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Methods of complex treatment of patients of Akhtal resort.

On the basis of long-term experience, careful clinical and experimental supervision Akhtal's resort, the differentiated methods of treatment of patients with various diseases are developed.

  1. Technique of mud cure of patients with diseases of the musculoskeletal device.
  1. Diseases of joints and backbone.

Inflammatory arthritises.

Rheumatic arthritis (infectious nonspecific infectious polyarthritis) – a system disease of a connecting fabric with primary localization of inflammatory process in joints. The illness is characterized by the steady progressing current bringing patients in efficient age to early disability.

The favorable outcome of mud cure sick rheumatoid an arthritis in many respects depends on the clinical-anatomical form of disease and degree of activity of inflammatory process. In this connection selection sick rheumatoid an arthritis for mud cure should be strict and individual, in order to avoid undesirable complications and aggravations.

Effectively passes mud cure of patients by rheumatoid polyarthritis, oligo-monoarthritis in a phase of remission or at the minimum degree of activity of pathological process with violation of function of the musculoskeletal device isn't higher than the first and second degree.

Treatment is appointed in the form of the general or local mud applications with temperature 40-42-440, with duration of procedure of 15-20 minutes. The first two applications are spent every other day, and further two-three days in a row with the next day of rest. The mud cure course depending on the general condition of the patient is defined by 12-18 procedures.

At multiple defeat of joints with success mud baths with temperature of mud solution 36-380, with duration of procedure of 15 minutes, plan of treatment of 10-15 baths are used.

For local anesthesia and biodegradable impact on inflammatory process in joints, mud cure is combined with the purposes a number of physiotherapeutic procedures among which are most often applied: ultrasound, phonophoresis hydrocortisone, electrophoresis various medicinal substances (analginum, novocaine, lithium and others), electromagnetic field of ultrahigh frequency (UVCH), microwave therapy, short-wave diathermy, ultra-violet radiation and others. No more than two joints are exposed to at the same time physiotherapeutic procedures. Depending on a condition of the patient one of above-mentioned procedures should alternate with mud cure, in case of simultaneous from appointment it is necessary to observe an interval at 3-4 o'clock after reception of mud procedure. It is recommended to appoint to plan of treatment from 10 to 15 physiotherapeutic procedures.

In a complex of treatment massage of regional muscles and the corresponding mode of movements – medical gymnastics or a mechanotherapy (a course from 15 to 20 procedures) join also.

The medical gymnastics and massage against mud cure promote restoration of function of joints and prevent development of contractures and anchylosis.

In the course of mud cure often after reception of 3-5 procedures there comes obliterated reaction which doesn't demand special treatment, is easily stopped by purpose of anti-rheumatic medicines (aspirin, Reopirin, Analginum, Butadion) and tranquilizers (Beloyd, Belaspony), without the mud cure termination.

If   balneology reaction with temperature increase of a body and activity of pathological process (balneo-pathological reaction), expediently temporary termination of mud cure and purpose of the corresponding medication therapy. Along with it within several days it is necessary to limit reception of carbohydrates and table salt. The food of the patient with rheumatic arthritis should be high-grade, containing vitamins A, В1. В2,Page.

One of important all-strengthening means at treatment of patients in Akhtal's resort is as well an aerogelio therapy – one of types of a climatic therapy.

Rheumatic polyarthritis (Sokolsky-Buyo illness). Rheumatism belongs to collagen diseases with primary defeat of heart, rheumatic polyarthritis is one of manifestations of a sharp stage of this illness.

Treatment of patients with rheumatic polyarthritis in Akhtal's resort should be carried out carefully. It is necessary to appoint mud cure in remission, an inactive phase, in 10-12 months after a bad attack, without clinically being shown symptoms of a disease and insufficiency of warmly vascular system.

Dirt is put a type of application on one or several joints. Temperature dirt 39-400, duration of procedure of 15 minutes. The first 2-3 mud applications are appointed every other day, the next days – two procedures in a row with one-day rest, plan of treatment of 10-12 applications.

During mud cure at moderately expressed balneal reaction reception of baths usually don't stop, at more expressed balneal reaction (body temperature increase to 380 and above, strengthening of pains in joints, increase of activity of rheumatic process) it is necessary to cancel mud cure and to carry out active medication therapy (antibiotics, salicylic, pirazolonovy, indolovy preparations, brufen, analginum, corticosteroids, etc.).

In an aggravation ultra-violet radiation of joints by eurhythmic doses, and also purpose of an anti-inflammatory diet as restriction of carbohydrates and table salt is effective. analginum, corticosteroids, etc.).

Ankylosis  spondylo-arthritis  (Bekhterev's illness) is considered as the general disease of an organism at which defeat of a backbone and peripheral joints is one of the main symptoms of an illness.

Bekhterev's illness belongs to group of collagenic diseases. A part of authors rank this disease to rheumatic arthritis, however the majority consider as more correct to consider Bekhterev's illness as an independent nosological form.

Treatment of patients Ankylosis spondiloartrity in Akhtal's resort is shown at the central and peripheral forms of an illness in a jet phase or at the minimum and moderate degrees of activity of inflammatory process. At an early stage of a disease, in the absence of viscerally defeats mud applications segmental are appointed to a backbone, transportation- sacral bone area and the struck joints. Dirt 38-430 temperature with duration of procedure of 15-20 minutes. Plan of treatment of 12-14 procedures. In later stage of an illness in the absence of defeats of an internal the number of mud procedures can be finished till 15-20.

From physiotherapeutic procedures for prevention of development of contractures, muscular atrophies, mobility restrictions in a backbone it is recommended to apply a diathermy, an inductothermy ultrasound. In the presence of inflammatory changes in joints it is expedient to appoint phonophoresis a hydrocortisone. At the central form of an illness of Bekhterev, low activity of inflammatory process and the expressed pain syndrome it is recommended to appoint dynamic currents. All physiotherapeutic actions are spent daily or in free days from mud cure. Plan of treatment from 10 to 15 procedures.

At Bekhterev's illness very effectively application of medical gymnastics and massage. These procedures should be carried out systematically.

Infectious specific arthritis, polyarthritis.

Under this name diseases of the joints which etiological factor is a certain specific infection (gonorrhea, a brucellosis, dysentery, sepsis, etc.) are incorporated.

Bacterial toxins, to sensitize an organism, can cause allergic reaction of joints. Thus arise or sharp or subacute a polyarthritis on a clinical picture extremely reminding rheumatic.

By clinical supervision it is established that at a known stage of the development, even at a complete elimination of the general pathological process, infectious specific arthritis get a chronic form. After carrying out therapy mud cure in the form of the general and local applications and baths is shown at dirt 38-440 temperature, lasting procedures of 15-20 minutes. The first 2-3 procedures are appointed every other day; at good shipping of treatment mud procedures are carried out two or three days in a row with the next day of rest. Plan of treatment is usually limited to 12-14 procedures.

Here it is necessary to specify that at brucellosis arthritis mud cure is admissible not earlier than in three months after stabilization of normal body temperature. At other arthritis (gonorrheal, dysenteric) mud cure is desirable for beginning probably earlier. In acute arthritis stages the temperature of mud applications should be low 38-390.

Deforming osteoarthritis (DOA)

Primary deforming osteoarthritis call a dystrophic disease of joints at the heart of which primary and degenerate defeat of a cartilage with the subsequent bone growths leading to deformation and violation lies. functions of joints.

Such generalized defeat of the musculoskeletal device is clinically expressed on a small number of the most destroyed joints. In certain cases the disease proceeds sweat to type a polyosteoarthrosis. Here it is necessary to mention about secondary deforming to an osteoarthritis because of a trauma, arthritis or congenital anomalies.

It is necessary to stop also on group of the diseases connected with primary degenerates by defeat of a cartilage in joints of a backbone. Them treat the intervertebral osteochondrosis deforming spondylitis and spondylarthrosis.

Mud cure at the above-stated diseases is carried out in a complex with physiotherapy, medical gymnastics and massage on the same to principles, as at inflammatory diseases of joints, stand only a difference that complex therapy here should be applied more widely and more intensively. The Applications method of mud cure is shown at defeat of one or two joints by the patient with defeat of joints of a backbone. At good shipping (in individual cases) it is better to appoint mud baths.

Gout

Gout – a disease of a metabolism which owing to a prevalence of articulate manifestations is considered in group of metabolic arthritis. Violation of an exchange of uric acid, adjournment of its connections in bodies and fabrics leads to development of inflammatory and destructive sclerous changes, more often in joints.

In clinic of gout allocate two periods intermitionary and chronic, each of which is characterized by features of clinical manifestation and a current.

Treatment of patients by gout is carried out differentially, depending on a form and the disease period, against dietetic therapy with orga.

Complex of actions on a reduce of the products rich purine and table salt (a table No. 6 according to Pevzner).

The complex of actions for reduction of the maintenance of uric acid in an organism should be carried out before resort treatment, in a clinic (uricosuric and uric depressive means, anthuran, Etamid (aethamidum), benemid, milurit, allopurinol, orotic acid, etc.). Therapy of a sharp gouty arthritis is spent in the conditions of a hospital, and treatment chronic gout a polyarthritis is recommended to be spent periodically on a resort of a balneal profile. Mud cure sick of a gout on a resort of Ahtala is recommended to be spent to stages of remission without visceral displays. Mud procedures are appointed in a complex with auxiliary medical means (physiotherapy, remedial gymnastics, massage).

Treatment of patients with diseases of joints in Akhtal's resort can be spent all the year round. Patients with bent to aggravations are better for planting in a warm season.

Diseases of bones, muscles and sinews

At fractures of bones, after emergence of a bone callosity, and also osteitises and periostitis a traumatic and fire origin it is recommended to carry out intensive mud cure (applications, the general and local baths), the temperature should be within 38-440, duration of procedures of 15-20 minutes, every other day or daily, on plan of treatment of 12-15 procedures.

Mud cure should be combined with physiotherapy, LFK, a mechanotherapy and massage.

According to the same scheme mud cure should be carried out at various diseases of juxta-articular soft fabrics (chronic myositis, fibromyositis, bursitis, etc.).

In case of resistant cicatricial contractures: skin, muscular tendinous, etc.

The course of mud cure serves as preparation for operative intervention or is carried out after it.

II. Technique of mud cure of diseases of peripheral vessels.

Mud cure of patients by obliterating atherosclerosis in Akhtal's resort is carried out by an applikatsionny method in the form of "trousers", at dirt 38-400 temperature, lasting procedures of 10-12-15 minutes.

In the first stage of an illness of 2-3 applications 3 procedures in a row, with the next day of rest are appointed every other day, and then. Plan of treatment of 12-15 procedures. At the second stage of a disease mud applications are appointed every other day, to a course 10-12.

In a complex of treatment physiotherapeutic procedures join: electrophoresis heparin, zinc lithium, an inductothermy (DKV), UVCh, dynamical currents (SNIM), the sinusoidal modulated currents (Amplipuls of ZT) - on 7-8 procedures on plan of treatment. Physiotherapeutic procedures are appointed in free days from mud cure or with 2-3 hour breaks between procedures.

At phlebitis, thrombophlebitises for the purpose of improvement of collaterally blood circulation mud applications on the struck extremity are successfully applied at temperature of dirt 38-400, 10-12 of procedures. mud cure is shown not earlier than in 5-6 months after the suffered sharp thrombophlebitis and attenuation of the sharp phenomena in deep veins.

From physiotherapeutic procedures the local darsonvalization on a course of the struck vein for 5 minutes daily is appointed. Course of 12-15 procedures. In case of hyper coagulation of blood application heparin-electrophoresis is expedient. If the disease is complicated by a trophic ulcer of a shin, UFO of area of an ulcer is recommended.

 

III. Technique of mud cure of diseases of the central and peripheral nervous system.

mud cure in Akhtal's resort is recommended to be carried out at the following diseases of nervous system:

A.Bolezni and consequences of traumas of peripheral nervous system.

1. Radiculitises of various localization, an infectious and allergic origin, and also secondary, depending on backbone diseases, including diskopatiya (osteochondroses, a condition after operation on disks), from gynecologic and other diseases upon termination of the sharp period, and also in later stages.

2. Poliradikulonevrita (polyneuritis, плекситы, neuritis infectious, toxic, upon termination of the sharp period, and also in later stages in the presence of continuing restoration of function).

3. Consequences early and other traumas, peripheral departments of nervous system (backs, textures and nervous trunks).

B.Bolezni and consequences of traumas of the central nervous system.

1. Meningomiyeloradiculitis, миелиты and consequences of epidemic poliomyelitis (in the restored and residual periods).

2. Consequences of an injury of a brain with unsharp violation in the impellent sphere (paralysis).

3. Consequences early and other traumas of a spinal cord, its covers and horse tail.

Dirt is appointed in the form of the general and local applications, and also the general baths in temperature 38-440, lasting procedures of 5-20 minutes.

Inclusion of physiotherapeutic treatment and alternation of procedures is carried out according to the same scheme, as at diseases of the musculoskeletal device.

4. Technique of mud cure of gynecologic diseases.

Mud cure in Akhtal's resort is recommended to the women having inflammatory diseases of genitals in a chronic stage (adnexitis, parametritis, postoperative infiltrates, exudates of not purulent character, infertility, etc.).

Mud cure is carried out daily, every other day or two in a row with rest on the third, in the form of the applications covering area are lower than a belt at temperature 42-440, lasting 15-20 minutes. Plan of treatment of 15-20 procedures or mud baths at temperature 36-380. At the same time patients receive vaginal mud tampons at temperature 44-460 for 15-20 minutes, on plan of treatment of 15-20 procedures.

Mud cure is expedient for combining with physiotherapy: An inductothermy (DKV), UVCh – therapy, electrophoresis various medicines (novocaine, calcium, antibiotics, etc.).

To the weakened patients having gynecologic diseases with a infraspinous current and having, besides the basic, it is necessary to appoint accompanying exstragenitalny diseases, mud applications every other day at temperature 38-400, lasting 10 minutes, vaginal tampons in temperature 40-420 up to 10 minutes. Plan of treatment of 10-12 procedures.

At vulvitis, a colpitis, cervicitis, erosion of a neck of a uterus, bartholinitis, and also gipogenitalny frustration mud cure is appointed in the form of applications to a underwears zone and vaginal tampons by the above-stated technique.

Mud cure as loading procedure isn't recommended at climatic frustration.

5. A mud cure technique at skin diseases.

Their skin diseases for mud cure chronic forms of the eczema, limited neurodermatitises and psoriasis with the limited inverted plaques (especially in the presence of psoriasis arthritis) are shown.

Mud cure at these diseases is applied in the form of applications, the most part local, at temperature 40-420, lasting 20 minutes. Procedures are appointed every other day or two days running with the next day of rest. Plan of treatment makes 12-15 applications.

 

Director of balneology, physiotherapy, medical practice of medical tourism service, doctorate of medicine sciences - I.Tarkhan-Mouravi  

Signed

Head of field studies of natural medicinal resources, honored figure, doctorate of medicine sciences, and academy vise-president of human’s ecological and preventive medicine sciences -A. Robakidze

Signed, Sealed