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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4087_Библиотеки_им_академика_М_И_Перельмана

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Page88
Footcircling
Circleyourfeetfromtheanklesfiteentimesasshown.Thenrepeatintheotherdirection
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Page89
Legraising
1.Withyourfeetandtoespointingupwards,raiseoneleg,keepingthekneestraight.
Holdtothecountofthreeandlowerslowly.2.Repeatwiththeotherleg.Perform
sequencetwentytimes.
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Page90
Leg`bicycling'
Alternatelybendandstretchyourlegsinacyclingmotiontoaslowcountoften.
Restandrepeatagainasyourfitnessallows.
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Page91
Afteralongdayonyourfeet,restingineitherofthesepositions,
withyourfeetaboveyourhips,willrelievetheaching.
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Page92
time.Walkingisthemostimportantactivityanditcanalsobepleasurable.Whenyou'rewalking,trynottolimp,sothatyoumakethecalfmusclesworktomaximum
efficiencyinhelpingyourcirculation.Astickmaybeoftemporaryhelpifyouarehavingaproblemwithpainorswelling.Ifyouneedtogooutlocally,trywalkingto
theshops,gettingoffthebusastoportwobeforeyouneedto,orparkingthecarfurtherfromyourworkplace.Ifyoushouldfindwalkinguncomfortable,trycycling.
Itmaysuityoubetterasthere'slessweightonyourlegs,whileatthesametimeyougettherightbendingandstretchingactiontoimprovethecirculation.
DailyChoresintoExercises
Don'tthinkthatexercisesshouldbeconfinedtocertaintimesduringtheday—theycanbeincorporatedintodailyroutines.Forexample,housewivesor
househusbandswhostandforlongperiodsinthekitchenshouldkeepmovingbytransferringtheirweightfromfoottofoot,orbystretchingupontotiptoesanddown
again.Thoseofyouwhospendthegreaterpartofyourdaysittingatdesksshouldrestyourlegsintermittentlyonastool,andfrequentlychangeyourpositionby
bendingandstretchingyourlegs.
Athomeintheeveningitiscertainlyeasiertorestwithyourlegsraised,butitisimportantnottositwiththemcrossedasthisslowsupthebloodflow.
Ifyourlegsache,youmayfindithelpfultolieonyourbackonthefloorwithyourheelssupportedonafootstoolorchair,orwithyourfeetflatagainstawall,heels
about3feet(1metre)abovethefloor,sothatgravityassistsindrainingthebloodfromthelegveins.
Allthesemeasureswillbefarmoreeffectiveifyourweightiswithinnormallimits(seechapter7),especiallyasthiswillreducethestrainontheheartandlungswhen
youexercise.Atnight,theendofthebedshouldberaisedonblocks.Lightbedding,suchasduvetsorloosefittingblankets,isuseful,sothataddedweightand
increasedpressurearenotputonyourlegsandfeet.
Beingsensibleaboutyourweightandlegsisacontinuingprocess,andoncegoodhabitshavebeenintroducedyou'llfindthatexercisingandrestingwithlegsraised—
possibly,too,thewearingofelasticsupportstockings,whichwearegoingtodiscussnext—becomeawayoflife.
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ElasticStockings
Elasticstockingshavebeenmentionedmanytimesinthisbook.Thereasonisthattheyplayanimportantpartinthetreatmentofvaricoseveinsandtheir
complications.Here,wewillattempttodrawtogetherandsummarizesomeimportantpiecesofinformationaboutthem.
Themainpurposeofthesesupportstockingsistoapplypressuretohelpthesurfaceveinstodowhatthey'velostthepowertodo—namely,toreturnthebloodinto
thedeepmusclepumpoftheleg.Thestockingsarealsousefulincontrollingtheswellingofthelegthatmayresultfromdiseaseoftheveins.
SomeUsesforElasticStockings
Elasticstockingsmaybeusedastheonlymethodoftreatmentofvaricoseveinsforpatientswhoareoldornotwellandforwhomneitherinjectionsnorsurgical
treatmentareadvisable.Inthesecaseselasticstockingsarenotintendedasacure,buttheycertainlyreduceswellingandstopfurtherspreadingoftheveins.Avery
goodexampleofthisisduringpregnancy,whenvaricoseveinscanbeverytroublesomebutwhenactivetreatmentisnotadvised,eitherbecausedoctorsknowthat
thelegswillimproveafterthebabyisbornorbecausetheyaregenerallyreluctanttoprescribetreatmentthatinvolvesinterferencewiththemother'sbloodcirculation
systemduringpregnancy.
Elasticstockingsareusedbothaspartofpostoperativetreatmentfollowingsurgeryandintheaftercareofinjectiontreatment.Theyarealsoinvaluableinthelong
termsupportofthelegsafterasevereclothinginthedeepveinsorafteralegulcerhasbeenhealed.
WhattoLookforinaWellDesignedStocking
Asuitableelasticstockingshouldhavethefollowingproperties:
1.Opentoes—aclosedcompressionstockingistoouncomfortableifthetoesareconstricted.
2.Astockingshouldbedesignedsothatcompressionisgreatestatthetoesandgraduallyeases
offtowardsthetopofthelegtohelpmaintainapressuregradientalongtheleg.
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3.Thematerialmustbeporoustoallowevaporationofsweatfromtheleg.
4.Thestockingmustbestrongenoughtoapplysufficientcompressiontotheleg.Apressureof
lessthan30mmHgisoflittlevalueandmostmakesofstockingscomeintwoortworangesof
pressurefrom30to60mmHg.
Elasticsupporttights,forexample,althoughgivingsomecomforttoachingandtiredlegs,havenotsufficientcompressiontobeoflongtermvalueinsurgicalconditions.
However,onspecialoccasionswhentheappearanceofyourlegsreallymatters,itisallrighttowearsupporttights,manyofwhicharecosmeticallyvirtually
indistinguishablefromordinarytights.Manywomenfindthatwearingtrousersallowsthemtolooktheirbest,whilewearinggoodsupportstockings.
ConditionswhereStockingsareInadvisable
Elasticstockingsshouldbeprescribedonlybyamedicalpractitionerbecausetherearesomecircumstancesinwhichtheycanbeineffectiveorevenpositivelyharmful.
1.Legsthatareswollen,especiallyifthelegtissueshavewateryfluidinthem(oedema)dueto
diseaseoftheveins,shouldfirstberaisedtoreducetheswellingbeforestockingsareputon.
However,yourdoctormustmakesurethattheswellingisduetotheveins,becauseitmaybe
duetomanyothercauses,suchasheartfailure,andundersuchcircumstancesmedical
treatmentofthepatientasawholeisrequired,nottheuseofelasticstockings.
2.Ifthereisanyassociateddiseaseofthearteriestotheleg(andinsomecasesulceration,
whichmimicsavaricoseulcer—seepage113),thentheconstrictingeffectofanelastic
stockingcanbequitedangerous.Adoctorwouldcertainlynotprescribeastockingundersuch
circumstances.
3.Ifthereisanassociatedsevereinflammationoftheskin(dermatitis)oraninfectedulcer,an
elasticstockingisnottherighttreatment,andinanyitcasewillrapidlygetsoakedthroughwith
secretionsandwillbecomeunpleasant.
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HowtoputonandtakeoffyourStocking
Ittakessomepracticetobeabletoputonanelasticstocking.Alittletalcumpowderappliedtoyourlegandfootishelpful.Ifyouhaveasurgicaldressingonyourleg
anothertipistoputonanordinarynylonstockingfirst.Theelasticstockingwillglideoverthismuchmoreeasily.Puttingyourhandsinrubberhouseholdglovesfirstis
helpful;thefrictiontheycreatemakesiteasierforyoutopullonyourstockings.Usethepimply,roughgloves—
notsmoothones.Somebrandsofstockingsupplyan
antislipfootpiecewhichisputonfirstandthenpulledoutoncethestockingisinplace.
TheProcedure
Firstturnthestockinginsideoutdowntoitsfoot;pullthefootportionoveryourfoot,takinggreatcaretosmoothitoutovertheheel;thendrawtherestofthe
stockingevenlyoveryourleg,makingsurethatyousmoothoutallthecreases.Don'tputthestockingonbypullingatthetop,butrolliton,bitbybit.
Whenyouwanttoremovethestocking,yourhouseholdrubbergloveswillagainbeuseful.Holdthestockingatitsupperedgeandpulldownwardstowardstheheel,
turningitinsideoutasyouremoveit.
Normallythestockingshouldbeputonfirstthinginthemorningafteryourleghasbeenkeptraisedinbedovernightandbeforeyouputyourfoottothefloor.Itis
rarelynecessaryforyoutowearthestockinginbed,providedyoukeepyourlegraisedwithyourheelaboveyourkneeandyourkneeaboveyourhip.
Belowkneestockingswillremaininplacewithoutanyfurthersupport(seepage49).Ifyourequireabovekneestockingsthenyouwill
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havetowearsuspenderstokeepthemup.Womencanuseanordinarysuspenderbeltandmencanuseeitheraspeciallymadesuspenderbeltor,lesseffectively,they
canattachthesuspendertoabuttonsewnontotheinsideofthetrouserwaistband.Somebrandsofthighlengthelasticstockingshaveawaistattachment,thatsolves
theproblemofhowtokeepthemup.Mostsurgicalappliancedepartmentswillhavetightswhicharemucheasiertowearandputon.
ObtainingandCareoftheStockings
Youcanbuyelasticstockingswithoutaprescription.Anyonecangetapairbygoingtoasurgicalapplianceshoporpharmacyandbuyingthemjustlikeanyother
purchase.However,wehavepointedoutthatitisstronglyadvisabletowearonlystockingsthathavebeenprescribedbyyourdoctororsurgeon.InBritain,adoctor
canprovidemostpatientswithaprescriptionforstandardelasticstockings.Butifthepatientisanawkwardsizeorshape,theywillneedstockingssuchasSigvaris,
MediorJobststockings,whichrequirecarefulmeasurementoftheleg,aremoreexpensiveandarenormallyprescribedbyahospitalconsultant.
Havinggotyourprescription,thelocalhospitalappliancedepartmentwillmeasure,orderandfitthestockings,andgiveyouexcellentadviceabouttheiruseandcare.
Yourelasticstockingsshouldbewashedinsoapandlukewarmwater,rinsed,squeezedoutinatowelandthendriedflat(notonaradiator).Ordertwopairs,sothat
thestockingscanbewasheddailyandusedalternately.Withreasonablecaremodernstockingsshouldlastforupto4months,althoughtheydograduallystretch.
Whentheyhavelostmuchoftheirelasticitytheyshouldbereplaced.Mostpeoplefindthat,likeordinarystockings,theheelwearsoutfirst.
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Page97
Chapter9—
ComplicationsandConditionsConfusedwithVaricoseVeins
Inthischapter,weconsideranumberof,fortunatelyuncommon,complicationsofvaricoseveins;wetalkabouttheirtreatmentanddealwithsomeotherconditions
whichmaybeconfusedwithvaricoseveinsandtheircomplications.
https://t.me/med1917
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