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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.
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.
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.
There remains uncertainty whether calcium supplements increase the calcium in coronary artery plaques, which is also called coronary atherosclerosis. 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. Alcohol isn't good for the heart, especially in people with heart failure. Finally, I've seen too many people take antacids for a long time for something that turned out to be a serious gastrointestinal problem.