My CO-1686: Hydrate, Hydrate, Hydrate

Hydrate! Hydrate! Everybody orders me to hydrate. The med techs tell me to drink lots of water before the bloodletting session. The CTscan peeps instruct me to start drinking water two hours before procedure time. They order me to hydrate, hydrate, as if I were a prune, which could not be farther from reality because this morning when I looked at the mirror, the reflection of a wrinkle-free face glowing in the mist of the Pacific Ocean spray winked at me. But doctors don’t use facial wrinkles as barometer for dehydration. If they did, Florida and Southern California would be designated Dehydration Zones. Physicians usually use creatinine readings from blood samples.

As I approached Month 17 of my participation in the CO-1686 clinical trials, the hydrate orders finally hit me in the head when my creatinine number became slightly elevated. Fortunately Onc did not say, “Your kidneys have gone kaput,” which would have sent me trembling in my toed socks. My Nursing Practitioner even assured me: “Don’t worry about a slightly elevated creatinine. As we age, our muscle mass, which affects creatinine production, decreases and if we all reach very ripe old age, we’d all die of kidney disease. Just hydrate, hydrate.” She’s my hero.

I figured, I could verify the impact of a serious hydration program if I start it one week before bloodletting time. I did just that.

All my life I’ve been told to drink eight glasses of water a day. But nobody specifies the glass size. As a former bar habituĂ© with the husband who widowed me, I know for a fact there are shot glasses, tall martini glasses, heavy beer mugs, curvy wine glasses, margarita bowls. To bag the measurement hassle, I chose bottled water.

On the program’s first day, I lined up four Stater Bros 16.9-ounce (1/2 liter) plastic bottles of water on the kitchen table. After a breakfast of one scrambled egg and a mug of coffee with cream, I guzzled up the contents of one bottle. An hour later, I did a bottoms-up to a second one. Suddenly I felt bloated, then drowsy. I blamed the drowsiness on the car trip from which my caregiver and I had just returned. As a rider, I had exerted an enormous amount of physical and mental energy solving crossword puzzles and scratching lottery tickets from California through Arizona to New Mexico and back. To repair myself, I took a nap. When I woke up, I was lethargic; blood glucose must be low. I tested a drop of blood with a monitor and it flashed “465.” The reading – way higher than my ideal of around 150 at 10:00a.m. – floored me!

I rushed to Google University. I searched “drinking too much water” and sure enough, scary titles rolled before my eyes: an American woman died after a drinking contest to win a Wii, a Spanish woman dropped dead after a beer drinking contest, a mother tossed in the slammer for killing her son by forcing him to drink too much water. Medical sites warn not to drink 2 liters of water ALL AT ONCE in less than two hours because the kidneys can only process 1/2 liter of fluid at most in an hour. Otherwise the fluid backs up, overloads the blood and dilutes its mineral contents. Athletes or laborers who must replenish fluid lost from physical exertion can safely drink more. Average women just need 1.9 liters or 64 ounces of fluid a day to replenish fluid lost in urine, sweat, and tears (hello, drama queens!).

I did the morning math: I had drunk 1/2 liter of coffee and chug-a-lugged 1 liter of water in an hour while my only energy expenditure was obsessing about hydration! Luckily, my body and I have a good thing going. It talks to me and I listen to it. It went on a “fight” mode and raised my blood sugar level in anticipation of the glucose dilution. I felt so bloated that if I ingested half a cup of anything, I would burst like a water-filled balloon.

I tweaked the hydration program. Considering 16 ounces of coffee, all I need for due-diligence fluid intake is 3 bottles of water drank NOT ALL AT ONCE until no later than 7:00p.m. so I don’t go potty all night. A 12-oz can of cold “cerveza” can be thrown in somewhere in the afternoon as a substitute or a bonus.

August 5, 2015 7:30a.m. Bloodletting; and 8:20a.m. Onc Visit

The Club Med Onc strode into the examination room briskly followed by his nurse. Onc and I shook hands, exchanged howdy-doodies.

“Lab results are good,” he declared without fanfare.

I pressed for juicy details. “How’s the creatinine?”

“Stable!” His word dropped with an unmistakable finality that calmed my fear of exposure to information overload. With that, he approached me with his stethoscope, our code for “Bueno-bye, have a nice day, see you in three weeks!”

I drink to that.

August 27, 2015 8:00a.m. UCI. Nine-month CTscans. A BRAND-NEW EXPERIENCE! After the CTscans, Onc ordered the radiology nurse to have flushed intravenously the dyed contrast solution that had been delivered intravenously to my body. Otherwise I would have had to do the flushing by drinking lots of water all day. The nurse assured me the hydration would take only an hour.

So there I was in the Infusion Room, seated next to an old geezer dozing off while receiving drips from two hanging bags of chemo solution. After our nurse hung the bag of clear saline water and connected the tube to my vein, I hogged her attention. I requested her to prop my feet up, get me a pillow for my elbow, a warm blanket for my legs, put my feet down again. It’s people like me who drove a caregiver to tie patients to their beds face down in a nursing home years ago.

Now I’m spoiled. I want intravenous hydration after my future CTscans. That’s what happens when the patient’s imagination takes off on a tangent to the real Club Med.

September 1, 2015 7:30a.m. UCI. Bloods; 8:00a.m. Onc visit
Results: lab – good; Scans – stable.

Let’s drink to that!