Weekly Update from the Bellingen Covid-19 Clinic- Dr Trevor Cheney

By November 10, 2020 In Focus 3 Comments
Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellingen Shire

10 November 2020

 

This week’s situation is fluid – in some parts.

So,

We are doing well

Victoria is doing well

Australia is doing well.

There is reason to be happy about spring.

No local Covid19 yet.

 

Like many others, when the border opened we trouped north for the weekend to visit our family. We have grieved for them being caged and trapped on the other side of that steel wall, thus surged we forth to bring them sustenance and news of the Deep South.

It was lovely. In fact, despite an impression of relaxed abandon one might pickup from news or posturing pollies, the Covid19 issue is being taken seriously in our northern family. The warnings are everywhere. The hotels enforce Covid19 regimes. They know how fragile their comfortable positions is – bearing in mind that tourism is the biggest employing industry in Qld and has been for a long time. How long that will last when the reef is being cooked may be uncertain, but there is a lot of not-so-noisy people who get this fact, and are working hard on it.

We went to the Rugby Union test match at Lang Park stadium. Very exciting, yes lots of people, but thoughtfully managed, with free masks given out at the gate and carefully identified zones of seating, with spaces.

The reality is that in QLD right now the risk of getting Covid19 is very tiny – about the same as Bellingen Shire. And so while that situation persists the role of masks is less potent. The role of hand washing is still huge, and people are out there doing it! But it’s why their health officers decided they could have an event.

By contrast, with a touch of Schadenfreude, I am delighted to see a certain QLD billionaire losing a court case – with costs – trying to usurp WA health management protocols and decisions with contempt.

You may wonder why the preceding waffle and “grandmotherhood statements”…

There has been a bit of a lazy politic to suggest that Queensland has had it too easy, have held their border too tightly, not respecting the suffering down south, and gaily partying on.   This kind of talk breeds meaningless division and resentment. Remembering that the research mentioned last week showed that border control is one of the 3 strategies that actually work in reduction of Covid19 harm.

But more importantly is that the atmosphere at the game was so joyful. I sat next to a Kiwi family. The whole crowd was out for fun and laughter, not violent tribalism, not beat the crowd of “others”, at all costs. Which, despite noise you might hear to the contrary, is a very different concept to actually winning. And aren’t we lucky to live in a nation that can so celebrate a shared, though competitive event., while respecting there needs to be restrictions for the times? The world is way too full of the alternative.

All prayers for our friends across the water in this very unstable and scary time, and here’s hoping some greater wisdom will prevail. On Tuesday night I had a face time call from an old friend and his lovely wife (a front line nurse /first responder) who live in Maryland, USA – on his little acreage on the Potomac River. Their words effectively – “pray for us, we’re really scared”

Despite what news commentators try to whip up, Australia’s lack of vitriolic tribalism is a positive privilege we must defend with fierce compassion, unrelenting forgiveness, intense sharing, and hotly focussed understanding of the other viewpoint.

More Covid snippets: in an analysis of 57 studies around the world it seems that asthma is not a heightened risk for Covid19, and some even suggest it is protective. It is not clear if the advantage is biological or behavioural. Even so this is fantastic news and asthmatics can breath a little easier.

More warnings that delaying cancer investigations by even a month increases mortality rates.

NSW Health reminds everyone that Christmas parties need to be managed under CovidSafe rules – you can check that out at NSW government :”What you can do under the rules”.

But – for something medical, totally unrelated. In the absence of being able to comment on anyone coughing, I could not help but note another phenomenon. Dark Yellow Urine.

Now, when one goes travelling, or to large events, one is usually obliged to use public toilets. I never quite understood why blokes particularly (being that is the only type of toilet I tend to use) have trouble: aiming, not leaving a mess, or not thinking to use the magnificent gift of moving water to remove their trace. No doubt there are many sisters shouting “Yeah!”. But even so, it provides an interesting observation of how often there is a dark yellow puddle in the bowl.

Millions of pages get written by health advisors about how much water to drink. There is usually a number around 2-3 glasses of water per day. However I have always found this completely useless. Having worked in the Pilbara and Kununurra- in WA deserts, when a distance runner came in asking how much he should be drinking – the guideline is meaningless.

Now you may ask why the hell is someone doing distance running in an environment of up to 50* Celsius?? Or 33* and 100% humidity??? – Yeah !!

Anyway, firstly it really matters. Dehydration acutely (acute means short term not severity as people often think, Vs. chronic which means long term) is lethal. Everyone knows that.

Under hydration, or chronic dehydration is a bit trickier.

It is recognised as causing headache, delirium, poor cognition, and fatigue. Water is ultimately the greatest vehicle – it carries all nutrients, including the oxygen holding red blood cells. Under hydration has been thought associated with increased kidney stones, bladder infections, bladder cancers, kidney failure, heart attacks, blood clots, stroke, constipation , but worst of all -lethal Halitosis (that is bad breath).

And yet according to an article in the Nutrition Review 2010, few countries even list water as a nutrient, even though it is the one substance whose absence can kill in just a few days. Even less clarity is available on how much is needed in normal life. It is recognised that kids lose more water than adults and are more susceptible to dehydration, yet are less in control of their access to water.

Environmental issues contributing include, fever, hot weather, very cold weather, (the driest place on earth is in Antarctica), Air conditioning (in all hospitals now).

What worries me even more is the long term effects. Australia has a high rate of kidney disease. Without the benefit of active research, I have certainly observed a difference in rates of kidney disease in drier inland towns vs cooler areas.

I recall pearlers in the north west, with poor access to water getting too many kidney stones at youthful ages.

You can also overindulge in water. Like anything, the difference between a medicine and a poison is the dose. I have dealt with people at raves sweating profusely – causing loss of water and salt, but then replacing it only with bottled water. This is particularly prone under the influence of Ecstasy. This causes a dilution of blood and then swelling of the brain. If not picked up, swelling inside the hard skull causes the brain to squeeze out the bottom of the skull – yes as bad as it sounds.

And of course there are people with kidney or heart or other disease for whom water balance is very tricky – these folk may be on a very tight fluid restriction from their Doctors and need to be helped to maintain that limit – their survival depends on it.

So what to say to most people especially kids, asking how much to drink?

Look at your wee.

If it is yellow you need to drink. If is watery coloured with just a hint of straw, you are doing well.

Nobody goes round with a lab – testing for the perfect concentration – and anyway it changes hour by hour. In the morning your wee will be concentrated because your pituitary glands sends out a hormone that causes the kidney to hold onto water and make it more concentrated while you sleep. Some think it’s so you don’t have to go out of the cave at night and risk meeting a sabre-toothed tiger!

Then if you drink it gets clearer. I believe the best time to hydrate well is in the morning – that way you are working in sync with your kidneys. Many kids and older people have a bit of a disconnect with that antidiuretic hormone and have an overactive bladder through the night. Denying fluids just before bed does not seem to help. But hydrating well in the morning, to allow the normal diurnal pattern to kick in, seems to make a big difference – better than drugs.

Remember alcohol does not offer hydration – it makes you lose more water than it contains – similarly coffee and to a lesser extent tea. My old SAS Survival Handbook emphasises that coffee is anti-survival in a resource desperate situation.

I’m not going to stop coffee just yet, but a cup of coffee should be followed by a cup of water.

The summary: drink what it takes to make smooth, clear, very pale yellow, Wee, and you will perform better, think clearer, preserve your organs, and not leave a smelly present in public toilets.

 

AS always this is one perspective. Please check details with your own (hopefully well hydrated ) GP – and offer them a drink of water.

 

Dr Trevor Cheney

3 Comments

  • Janet Hosking says:

    More words of wisdom. Thankyou Trevor.

  • Jane S says:

    Thanks for putting in the time on this Trevor, including your extensive research involving long distance travel and bearing up with attending a sports fixture. Your information is so appreciated, I relay it to friends in other areas hoping they are able to install the sense of community Bello fosters.

  • Anne Graham says:

    Very timely advice. So many of us never think about the amount of water we drink, or include the teas and coffees in our guesstimate. I too send this report to relatives and friends in other areas and it is greatly appreciated. Can’t say it often enough. We are so lucky and privileged to have access to a local, current report on Covid, and reminders on simple things we need to keep in mind, like WATER.
    Your time is very much appreciated.

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