Hypervolemia

October 17, 2016

Dennis had some breathing issues today. He would get short of breath for no apparent reason and then feel very dizzy. I sent an email to the LVAD Team. They suspected that because Den’s weight was up that he had too much fluid in his system. We decided the following course of action

• to add 1mg of Bumex for 3 days
• Den should use his Bi-Pap as much as needed to help control his breathing and clear any fluid out of his lungs.
• Go for another blood draw tomorrow to check his levels

Den did seem better later in the day, but he felt very tired and worn out.

October 18, 2016

We went for Den’s blood draw this morning. The LVAD Team let me know later in the day that all of Den’s lab results looked fine. We all agreed that he should continue the actions we put in place yesterday and keep a close eye on his weight.

***Note about water retention***

If you have Heart Failure, you know how important it is to monitor your weight. For those of you that do not have this problem, a weight gain of more than one pound in 24 hours is significant. It is an early indicator of excess fluid in the system. There are many early warning signs of excess fluid.

Here are the most common:

• bloating, especially in the abdominal area.
• swollen legs, feet, and ankles.
• puffiness of the abdomen, face, and hips.
• stiff joints.
• weight fluctuations.
• indentations in the skin, similar to what you see on your fingers when you’ve been in the bath or shower a long time.

This is commonly refereed to as hypervolemia. It can be caused by several different conditions, including

•  heart failure, specifically of the right ventricle
• cirrhosis, often caused by excess alcohol consumption or hepatitis
• kidney failure, often caused by diabetes and other metabolic disorders
• nephrotic syndrome, a disorder that causes excess excretion of protein in the urine
• premenstrual edema, or swelling that occurs prior to a woman’s menstrual cycle
• pregnancy, which changes a woman’s hormonal balance and can result in fluid retention

There are many ways to treat and prevent fluid retention. Den is currently on a general fluid restriction, low sodium diet and takes diuretics. The diuretics (prescription medication) pull excess fluid out of body tissues and it is expelled thru the urinary system. If you take one of the many diuretics on the market, you know when it kicks in! You tend to double or triple your bathroom trips for 4 to 6 hours after taking it.

If left untreated, fluid retention can lead to some nasty problems. Not to scare any of you, but here are some of them.

• pericarditis, or swelling of the heart tissues
• heart failure
• delayed wound healing
• tissue breakdown
• decreased bowel function

One symptom that is not mentioned that we have experienced is cracking skin that constantly weeps clear fluid. Before Den had his LVAD surgery, I was putting gauze on his legs under his compression socks to keep the new open wounds clean. I needed to change the gauze 2 or 3 times a day to keep his socks dry and the wounds clean.

Almost all of the information about can be found on the web. I rarely use the web any more for Den’s health issues. I trust our team of doctors and nurses too much. My best advice for any medical issues….find a doctor that you feel good about and build a relationship of trust.