Convalescence


Categories: Uncategorized
Sources: Disturbances Of The Heart

When compensation has been restored, the patient may be allowed

gradually to resume his usual habits and work, provided these habits

are sensible, and the work is not one requiring severe muscular

exertion. Careful rules and regulations must be laid down for him,

depending on his age and the condition of his arteries, kidneys and

heart muscle. It should be remembered that a patient over 40, who

has had broken compensation, is always in more dancer of a

recurrence of this weakness than one who is younger, as after 40 the

blood pressure normally increases in all persons, and this normal

increase may be just too much for a compensating heart which is

overcoming all of the handicap that it can withstand. Such patients,

then, should be more carefully restricted in their habits of life,

and also should have longer and more frequent periods of rest.



The avoidance of all sudden exertion in any instance in which

compensation has just been restored is too important not to be

frequently repeated. The child must be prevented from hard playing,

even running with other children, to say nothing of bicycle riding,

tennis playing, baseball, football, rowing, etc. The older boy and

girl may need to be restricted in their athletic pleasures, and

dancing should often be prohibited. Young adults may generally,

little by little, assume most of their ordinary habits of life; but

carrying heavy weights upstairs, going up more than one flight of

stairs rapidly, hastening or running on the street for any purpose,

and exertion, especially after eating a large meal, must all be

prohibited. Graded physical exercise or athletic work, however, is

essential for the patients' future health, and first walking and

later more energetic exercise may be advisable.



These patients must not become chilled, as they are liable to catch

cold, and a cold with them must not be neglected, as coughing or

lung congestions are always more serious in valvular disease. Their

feet and hands, which are often cold, should be properly clothed to

keep them warm. Chilling of the extremities drives the blood to the

interior of the body, increases congestion there, and by peripheral

contraction raises the general blood pressure. A weak heart

generally needs the blood pressure strengthened, but a compensating

heart rarely needs an increase in peripheral blood pressure, and any

great increase from any reason is a disadvantage to such a heart.

The patient should sleep in a well ventilated room, but should not

suffer the severe exposures that are advocated for pulmonary

tuberculosis, as severe chilling of the body must absolutely be

avoided.



The peripheral circulation is improved, the skin is kept healthy,

the general circulation is equalized, and the heart is relieved by a

proper frequency of warm baths. Cold baths are generally

inadvisable, whether the plunge, shower or sponging; very hot baths

are inadvisable on account of causing a great deal of faintness;

while warm baths are not stimulating and are sedative. The Turkish

and Russian bath should be prohibited. They are never advisable in

cardiac disease. With kidney insufficiency, body hot-air treatment

(body-baking), carefully supervised, may greatly benefit a patient

who has no dilatation of the heart and who has no serious broken

compensation. Surfbathing, and, generally, sea-bathing and lake-

bathing are not advisable. The artificial sea-salt baths and carbon

dioxid baths may do some good, but they do not lower the general

blood pressure so surely as has been advocated, and probably no

great advantage is apt to be derived from such baths. If a patient

cannot properly exercise, massage should be given him

intermittently.



Any systemic need should be supplied. If the patient is anemic, he

should receive iron. If he has no appetite, he should be encouraged

by bitter tonics. If sleep does not come naturally, it must be

induced by such means as do not injure the heart.



Perhaps there is no better place in this series on diseases of the

heart to discuss the diet in general and the resort treatment than

at this point, as the question is one of moment after convalescence

from a broken compensation, at which time every means must be

inaugurated to establish a reserve heart strength to overcome the

daily emergencies of life.





More

;