DEAR DR. ROACH: My husband started having falls, and ended up in the emergency room twice. The second time, the doctor figured out what had happened. He was dehydrated and was fainting because of it. The doctor ordered a liter of fluid intravenously before allowing him to get out of bed. He was told to drink water all day long, not to rely on his thirst, because dehydration doesn’t make you thirsty — you’re beyond it. He has a schedule of drinking water all day, and is doing well. As I tell people about this, I’m hearing more stories of others having had the same problem. One woman had seizures because of dehydration. My neighbor told me that dehydration and falling are big factors in Florida.

Most of us are familiar with the advice to drink more water, but it should follow with “because if you don’t, you will start fainting, particularly older people.” I thought it would help to get this information out to others.

Thanks for your column. — I.L.

ANSWER: Thank you for passing on the advice. As it starts to get warmer, it is important to make sure that your fluid intake is appropriate. I think you are right that older people may not have as strong a thirst mechanism, and that keeping up water intake is important, especially if on a diuretic.

I have seen the opposite problem, too — people exercising in the heat and drinking too much water, which can cause the salt level in the blood to drop dangerously low. It’s a real danger for endurance events like marathon running. Athletes learn to balance their input and output (recognizing that sweat is a major output when exercising in heat) and to have some salt in their rehydration fluids.

The booklet on sodium, potassium chloride and bicarbonate explain the functions of these body chemicals and how low or high readings are corrected. To obtain a copy, write: Dr. Roach — No. 202, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I have a bottle of Regular Strength Mylanta original classic flavor, with an expiration date of January 2012. I have heard from several different knowledgeable persons that medications (prescription and over-the-counter) could be used one and two years after their expiration dates. What is your opinion on this subject? — S.R.

ANSWER: There’s little written about safety of medicine beyond their expiration dates, and what there is suggests that the medicines are likely to safe but perhaps a bit less effective after they expire. The one exception is the antibiotic tetracycline, which can be dangerous after it expires. I personally wouldn’t take any medication more than a year after it expired.

DEAR DR. ROACH: I recently finished taking medicine for tuberculosis exposure — my skin test was positive. I read that tuberculosis germs can “hide” from treatment in the bone marrow. Am I cured? — T.R.

ANSWER: A positive skin test, with a normal X-ray and with no symptoms, is referred to as latent tuberculosis. Without treatment for latent TB, your likelihood of developing invasive tuberculosis — the “real thing” — is about 8 percent over your lifetime. With treatment, of the kind you took, your risk is about 1 percent. The reason it isn’t zero may be what this new research has found, that the bacteria can find places to hide in the bone marrow.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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