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Does Decrease In Urination Cause Water Retention?
Question: Dear Dr Iliri,
Wishing you a very very happy New Year. You have been so helpful to me, I cannot thank you enough. I hope as I go through a year of being healthy, I will forget what happened and can move on.
I have lingering fears of water retention. I have noticed this pattern of urinating less when I've been just slightly active, like while grocery shopping or cooking as compared to being totally inactive, such as working at my desk or watching television. I badly decided to research this and saw this page about how diuresis is increased when heart failure patients are recumbent. This, of course, worried me endlessly, as I have concluded that while I don't have visible edema, I must have some or else I wouldn't notice this. This is the page:
http://YYYYYY.com/6-XXXX-XXXXX-CCCC-XXXXX-XXXXX/
Do you think I could use a renal blood flow scan to assure that my heart is providing proper blood flow to my kidneys? I am worried that athough my kidney function tests have been normal, they've been early in the day before I've become overloaded with fluid. Also it's been 4 months since my last check of kidneys so I'm worried that could have changed. It has, of course, only been one month since last echo.
Thank you Dr. I hope so much to be over this fluid obsession soon.
Happiest of New Years to you.
XXXX
Wishing you a very very happy New Year. You have been so helpful to me, I cannot thank you enough. I hope as I go through a year of being healthy, I will forget what happened and can move on.
I have lingering fears of water retention. I have noticed this pattern of urinating less when I've been just slightly active, like while grocery shopping or cooking as compared to being totally inactive, such as working at my desk or watching television. I badly decided to research this and saw this page about how diuresis is increased when heart failure patients are recumbent. This, of course, worried me endlessly, as I have concluded that while I don't have visible edema, I must have some or else I wouldn't notice this. This is the page:
http://YYYYYY.com/6-XXXX-XXXXX-CCCC-XXXXX-XXXXX/
Do you think I could use a renal blood flow scan to assure that my heart is providing proper blood flow to my kidneys? I am worried that athough my kidney function tests have been normal, they've been early in the day before I've become overloaded with fluid. Also it's been 4 months since my last check of kidneys so I'm worried that could have changed. It has, of course, only been one month since last echo.
Thank you Dr. I hope so much to be over this fluid obsession soon.
Happiest of New Years to you.
XXXX
Brief Answer:
I could explain:
Detailed Answer:
Dear XXXX,
I am glad to hear from you again.
I understand you concern about fears on nonvisible fluid overload.
Also checked your uploaded web link.
Let me explain that renal function doesn’t change by modulating your posture.
A slightly lower urine output during physical activity and when on the upright position is not an expression of fluid retention.
I would say that in normal individuals urine production is increased when staying on recumbent position.
If the person takes a physically active role, compensatory cardio-renal mechanisms become active, such as increased heart rate and stroke volume; redistribution of blood by increasing the proportion that supply skeletal muscles, brain and lungs and decreasing to the kidneys and other splanchnic organs.
This explains your intelligent observation.
I just want to reassure you again that nothing wrong is happening with your heart and kidneys.
First of all, your cardiac output has shown a sustainable improvement since your successful cardiac ablation.
So, there is no rationale evidence for thinking about a renal blood hypo-perfusion.
Also you have no medical evidence of renal vascular disease (no diabetes, no systemic disorders, no previous parenchymal renal disorders, no renal infections, etc.)
Furthermore your renal function tests (BUN and creatinine) confirm the opposite; your kidneys are perfectly supplied with blood.
I would just recommend you performing follow up tests of renal function and blood electrolytes level (every six to 12 months).
As long as you are feeling clinically perfect and your medical tests are normal you shouldn’t worry about any unexpected medical issue.
I think your fears on certain health issues will be gradually resolved during the New Year which is coming.
I wish you all the best!
A happy New Year!
Let me know on your tests results and future medical checkups.
Kind regards,
Dr. Iliri
I could explain:
Detailed Answer:
Dear XXXX,
I am glad to hear from you again.
I understand you concern about fears on nonvisible fluid overload.
Also checked your uploaded web link.
Let me explain that renal function doesn’t change by modulating your posture.
A slightly lower urine output during physical activity and when on the upright position is not an expression of fluid retention.
I would say that in normal individuals urine production is increased when staying on recumbent position.
If the person takes a physically active role, compensatory cardio-renal mechanisms become active, such as increased heart rate and stroke volume; redistribution of blood by increasing the proportion that supply skeletal muscles, brain and lungs and decreasing to the kidneys and other splanchnic organs.
This explains your intelligent observation.
I just want to reassure you again that nothing wrong is happening with your heart and kidneys.
First of all, your cardiac output has shown a sustainable improvement since your successful cardiac ablation.
So, there is no rationale evidence for thinking about a renal blood hypo-perfusion.
Also you have no medical evidence of renal vascular disease (no diabetes, no systemic disorders, no previous parenchymal renal disorders, no renal infections, etc.)
Furthermore your renal function tests (BUN and creatinine) confirm the opposite; your kidneys are perfectly supplied with blood.
I would just recommend you performing follow up tests of renal function and blood electrolytes level (every six to 12 months).
As long as you are feeling clinically perfect and your medical tests are normal you shouldn’t worry about any unexpected medical issue.
I think your fears on certain health issues will be gradually resolved during the New Year which is coming.
I wish you all the best!
A happy New Year!
Let me know on your tests results and future medical checkups.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much Dr Iliri,
So even if there is slightly less urine output while active, the fluid is being used by the body so it's not causing fluid retention to be upright? I know it sounds so so so crazy but because of this, although I have to be active for my son, and I exercise, I often will try and be as still as possible after drinking. I would like to further increase my exercise but am afraid of much less I would urinate when sweating more and so needing much more water. Even as I type those words, they sound crazy. I am so afraid of water retention that I sometimes will not go out.
I have noticed since starting Prozac in May that I have to be extremely strict with calories in order to not gain weight. As it doesnt seem to help my anxiety or ocd, I am going to talk to my psychiatrist about stopping. My one fear is that last time I stopped Prozac and started a new antidepressant- Brintellix- my PVCs started and they did not stop when reinstated. By time of my ablation I was not on any AD and didn't start until May. Have you ever heard of stopp
So even if there is slightly less urine output while active, the fluid is being used by the body so it's not causing fluid retention to be upright? I know it sounds so so so crazy but because of this, although I have to be active for my son, and I exercise, I often will try and be as still as possible after drinking. I would like to further increase my exercise but am afraid of much less I would urinate when sweating more and so needing much more water. Even as I type those words, they sound crazy. I am so afraid of water retention that I sometimes will not go out.
I have noticed since starting Prozac in May that I have to be extremely strict with calories in order to not gain weight. As it doesnt seem to help my anxiety or ocd, I am going to talk to my psychiatrist about stopping. My one fear is that last time I stopped Prozac and started a new antidepressant- Brintellix- my PVCs started and they did not stop when reinstated. By time of my ablation I was not on any AD and didn't start until May. Have you ever heard of stopp
Brief Answer:
My opinion:
Detailed Answer:
Dear XXXX,
You shouldn’t be afraid of exercising and being physically active.
Remember that movement means more health and a longer life.
As I have explained you previously, those slight variations when performing physical exertion are due to activation of several compensatory mechanisms which maintain the normal blood volume and compensate for water loss by other ways (such as sweating, increased breathing).
At the end, when concluding on this point we call for help renal function tests, which in fact are quite normal.
Regarding Prozac, I would explain that this is a SSRI drug, just like Brintellix.
You should know that when stopping these drugs can lead to exacerbation of anxiety, thus causing PVCs.
From the other hand the concomitant intake of these drugs, or the beginning of another SSRI before 2 weeks after stopping Prozac can lead to serotoninergic syndrome, which could be related to PVCs besides other symptoms.
You should discuss with your doctor on the possibility of gradually stopping Prozac (as the way you started it), in order to avoid possible adverse effects (such as exacerbation of anxiety), even though you feel that it has not been effective.
Wishing you all the best for the New Year!
Regards,
Dr. Iliri
My opinion:
Detailed Answer:
Dear XXXX,
You shouldn’t be afraid of exercising and being physically active.
Remember that movement means more health and a longer life.
As I have explained you previously, those slight variations when performing physical exertion are due to activation of several compensatory mechanisms which maintain the normal blood volume and compensate for water loss by other ways (such as sweating, increased breathing).
At the end, when concluding on this point we call for help renal function tests, which in fact are quite normal.
Regarding Prozac, I would explain that this is a SSRI drug, just like Brintellix.
You should know that when stopping these drugs can lead to exacerbation of anxiety, thus causing PVCs.
From the other hand the concomitant intake of these drugs, or the beginning of another SSRI before 2 weeks after stopping Prozac can lead to serotoninergic syndrome, which could be related to PVCs besides other symptoms.
You should discuss with your doctor on the possibility of gradually stopping Prozac (as the way you started it), in order to avoid possible adverse effects (such as exacerbation of anxiety), even though you feel that it has not been effective.
Wishing you all the best for the New Year!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I hope you had a wonderful new year holiday and wish you much happiness in 2016.
I was thinking today that despite my anxiety, I have improved a lot, and I have you to thank for much of my improvement. 6 months ago, I was barely working, found it hard to eat or get out of bed, slept only two hours a night, and went to the ER every week. I haven't been to ER in 5 months now, sleep much better, am cycling 10 miles per day, and work full time while caring for my son and my sick parents. I only wish that I could put the thoughts of sudden heart failure and fluid retention out of my head.
In one week, I have my first post-med 48-hour holter. My heart rate has not gone up at all off the carvedilol and I'm not feeling PVCs which I hope means I'm not have PVCs. In the past, I could always feel them but the sensation of them decreased when I started carvedilol. Then in 3 months, another holter and an echo.
Is there another mechanism other than heartrate, BP, arrythmia that carvedilol affects? Even at highest, carvedilol was 9.375 and had been just 3.125 before stopping a month ago. The fluid obsessed former doctor I had told me that as soon as I went off meds, I would quickly slide back into heart failure, fluid overload, and soon die. I know he he was deliberately frightening me but the doubts creep in.
As far as kidney function tests, my doctors say I dont need tests for another 2 years as even when I was sick, creatinine was normal. Does this mean that even with advanced cardiomyopathy, this dreaded fear of lowered urine may not even be a symptom? It was not one I noticed.
I am trying to live my life and not worry so much about fluid but its a challenge every day. I do notice I look healthier and happier than at any point in recent past. Attaching a picture.
Thank you so much, dr. Again wishes for a joyful new year.
XXXX
I hope you had a wonderful new year holiday and wish you much happiness in 2016.
I was thinking today that despite my anxiety, I have improved a lot, and I have you to thank for much of my improvement. 6 months ago, I was barely working, found it hard to eat or get out of bed, slept only two hours a night, and went to the ER every week. I haven't been to ER in 5 months now, sleep much better, am cycling 10 miles per day, and work full time while caring for my son and my sick parents. I only wish that I could put the thoughts of sudden heart failure and fluid retention out of my head.
In one week, I have my first post-med 48-hour holter. My heart rate has not gone up at all off the carvedilol and I'm not feeling PVCs which I hope means I'm not have PVCs. In the past, I could always feel them but the sensation of them decreased when I started carvedilol. Then in 3 months, another holter and an echo.
Is there another mechanism other than heartrate, BP, arrythmia that carvedilol affects? Even at highest, carvedilol was 9.375 and had been just 3.125 before stopping a month ago. The fluid obsessed former doctor I had told me that as soon as I went off meds, I would quickly slide back into heart failure, fluid overload, and soon die. I know he he was deliberately frightening me but the doubts creep in.
As far as kidney function tests, my doctors say I dont need tests for another 2 years as even when I was sick, creatinine was normal. Does this mean that even with advanced cardiomyopathy, this dreaded fear of lowered urine may not even be a symptom? It was not one I noticed.
I am trying to live my life and not worry so much about fluid but its a challenge every day. I do notice I look healthier and happier than at any point in recent past. Attaching a picture.
Thank you so much, dr. Again wishes for a joyful new year.
XXXX
Brief Answer:
I strongly recommend you continuing on this rationale strategy.
Detailed Answer:
Dear XXXX,
I am glad to hear you feel much better now. I have been always sure that your clinical course would nothing else but improve gradually.
Here I mean especially your psychological fears about health issues.
Regarding your cardiovascular status, I have tried to explain that all the already gathered medical evidence confirms you are pretty fine; your cardiac performance, but also your kidney function as well, are perfectly normal.
Down-titration (gradual increase) up to total stopping was expected with this wonderful improvement.
You should relax even more, as there is no medical explanation to support the re-appearance of any heart failure symptomatology.
Carvedilol withdrawal couldn't be a reason to increase your fears about fluid retention.
Contrary, this action means your are already quite normal, without clinical implication of heart failure symptomatology, no arrhythmia.
You should be happy on this conclusion.
I strongly recommend you continuing on this rationale strategy, including a lot of physical exertion, recreational activities, a close medical discussion regarding all your actual uncertainties.
Hope, this New Year will bring al the best to you and you family.
Kind regards,
Dr. Iliri
I strongly recommend you continuing on this rationale strategy.
Detailed Answer:
Dear XXXX,
I am glad to hear you feel much better now. I have been always sure that your clinical course would nothing else but improve gradually.
Here I mean especially your psychological fears about health issues.
Regarding your cardiovascular status, I have tried to explain that all the already gathered medical evidence confirms you are pretty fine; your cardiac performance, but also your kidney function as well, are perfectly normal.
Down-titration (gradual increase) up to total stopping was expected with this wonderful improvement.
You should relax even more, as there is no medical explanation to support the re-appearance of any heart failure symptomatology.
Carvedilol withdrawal couldn't be a reason to increase your fears about fluid retention.
Contrary, this action means your are already quite normal, without clinical implication of heart failure symptomatology, no arrhythmia.
You should be happy on this conclusion.
I strongly recommend you continuing on this rationale strategy, including a lot of physical exertion, recreational activities, a close medical discussion regarding all your actual uncertainties.
Hope, this New Year will bring al the best to you and you family.
Kind regards,
Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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