Throughout 2020, humanity has been trying to understand which virus it has encountered, what are the mechanisms of its defeat and how to resist it. The main thing was to snatch another patient from the clutches of death. But a year has passed since the start of the pandemic, and it turned out that recovery is not all. It is equally important to correctly restore the body after a virus attack. And here a noticeable gap has formed – if even medical students know the treatment regimens for covid, then the recommendations of the Ministry of Health of the Russian Federation on rehabilitation are temporary. Because the medical and scientific community simply did not have time to study the postcoid state of patients. However, the specialists of the Saransk polyclinic named after Katkova – head Yulia Shevolaeva, exercise therapy doctor Anatoly Shiryaev and physiotherapist Irina Malysheva – studied the temporary recommendations of the Ministry of Health of the Russian Federation and WHO for the rehabilitation of covid patients. Details are in the article by Olga Voronina.
Physics and no lyrics
“Yes, for many months our health care has been working for one thing – to pass as many coronavirus patients through the hospital as possible and not let them die. But, when a person is discharged, he is left alone with all the postcoid symptoms – fatigue, malaise, muscle atrophy, affected lungs, who have forgotten how to breathe, etc. And he absolutely does not know what to do with all this: whether to call a doctor , whether to go to an appointment at the clinic or just wait for the “release”, – says Yulia Shevolaeva. – But, firstly, because of wild weakness, not everyone can reach the clinic immediately after the hospital. Secondly, the district doctors are still so loaded with calls for covid patients that they obviously will not reach a person complaining of weakness, rapid fatigue and poor memory soon. Therefore, now we have collected all the latest recommendations for recovering the body after covid and we hope that many will apply this in practice or tell their families and friends. ” According to Yulia Shevolaeva, the most important thing is physical respiratory rehabilitation. Physiotherapy exercises, and once again it is the most. “The fact is that many patients with moderate and severe covid are literally learning to breathe again. This happens because the nerve endings of the respiratory center and the nerve endings that stimulate the work of the respiratory muscles are affected, and also because a person began to breathe differently during an illness due to shortness of breath. And in order to ventilate all parts of the affected lung, it is necessary to perform a complex of breathing exercises daily. Despite the weakness and infirmity, apathy and the Russian maybe, ”the doctor explains. And for this, says Yulia Shevolaeva, it is necessary to understand: waiting for the weakness and other manifestations of postcovid to disappear by themselves, threatens with further loss of health, and sometimes disability.
No balls!
But it is equally important to competently approach the restoration of the respiratory system. Unlike all other pneumonias, covid rehabilitation is aimed at restoring the INHALATION function. “Most patients with coronavirus pneumonitis have not produced sputum and have nothing to cough up. Therefore, they need to train specifically the respiratory muscles. There are special exercise machines that help to strengthen it. One of the most effective is Threshold IMT (average price 1606 in the WildBerries online store – “C”). But another modification of the device – Threshold PEP – is not suitable, it is used for bronchitis with a large amount of sputum, ”says Yulia Shevolaeva. At the second stage of power recovery, Threshold IMT becomes insufficient, then you can switch to the POWERbreathe Medic device, however, its price is already twice as high and it is more difficult to get it on the Internet.
The doctor once again reminds: the patient must work on INHALATION (not on exhalation!), So balloons, especially new ones, should not be inflated, this can lead to lung damage.
Take a deep breath, wider arms, do not rush …
The main function of breathing exercises is to use all parts of the lungs, especially the lower ones, which are the worst ventilated, as well as to strengthen the respiratory muscles, says the doctor of the exercise therapy clinic named after. Katkova Anatoly Shiryaev. Classes should begin with several exercises and approaches per day, gradually you can increase the load and do 8-10 repetitions of each exercise. Weakness and fatigue are not a reason to postpone gymnastics until better times. “Right after the hospital, many feel so weak that it is difficult for them to get out of bed. For this stage there is a set of exercises that can be performed in bed, ”says the doctor.
1. We train diaphragmatic breathing. Bend your legs at the knee joints. Put one hand on the chest, the other on the stomach. Inhale with your nose and exhale with your mouth. When inhaling, inflate the abdomen (while the chest is motionless), when exhaling, return to its original position and draw in the abdomen.
2. Place your hands along the body, lying on your back. When inhaling, raise your shoulders, bring your shoulder blades together, and push your chest forward. On exhalation, return to the starting position.
3. With an inhalation, raise your arms and put them behind your head with an exhalation, lower them along the body. Always inhale through the nose for one-two-three counts and exhale through closed lips, slowly, not forced, as if a “flat tire”.
4. The legs are bent at the knees while lying on the back. Put your hands on your hips. In this position, take a deep breath, and as you exhale, stretch your hands to your knees and exhale. Return to starting position.
5. Hands spread apart, lying on your back. Take a deep breath once, press your right knee to your chest for two, hug it with your hands and exhale, and return to the starting position for three. Repeat with the second knee.
The next stage is for those who already feel more cheerful. Chair exercises.
1. Put one hand on the chest, the other on the stomach. Take a deep breath with your nose – inflate your stomach. Exhale through pursed lips, drawing in your stomach.
2. Lean on the back of a chair. Make head turns: inhale, turn your head, stretch your chin to your shoulder and exhale. Return to the starting position and repeat the turn to the second shoulder.
3. Lean on the back of the chair. Spread your arms to the sides, take a deep breath and rotate your arms, exhaling for each rotation. Immediately rotate your arms forward, and then back.
4. Stretch your legs, put your hands on your knees. Take a deep breath, then reach with your hands to your toes and exhale fully.
5. Lower your arms, take a deep breath, stretch your right hand to the floor and exhale. Return to starting position and repeat with the other hand.
When the state allows you to do exercises while standing, you can recall the school warm-up: turns, bends, head rotation, shoulder rotation, arm swings, rotation of the forearms, hands, arm extension, circular movements of the trunk, pelvis, back turns of the trunk, bends to the side, forward, etc. .d.
Physiotherapy
During the period while the edema of the pulmonary alveoli persists, physiotherapy is contraindicated, the physiotherapist of the polyclinic them. Katkova Irina Malysheva. “But it is necessary if there are fibrotic changes in the lung tissue. Then we prescribe electrophoresis, magnetotherapy, ultrasound, depending on the nature and degree of lung damage. In case of muscle atrophy of the legs, which occurs with prolonged bed rest, we prescribe electrical stimulation of the thigh muscles. The necessary equipment is in the arsenal of our clinic, ”assures Irina Malysheva. According to her, a light massage of the chest is very helpful – front and back over the entire surface, bypassing the heart area, – short tapping with the edge of the palm or fist. In this case, it is better to sing the sounds a-a, o-o, or to buzz with a drawn out w-w, h-z. “These vibrations help” breathe out “little accessible areas of the lungs, and tapping improves blood microcirculation.
What to eat and drink
In moderate to severe form, the coronavirus puts a person to bed for a long time. First, a sick leave, then at home, when postvoid weakness and high fatigue do not allow to get up on skis and just return to an active lifestyle. “Typically, these patients experience a large loss of muscle mass. They lose weight by 5-10 kilograms, but not at all due to the fat mass. And due to protein catabolism – the breakdown of muscle tissue. Therefore, it is so important to provide the patient with proper nutrition, focusing on easily digestible protein. A person simply needs to be fed. If you have no appetite at all, you can include in the diet high-calorie nutritional drinks and high-protein formulas such as “Little Drops”, which are used for children and adults during illness and recovery. In the diet of those who have had pneumonia, the proportion of fats and carbohydrates 50/50 should be observed, because the body is in dire need of lipids to restore the lipid membrane of the alveoli. The basic principle of the post-ovarian diet is fractional nutrition. This will allow you not to burden the digestive system and give the body the strength to fight infection. Meals should be 4 to 6 times a day in small portions of 200-250 g. For breakfast, it is better to prepare dishes from dairy and cereal products, for lunch there must be broth or soup, and for dinner – steamed vegetables, white meat or lean fish.
With coronavirus, it is important to prevent dehydration of the body, the norm of pure water is 30 ml per 1 kg of body weight. Also recommended are juices, herbal tea, but not black, vegetable juices with the addition of citrus fruits. The main purpose of nutrition is to give the body strength, but not to overload it with “extra work”, so you will have to exclude all semi-finished products, fast food, sausages, sausages, etc.
We continue to drink medicines
Many have already realized, as they say, for themselves that the body’s recovery after covid is rather slow. Therefore, in addition to physical exercise and proper nutrition, in order to avoid postcoid complications, it is necessary to take medications until the attending physician cancels them. “First of all, we continue to drink blood thinners. The course of treatment is 1–3 months, depending on the state of the organism. As already mentioned, coronavirus causes thrombovasculitis, when every small vessel in the lungs, intestines, spleen and even stomach, other organs, as well as nerve endings, including the brain, can be clogged with blood clots. And this process cannot be reversed so quickly, ”Shevolaeva says. It is thrombovasculitis that is most often the cause of post-ovarian death. Especially among patients who do not comply with the doctor’s prescription or take drugs on their own. Also, after covid pneumonitis, so-called consolidation foci appear in the lungs, when the airspace of the alveoli is filled with blood and other biological fluids. “After a covid lesion of the lungs, the healing and restoration of lung tissue occurs rather slowly, for resorption and acceleration of the process, the doctor prescribes drugs depending on the situation. In addition, we prescribe vitamin and mineral complexes, which are selected individually, and antioxidant therapy – “Mexidol”, “Cytoflavin”, “Mildronat”, and with a large loss of muscle mass and high fatigue – “Elkar”, – reveals the scheme treatment Julia Shevolaeva. – And remember – the human body, even an adult, has a colossal capacity for recovery or compensation. But in order to launch this mechanism at full power, you need the strength that the love of life gives. The belief that patience and work will grind everything. You understand this well when you put yourself on your feet. “
So far, sanatorium and resort treatment for Kovidniks has not been organized in Russia, but the Ministry of Health of Mordovia is going to open rehabilitation beds where people will recover from coronavirus infection. This became possible with a decrease in the level of hospitalized patients and the release of the bed capacity. Apparently, the near future of therapy belongs to post-ovarian rehabilitation.
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