Monday, March 23, 2020

Help! Fomentations for COVID-19


Good morning,

I'm needing your help, and so are a few billion others.

A GP (family physician) friend of mine asked me for something to share with fellow GPs about hydrotherapy for COVID-19. Fortunately this friend was NOT happy with my ramblings on the topic, so I spent my Sunday going back to the books, specifically "Physical Therapy in Nursing Care" telling of the successful treatment of the last pandemic, the 1918/19 Spanish Flu.

So the treatment is: hot fomentations to chest and spine with simultaneous hot foot bath and cold compress to head followed by cold mitten friction once or twice daily with absolute bed rest between.
 
Basically they treated the person as if they had pneumonia right from the beginning.

So I wrote a page as requested for the General Practitioners' perusal.

But then I woke up this morning and realised it was useless!

How is it possible for an untrained person to do this treatment... safely (I've burnt people with fomentations), effectively (I've hospitalised a lady by changing things slowly and allowing her to get chilled... and consequently making her condition worse, I was lucky/blessed not to have killed her) and efficiently (if I follow the directions for hot fomentations I need 10 towels and 5 each fomentations and covers for just one treatment. If I don't have foments/covers then that's 10 more towels. 20 towels! Twice a day!)

And to be really effective, both the fomentations and the friction work best with 2 therapists. And finally, I don't remember ever doing that treatment. It's too much work! I don't remember treating pneumonia either. And I had a staffed hydrotherapy department at my disposal.

This treatment is big and dangerous but apparently, powerfully effective.

 In the past I've effectively treated all the fevers, flu, dengue, malaria, glandular with a strong, individualised revulsive to sweating, daily for 3 days, but I'm sure we are going to need something more targeted at Active Chest Congestion before this thing is over.

I've checked the Pneumonia and Active Chest Congestion pages on the website and the only alternative seems to be hot blanket pack (which doesn't really excite me - "Make sure the blanket is wrung dry of all water - patient may be scalded otherwise")

So you can help me by answering these questions (or sending this on to someone who can answer them):

1. Have you ever used the protocol (Fo chest back, HftB, CMF) for pneumonia? How did it go?

2. Can you think of a modern, safe and simple alternative way of heating the chest/spine to erythema with moist heat? It should be ubiquitous and cheap.

3. Any other thoughts and suggestions... So many people have contacted me lately that I'm wondering if this is the time.

 Here are links to:

My ramblings, "Treatment for Coronavirus"
The successful treatment of Spanish Flu in an Adventist seminary
And most importantly - The whole chapter on Acute Infections of the Respiratory System from Physical Therapy in Nursing Care.

Thank you for your help, I really do appreciate it,
Bruce

5 comments:

  1. Hi, Bruce! I just posted several further remarks on your last post before realizing you had posted this new one. That's OK, because my remarks/questions were more directly relevant to the last one. So...

    I am not a trained practitioner at all. I'm a retired industrial research chemist with a career in plastics technology. So I can't help you on the experience/expertise/etc. end that you are asking for. However, I have already been thinking through some of the questions of how best to do this. I had seen Youngberg's presentation, and also YouTube presentations on how to do fomentations (check Fallbrook SDA's YouTube channel for a direct demo by Youngberg; there are others), and I have read old books from early 20th century on it. Without a scientific understanding of the basis for these treatments or why(if) they work on coronavirus vs. flu vs. other respiratory conditions, it seems very difficult to suggest a procedure intelligently. Practitioners can speak from experience, but that has limitations, especially since this is a new virus and also patients vary. Anyway, check the references I gave in the earlier posts for pneumonia procedures apparently used in 1918, or at least recommended by people who had treated that then. Note also the warning by Miller if not treated early. (continued next post; 4096 char limit!)

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  2. The Life & Health (and Epidemics book) give home treatments. These are simple, so seems like they could be applied now without difficulty. Of course, if it develops to pneumonia, may be another story. From Hansen et al's book, they give home remedy for influenza:

    Hydrotherapy, or water treatment, has proved to be the very best remedy for this disease. It must be given with great care, however, in order not to expose the patient unduly. Fomentations to the spine and a hot foot bath in bed are best. If there is a cough or a cold in the head and throat, fomentations may be given to the throat, chest, and face. Follow this treatment by sponging with cool water, alcohol, or witch-hazel under the bedclothes. Keep the room fairly warm, 68° to 72°, with good ventilation.
    In case of high temperature,— that is, above 103°,—use sponging (pages 113, 114), or a pack (pages 103105), or the cool enema (pages 106-108). Drugs, except mild cathartics, are of little use. Keep cold on the head when giving fomentations and when the temperature is high. If there is pain in the head, especially in the eyes and nose, it may be relieved by alternate hot and cold applications, or fomentations and cold compresses.

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  3. (continued from Hansen et al)
    If the pulse beat is above 100 a minute, use a dry icebag, with a towel under it, to the heart, for ten minutes every three hours. Be sure to keep the bowels active. Secure a movement twice a day by enema or cathartic, if they do not move naturally. Keep the mouth clean by using a saturated solution of boracic acid as a mouth wash two or three times daily. A " saturated solution " is as much as the water will dissolve.
    It is most important that the patient remain indoors, preferably in bed, for a few days after the temperature is normal. A safe plan is to remain in bed as many days after the temperature is normal,— morning", noon, and night,— as one has had fever. The temperature, not the patient's feelings, should be the guide. Even after that he should be careful to avoid exposure or overexertion. Exposure is likely to cause a relapse followed by pneumonia, while overexertion may result in serious heart trouble, or even in death from heart failure.

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  4. Finally, to address modern how-to, I have been thinking and already experimenting. You can tell me if I'm wrong. It seems to me that the goal is moist heat (but not super heated steam!), and penetrating cold. With a purely water based system, this can be tough for the reasons you gave: Lots of towels, and may need assistants. Also, may be tough to get cold enough water out of a shower/faucet depending on climate. So, some kind of artificial cooling is needed in those cases. Ideas: (a) electric heating pad with sponge capability for moist heat--about $15-20 on Amazon--and avoid towels altogether except as separation layer if needed; (b) if using towels, use Styrofoam insulated ice chest for ice bath, or for keeping hot towels, vs. the paper mache' pot used in Battle Creek!; (c) reuse moist towels by heating in microwave; (d) use freezable gel-packs (about $20 on Amazon) for the cold treatment--they are available in various sizes, including a small one for neck and one with an elastic encasement that straps around head which you could apply to keep forehead cool. These are some ideas I have for facilitating fomentations in a modern home setting with unskilled and limited labor. Thoughts? Also, as Youngberg has said, why not just a hot path/pool (or ice packs), or a hot shower and same, if patient is well enough? I don't understand the fixation with total immobilization, including even going to the bathroom in the bed, if the patient is strong enough to get up and use the shower or toilet. Why not? Your comments welcome!

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  5. Thanks again RJ. The fomentations and hot foot bath is essentially the treatment for pneumonia. They assumed the worst from the beginning and treated for it. The reason why it doesn't matter which disease-causing organism is present is that these treatments are for supporting the body. It is interesting when you actually treat someone who is sick, they "just know" what they need and respond to it by symptom relief. Which is how you know if a second treatment is needed per day. If symptoms return, you then repeat the treatment.
    Thanks again for the Epidemics book, I have downloaded it. Where do you find this stuff RJ?
    The bed rest and lots of the other things may relate to the cold climate and relatively poor and spotty heating of the houses at that time, more than to total bed rest.
    I like the suggestions for the modern how-to. Will definitely use some of them.
    RJ please continue commenting, you have been a very provocative and informative contributor.

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