For advice addressed to a reputable rehabilitation specialist Leonid Diacov. He is a specialist of the Department of medical rehabilitation, sports medicine, physical education with a course of medical and social assessment of the Rostov state medical University. As well as a member of the Association of physicians of outpatient rehabilitation and the European Association of outpatient rehabilitation.
Leonid Leonidovich, what is the first thing to pay attention to friends and relatives of those who suffered COVID-19 ?
Leonid Dyakov: I would pay attention primarily on the psychological, even philosophical moments. It is important to understand that the discharged patients went through a difficult phase in your life.
the Disease is forced to stop, which, in my opinion, is to slow down, look, think about how you live. In a crisis people reinvents a lot, understands what he did wrong and what needs to change in himself. A disease is a crisis. Sort of a warning, a Wake-up call, a chance to fix something, try to change the attitude to their health.
loved ones can help to survive this “postcrisis”?
Leonid Dyakov: My deep conviction that the relatives, close friends can provide invaluable support. But for this you must have complete information to understand the danger of the state that survived their loved one.
unfortunately, the coronavirus can affect the soft membrane of the brain. Hence the bad mood, do not want to do, become depressed. It takes a tough soul-searching, the man reacts.
Relatives need to understand this and to support recovering. In General, the role of loved ones is very large at all stages of rehabilitation, which can last quite a long time – from three months to a year.
What exactly should they do?
Leonid clerks: for Example, urban residents unaccustomed to walk, but for recovery you need, and in parks or outside the city. Relatives can make a company, to organize a two or three hour walk with curative intent. Do not skimp on this time.
to Approach such loads must be strictly individually. To start with just a slow walk. Later, when people will get stronger, you can learn Nordic walking (better to start with an experienced instructor or doctor of physical therapy who work on this technique). Persistent healing effect swimming. But it should be an active movement in the water. Maybe for some patients it is advisable to start with hydrokinesiotherapy (special complexes of exercises in water with the instructor).
in addition to psychological condition, what else should pay attention?
Leonid Dyakov: Tocoronavirus – a serious disease that harms not only the respiratory organs (the lungs heard everything), but also other systems and organs of the human body. First of all, cardiovascular system. One of the most common complications COVID-19 – myocarditis, inflammation of the heart muscle. It is particularly dangerous in that it may not develop immediately, but after a time.
the Virus is introduced into the myocardium?
Leonid Dyakov: the Virus affects endothelium, the inner “lining” of blood vessels, and blood vessels pass throughout the body. One of the most vulnerable areas of the myocardium. For this reason, may be suffering from kidneys. After all, they are a tangle of blood vessels. If the virus infects them, the inevitable problems.
What symptoms should alert when it is necessary again to urgently run to the doctor?
Leonid clerks: Inexplicable, sudden weakness. The disruption of the heart, a feeling of interruption. Increasing the temperature to 37 degrees or more. Increasing shortness of breath.
Even if the person is discharged from hospital if you encounter these symptoms you need to contact the doctor. Ideally, a cardiologist, can to the physician, the pulmonologist.
If there is swelling of the face and hands, there is frequent urination is signs of fluid exchange, also do not delay with the visit to the doctor.
by the Way, myocarditis, too, are swelling, most often on the feet is an important symptom developing complications.
Assume apparent symptoms, you are talking about, no. But to be confident in a full recovery, do I need to take tests? Enough fluorography once a year or need a CT scan? How much time needs to be observed?
Leonid Dyakov: during the year after discharge would be good to do three times a lung CT scan. No need to fear radiation dose of modern machines are almost harmless. Complications can be detected only by computed tomography. It will show parts of the lungs that are affected. And to take timely action. Also after discharge, suggest three times a year to do an ECG, General blood and urine analysis.
an Important indicator of respiratory system – respiratory function – can be tested using spirometry. It’s a simple manipulation, it holds a pulmonologist or departments of functional diagnostics.
at home, you can use a portable pulse oximeter. Miniature device detects saturation of blood oxygen (saturation). This indicator should be monitored in the course of the year, it should become a habit, as, for example, measurement of pressure using the tonometer.
do I Need a special diet?
Leonid clerks: For convalescents important good nutrition, enough protein and fat. In severe course of the disease in the body occurs�� significant loss of protein.
And the fat needed to light fully working, special substance, consisting of fat, prevent the adhesion of alveoli. And of course, vitamins. Large dose a person receives during the course of treatment. But after discharge it is advisable to take a multivitamin for three months. Of course, under the supervision and prescription of a physician.
How long immunity after people have been ill? And how do you know that the immune system is exhausted?
Leonid clerks: Resistant immunity is not formed. The concept of specific immunity, the person gets it, but there are many varieties of viruses, and they change so rapidly that lifelong immunity and not acquired. And to know that it is drained – simple: man gets sick again.
People seriously ill COVID-19, talk about the defeat of the lung, sometimes up to 40 percent. Recover it a fabric? Or they are replaced by connective and non-functional? How to live, figuratively speaking, with half a lung? What to watch out for? Are there any restrictions on professional sports activities?
Leonid clerks: In fact, the lung tissue well kompensiruet. Even the alveoli are restored.
Nature has covered the person on this case, that’s why the lung is a paired organ and a person can live with only one lung. Of course, the main thing – the correct treatment and rehabilitation.
Restrictions after a severe course of the disease may exist for work related to the change in atmospheric pressure – at depth, the height. Restrictions can affect the sports career.
there are cases when sick people not only risk, but strong healthy men who regularly engaged in sports. When they can get back to training?
Leonid clerks: In the first days after discharge should be a very small load, you need to be careful. Walk a little and to constantly monitor its state.
Start with the usual exercise, but under control, individual adjustment of the load. Of course, we cannot do without specialists, rehabilitation specialist, physical therapist, a pulmonologist, cardiologist, and others.
How long could the recovery period?
Leonid clerks: Rehabilitation will take quite a long time, especially if I had to resort to the help of a ventilator. Very nice old Soviet system restore was taken to the treatment of pneumonia for three months, and this period necessarily included a Spa treatment.
It was a crucial stage. Earlier, before the revolution, the patients went “on the water” and breathe the air. Some places still preserved balneological technologies, climate. Healing dry sea, HVOany the air. It Is The Crimea, Gelendzhik.
Leonid Leonidovich, now there is some kind of rehabilitation program for people undergoing COVID-19?
Leonid clerks: the Problem of coronavirus – new. Such programmes have just appeared. There are recommendations for different community rehabilitators. There are recommendations for rehabilitation after community-acquired pneumonia.
In Soviet times, the man who has had pneumonia for three months, watched intently, and then another year was out of control. During this period, it’s important to recognize the outbreak of the complications that the person became disabled.
After pneumonia in lungs is scar, like after an injury or infarct, so-called fibrosis. It can be minimized to the maximum body to function effectively. This requires a rehabilitation program, and each patient is individual. Someone enough breathing exercises, someone shows electrotherapy, massage, physical therapy, and kinesiotaping, Spa treatments, etc.
Now in our country has remained at approximately 1700 resorts, some are doing the correct procedure. There are a number of technologies that can be applied on an outpatient level of care.
the Specialty “rehabilitation therapist” appeared recently. They are still very small. And the whole problem is to build this chain of after-hospital care for patients. But doing this is very important as quickly as possible to the effects of coronavirus have not responded to all of us in the near future.
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