Hydropathic procedures (balneotherapy)

· Here belong showers, baths, dousing (affusion), rub-downs, wet wrapping.

· Cold (less than 20⁰C) and cool (20-30⁰C) water causes spasmodermia, slows down heart rate, increases blood pressure, increasesskeletal muscle tone, nonstriated inner organs muscles. Hydropathy with such temperatures is used for general health improving and to harden oneself, to stimulate CNS functioning, increase metabolism.

· Indifferent (34-36⁰C) produces a notable sedative effect, relaxation.

· Warm (37-39⁰C) and hot (higher than 40⁰C) water provides evident exciting/stimulating effect, dilates skin vessels, increases heart rate, decreases blood pressure, decreases muscle tone, relaxes inner organs nonstriated muscles, increases sweating.

· Baths differ according to the purpose (hygienic and therapeutic), place of application (general and local), contents – “pearl” (air bubbles under pressure), foamy (foamy substances), vibrating and vortical (increase mechanical impact of water), aroma (coniferous, sage, etc.), mineral (hydrosulfuric), etc. According to their duration the baths can be short (up to 5 min), average (10-20 min), and long (up to several hours).

· Contra-indications: severe form of atherosclerosis, cardiac insufficiency, hypertensic crisis, obstruction of brain and coronary blood circulation, active form of tuberculosis.

· During the procedure the patient must be under constant control because the increase of blood pressure, heart and breathing ratecan make him feel worse.

Phlebotomy

Bloodletting – removal from the body of a certain amount of blood to decrease the circulating blood volume, arterial and venous pressure. Phlebotomy are used in cases of acute aortic ventricle (left ventricle of heart) insufficiency (pulmonary edema, in absence of shock or collapse), hypertonic crisis, pulmonary hypertension, polycythemia (expressed increase of erythrocytes), poisoning with the types of poison that remain in blood for a long time. Nowadays there are a lot of highly effective medical substances so bloodletting is not frequent. Nevertheless, in some cases only bloodletting can help or even save the patient.

Contra-indications: decreased blood pressure, hypovolemia (decrease of circulating blood volume), anemia (spanaemia), blood coagulation dysfunction, yellow fever.

Bloodletting is done by means of venipuncture or venesection; 200-400 ml of blood is released. The procedure is slow and careful in order to avoid complications (faint, blood pressure decrease, etc.).

Equipment; needles for venipuncture, rubber garrot, container for blood (with a scale), sterile napkins, alcohol, iodine, small oilcloth cushion, rubber gloves.

The procedure:

· Place the cushion with the napkin under the bend of elbow.

· Smear the skin with alcohol (iodine can’t be used). The medical worker first washes his hands, then smears them with alcohol, then puts on the gloves.

· Before inserting the needle we tie the garrot above the elbow bend for 1-3 min (the pulse should remain detectable, only the veins should be pressed).

· We puncture the vein, the needle is injected along the blood flow with the slant of the sharpened end facing upwards.

· Do not remove the garrot! After releasing 200-400 ml of blood (depending on the prescriptions) we take out the needle and then the garrot.

· At the end of the procedure place the sterile napkin on the place of injection and make an aseptic bandage.

· Take off gloves, wash hands.

Hirudotherapy

Hirudotherapy (L. hirudo leech),or bdellotomy(Gr. bdella leech) is the use of medical leeches for treatment. Hirudotherapy is used for local bloodletting and also to decrease blood coagulation (anticoagulative effect). Along with the secretions of leech’s salivary glands hirudin and histamine-like substances penetrate blood; they dilate the lumen of minute blood vessels and increase bleeding. In the extracts made of leeches one more enzyme was discovered – hyaluronidase; it increases the permeability of tissues and capillaries walls. So hirudotherapy, although being treated as one of the physiotherapeutic methods, is in fact a type of drug therapy.

To treat the patients the same way, but without leeches we can use the hirudin itself, which can be either extracted from the leeches or synthetically made.

Prescribed: hypertension crisis, hypertension, coronary heart disease (stenocardia, myocarditis infarction), venous congestion in liver, venous thrombosis and thrombophlebitis, haemorrhoids.

Contra-indications: anemia, decreased blood coagulation, treatments with anticoagulants, decreased blood pressure, pyoseptical diseases and allergies, increased skin sensitivity, pregnancy.

P ossible complications:

· skin itch (to remove it the skin around the wound should be smeared with a mixture of ammonia spirit and vaseline oil in equal proportion);

· if the leech is placed on the superficial vein – bleeding (to stop it we can use pressing bandage);

· pyodermatitis and furunculosis appear if a- and antiseptics rules were broken;

· hemorrhage into hypodermic tissue.