Living inside a fluid limit without counting all day

Ask someone on dialysis which instruction is hardest to follow and it is rarely the medicines or the appointments. It is the fluid limit. Partly because thirst is not negotiable, and partly for a much more boring reason: through the day, nobody actually knows their total.

“How much have I had today?” gets answered from memory, and memory is optimistic. Two cups of tea become one. The glass with the tablets does not register at all. By evening the honest answer is a shrug, which means the limit stopped being a limit somewhere around lunchtime.

Measure the containers once, then stop measuring

The single most useful hour you can spend is with a measuring jug and your own kitchen. Fill the glass you normally use and read off what it holds. Do the same for your tea cup, your steel tumbler, your water bottle, the katori your dal comes in.

After that you never measure anything again. You count containers, and you already know what each one is worth. Two of your tea cups is a number, not a guess.

Fluid is more than what you pour

This is where most totals quietly go wrong. Anything liquid at room temperature counts, and several things that do not look like drinks are mostly water.

• Dal, sambar, rasam, and thin curries — the liquid in the bowl is fluid, not food.
• Tea, coffee, buttermilk, chaas, lassi, curd, and milk with cereal.
• Ice. It counts as the water it becomes, not as the volume of the cubes.
• Watermelon, muskmelon, oranges, mosambi, grapes — juicy fruit is largely water, and many of these carry potassium as well.
• Kulfi, ice cream, jelly, and the syrup a sweet is sitting in.
• The water you use to swallow tablets. Small each time, and there are a lot of them.

Thirst is a salt problem more than a water problem

Drinking less when you are thirsty is a fight you have to win several times a day. Being less thirsty in the first place is a fight you win once, in the kitchen. Salt is what drives thirst, and Indian kitchens hide it well beyond the shaker: pickles, papad, namkeen, chutney, packet masalas, instant noodles, biscuits, tinned and packet soups, and bakery bread all carry a lot.

People who cut the obvious salty items usually report the same thing — not that the limit became easy, but that it stopped being a constant battle. That is a much better position to manage from.

Habits that help with the last stretch of the day

• Decide the day's shape in the morning: which cups of tea, roughly when. An allowance with a plan behind it survives the afternoon better than one without.
• Use a smaller glass. The same number of glasses, less fluid, and the ritual of drinking is untouched.
• Rinse your mouth and spit rather than sipping. Cold water, a mouthwash, brushing — all take the edge off dryness without adding to the total.
• Try something sour or frozen. A wedge of lemon, a frozen grape, a boiled sweet, sugar-free chewing gum. Ask your unit first if you have diabetes.
• Keep some allowance for the evening. Running out by 4pm is what makes a limit feel unliveable.
• Take tablets with the fluid you were going to drink anyway, rather than a fresh glass each time.

When the limit is a real problem, say so

Constant, unbearable thirst is worth reporting rather than enduring. So is breathlessness lying flat, new swelling in the ankles or face, or a run of sessions that leave you wrung out. These are the things your unit can act on, and they are much easier to act on with a fortnight of honest records in front of them than with a description from memory.