water affects the complexion. One twin did the water thing, the other had none. Result: no difference.
Physiologically, you absolutely need a certain daily intake of water. But this intake can come from water content of food (e.g. fresh fruit and veg, to give the most obvious) or from ANY drink.
One of the things endlessly repeated by the Womens' Mags and idiot newspaper "Natural Health" correspondents, and which pisses us physiologists off, is the nonsensical statement that "cups of tea and coffee and caffeinated soft drinks don't count as part of your daily water intake, as they dehydrate you".
Duh. A large cup of tea contains a lot of water. It also contains some things, like caffeine and related substances, that cause a slight diuresis (peeing out more). The two things are working in opposite directions, so the "net rehydration" you gain from your cup of tea might be a bit less than if you had drunk exactly the same amount of plain water. But to infer that the cup of tea "doesn't count" as hydration, and that you therefore have to drink the same VOLUME again (or more)as plain water, is complete garbage.
Anything with water in it counts as water. (Unsurprisingly).
Over the course of a day, water in equals water out. If anyone wishes to do an experiment, try measuring what comes out the obvious way (an old kitchen measuring jug is good) and comparing it to what you drank. Not very exact, as there are other "routes" in (food) and out (sweating and... use your imagination) but instructive all the same.
OK OK so, why don't they also carry a sandwich in case they are hungry and a plastic urine bottle in case they need a pee.
It is an affectation
People generally eat three meals a day, and don't really eat much in between. They tend to want to have a drink with somewhat greater frequency. We should not be surprised, therefore, to find more carriers of water than carriers of sandwiches or chocolate bars.
And I'd have thought that people don't generally want to carry a plastic bottle for the other end as, if they find they have to use it, they then have to finish their day carrying around a bottle of piss.
PhD scientist, if you're a physiologist maybe you can answer my question. When I mentioned this debate to my other half, including the fact that Dr Crippen (apparently) doesn't carry water around much, he said, huh, he obviously doesn't sweat as much as I do.
So the question is, is it reasonable to suppose that some people naturally sweat more (assuming the same environment); and therefore have to drink more, to the extent that they don't pee less?
Or is it more likely that if people drink more (because they are affected, whatever), then they sweat more and/or pee more?
This is a very hard subject to Google!
One of the things endlessly repeated by the Womens' Mags and idiot newspaper "Natural Health" correspondents, and which pisses us physiologists off, is the nonsensical statement that "cups of tea and coffee and caffeinated soft drinks don't count as part of your daily water intake, as they dehydrate you".
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I have an ileostomy and we are told not to drink plain water as it will increase dehydration, rather we should drink squash. Everyone is different!
Who is Professor Sir Ara Darzi? Is he any good?
K
K - I researched him a bit - he was born in Armenia, educated in Ireland, and now, at 47, has more honours and posts than I can be bothered to type out, with his prime role being Professor of Surgery at Imperial. He has a kind of engineering focus (according to him). He is into minimally invasive techniques. I found a nice story about him working as a porter for an evening at the hospital where he was a consultant surgeon (with the full knowledge of the management thereof), to see if anyone noticed it was him, to make a point about porters being generally ignored.
He sounds like he might not be a yes-man, anyhow.
Hi Potentilla
The short answer is that this is more likely to be a behavioural thing - your other half thinks he needs to drink because he thinks he sweats a lot! - rather than physiological.
This isn't my specialist field, I should say, so I have been looking about to check dimly recalled info. Having done so, I can see why people are confused - there is a shed-load of disinformation and rubbish out there, much of it promulgated by various natural health nitwits. I suspect the drink sellers have a role too, although more in terms of "carry your water bottle" (selling lifetyle, which is what they are good at) rather than " drink 4 L / day". Though I doubt the widespread "drink loads" idea makes them sad.
Anyway, the general idea is that your daily body water loss in a temperate climate is about 2.5 L / day. Only a few hundred mL (cubic centimetres) of this are sweating, though this figure is sometimes quoted bigger as some people include evaporation along with it.
Urine output is the biggest part of the 2.5 L, usually quoted as 1.2 - 1.5 L / day or thereabouts.
To compensate for the 2.5 L loss you need to take around 2.5 L in . You probably get about a third of this from the diet, so you need to drink about 1.5-2.5 L TOTAL FLUID a day. I think this is what the British Dietetic Association, who as Dr C give sensible advice on things food and drink-related, recommend.
Of course, if you are in a hot climate, or exercising, you can sweat much more, up to 1 L an hr. Then you would need obviously need to take in much more water. Hence the typical advice to drink after strenuous exercise, esp. in the heat.
So it is possible, I guess, that your other half is losing lots by sweating. But if it is just "a bit more than average" his kidneys should just output a bit less urine. Anyway, unless he is dripping with sweat all day, the urge to drink is more likely not physiological.
Like many things that seem simple, water intake / output is actually much more complicated underneath. Apart from the in / out balance, (and I forgot to mention water loss by breathing / evaporation in the last post - oops) there is adjustment "on both ends". If you are dehydrated (say after exercising), your body will tells you to drink more to rehydrate. Conversely, if you drink more (e.g. because your personal trainer told you to drink 4 L day) your body will adjust to pee out bigger volumes of dilute urine.
Sue - the different advice you have been given re what to drink relates to your ileostomy, since normally the colon is a major reabsorption site for the water in the fluid you drink / in your food / from your digestive juices.
Thanks PhD Sci. "Dripping with sweat all day" would be an exaggeration when we're in in sunny Scotland, but not totally hyperbolic, in fact. And I've seen him come in from walking around Hong Kong in 30C and 100% humidity in a state where he could actually take his shirt off and wring it out.
We probably also both have a bit of a water habit left over from NSW in the summer. I remember one particular journey with three of us in the car when the outside temp was well over 40C, the aircon was feeble, and every time we stopped for fuel we bought more water than petrol by volume. And never needed to stop for a pee at all!
PhD scientist
You say "Sue - the different advice you have been given re what to drink relates to your ileostomy, since normally the colon is a major reabsorption site for the water in the fluid you drink / in your food / from your digestive juices."
It seems from what you've said:
The ileostomy means the colon is not reabsorbing water as it used to.
Therefore the body tends to lose more water than it used to.
So the extra water being lost needs to be replaced.
That doesn't explain why drinking plain water won't do the job.
Potentilla - on your point about people having varying needs for water - I never cease to be surprised by the fact that my father, who is in his nineties, sprinkles very generous quantities of salt on food that I already feel is to salty, and probably drinks a total of less than half a litre of fluid a day. Given he has reached his nineties in good health I hesitate to suggest he does anything different. But I find it hard to square what he does with current accepted wisdom.
Wise old woman
Because of the no-colon effect ileostomy patients tend to lose (since they don't reabsorb it as well) water AND electrolytes, mostly sodium but sometimes potassium as well.
Because of this they may be told to take "sports electrolyte drinks", or fruit drinks with some electrolytes in them, or (fruit) juices which have a lot of potassium in them, rather than plain water - this is to help keep the electrolyte levels topped up. But getting enough fluid in is important in itself.
These regimens will be adjusted for the individual.
Perhaps the earlier explanation was too simple. Truth is, I can't really see why a sugary fruit drink (probably mostly fruit sugars) rather than water, but maybe a gastro type reading this can enlighten us...!
Most sensible advice I've heard on 'how much fluid?': pay attention to the colour of your pee.
But doesn't work when you're jaundiced....
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