Anyone Notice Any Dehydration Problem While Taking Imodium?

[tex]

Hi All,

On Saturday, I increased my dose of Imodium to 1 and a half caplets per day, (a half with each meal). Prior to that, I had not been taking any with breakfast. This is a low dose, but the label says to never take it more than three times in 24 hours, without consulting with a doctor, so the frequency may be more important than the dose, for all I know.

Anyway, yesterday, starting about an hour or so after breakfast, I noticed that I was dizzy, and the effect seemed worse, whenever I stood up, (as if I had postural hypotension), but when I checked my BP, it was elevated a little, rather than low. This morning the dizziness seems to be just about gone.

Dizziness is listed on the label, as a possible side effect of Imodium. I wonder, though, if what I experienced was dehydration. An ileostomy greatly raises one's risk of dehydration. Also, the label on Imodium points out that one should drink additional water, while using Imodium, (which seems counterintuitive, since Imodium allows the small intestine to absorb more water from the fecal stream, but I wasn't aware of that, and maybe it's good advice that I shouldn't have overlooked). Maybe Imodium makes the kidneys more active, because I notice that when I'm taking it, my bladder is always yelling "uncle" every few hours. Without it, I can easily last all night, but when I'm taking Imodium, that time gets cut to about 3 hours, tops.

Maybe, because of the cold weather all weekend, I reduced my water intake, and didn't even notice. Anyway, my question is, has anyone else noticed a greater risk of dehydration symptoms while using Imodium? And, has anyone else noticed that their kidneys seem to be much more active while you are using Imodium, (or is it just me, and there's something wrong with my renal system)? Finally, does this mean that I should be drinking Gatorade, or something similar, to replenish my electrolytes, rather than just plain water?

To complicate the issue, though, here's another possibility: According to expert advice, (found on the web, but not mentioned by any of my doctors), immediately following a colectomy, (complete removal of the colon), electrolytes, (especially sodium), are eliminated at an accelerated rate. Increased electrolyte intake, (primarily salt), is recommended, to counteract that trend. Supposedly, after enough time passes, that accelerated loss will be reduced, as the small intestine begins to adjust, and it "learns" to take over some of the functions that were previously handled by the colon, (mostly, increased fluid absorption). As part of the adjustment, it will "relearn" how to absorb more sodium, and other electrolytes, so that they are not lost in the fecal stream.

Here's why I mentioned that last paragraph: Following my surgery, I developed a habit of eating Lay's Kettle Cooked potato chips, as part of an evening snack, (in place of supper, I would usually nuke some leftover grilled jalapeño pork sausage, and eat it with those chips). Those chips are very salty, which I figured would fit right in with the need for additional sodium, while my small intestine was "going to training school". Well, I noticed that my blood pressure was trending slightly higher, after a while, (not a lot, but enough to approach the "High BP" range). I determined that my BP is fairly sensitive to salt intake, so I stopped eating those chips, a few days before this dizzy event showed up. Hmmmmm.

So maybe I just need to go back to eating those chips for a while, but eat less of them. That's probably not any more unhealthy than drinking Gatorade. Or am I wrong?

It's never easy, is it? Every action has a consequence, and we always seem to be in the position of having to choose the lesser of two evils.

Any thoughts on what you would do, if you were in my shoes, would be appreciated.

Thanks,
Tex

[starfire]

I'm not really know for my wise decisions about diet. However, you can use this as you choose.

I'd probably go for the potato chips in reduced amount. Also, I do believe that some kind of electrolyte drink would be beneficial. I can't stand the taste of Gatorade so if I feel I need some electrolytes I use the concentrate mixed with water. It lasts quite a long time but I don't use it all that often. I remember a recipe for making it yourself in another "room" on the main menu.

Hope you get things "balanced" soon Tex. We all want you feeling chipper.

Love, Shirley

[Jan]

Tex,

I've never had any dehydration problems taking Immodium, however, I'm not taking it every day like you. I would think it says to drink more fluids on the bottle because as we all know D can cause dehydration.

I don't drink Gatorade, primarily because of the taste and calories. I have been drinking, when I feel that I might be imbalanced, Propel. It's made by Gatorade but doesn't taste as bad and doesn't have the corn syrup in it.

Hope you get this figured out. I know my blood pressure goes up with salt also. Kind of one of those "damned if you and damned if you don't".

Jan

[barbaranoela]

I never had any side effects when taking Immodium---when needed I did sip on the dreaded Gatorade---

Lately --since not drinking enuf fluids--(outter laziness) I notice a nice yellow color after I *whizz* --so I got myself back on track with fluids--

I have to watch *salt* intake also-----which I imagine everyone *should* be on the alert of over dosing on salt!!!
I know Mr. L luves salt but I can say just so much---so I sorta keep my mouth shut---even since I am seeing the blood pressure machine *out*

Barbara

[Gayle]

Hi Tex,

Electrolyte Balance in the body is maintained through an intricate and delicate dance of the bodies various buffer systems.

Sodium level will inversely affect Potassium level. Etc. Etc. Etc. When one thing, for some reason, get out of whack - it can become something of a cascading adventure.

Just as you are speculating, it may indeed take a while for the body’s regulatory systems to re-adjust to the absence of having the colon acting as thee major actor in re-absorption of fluid from the Gastro-intestinal tract. I think this would be worth a discussion with your GI Doc and Surgeon. You must still be on follow-up visits, since your surgery was not that long ago.

FWIW -- Meanwhile, personally I would opt for using some type of electrolyte solution such as Gatorade or G2. -- A small amount (meaning 3 or 4 ounces) a couple times a day to see what the effect is. I have always found G2 to be more palatable that Gatorade, but that is a matter of individual choice.


Gayle

[Polly]

Hi Tex,

I've never taken Imodium, but that would be my guess as to the reason for the dizziness. Dizziness is not a major symptom of low sodium (hyponatremia), although it can be a symptom of dehydration. If due to dehydration, I would suspect you would be noticing other changes - less frequent urination, very dark urine, sticky saliva, thirst, etc.

I prefer to eat potato chips and plain water if I believe I am dehydrated. I don't do well with all of that sugar in Gatorade (and the other replacement drinks) - not to mention those colorings, flavorings, etc.

Keep us posted on your progress, please. When can you go back to work?

Love,

Polly

[tex]

Thanks everyone. I appreciate your insight.

I think this would be worth a discussion with your GI Doc and Surgeon. You must still be on follow-up visits, since your surgery was not that long ago.

Actually, my last regularly-scheduled follow-up visit was almost three weeks ago, (Wednesday, the day after tomorrow, will be the three-week anniversary), but I did go back one time after that, to check a minor infection, in my old stoma, (which was in the process of growing shut), but that was a couple of weeks ago, (and they pronounced it AOK). Anyway, no more follow-up visits are scheduled.


Polly,

I agree with you, because I didn't notice any of the other significant symptoms of dehydration, and dizziness is indeed listed as a side effect of Imodium.

I picked up some G2 today, (I couldn't find any Propel, or anything else that looked promising), but that stuff has almost as many calories as a Dr. Pepper or Coke. The main difference seems to be that it has more sodium than a Dr. Pepper or Coke. I may try it if I have any symptoms again, but like you, I'm not favorably impressed by all the flavorings and dyes, either.

So for tonight, I hedged my bet, and followed your advice, (and Shirley's, I believe), and ate a few of those potato chips, and I also cut my Imodium intake down to a half a caplet, twice a day. If I have another round of dizziness, I'll probably cut the Imodium out completely, because I don't believe the extra salt is going to "play nice" with my BP, in the long run. Right now, I feel great - we'll see what tomorrow brings. Anyway, it makes more sense to me, to avoid the salt, and also avoid having to take BP meds, than to eat it, and have to take BP meds to control my BP, because of it, especially if the Imodium is causing the dizziness, in the first place.

Actually, my 6 weeks of not being allowed to lift more than 10 pounds, expired last Wednesday, so the next day, (Thursday), I worked a little while, in order to start getting back into shape, (and to make sure that I was physically up to it). Everything went OK - I only stacked 3 tons of corn onto pallets, (120 bags, at 50 lbs. each), but I didn't seem to bust any seams, or anything, and I didn't even notice any sore muscles, the next day, so now that the weather has straightened out, I think I'll do some more of that, tomorrow, and try to finish a truck load, while I'm at it.

That reminds me of something else - the next morning, after stacking those bags, the fingers of my right hand were rigid, and I couldn't bend them, to make a fist, (except for my thumb - it still worked normally). I had to take the other hand, and physically force the fingers down into position. Once that was done, they worked normally. Now that happens somewhat frequently, after stacking bags, especially after extended periods of work, and I've had it happen to either hand, but almost never at the same time. When you stack bags, you have to lift them by grabbing them by the "ears", (the top, outside corners), which means that you have to put a substantial amount of force into your grip, so that the bag doesn't slip, while you are lifting it vertically. Consequently, carpel tunnel syndrome, and rigid fingers, are somewhat common problems, for this type of work. I've never had any carpel tunnel pain, however, though my brother, and many others who do this type of work, have had major problems with carpel tunnel syndrome.

Anyway, the point that I am getting around to, is that I always assumed that the "stiff fingers" issue, was due to rheumatoid arthritis, (especially since osteoarthritis does not affect the hands and wrists). And yet last summer, when the neuro doc had all those tests done, one of the blood tests was for "RF", (Rheumatoid Factor, I believe), and that result was negative. So what causes the rigid fingers?

Love,
Tex

[Rosie]

the next morning, after stacking those bags, the fingers of my right hand were rigid, and I couldn't bend them, to make a fist, (except for my thumb - it still worked normally). I had to take the other hand, and force them down into position. Once that was done, they worked normally. Now that happens somewhat frequently, after stacking bags, especially after extended periods of work, and I've had it happen to either hand, but almost never at the same time.

Tex, it sounds like it might be something like "trigger finger", which I am pretty familiar with. It's basically an inflamation of the tendon sheaths in the fingers, that the tendons/ligaments slide through without much friction. When inflamed, the tendon sheath can thicken and/or the lubricating fluid be reduced so that the tendons are unable to slide easily. So in your case, you have to manually move the fingers so that they close. In some cases, the fingers resist closing until you exert a lot of force, and then they release with a snap, thus the name of "trigger finger". This can be surgically corrected, and is a rather common surgery, by cutting the thickened tendon sheath in the palm of the hand. It worked well for me, except that now I've noticed the beginnings in other fingers too, complicated by the inevitable osteoarthritis that occurs as we get older....... Golf was really hard on them, so I've given it up, but you need your fingers for your job. I suspect that chronic stress on your fingers over the years has led to some inflamation....... The basic treatments besides surgery are NSAID's, which we MCers have to avoid, and a local steroid shot, which is only temporary and would actually weaken the tendons over time.

I've also had carpel tunnel issues too, involving surgery, and the trigger finger is quite different.

Rosie

[tex]

complicated by the inevitable osteoarthritis that occurs as we get older

But it's claimed that osteoarthritis only affects the major joints, not the wrist or finger joints. ???

Isn't "trigger finger" a condition where the thumb, or a finger is contracted into a tightly arched position, (as if it were pulling a trigger - that's how it got it's name, I believe). When my fingers "lock up", they are always very close to straight, in the direction of the plane of the hand, (never clinched). Also, invariably, every finger on the hand is involved, (not just one or two of them - every last one, completely uniformly, and symmetrically).

Tex

[Bifcus16]

Hi Tex,

Had any minor gluten cross contamination recently?

I ask because whilst I don't get exactly the same symptoms, I do get my fingers swelling a little and getting 'hard bits' and bending them becomes difficult. I have often thought of it as carpel tunnel type symptoms. And it is often precipitated by heavy use - like weeding the garden or heavy lifting.

However, over time I have become convinced that it is part of the gluten response spectrum for me. No cross contamination, no finger problems. Easiest way to tell, if the head is clear the body behaves nicely. If the head is fuzzy (got glutened somehow) then the body will do it's thing as well, and tend to swell up and stiffen. For me it is also accompanied by odd aches and pains, and sometimes I get these egg sized lumps appear. I don't usually get it in all fingers at once, but the similarity is still there.

Oh yeah, I'm RF negative as well - the Rhuemy said 'some kind of sponylising arthritis but can't give a definitive diagnosis'. Well, I reckon I know the diagnosis - 80% gluten, 20% overwork.

Hope those chippies are PLAIN and not fancy flavoured ones!

Lyn

[Mackenzie]

Hi Tex,

I took Imodium every day for more than 6 months after Asacol didn't work for me. I had dehydration with it. I took 1 pill once a day. I found I had to drink extra water, I did drink Gatorade or Propel on occasion also. If you dislike regular bottled Gatorade or Propel, you could try the powder packets. You can decide how much powder to use to create the flavor/consistency you like.
I have stopped taking Imodium daily, it never worked consistently for me.

Good luck with it- you have been thru so much.

[tex]

Lyn,

Hmmmmmm. Interesting observation. Of course, one can never be absolutely sure that no gluten has somehow crept into one's diet, but as best I can tell, that shouldn't have happened. I need to start keeping a closer watch on the details, whenever it happens, to see if I can spot some sort of connection. It doesn't happen very often - maybe once every few months or so, but occasionally it occurs on consecutive days, if I've worked extra long hours, for example. I always just assumed that it was work-related, rather than gluten-related. I'll try to keep my eyes open in the future, though.

Thanks.


Mackenzie,

Thanks for sharing your experience with Imodium. I find that if I reduce the dose to a total of one caplet per day, the dizziness almost totally disappears, but the benefits are significantly reduced, also. Soooooooo, I believe that I'm going to do what you did, and just stop using it, to see what will happen. I haven't taken any today. I'll compare the results, and see if I get enough benefit from it to justify using it. Somehow, the idea of using a drug that makes me dizzy, (even if reducing the dose can make the effect almost disappear), just doesn't appeal to me.

Thanks for the kind words, too,
Tex

[Rosie]

Isn't "trigger finger" a condition where the thumb, or a finger is contracted into a tightly arched position, (as if it were pulling a trigger - that's how it got it's name, I believe). When my fingers "lock up", they are always very close to straight, in the direction of the plane of the hand, (never clinched).

I think that while contraction of the fingers is common, it is not always always the case with "trigger finger", or flexor tendinitis. For example, my trigger finger started out as generalized soreness and stiffness in my fingers and across the top of my palm. My fingers never wanted to be contracted, but instead were actually difficult to contract, and the "catch" in motion would occur when trying to bend, not extend my fingers. Perhaps if I had waited longer for surgery, the finger would have been in a contracted state much of the time. The articles on the various web sites seem to present a generalized picture of the end state, not the process of developing trigger finger. I can certainly see where chronic stress on your fingers when loading hundreds of sacks of corn a day could lead to inflamation and difficulty in flexing them. And it certainly may be that what you have isn't what would be called "trigger finger" but some sort of sporadic tendonititis or tendon sheath inflamation that results in your symptoms. Hopefully it won't progress........

But it's claimed that osteoarthritis only affects the major joints, not the wrist or finger joints. ???

I've never heard that claim, Tex. Osteoarthritis most certainly can affect the hand. Maybe you haven't heard about it because it's most common in post-menopausal women..... A common symptom is bumps on the finger joints called "Heberden's nodes", of which I have a few.

I hope you can find some sort of relief for your hand problems. Is there any sort of a brace you could use to help your fingers from getting such stress?

Rosie

[tex]

Rosie,

I was just going by what this article mentioned:

In addition, rheumatoid arthritis has a tendency to affect the knuckles and the wrists -- areas that are usually not affected by osteoarthritis.

http://physicaltherapy.about.com/od/typ ... a/RAOA.htm

and this one:

OA, which is the far more common type, commonly affects weight-bearing joints such as the back, knees, neck, hips as well as the toes. It will also worsen with activity throughout the day. RA often causes swelling in pairs of joints, especially in the hands, wrists, knees and ankles. A classic sign of this arthritis is that pain and swelling generally is worse in the morning or after resting.

http://arthritis.suite101.com/article.c ... _arthritis

An important distinction between the two conditions is that osteo arthritis is confined to the weight bearing joints only.

http://www.differencebetween.net/scienc ... arthritis/

Of course, you could argue that I'm using my arms/wrists/hands/fingers for weight-bearing, in my work, but that's kind of a dubious distinction, because the amount of time involved with actual weight-bearing is relatively short, on a 24-hour basis, and everyone uses their arms/wrists/hands/fingers for some degree of weight bearing, virtually every day. Right? Even when I'm stacking bags, I'm actually only in the process of lifting the bags, for a fraction of the time, compared with the overall cycle - probably less than a third of the cycle. I'm not trying to say that you're wrong, I'm just trying to rationalize my position, by pointing out that the issue is a lot more complex than the "rules and regulations" would suggest, (as usual).

Yes, there are some very good wrist braces available, targeted at Carpel Tunnel Syndrome, (CTS), that I used to issue to employees, to make sure that they weren't running the risk of developing CTS, but the problem is that the good ones, (which contain a metal splint), are pretty restrictive of hand motion, relative to the wrist, and they make the work more tiring, (since your muscles have to sort of "fight" the splint, in order to achieve adequate freedom of motion), but they do effectively prevent CTS, and they also help, if CTS is already present. If you're going to work at full capacity, (stacking roughly 150 bags or so per hour, for 8 to 10 hours per day, (IOW, 1.5 to 2 semi-trailer loads per day), day after day, you definitely need those wrist supports. Back when we used to supply some national chain stores, we worked those long shifts, (sometimes 2 shifts), 6 or 7 days each week, and at the end of the day, our hands and wrists would actually be numb, even wearing the wrist supports. These days, though, I'm mostly retired, and I usually only do that type of work for a few hours at a time, for the benefit of the exercise, and usually only 3 or 4 days per week, so those wrist supports would be sort of an overkill. As I mentioned, I usually only have the "rigid fingers" issue about once every few months or so, depending on my work schedule. It's more of a curiosity, than a nuisance, and I haven't noticed any significant change in the status, in at least several years.

Also, there is very little pain involved, and no discernible swelling, redness/inflammation, etc., so it's pretty tough to connect it with anything. Back when I was having clear RA symptoms, (before I discovered that gluten was a problem), my joints were red, swollen, and extremely painful, 24x7. After I cut out the gluten, of course, those symptoms disappeared.

I definitely appreciate your insight, though

Tex

P. S. Besides, how could I have osteoarthritis? I have been taking glucosamine sulphate, with condroitin for about 10 years, now.

[Rosie]

Well, Tex, we could go "dueling quotes" about osteoarthritis and the hands!

So for my set of quotes, from the Mayo Clinic and Brigham and Women's Hospital web sites:

http://www.brighamandwomens.org/patient ... ritis.aspx

Where does osteoarthritis occur?

Although osteoarthritis could potentially occur in any joint of the body, it most commonly is found in the major weight bearing joints of the body. Some of the most common joints involved include:
• The hip: The hip is one of the major weight bearing joints of the body. In younger patients, hip osteoarthritis occurs because the individual has an imperfect ball and socket joint- something that occurred when the hips were developing. In older patients, it is the result of wear and tear over time. Hip arthritis causes groin pain and knee pain. Activities that can become difficult include walking, tying one’s shoes, and crossing one’s legs.
• The knee: The knee is the other most common place to develop osteoarthritis. Patients will often complain of pain with walking and, over time, limit their walking distance. The knees can develop a bony prominence and a crunching sound with movement.
• The hand: Hand osteoarthritis is very common, especially in women. Most women will experience this type of arthritis at some point in their life. Bony overgrowth occurs at the joints of the fingers. These growths, which are called Hebernon’s and Bouchard’s nodes, occur in the sets of joints closest to the fingertips. Pain, swelling and redness occur during the bony deposition, which lasts anywhere from six months to three years. After that, most patients are just left with bony deposits on their joints but no pain and no loss of function. Individuals can also get arthritis at the base of the thumb.
• The spine: The cervical (neck) and lumbar (lower back) spine is composed of vertebral bodies that are connected by joints and have cushioning discs between levels. Over time, these joints are subject to wear and tear, which can cause osteoarthritis and disc degeneration. This can lead to pain in the neck, and the upper and lower back.

and http://www.mayoclinic.com/health/osteoarthritis/DS00019

While osteoarthritis can affect any joint in your body, the disorder most commonly affects joints in your:
 Hands
 Hips
 Knees
 Neck

I rest my case!

But I agree that your issues don't sound like trigger finger, given that there is no pain involved and it's very intermittent!

Rosie