CVD And Water Retention: More Common Than You Think
“I am not afraid of storms for I am learning how to sail my ship.”
Amy March — Little Women
I have heart failure, but I am not afraid of it. It may sound odd, but I think it’s because I have lived with cardiovascular disease (CVD) my whole life that I see this as one more thing to handle rather than a death knell. There was never a way to avoid it, so my only choice is to manage it, as it is for anyone with the condition.
What matters isn’t that the ship is sinking, but how we sail it. Surrender only sinks it faster.
A Phone Call:
If you can't cure it, learn to manage it, or it will manage you.
When I first got back to Germany, I called a family friend. I caught her up on my trip as I set down my bags and made myself a cup of tea, then explained my new, managed health situation and how it might affect some of my plans.
I told her I now had to manage my salt and water intake, not because things were getting worse, but because it was a new factor to consider. Instantly, the conversation switched from a lovely update to chaos-wrangling.
She screamed, “You’re retaining water!” It was as if everything I had said before, and all my plans, had been washed away by that single firing neuron.
If you’ve ever dealt with someone who gets their information about you from other people instead of from you, someone who would rather join the team “managing” you, and collect good-person-victimhood points for it, than see you as a real person instead of a disabled checkbox waiting to be filled, then you know the type.
If you have a disability or a cardiovascular condition, you have likely met, or will meet, people who would rather believe a comfortable story about you than listen to a single word the “sick” person says.
Like the rest of my family, she had absorbed the story that I was basically a walking corpse. So she listened to me while searching for faults and weaknesses that would prove my inherent frailty.
She filed the conversation under “She just doesn’t understand,” a phrase I have heard over and over whenever people assume I am either too cognitively impaired to grasp my situation or too deep in denial to face it. Either way, it amounts to the idea that I cannot understand my own medical condition.
I froze on the phone as it dawned on me: she was waiting for confirmation that I was dying, and preparing to follow the proper social protocol for such tragic news. Living with heart failure was beyond her comprehension, but not beyond medical science, or beyond the many people who do it every day.
The truth is that I am very aware of my situation. I have researched water retention and heart failure thoroughly, and I know denial is not an option. Knowing and understanding your condition helps you take charge of your health and your life.
That’s how we protect our health, our lives, and our longevity.
Water Retention and Heart Failure:
Let me be clear: heart failure is nothing to scoff at. In fact, according to the article, Pathophysiology of Sodium and Water Retention in Heart Failure by Cadnapaphornchai et al. “heart failure is a leading cause of morbidity and mortality. In the United States, there are more than 5 million patients with heart failure and over 500,000 newly diagnosed cases each year” (Cadnapaphornchai et al., 2001). These figures are from 2001, and they have only risen since.
While CVD is one of the leading causes of death worldwide, heart failure is usually described as a major cause of hospitalization and death. The two are connected. In my view, CVD is a flashing yellow light, and a heart failure diagnosis is the same light with a blaring horn attached: “Danger!” But that doesn’t mean “The end is nigh.” It means “You must adjust” and “You can’t ignore this any longer.” I’d argue the real danger lies in mismanaging the condition, not in the condition itself.
Heart failure is a spectrum, and so is the age at which people are diagnosed. I am 35, and it came after more than three decades of critical congenital heart disease, three pacemakers, and two mechanical heart valves. For me, it was always the whirlpool my ship was circling. Not everyone born with a heart condition will develop heart failure, though, and most people who do develop it later in life, through aging or other health factors.
As such, the condition can range from having no symptoms at all to advanced disease; symptoms like water retention appear only midway through this scale.
Research into why this happens has grown more sophisticated over the years. The article, Sodium and Water Retention In Heart Failure and Diuretic Therapy: Basic Mechanisms by Domenic A. Sica, describes how diuretics can be prescribed as a medical treatment for this condition because “the pathophysiology of sodium and water retention in heart failure is characterized by a complex interplay of hemodynamic and neurohumoral factors. Relative arterial underfilling is an important signal that triggers heart failure-related sodium and water retention” (Sica, 2006). Therefore, managing both sodium and fluid in the body mitigates the risk of excess fluid retention and diuretic use. This is because “sodium and water handling becomes abnormal early in the development of heart failure. This tendency to retain sodium and water is a byproduct of a complex interplay between hemodynamic forces and the often generous increase in neurohumoral factors, cytokines, and growth factors that marks this disease” (Sica, 2006). And yet, while diuretics do help the kidneys excrete the excess fluid, these are dangerous medications if mismanaged, so they are not a miracle drug. The article addresses this by pointing out how “the abnormal sodium and water handling in untreated heart failure carries over to the response to diuretics as well. Diuretic resistance in heart failure is a byproduct of multiple factors, and its management can prove quite challenging” (Sica, 2006). So in some ways, the nature of the treatment itself can even create more problems along the way.
So, in summary, here’s what’s happening in plain terms. When the heart can’t pump enough blood forward, the kidneys sense that the arteries are “underfilled” and assume the body is short on fluid. So they hold on to salt and water, the exact opposite of what a struggling heart needs. Doctors were already proposing this kidney connection in 1949 (Merrill), and today it’s understood as a chain reaction of pressure changes and hormones (Sica, 2006). Diuretics help the kidneys release the extra fluid, but heart failure can blunt how well they work, which is why dosing needs close medical supervision.
Research keeps expanding our understanding and our treatments, but one method has stood the test of time.
Maintenance. This means open, consistent communication with your doctor to monitor your heart failure and maintain the necessary balance of fluid and salt in your system, because if it slips, things can become very serious very quickly.
My Experience So Far:
Given my unique physiology, it turns out I’ve had too much fluid and salt in my system for decades. So discovering the water retention and learning to manage it was strangely a relief. I hadn’t realized I’d been gaining both degrees and weight while traveling the world, all while basically breathing through a straw. Now I feel more active and alert than I have in decades.
Even though it did take a few months of trial and error, I now have a balance down and can make the decisions and manage my food and drink enough to return to life as normal… with heart failure.
Perhaps “normal” is a strong word, but at this point I do not believe any real part of my life with CVD can be described as normal. It’s something I have mourned for most of my life, and hearing “heart failure” ripped that old wound open.
My point is that in my experience, the best way to deal with CVD and heart failure is to accept them. They take no prisoners, and you need to understand that to fight for yourself.
Remember, your heart, even if it is failing, is your ally.
Help it fight for you.
Tips:
See your doctor regularly.
Your doctor can catch heart failure before you notice it, and can set you up with the right medication, fluid limits, and salt limits.
Know the warning signs.
If you have a heart condition and notice rapid, unexplained weight gain or new swelling, call your doctor. If you suddenly can’t catch your breath, call emergency services (112 in Europe, 911 in the US).
Water retention can look like ordinary weight gain. Once, even my doctors didn’t realize my sudden ten-pound gain was fluid. It was only when I was given diuretics for something else entirely that the weight melted off overnight.
Diet changes were extremely helpful for me.
I’m a huge fan of bread, pasta, and especially sushi. But even the low-salt versions brought the water retention back worse, so I’ve cut out bread, pasta, and rice. I now lean on potatoes, chicken, salmon, fruits, and vegetables, and I feel better than I ever have. Ironically, it took a heart failure diagnosis to figure that out.
Talk to your doctor before changing your diet. Some foods interact with heart medications: potatoes are high in potassium, which matters with some heart failure drugs, and leafy greens can affect your INR if you take a blood thinner like warfarin.
Coffee vs. Green Tea
Another change I made was switching from coffee to green tea. It’s complicated because I love coffee, and green tea can lower my INR, which makes it trickier to keep stable. For me, though, it’s a worthwhile sacrifice.
Plain coffee is very low in sodium, but the extras in something like a white chocolate mocha latte may not be. Green tea also has less caffeine, so you feel refreshed rather than buzzed. And if your doctor has you on a fluid limit, remember that tea and coffee both count toward it.
Talk to your doctor before switching.
If your diuretic is “as needed,” get clear rules.
Diuretics help with water retention, but they can be dangerous if mismanaged. Ask your doctor exactly what “needed” means for you, and get explicit instructions before you take them. If you have any questions, ask. It’s far better to be safe than sorry.
Conclusion:
Water retention is a drag, but managing it and finding the right balance has given me more health and freedom than I’ve ever had. It is a sign of heart failure, and people may assume it means you’re dying, but it doesn’t mean the end. It means it’s time for a change.
CVD, heart failure, and water retention are warning lights telling you to pay closer attention. They don’t mean you should stop living your life or give up on your dreams. They mean you need to take the helm. If you have these conditions, educate yourself, advocate for yourself, listen to your doctor, and do all you can to manage the situation.
So if you have water retention, it simply means it’s time to hunker down, grip the wheel tighter, and keep sailing.
What do you think? Can you relate?
Comment below.
Keep ticking, everybody!
P.S. Are there any aspects of CVD health or pacemakers you’d like to know more about?
Feel free to email me at:
Reference List:
Cadnapaphornchai, M.A., Gurevich, A.K., Weinberger, H.D. and Schrier, R.W. (2001). Pathophysiology of Sodium and Water Retention in Heart Failure. Cardiology, 96(3–4), pp.122–131. doi:10.1159/000047396.
Merrill, A.J. (1949). Mechanisms of Salt and Water Retention in Heart Failure. The American Journal of Medicine, 6(3), pp.357–367. doi:10.1016/0002-9343(49)90173-4.
Sica, D.A. (2006). Sodium and Water Retention in Heart Failure and Diuretic Therapy: Basic Mechanisms. Cleveland Clinic Journal of Medicine, 73(Suppl 2), pp.S2–S7. doi:10.3949/ccjm.73.Suppl_2.S2. Available at: https://www.ccjm.org/content/73/6_suppl_2/S2
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