Coronovirus C19 & our Osteopathic Practices.
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As I write, we are in Lockdown here and The Osteopathic Clinics are Closed until further Notice.

As we have a number of high risk folks in our household and Practices, I fear we will not be back in Practice for the majority of this year..

If you wish to talk to us over the phone please note we can't diagnose over the phone, but will probably be able to suggest some of the following:.
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1/ Remember that although most out-Patient clinics and GP Surgeries are reduced working at present, they are still available for non-covoid-19 complaints and you should not neglect your health if you feel you need to be "seen".

You can still phone/email your GP and send them photos and descriptions of your complaint and/or visit the Accident and Emergency areas of your local hospital if you really need to. Hospitals at present are not performing any non emergency procedures, but it is often still important to ensure that your structural problem is indeed structural and not anything else..

For example one of our number has had a very swollen knee and calf and though it seemed as if it was a structural problem of the knee, it was important to check that it wasn't a Deep Vein Thrombosis so, after sending photos to the GP, said member of the family went to the Hospital today to have an ultrasound, which confirmed that it was a ruptured cyst causing the swelling and not the more serious DVT. So, said member of the family is continuing with home treatment of the leg;.

namely ICE which is usually Ice, Compression and elevation, but is being undertaken as rest , elevation and cold compresses twice or more a day..

!/ Rest.
It is important to rest the injured area- ensure it is no longer weight bearing for periods of 20 mins or so..
2 or 3 'oasis/s of rest' throughout the day ensures that the limb or back gets a chance to heal and undergo less strain..
2/ Pain relief - take sufficient pain killers especially if pain is preventing you sleeping..

Do speak to your GP for advice if needed, remembering that anti-inflammatories are not being advised as much because of suspected interaction with C19. Paracetamol is probably the best to start with.*.

3/ although Ice is excellent for acute injuries (the day of the injury) , as pain relief and to prevent too much swelling, I usually recommend Patients use a cold compress that starts cold but warms up resulting in a warm moist feeling at the site of Pain..
a/ lay a dry normal towel down, wring out a tea towel or cotton handkerchief in cold water and place on the dry towel. Rest the arm , limb, back on the wet T towel and wrap round, so that the wet wrung out cloth is completely covered with the dry towel..
b/ 'simmer' for 15-20 mins until the inner damp rag has dried out.

(blood retreats to protect heart and vital organs on contact with Ice or the wrung out rag, but unlike ice, the cloth will warm up, as blood returns to the area, drying it out and thus increasing blood flow to the area and drainage away from the area. (All cells need DIN D for drainage, I for innervation and N for nutrition (and O2) which all comes in the blood).


You can self massage if not painful, and you can gently keep the limb or back moving preferably without weight bearing, hence back exercise like gentle knee hugs, gentle Yoga cat etc..
The best position for resting your low back and neck is semi supine, lying on your back (pillow for head if needed) with your knees bent and the soles of your feet down little way from your torso..


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Re C19 there is much info out there ( i have started a database of links and notes i have found interesting HERE) but if you fear you do have the symptoms do use the online Govt link and follow up if your symptoms worsen after 5 days i.e. and /or if you have difficulty breathing see Guardian Article Here.

There are a couple of Youtube videos here you may find useful...
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1/ is preventative and shows cleaning prep of shopping and goods coming into the home .
and 2/ .
this youtube shows a good breathing exercise for those self treating their C19 at home incl lying on tummy for 5 deep breaths
this from the BBC "author JK Rowling has revealed that she has been showing "all symptoms" of coronavirus over the last fortnight. In a Twitter post , Ms Rowling said that she was now "fully recovered". She added that a video posted by doctors at Queen's Hospital in east London, on how to relieve respiratory symptoms had "helped a lot" during her illness. Her husband - a doctor - had recommended it to her.".
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and 3/ a Nurse shares advice on caring for those with coronavirus symptoms at home
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her website First Aid for Life is also highly recommended
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*a friend posted this video about NOT taking paracetamol and anti-inflammatories , and asked what we thought

this was my response

yes v good, basically what I was taught in naturopathic medicine and osteopathic medicine at college.

the only caveat which he did point out at the beginning, but does need emphasising, is the danger of high grade fever.

Thus if a patient is getting into those higher temperatures then it is recommended to bring down the temp and whether that be by turning down heat in the environment , increasing ventilation wearing looser or fewer clothes or the use of cold compresses to the forehead, it is important to continually assess the temperature.

The healing process of fever he describes well, and is what i was taught as the 'healing crisis', where the symptoms seem as a crisis but are in fact our natural defences working well.

a 'death crisis' though is when there is over reaction, or in this case when the temperature gets too high, so again Caution; if the temperature being recorded gets too high, but this vid was a very good account of the process.

We have all got so used to paracetamol and anti-inflams but often we turn to them for pain relief, which as Dr John rightly points out are more antipyretic .

It is though important to control pain if the patient is undergoing other stresses such as difficulty in breathing, and thus other forms of pain killers may need to be employed. another subject really,

but ensuring frontal breathing for example has been shown to help C19 sufferers. Muscle ache pain and general decline does need careful managing so the advice to seek Medical assistance is important if breathing becomes difficult, but if necessary you can ask your GP for other non pyretic pain killers, although care is needed there too, as many are morphine based products and can suppress deep breathing (Respiratory depression) etc.

In conclusion it is important for anyone caring for a C19 patient who is not taking paracetamol or similar to constantly monitor and record body temperature, and seek medical advice if the patient experiences difficulty breathing or is in too much pain.



Caveat

This advice to avoid paracetamol and NSAI does conflict with current NHS advice (March 20 2020) such as this which appears in the NICE BNF pages for some of the most used painkillers.



Again it is important to speak with your GP or Specialist if you are caring for someone with C19 at home, and if they are in Pain, or having breathing problems, then firstly they should be thinking of contacting 111 and/or then maybe if no other painkiller is suitable, then the risk benefit of Paracetamol may be that it is needed.

If the patient is coping quite well except for having a temperature, then as long as their temperature is being monitored and recorded regularly (and isn't too high - the red zone in the vid), perhaps even as much as 1x an hour, then they can continue avoiding antipyretic painkillers such as NSAI paracetamol aspirin and ibuprofen etc.*

the dangers with the other Painkillers such as morphine, codeine etc is their breathing suppression side effects, so those too are best avoided where possible.

In hospital though, they may have to be used for analgesia to initiate ventilation etc but then again they may also use other pharma such as ketamine or diazepam like drugs.

* some of us of course are already on lo-dose daily aspirin for CV maintenance treatment

Do speak with your GP or Pharmacist if undecided or at all concerned as this is general advice and everyone is different or at a different stage or in different circumstances.



Keep Safe out there, socially close but physically distant. .
Best wishes Jol & Val Wardle (April 6 2020)(*revised 14/4/20).


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