Sunday, September 25, 2016

Don’t stay in bed; walk!

"... the danger of keeping a patient in bed was often more serious than disease itself." 

Dr Arturo  B. Rotor, MD
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Do you remember not too long ago, how after a routine removal of a chronic appendicitis your surgeon kept you in bed for a week or so? The idea was to have the operative wound heal completely; a weak scar would break with the first attempt to stretch out the leg muscles.
Dr Arturo B Rotor was a newspaper columnist Confidentially Doctor.  He served as executive secretary of Presidents Quezon and Osmeña.  A rare endocrine disease he discovered was named Rotor Syndrome.  



That was the best medical opinion at that time and it was followed by surgeons, obstetrician, and cardiologist. The typhoid patient stayed in bed for weeks, “to prevent a relapse,” and as for heart disease, some patients were told to resign themselves to being bed patients for the rest of their lives.

It took doctors a long time to find out that the dangers of keeping a patient in bed was often more serious than disease itself. Asher expressed the new philosophy in strong words:

“Look at the patient lying in the bed. What a pathetic picture he makes. The blood clotting in his veins, the lime draining from his bones, the scybala stacking up in his colon, the flesh rotting in his seat, the urine leaking from his distended bladder, and the spirit evaporating from his soul.”
Many factors contributed to this changed outlook. Firstly, the development of antibiotics necessitated a revision of methods of treatment. The fever of pneumonia could be brought down in 48 hours, gangrenous legs that formerly would be amputated could be saved, infected wounds that used to keep patients in bed could be cleared up in a week.

Gradually, the surgeons observed certain strange developments in their patients for whom they had prescribed prolonged bed rest. Often,  after a brilliant operation, the patients would develop blood clots along their legs or lungs. Some persons could not even be kept in bed for more than a week or two for their muscles became flabby, or worse, they developed deep ulcers where their back pressed on their beds.

Newer methods of studying the heart and lungs also made the doctors realize how wrong some of their concepts were. It has been shown for example that when you are lying down, your heart does 25 percent more work than when you are sitting up. After major surgery the breathing capacity of the lungs is reduced by more than two thirds; you have to get up to breathe normally.

The modern physician therefore does the opposite of his predecessor.

Instead of telling the patient to stay in bed, he tells him to go take a walk. 

In many cases, the effect on the patient’s morale is nothing short of miraculous. His face lights up, his appetite returns, he takes a long step towards convalescence. Typically, he expresses his regained confidence in one revealing sentence:

“Thank heavens; I can go to the bathroom again.”

Dr. Arturo B. Rotor Memorial Lecture,
11th Biennial Convention, September 6, 2008
Philippine Society of Allergy, Asthma & Immunol
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