Hydration

Everyone knows that drinking water is good for you.

It has to be said that advice differs over how much to drink. Sometimes advice is given in litres, sometimes in pints and sometimes in glasses (but how big is a glass anyway?) At one office where I work, a hydration poster on the back of the cubicle doors in the Ladies gives three different numbers for how much to drink per day – on the same poster!

And it’s also fair comment that the advice on what to drink can be a bit confusing. Does it count if it’s not water? Sugary drinks and caffeinated drinks and alcoholic drinks are all  pretty wet – but not especially good for you – and the sugar, caffeine and alcohol do have some counterproductive effects – so do they count? Advice is mixed.

But everyone agrees that drinking plenty of water is good for you.

I have seen advice that it’s particularly important for those with MS in general, and those undergoing treatment with alemtuzumab in particular. Why?

As for MS in general, there is evidence that dehydration can worsen fatigue:

I didn’t find anything else specific to MS symptoms, although symptoms like headaches, general pain and dizziness, as well as general brain fog, are triggered or worsened by dehydration – and these are symptoms many people with MS will know all too well. I have also heard anecdotally that dehydration can worsen muscle spasms and twitches (fasciculations).

There is also evidence that staying hydrated reduces the risk of UTI’s, which can worsen MS symptoms or even trigger a relapse. See this advice from the MS Trust and this NHS advice on UTI prevention.

And for alemtuzumab treatment specifically, this paper provides a review of infusion-associated reactions for patients being treated with alemtuzumab during the CARE-MS alemtuzumab trial.

While not citing any detailed information showing why hydration helps, or exactly what difference it makes, the paper certainly advises that patients should get plenty of it, in order to reduce the effects of infusion-associated reactions.

The IARs can be reduced with several proactive measures, including patient education, oral hydration, premedication, and diligent monitoring. Skilled nursing interventions and support may improve the overall tolerability profile of alemtuzumab in the treatment of patients with RRMS.

And the Lemtrada website includes a nurse recommendation to stay hydrated during the infusion – LEMTRADA: Helpful Strategies to Stay Comfortable During Infusions

I always tell my patients that staying hydrated is an important part of keeping your body healthy. Keep water with you at all times—and drink, drink, drink! Staying hydrated will help your kidneys function properly to remove wastes and toxins and help regulate your temperature. Don’t wait until after infusions to start thinking about drinking some water. If you’ve already made a habit of drinking water before starting treatment, it won’t be as difficult after treatment.

So, if I’ve never made much effort before to up my fluid intake – now is the time!

I’ve started targeting an ambitious 3 litres a day using a phone app and hope that my bladder will be used to it before I go in for treatment. Piddling every hour (or more) whist attached to a drip will not be fun!

This article at Spoon University (How to Drink Enough Water and Not Have to Pee Every 2 Seconds) is reassuring about the effect on my bladder. And this Harvard Medical School article (Training your bladder) includes a plan in case frequency doesn’t sort itself out within a reasonable amount of time.

Stay moist, people 🙂

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