Drink Up

Ah, water. The most constructive and destructive force in nature. Too much and it will destroy your life (hurricanes, sinkholes, floods). Too little and it will, well, destroy your life (drought, wild fires). It’s all about balance. The human body just can’t live without it.

Dehydration is a danger to everyone in the summer, but especially for those with chronic conditions. It can cause, worsen, or be a symptom of heart disease, hypoalbuminemia (too much albumin in the blood), hyper-/hypothyroidism, cancers requiring a certain course of chemo (cisplatin), and my own lovely monsters, diabetes and kidney disease. If I’m outside too long, I’m dehydrated. If I travel on a plane, I’m dehydrated. If I get sick to my stomach, I’m dehydrated. If my blood sugar is high, I am dehydrated. Around 66% of adult bodies are water, and if we don’t replenish what we use, it can make our conditions worse.

Every year, there is a host of articles warning about the dangers of dehydration, especially in the summer. But what happens if you actually get dehydrated?

Dehydration is a sneaky little devil. Even a little imbalance can cause you to feel spacey and clumsy. Inside your body, your blood thickens, which makes it slow and sluggish, so your heart rate rises. Your body starts conserving water for the most necessary tasks like blood flow and cell function. By the time you feel thirsty, you are already dehydrated.

And it’s not just a matter of being thirsty. Cottonmouth, unexplained exhaustion, and not needing to pee for an unusually long time are all pretty well-known symptoms. But in my experience, dehydration can also cause headaches/migraines, muscle cramps, and a weird, extended numbness in your extremities, like your hand fell asleep and won’t wake up when you shake it. That time I didn’t hydrate properly for exercise, I had the worst cramps I have ever felt. I felt it coming, and just wanted to finish the last few minutes. By the time I got off the treadmill and grabbed water, I couldn’t even sit up straight. I felt nauseated as I slowly sipped water. It didn’t let up completely until over 20 minutes had passed, and that was in an indoor, controlled environment. I have never made that mistake again.

How do you treat it?

Sometimes it’s not as simple as drinking a glass of water.

Water is great, but it may not be the best or fastest treatment, at least by itself. There is a reason “smart” drinks and sports drinks are popular with athletes. They have electrolytes. Electrolytes are a collection of salts -- calcium, magnesium, potassium, and plain old table salt – that help regulate water flow in and out of your cells. A banana can help (but not too much – too much potassium can mess with your heart) and if you don’t have one of those enhanced options close when you need it, you can add salt and/or lemon juice to tap water. There is also Pedialyte, which comes in popsicles!

While you are treating dehydration, you also might want to avoid caffeine, alcohol, sugary drinks (and foods), and anything overly salty, like soy sauce, as they will just work against you.

In the most extreme cases – you can’t tear yourself away from the bathroom due to one end or the other – it’s time to visit the emergency room or urgent care center. They can hook you up, literally. A few hours on IV saline (diabetics out there, make sure it’s the kind without glucose), can work miracles.

Even when you start feeling better with treatment, don’t be fooled. When I asked my doctor about it last time I had this issue, he said that it takes a day or two to recover completely. Don’t be surprised if you are completely wiped out for one or two days.

Of course, the best treatment is no treatment at all. It’s prevention, like all those articles tell you. Keep a bottle of water with you if you’re going to be outside (especially in the summer heat) or away from somewhere you can easily get a drink. Throw a few bottles in your car or your bag. Your body will thank you for it.

If You Can’t Stand the Heat . . .

Summer in Washington is, um, special. Innumerable tourists flooding the attractions in matching neon t-shirts, buses eating up all the parking. Protests, interns, festivals. Tons of stuff to bring people to city center. Nevertheless, sometimes I brace myself in an attempt to not take my city for granted. The National Portrait Gallery is a favorite hidden gem.

But I digress. Everyone who knows anything about DC knows the worst part is the weather. As I write this, we are in the midst of a string of over 10 days in the mid-to-upper 90s. The “feels like” temperature often crosses 100 degrees -- all of the heat and humidity of the swamp it was, but without much in the way of relief. No breeze, no swimmable body of water. (My friends who sail take a break in the summer because the wind dies, and the Potomac and Anacostia Rivers are questionable at best.)

I absolutely refuse to protest in the summer. Shuffling along for at least six hours carrying a sign and a backpack in that kind of heat -- oh, yay. But the rest is doable. With the right kind of planning.

I’ve talked about this before, about what I have to shlep with me every day. Summer adds something to it. Heat and dehydration can be dangerous for people with autoimmune conditions. Many of our conditions make us vulnerable to dehydration without the heat – Crohn’s Disease, irritable bowel syndrome, anything that comes with low blood pressure (which makes it hard for the body to retain water), certainly diabetes. Things that are usually treated with a lie down and Gatorade -- exhaustion, dizzy spells, heat stroke -- can land you in the hospital with IV saline if you’re not careful.

I haven’t been admitted to a hospital for over 15 years and I don’t intend to ruin my record. But I also don’t want to stay cooped up in my apartment for four months if I can avoid it. I’m sure you feel the same, so here are a few tips to help deal with the worst of the summer heat:

• Drive. There is often no help for our kind of problems in metro stations. In Washington, there are no water fountains or restrooms at most stations, and air circulation is poor in the underground stations, which is most of them.  
• Even if you think you’ve had enough water, keep drinking. I bring two bottles of water with me during the day, one frozen and one not. I also keep water in my car for emergencies. Warm is better than nothing.
• Take stock often. Do that mental check you run through every morning to see how you are feeling. I am lucky that I have a way to monitor my disease dehydration, so I test my blood sugar at least every couple of hours. I only have to guess on regular dehydration. Pay attention to your respiratory rate and do not allow yourself to wait for a drink if you are thirsty. Nutritionist Kathy Rodgers says that if you’re thirsty, dehydration has already started.
• Limit your time in the sun. The National Mall and trail around the Potomac River tidal basin is over three miles. If you are out in a place like that, stop in museums or in the shade at regular intervals.
• Don’t push yourself too hard. Keeping up with healthier friends and not accommodating your condition may seem like a good idea at the time, but it will make the problem worse. I’ve never been dehydrated due to the weather, but I have experienced dehydration by pushing myself to do cardio past when I began to feel dehydrated. For me, that means excruciating abdominal cramps that take a minimum of 20 minutes to ease even when I am guzzling liquid. Great way to kill a workout.
• If you’re at a beach or a pool, splash around as much as you can. Sweat is your body’s way of cooling you down when you are too hot. Give it a boost with a cannonball or a good splash fight with your friends.

Above all, trust your instincts. They are a well-developed tool that we don’t trust enough. If your body is telling you to get out of the sun, get out of the sun.

Enjoy your August!