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DEAR DR. ROACH: I’m 74 years old, and I was diagnosed with congestive heart failure with a recent ejection fraction of 25%. My cardiologist has me taking empagliflozin (Jardiance) and furosemide (Lasix) daily. With moderate cardio exercise therapy every other day and two diuretics daily, my thirst runs rampant during the evenings, and I find myself drinking fluids to compensate. Am I nullifying the intended purpose of the diuretics? — D.P.
ANSWER: The main purpose of diuretics is to remove excess salt and water from the body. However, we all need some salt and water, so the patient’s goal here is to maintain a consistent and appropriate intake. Of the two, salt is more critical. If you’re on a low-salt diet (at a level recommended by your cardiologist), then the amount of water that you need to take in depends more on your activity level than on your medications.
Thirst is a good but not infallible way to regulate water intake. Diuretics can affect a person’s sodium level, so your doctor will check this frequently while you’re taking them. In summary, you should drink water when you’re thirsty to replace what you lose with activity and be careful not to exceed your recommended salt intake. Overdrinking water while on diuretics can lead to a low sodium level, so don’t overdo it. You should also get your labs checked frequently.
DEAR DR. ROACH: For years, I’ve been taking one to two antacid tablets (500 mg of calcium carbonate) per day for mild acid indigestion. I love some spicy foods and my daily Manhattan. I am 86 years old and have been diagnosed with chronic congestive heart failure. (Though, my cardiologist says it isn’t as bad as it sounds.)
I also have arteriosclerosis, for which I take atorvastatin and baby aspirin. I’m reasonably active and about 20 pounds overweight, but I still play 18 holes of golf twice a week. Are there any long-term consequences of taking these antacids? — B.L.
ANSWER: Many people take calcium for bone health, and the risk of taking 500 or 1,000 mg daily is small. But I do have a few comments.
The first is that there remains uncertainty whether calcium supplements increase the calcium in coronary artery plaques, which is also called coronary atherosclerosis. I think it’s unlikely that there’s a major heart risk from taking calcium supplements, but since you have known blockages, you should know that the supplements may increase the progression of your blockages, despite atorvastatin.
The second is that calcium supplements increase the risk of kidney stones. However, if you haven’t had one at 86, you aren’t likely to get one now. Third, alcohol isn’t good for the heart, especially in people with heart failure. It’s your body and your choice, but you should know that there’s some damage being done by your daily Manhattan.
Finally, I’ve seen too many people take antacids for a long time for something that turned out to be a serious gastrointestinal problem. So, you should talk to your general doctor (an internist or a family medicine doctor, for example) or a gastroenterologist about your symptoms of mild acid indigestion. The odds are this is all that it is, but you should tell your doctor, who knows which questions to ask to determine whether there are any “red flag” symptoms that might prompt further investigation.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.