Doctor Said I had a "Drinking Problem"

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MikeS24
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Date Joined Oct 2010
Total Posts : 131
   Posted 3/25/2011 7:59 AM (GMT -6)   
To All:  I continue to monitor my path to continence recovery and now at nearly 8 full months since surgery, I still have a small amount of leakage.  I measure my pad input and the leak is around 12 to 15 cc for an entire working day.  Not much but it still requires some protection.  On my scheduled phone call appointment check in with my urologist to confir on my 2nd PSA test results (<0.1 undetectable) he asked me how much fluid I was consuming.  I told him it was 16 oz at breakfast,  22  to 24 oz during the work day, 16 oz in the evening with dinner and another 8 oz in the mid-evening for a total of around 64 ounces of fluid.  He told me I was drinking WAY TOO MUCH fluid each day so no wonder I was leaking so much.  Discussed the common myth about having to consume a set amount of water each day and told me to start cutting back, slowly, because my kidneys were accumstomed to such a fluid bombardment each day and that I needed to ween myself to an acceptable level.  That level was to drink when I get thirsty not out of a scheduled habit.  It was an interesting revelation and not the direction I expected to go with my phone appointment.
 
I have found a few other medical professionals on line who profess the same concern that folks drink too much fluids.  The bottled water craze may have prompted this observation by urologists.  Much of the myth stared with Weight Watchers who came up with the 8 glasses per day dictum for everyone. 
 
Curious if others follow the drink when thirsty rule or have a set amount of fluid the consume daily.  Of course, your climate, medications, (including caffeine)activity level and salt consumption play a role in how much water you consume.  This has really rocked my mindset on fluid consumption.   Any thoughts?
 
Mike S.
 
 
Dx 56
Biopsy: Gleason 3+3=6, PSA 6.6 One core of 12 with 5% T1c
Surgery: July 2010 J. Hopkins
Path: Gleason 6, Neg Mar, Neg LN, Neg Sem Ves
9/15/10 1st post op PSA <0.1 undetectable
3/11/11 PSA - TBD <0.1
Incontinence - seeing some progress
Aug -Sept 2010 - 4-5 pads
Oct 2010 3 pads
Nov 2010 2 pads
Dec - Mar 2011 1 pad all day -slight leaking
ED: slow steady improvements

tatt2man
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Date Joined Jan 2010
Total Posts : 2845
   Posted 3/25/2011 8:10 AM (GMT -6)   
MIKE:
mayo clinic's response the question "- to how much fluid should I drink a day .."
www.mayoclinic.com/health/water/NU00283

and I leak 25ml a day (daytime - negligible at night) due to stress incontinence

hugs (but not too tight).
BRONSON
Age:55 -gay with spouse of 14 years, Steve -Peterborough, Ontario, Canada
PSA:10/06/09 3.86
Biopsy:10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy:11/18/09
Pathology:pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA:04/08/10 -0.05 -Zero Club
PSA:09/23/10 -0.05 -Zero Club
PSA:03/24/11 -0.02 -Zero Club
PSA:03/24/12- TBA

142
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Total Posts : 7080
   Posted 3/25/2011 8:12 AM (GMT -6)   
The only times I've ever even looked at how much water (measured) that I actually drink was first during post-DaVinci to compare to urine output volume, and last during RT, when I had to drink the 500ml before treatment.
 
Never before. Always seemed ridiculous to force down water for no reason.

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 3/25/2011 8:21 AM (GMT -6)   
Funny, how different doctor's advice can be on any number of subjects. Since my first round of radiation in 2000, I have been encouaged by a host of doctors to drink between 2 and 3 liters of water a day. I rarely drink anything but water. It is important to remember that the body extracts water from what we eat too, I think that is what the "8 Glasses of water a day" school seem to forget.

If you are thirsty, you need to drink, and pure water is still best for the system.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

medved
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Date Joined Nov 2009
Total Posts : 1100
   Posted 3/25/2011 8:49 AM (GMT -6)   
Mike - was it a Hopkins urologist that made this recommendation?

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/25/2011 8:55 AM (GMT -6)   
Purgatory:  I can see that post radiation, your recovery protocol might have included a good daily "flushing" of your system.  In your case, it is also most likely important to keep your redirected urinary system from being either too acid or base and to prevent those nasty UTIs that you are prone to get.  So, even without any treatment protocol I just naturally was drinking almost 2 liters per day.  Always thought it was best to keep ones kidneys well cleaned.  I guess that was an urban myth as well.  I would like to see the medical science behind my urologists reasoning.  He is no stranger to medical research and is extremely well published in the urology field so I don't think he was "shooting from the hip" on this topic.
 
I42   I drank 5 times the amount with my cath in post surgically.  I could literally watch my bag fill up by the second as my kidneys were working their little hearts out to clear fluid from my system.
 
Bronson:  thanks for the Mayo info.  I will send you an email shortly.  We have many common interests.  More later.
 
Peace all and onward to a drier day.
 
Mike S.

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 3/25/2011 10:05 AM (GMT -6)   
The radiation folks encourage me to drink a lot of water and eat a lot of protein while undergoing radiation. But my understanding is it is goodd to drink, drink, drink. I've been told that by many doctors. I have a problem in that I am never thirsty so never feel like drinking. I have to force myself to drink (especially water; I do tend to drink assorted juices). Also, from time-to-time I have problems with constipation. All-Bran has been most helpful, but I need to drink a lot.
 
Mel

Tigerfan53
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Date Joined Jan 2011
Total Posts : 929
   Posted 3/25/2011 11:54 AM (GMT -6)   

Mike – I can’t comment on the fluid intake because I’m still on the “other side”.  But I see in your signature that you had surgery at Hopkins.  I had consults there and I am considering having treatment there.  I would be very interested in hearing about your experience and who your surgeon was.  Also, since we have similar numbers, I was wondering if you considered seeds.  I’m still trying to decide between surgery and seeds.  Perhaps you could email me.  Any input would be greatly appreciated.


Age 53
Diagnosed Dec 2010
PSA 5.3
Biopsy 50% in 1 of 12 cores, Gleason 6

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/25/2011 11:59 AM (GMT -6)   
Medved:  Yes it was a Hopkins urologist/surgeon who told me I was consuming too much fluid.  I have been drink around 1,900 ml per day.
 
Mel:  You definitely need to follow your physician's advice on drinking.  My comments are only for normal everyday drinking to keep myself well hydrated.  Various therapies will impose conditions that require more of less fluid and your doctor will make you aware of what fluid intake is needed.  Your SRT protocol most likely has some fluid consumption recommendations attached. 
 
Absolutely agree that taking any kind of fiber requires more fluid than usual.  Fiber plus no fluid equal cement in your GI tract.  As stated earlier none of these guidelines accounts for RH, climate, salt intake, exercise and anything else that can rob the body of fluid.   Reading more and a few other qualified medical folks apper to support the drink when thirsty guidelines.  Most notable so far is  Heinz Valtin, a retired professor of physiology from Dartmouth Medical School.  Kidney function can even be diminished through too much fluid.  It appears to make the kidneys less efficient at their filtration function.
 
All this talk of water is making me thirsty.....
 
Mike S.

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 3/25/2011 12:18 PM (GMT -6)   
Mike,

I'm in the "drink when I'm thirsty" group. There are only a couple of rules I try to follow:
- Avoid liquids with a high suger content
- Avoid caffiene
- Stay well hydrated when the Florida heat and humidity go up

I've also had no alcohol for the last 23 years....but that's another story.

Joe
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. Normal activity within 3 days. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 12/9/10 - 0.1

James C.
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Date Joined Aug 2007
Total Posts : 4463
   Posted 3/25/2011 2:11 PM (GMT -6)   
First, congrats on the less than .1 ---AKA zero results.

I am one of the drink when thirsty guys. I probably drink less water than most, but I am also seldom thirsty. A few large mugs of coffee during the day, milk or tea with meals, and water with my meds. I don't find myself standing at the sink and drinking water often. Just the way I have always been..
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 12/10-.09, 02/11-.08
ED-total-Bimix 30cc

Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 3/27/2011 8:34 AM (GMT -6)   
Mike,

I started drinking water like crazy after my surgery. My surgeon could not believe the amount of urine I was producing. I continued it while my catheter was in in an effort to flush the blood that was still in my urine. Well, that problem is gone. I am still drinking water throughout the day. The result? Without even trying, I have dropped that extra 15 lbs that I have been trying to shake for years. When I am filling up on water, I don't feel as hungry. And I think previously my mind would confuse thirst and hunger.

Now obviously a way to correct leaking is to drink less. But I am a believer in the benefits of staying hydrated.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

open RP on 2/14/11 at Mass General

Post Surgery Pathology Report: Gleason 6, T2, Cancer in 35% of Prostate, All Margins Clear

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 3/27/2011 9:43 AM (GMT -6)   
I know it sounds counterintuitive, but I think I was advised that drinking a lot actually HELPS with the incontinence. Maybe your bladder gets a bit more used to holding more?
 
Mel

142
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Date Joined Jan 2010
Total Posts : 7080
   Posted 3/27/2011 10:00 AM (GMT -6)   
Mel,
 
The advice I got was to watch that the urine was never dark. That was to be my indication that I should drink more water.
The logic is that urine that is very concentrated is more irritating to the bladder, so to a point, more water is good.
 
I also drink some more due to gout (yes, again a uric acid issue), but I don't drink till I float, which at the quantities that were originally mentioned, I would. Or would at least be constantly at the pot.
 
After all those "xx ounces (quarts) a day" stories years ago, I just quit listening unless there was a valid reason. If I feel like I need it or want it, I drink it.
 
I tried the "drink more to stretch the bladder" routines, and did add about 50ml "full" capacity over about 6 months, but my water use went up much more with the excessive (daily) laundry runs  sad .

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/28/2011 8:20 AM (GMT -6)   
To All: I never meant to imply that one should get dehydrated. As you all stated that would be just as bad. The hard thing to get my head around is not to drink just for the sake of drinking but to respond to what my body needs as it is telling me. Drink when you are thirsty. Eat when you are hungry. Seems simple enough. I was always of the mindset that the more water the better. It cleanses, it lubricates, etc. However, right now more water just means more stress on my sphincter.
I still track how much I am drinking and even cutting back from 64 oz to 50 oz for part of last week, I noticed a drop in my pad weight by 2 or 3 cc. Last month my average pad input was 10.7 cc and now my average is 9.2 cc of fluid.
I am not feeling thirsty but I don't sit at my desk and drink down big gulps of water throughout the day. I still try to finish a 20 oz glass between 9:30 am and 3:30 pm just to make sure I have enough fluid. So I am really doing a hybrid modification of my drinking habits. I drink when thirsty but sip water in a more limited fashion than before to keep my fluid levels up.

Just wanted to share my thoughts on this subject for those who are still incontinent and are evaluating their own water intake.
Have a great day.

Mike

142
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Date Joined Jan 2010
Total Posts : 7080
   Posted 3/28/2011 8:54 AM (GMT -6)   
Mike,
 
I can't imagine anyone thinking that you or your doctor promoted too little water intake.
 
I understand your situation, though - lots of people in my workplace walk around with water bottles. I wonder about them sometimes, and think that the big push was formulated by bottled water companies (yes guys, another conspiracy theory devil )
 
It is hard to change habits we've built over time.

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 3/28/2011 9:21 AM (GMT -6)   
Mike:
 
Everyone is different. I, for example, am rarely thirsty. But many doctors have advised me to drink more.
 
So, I need to do more than "listen to my body." I need to drink more than I do (I'm getting there).
 
Mel

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/28/2011 10:55 AM (GMT -6)   
Mel: Now I am curious. How much do you drink per day? I have rarely been thirsty but, heck, I have been drowning myself in fluids for years. Mostly water, milk and ice tea. I gave up on soft drinks years ago when my kids were growing up. As a result they are NOT soda drinkers today.
Mike

p_elliott
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Date Joined Nov 2010
Total Posts : 143
   Posted 3/28/2011 11:18 AM (GMT -6)   
Switch from water to bourbon you may still piss yourself but you won't care. smilewinkgrin

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 3/28/2011 11:52 AM (GMT -6)   
Mike:
 
Excellent, fair question. I've never really measured how much I imbibe.
 
Let's see -- when left to my own devices, just listening to my body:
 
6-7 oz. of OJ in the AM and a little bit of cereal/milk.
 
For lunch, I may include 6 ounces of liquid (pop or hot chocolate).
 
For dinner, maybe 6 oz. of something but sometimes nothing to drink.
 
Later in the evening, maybe 10-14 ounces of assorted juices (apple, cranberry, or grape).
 
HOWEVER, in the last year I have reduced drinking pop (soda for those of you out East). I try and drink more water -- usually a 16.9 oz. bottle. I have that on my desk when I'm teaching and it helps with the voice, too. Also, I forgot to add that I work out 2-3 times per week and I do down another 16.p oz. bottle of water.
 
That's a very rough estimate.
 
Mel

142
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Date Joined Jan 2010
Total Posts : 7080
   Posted 3/28/2011 4:30 PM (GMT -6)   
Just did a quick note yesterday. Had to measure what is in the normal cups/glasses I use, as it had never been of interest before.
I guess I'm in between, but close to the higher end  -
 
8 oz. of water to choke down the handfull of pills early in the morning
6-8 oz. of juice with breakfast
12-16 oz. of water with lunch (depends on the glass I use)
12-16 oz. of water with dinner
8 oz. of water with the late-night pills
 

logoslidat
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Date Joined Sep 2009
Total Posts : 6057
   Posted 3/28/2011 6:18 PM (GMT -6)   
Im not so sure about drinking only when your thirsty. Especially if you are at all active, the advice I have always heard is if you wait till your'e thirsty, you are already dehydrated. Makes since in a subtle way. I mean what makes you thirsty? So if true, is it ok to get dehydrated, hence thirst, then hydrate. Or should you stay ahead of the power curve and not risk kidney stones. 142 said it , though, the darker the urine the more dehydrated you are. I go by the color, but was just scoped,cause of blood in urine, small sharp stone in bladder.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/29/2011 7:33 AM (GMT -6)   
The only thing certain I am going by are these factors: My doctor, who is a leading urologist in the field told me that my consumption of 1,900 ml of fluid a day was far too much. I should use thirst as a guide for consuming fluid. Before cutting back I was constantly going to the bathroom and my sphincter and bladder were always under stress.

The 8 glasses per day "rule" appears to have been made up by Weight Watchers as a hunger mitigator. It then slipped into the cannon of medical truths. Heinz Valitin, physician and Dartmouth Med School Instructor has published on this as well. He dismisses the notion of 8 x 8 glasses per day as having no scientific support behind the claims. He addresses the notion of dehydration when he states: "It is often stated that by the time people are thirsty, they are already dehydrated. On the contrary, thirst begins when the concentration of blood (an accurate indicator of our state of hydration) has risen by less than two percent, whereas most experts would define dehydration as beginning when that concentration has risen by at least five percent." A similar argument is given for urine color. It has no particular diagnostic sign.

Again, if a person is on medications that require higher fluid consumption, live in dry climates that force more fluid consumption or are in a rigorous exercise program, they need to act appropriately and consume fluids to desired or obligated levels.

Thirst is a very powerful sense in our body. I merely cut back from 64 plus ounces to somewhere in the 50 ounce range and am seeing some positive results for myself in terms of bladder stability and a reduction in leaking. I am erring on the side of drinking a bit more rather than letting myself get too dry. I agree, kidney stones are not the desired goal.
Mike

logoslidat
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Date Joined Sep 2009
Total Posts : 6057
   Posted 3/29/2011 5:02 PM (GMT -6)   
Roger that!, Mikes24, thanks
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 3/29/2011 5:53 PM (GMT -6)   
mIKE:
 
Very interesting post. I have a friend who is the opposite of me: he is always VERY thirsty. He has been checked for diabetis, but he is fine. We joke a bit about thaat as we are both abnormal in regards to our thirstiness.
 
In my case, I have been advised to drink more.
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64. Surgery: Dr. Menon @Ford Hospital, 1/26/10. Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27
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