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What Causes Fluid Retention And Excessive Urination?
Question: Dear Dr Iliri,
As always, thank you so much for your endless knowledge, kindness, and patience.
As I am so anxious about fluid retention, does it make any sense to use a diuretic?
I know that sounds crazy and even when I was sick, I was not on a diuretic ever. When I had a urine volume measure, it was over 3 liters though I only drank 2.2 liters, I think because I eat a vegetarian diet. Still it seems that most days I do drink far more than I am urinating and I'm terrified about it all the time. It seems to me that everyone around me drinks far less and are always running to the bathroom. I am so anxious on this matter but I do know diuretics can have dangerous side effects.
I am at a loss at the moment. Therapy and medication fail to fully alleviate my fears on this matter.
As always, thank you so much for your endless knowledge, kindness, and patience.
As I am so anxious about fluid retention, does it make any sense to use a diuretic?
I know that sounds crazy and even when I was sick, I was not on a diuretic ever. When I had a urine volume measure, it was over 3 liters though I only drank 2.2 liters, I think because I eat a vegetarian diet. Still it seems that most days I do drink far more than I am urinating and I'm terrified about it all the time. It seems to me that everyone around me drinks far less and are always running to the bathroom. I am so anxious on this matter but I do know diuretics can have dangerous side effects.
I am at a loss at the moment. Therapy and medication fail to fully alleviate my fears on this matter.
Brief Answer:
There are no obvious medical indications for using diuretics.
Detailed Answer:
Hello dear XXXX!
I would like to explain that it's impossible to have a daily urine volume greater than fluids you take with drinking and foods.
Instead, daily urine volume is less than what we take (fluids), as a part is eliminated with skin perspiration (sweating) and respiration (it may be up to around 1 liter).
I would not prefer to make comparisons with other individual as this could lead to quite wrong conclusions.
As far as you haven't any clinical signs and symptoms of heart failure (no dyspnea, no systemic or pulmonary congestion [no edema], a perfectly normal cardiac structure and function, and a quite normal NT-pro BNP and BNP), as well as no evidence of renal dysfunction, there is no evidence-based reason to use diuretics. This issue could not be a matter for discussion.
I think you are just a bit anxious, and this leads to unpleasant thoughts. But, indeed, there is nothing to worry about!
I am glad to be able to explain these facts to you!
I hope that your anxiety will be relieved after my explanations.
Nevertheless, if you have further uncertainties, feel free to contact me!
Kind regards,
Dr. Iliri
There are no obvious medical indications for using diuretics.
Detailed Answer:
Hello dear XXXX!
I would like to explain that it's impossible to have a daily urine volume greater than fluids you take with drinking and foods.
Instead, daily urine volume is less than what we take (fluids), as a part is eliminated with skin perspiration (sweating) and respiration (it may be up to around 1 liter).
I would not prefer to make comparisons with other individual as this could lead to quite wrong conclusions.
As far as you haven't any clinical signs and symptoms of heart failure (no dyspnea, no systemic or pulmonary congestion [no edema], a perfectly normal cardiac structure and function, and a quite normal NT-pro BNP and BNP), as well as no evidence of renal dysfunction, there is no evidence-based reason to use diuretics. This issue could not be a matter for discussion.
I think you are just a bit anxious, and this leads to unpleasant thoughts. But, indeed, there is nothing to worry about!
I am glad to be able to explain these facts to you!
I hope that your anxiety will be relieved after my explanations.
Nevertheless, if you have further uncertainties, feel free to contact me!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Iliri,
As always thank you so much. I am trying very hard to control my anxiety but as I was told repeatedly fluid would literally kill me and I was essentially asymptomatic, I am finding it so difficult to believe that something as seemingly benign and pure as water isn't very dangerous.
I understand about "insensible losses" and I merely meant that I believe I get considerable fluids from my diet which is mostly vegetarian and therefore contains many watery foods.
I am under strict instructions by my therapist to cease ER visits and seeing more specialists as they only build up anxiety. But you see, as a month now has passed since my heart, kidneys, and blood have been tested, my fear grows and I feel certain that my heart or kidneys are possibly failing. I wish heart and kidney function could be tested at home as easily as blood pressure or glucose. I am so scared as I feel fine but also felt fine at EF 25/30. If my EF began to fall below 55, do you think I would
Notice symptoms as I am so sensitized now?
Thank you thank you
As always thank you so much. I am trying very hard to control my anxiety but as I was told repeatedly fluid would literally kill me and I was essentially asymptomatic, I am finding it so difficult to believe that something as seemingly benign and pure as water isn't very dangerous.
I understand about "insensible losses" and I merely meant that I believe I get considerable fluids from my diet which is mostly vegetarian and therefore contains many watery foods.
I am under strict instructions by my therapist to cease ER visits and seeing more specialists as they only build up anxiety. But you see, as a month now has passed since my heart, kidneys, and blood have been tested, my fear grows and I feel certain that my heart or kidneys are possibly failing. I wish heart and kidney function could be tested at home as easily as blood pressure or glucose. I am so scared as I feel fine but also felt fine at EF 25/30. If my EF began to fall below 55, do you think I would
Notice symptoms as I am so sensitized now?
Thank you thank you
Brief Answer:
Follow advice:
Detailed Answer:
Hi again, dear XXXX!
As you feel physically fine, you don’t have to be scared. Your well being is a good marker that your heart, kidney and entire body are in perfectly good conditions.
If something would be wrong, it would certainly appear clinical signs and symptoms. Being so sensitized, you would be able to detect even the minor clinical change.
So, you need to disregard your unjustified fears, as nothing bad is going to happen, though it is now a month from the last lab tests.
Even during arrhythmia induced cardiomyopathy, there has been clinical symptomatology, which has guided your doctor through the right diagnostic work up and appropriate treatment.
I don’t recommend you to monthly check laboratory tests. They are not necessary.
Instead, I encourage you being in close contact with your therapist. A medical checkup performed twice yearly is quite enough to monitor your clinical conditions.
I recommend you being physically active, as it will help relieving your anxiety and fears.
Do not hesitate to contact me in case of further support!
Kind regards,
Dr. Iliri
Follow advice:
Detailed Answer:
Hi again, dear XXXX!
As you feel physically fine, you don’t have to be scared. Your well being is a good marker that your heart, kidney and entire body are in perfectly good conditions.
If something would be wrong, it would certainly appear clinical signs and symptoms. Being so sensitized, you would be able to detect even the minor clinical change.
So, you need to disregard your unjustified fears, as nothing bad is going to happen, though it is now a month from the last lab tests.
Even during arrhythmia induced cardiomyopathy, there has been clinical symptomatology, which has guided your doctor through the right diagnostic work up and appropriate treatment.
I don’t recommend you to monthly check laboratory tests. They are not necessary.
Instead, I encourage you being in close contact with your therapist. A medical checkup performed twice yearly is quite enough to monitor your clinical conditions.
I recommend you being physically active, as it will help relieving your anxiety and fears.
Do not hesitate to contact me in case of further support!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much, Dr. Iliri. Despite my continued anxiety you are helping me very much. Today I had my 6-month follow-up with my EP. I had an ekg, which was normal but no other tests, not even a physical exam. It has been very recent since I had testing with regular cardio, but I was surprised that he feels no testing necessary at this point. He believes firmly that I am completely cured and now 9 months after ablation, the chances of recurrence are nearly zero. I will see him again in 3 months. He says if I were not anxious he would say that I would not need further follow ups other than normal general physicals with my GP annually. Do you agree with that?
I do feel healthy, other than the horrible obsession with fluids so I hope it is true that if I were to get sick again, I would know right away.
Every doctor I see is 100% certain I am cured. I don't know why I cannot believe it and remain so worried. My EP did think I seemed much better now though. He believes testing me now when it's not necessary fosters belief that I may be sick and need close monitoring when it is not true.
Thank you so much, as always.
XXXX
I do feel healthy, other than the horrible obsession with fluids so I hope it is true that if I were to get sick again, I would know right away.
Every doctor I see is 100% certain I am cured. I don't know why I cannot believe it and remain so worried. My EP did think I seemed much better now though. He believes testing me now when it's not necessary fosters belief that I may be sick and need close monitoring when it is not true.
Thank you so much, as always.
XXXX
Brief Answer:
The most challenging issue is the management of your anxiety.
Detailed Answer:
Hello dear XXXX!
I am glad that your EP has concluded that everything is going OK.
As we have discussed in our previous threads, you are in clinical perfect conditions.
Your cardiac and lab tests confirm this.
I agree with your EP that a very close cardiological follow up would not be necessary as you are considered quite a healthy normal individual.
Coming to this point, a yearly follow up by your cardiologist would be sufficient to check your clinical conditions.
For the moment the most challenging issue is the management of your anxiety and OCD disorder.
I would recommend discussing with your psychiatrist to consider the possibility of switching to another antidepressive drug or to raise the doses. You should know that the fispathological mechanism of OCD and anxiety is related to different neurotransmitters like serotonine, noradrenaline, adrenaline, dopamine etc.
Different antidepressant act by affecting different neurotransmitters metabolism.
For example, if a SSRI class drug results ineffective in treating depression, anxiety or OCD disorder, another class (like tricyclic antidepressants or venlafaxine) can result effective after switching into this therapy.
Anyway, I don't believe that only drugs will bring to the magic improvement that trying to achieve.
You should engage yourself in some recreational physical activity and sports, which act into your brain with the same mechanism as antidepressants .
Hope to have been helpful!
Wishing a nice weekend,
Dr. Iliri
The most challenging issue is the management of your anxiety.
Detailed Answer:
Hello dear XXXX!
I am glad that your EP has concluded that everything is going OK.
As we have discussed in our previous threads, you are in clinical perfect conditions.
Your cardiac and lab tests confirm this.
I agree with your EP that a very close cardiological follow up would not be necessary as you are considered quite a healthy normal individual.
Coming to this point, a yearly follow up by your cardiologist would be sufficient to check your clinical conditions.
For the moment the most challenging issue is the management of your anxiety and OCD disorder.
I would recommend discussing with your psychiatrist to consider the possibility of switching to another antidepressive drug or to raise the doses. You should know that the fispathological mechanism of OCD and anxiety is related to different neurotransmitters like serotonine, noradrenaline, adrenaline, dopamine etc.
Different antidepressant act by affecting different neurotransmitters metabolism.
For example, if a SSRI class drug results ineffective in treating depression, anxiety or OCD disorder, another class (like tricyclic antidepressants or venlafaxine) can result effective after switching into this therapy.
Anyway, I don't believe that only drugs will bring to the magic improvement that trying to achieve.
You should engage yourself in some recreational physical activity and sports, which act into your brain with the same mechanism as antidepressants .
Hope to have been helpful!
Wishing a nice weekend,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
I am being very much challenged by the temptation to visit the ER for testing of my heart/kidneys. I have managed to have an echo about once a month and now it has been two months. I feel fine, other than anxiety, but again I felt fine with an EF of 25-30. Do you think it's impossible that I can be experiencing any problems 6 weeks after last echo? Is it not worth it for me to seek echo and other tests to feel reassured I am still ok?
Thank you so much, dear Dr Iliri.
I am being very much challenged by the temptation to visit the ER for testing of my heart/kidneys. I have managed to have an echo about once a month and now it has been two months. I feel fine, other than anxiety, but again I felt fine with an EF of 25-30. Do you think it's impossible that I can be experiencing any problems 6 weeks after last echo? Is it not worth it for me to seek echo and other tests to feel reassured I am still ok?
Thank you so much, dear Dr Iliri.
Brief Answer:
Nothing bad could be possible on your actual clinical conditions.
Detailed Answer:
XXXX!
I would like to explain that in your case the risk for adverse cardiac/kidneys complications is not increased over the time, as long as no precipitating (triggering) underlying factors exist.
Your cardiac function is quite perfect (as you already know), and it can't altered from nothing nonexistent.
I personally don't believe that your obsession for monthly visiting the ER service will help in relieving your fears. In fact this ritual is just a component of your OCD. If you keep refreshing your obsession, it will never disappear (this could not be reassuring for your health).
So my advice would be to disregard that medically non-based option of a potential cardiomyopathy relapse after a couple of weeks. Nothing bad could be possible on your actual clinical conditions.
So, don't go to the ER; instead enjoy your valuable time in any recreational activities.
Don't think about bad health implications, as it is absolutely not your case.
You are perfectly normal! Don't forget that!
Wishing you a nice time!
Dr. Iliri
Nothing bad could be possible on your actual clinical conditions.
Detailed Answer:
XXXX!
I would like to explain that in your case the risk for adverse cardiac/kidneys complications is not increased over the time, as long as no precipitating (triggering) underlying factors exist.
Your cardiac function is quite perfect (as you already know), and it can't altered from nothing nonexistent.
I personally don't believe that your obsession for monthly visiting the ER service will help in relieving your fears. In fact this ritual is just a component of your OCD. If you keep refreshing your obsession, it will never disappear (this could not be reassuring for your health).
So my advice would be to disregard that medically non-based option of a potential cardiomyopathy relapse after a couple of weeks. Nothing bad could be possible on your actual clinical conditions.
So, don't go to the ER; instead enjoy your valuable time in any recreational activities.
Don't think about bad health implications, as it is absolutely not your case.
You are perfectly normal! Don't forget that!
Wishing you a nice time!
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Iliri,
While it may not be obvious given how frequently I continue to need to ask the same questions, you are helping me greatly.
I have not been to ER in over a month now and I am working hard to continue to resist that urge.
My greatest fear is still that if I drink a large amount of fluid, I will immediately go into heart failure. It's difficult to believe I went from EF 25-30 to EF 65-70 without feeling very different. You and all my doctors are very sure I am cured but I am struggling to believe that's true without needing frequent echoes and other tests to be absolutely sure.
Thank you, Dr Iliri. You are helping me so much and I hope I will feel normal soon.
XXXX
While it may not be obvious given how frequently I continue to need to ask the same questions, you are helping me greatly.
I have not been to ER in over a month now and I am working hard to continue to resist that urge.
My greatest fear is still that if I drink a large amount of fluid, I will immediately go into heart failure. It's difficult to believe I went from EF 25-30 to EF 65-70 without feeling very different. You and all my doctors are very sure I am cured but I am struggling to believe that's true without needing frequent echoes and other tests to be absolutely sure.
Thank you, Dr Iliri. You are helping me so much and I hope I will feel normal soon.
XXXX
Brief Answer:
Water intake could not harm you at all.
Detailed Answer:
Dear XXXX!
I believe that your persistent fears will vanish soon, as you are on the right way of understanding all the pathological processes you have experienced with your heart, possible harmful factors, how they work, and what features a regular cardiac check up consists in.
As, you have realized by yourself that too much ER visits are useless, you have to understand that water intake isn’t a responsible cause for leading to heart failure when every cardiac parameter is normal.
You can have all the water you need without being afraid of any adverse consequences.
If you follow a healthy life style and medical advices, you are going to live a very long and happy life.
Everything depends on how you are going to manage your anxiety. As I will be here to support you, feel free to contact me when uncertainties come on the horizon.
Wishing you a pleasant weekend!
Dr. Iliri
Water intake could not harm you at all.
Detailed Answer:
Dear XXXX!
I believe that your persistent fears will vanish soon, as you are on the right way of understanding all the pathological processes you have experienced with your heart, possible harmful factors, how they work, and what features a regular cardiac check up consists in.
As, you have realized by yourself that too much ER visits are useless, you have to understand that water intake isn’t a responsible cause for leading to heart failure when every cardiac parameter is normal.
You can have all the water you need without being afraid of any adverse consequences.
If you follow a healthy life style and medical advices, you are going to live a very long and happy life.
Everything depends on how you are going to manage your anxiety. As I will be here to support you, feel free to contact me when uncertainties come on the horizon.
Wishing you a pleasant weekend!
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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