DEAR DR. ROACH: In your response to a question regarding Paxil for anxiety attacks, you suggested that there are some nonpharmacologic treatments that are effective. I would suggest that most physicians are possibly not aware of all such therapies. I would appreciate any information you can provide. I have a son who is affected by anxiety problems, and his current medications have serious side effects. — A.K.

ANSWER: Although my previous answer was about panic attacks, there are nonmedication treatments for generalized anxiety disorder as well. They are similar conditions, but generalized anxiety disorder is characterized by excessive worry and anxiety more days than not, whereas panic attacks are sudden, often disabling anxiety attacks with physical symptoms such as chest pain or shortness of breath.

The best-studied nonpharmacologic treatment for both of these conditions is cognitive behavioral therapy. This includes education and such techniques as breathing retraining, muscle relaxation and, importantly, monitoring mood and recording details of any panic attacks. CBT is done by a trained therapist, usually a psychologist, and typically lasts 10 to 20 weekly sessions.

Many people find a combination of medication and CBT works better than either separately, but if your son can’t take any of the effective medications, then CBT alone is usually effective.

DEAR DR. ROACH: How much water should an adult drink in a 24-hour period? The minimum I have heard is a half-gallon and a maximum is two gallons. In your opinion, what should the amount or range be for the average person? Also, do you think any of the following factors should be considered in setting an amount of water intake: weight, gender, age, occupation and other liquids and food consumed? — G.W.

ANSWER: Probably the most important factors in determining how much water a person needs are activity and the temperature/humidity where the activity is taking place. A letter carrier walking all day outside in high heat and low humidity may require the high end of the range you mention. The minimum absolutely required for someone not exercising and in a cool climate is much lower than you might think — half a liter, or just over a pint. Healthy kidneys are able to maintain fluid balance even with wide variation in fluid intake. Liquid in food and other beverages counts as fluid intake, but alcohol interferes with the body’s water regulation.

I am a big believer that the body is able to regulate itself in most circumstances. If you drink when you are thirsty, that’s going to work fine most of the time.

DEAR DR. ROACH: I have a strange question to ask and hope you can answer it in your newspaper article. Every time I stand up from being in bed, I get hiccups that last about a minute or so (at least a dozen hiccups). I was wondering if there is a medical reason for this, or is it something that is just a fluke that happens to me? — N.C.

ANSWER: It’s not just you; I have heard of several cases, and I suspect it’s not that rare. It’s thought to be brought on by a change in position of the stomach, which causes a reflex in the diaphragm. Esophageal irritation, especially from reflux disease (stomach acid going backward into the esophagus), also might be a cause.

The booklet on heartburn explains reflux disease. Readers can obtain a copy by writing: Dr. Roach — No. 501, 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.

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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