It is always assumed that the first thing in any illness is to put the patient to bed. Hospital accommodation is always numbered in beds. Illness is measured by the length of time in bed. Doctors are assessed by their bedside manner. Bed is not ordered like a pill or a purge, but is assumed as the basis for all treatment. Yet we should think twice before ordering our patients to bed and realize that beneath the comfort of the blanket there lurks a host of formidable dangers.
In "Hymns Ancient and Modern," No. 23, Verse 3, we find: "Teach me to live that I may dread The grave as little as my bed."
It is my intention to justify placing beds and graves in the same category and to increase the amount of dread with which beds are usually regarded. I shall describe some of the major hazards of the bed. There is hardly any part of the body which is immune from its dangers. Respiratory System. The maintenance of one position allows the collection of bronchial secretions, which, stagnating in the bases, encourage the development of hypostatic pneumonia.
Further, the absence of exercise and the diminished respiratory excursion consequent on bed rest prevent the re-expansion of collapsed or diseased lung. Blood Vessels.-Thrornbosis and thrombo-embolism are some of the most disabling and lethal catastrophes that bed rest can bring to a patient. The absence of leg movements means that the venous blood lacks the helpful squeeze from the muscles which normally speeds its flow, and the flexion of the thighs (particularly when there is Fowler's position or a knee pillow) obstructs it the more.
One theory of phlebothrombosis is that it starts with endothelial damage caused by the weight of the leg on the bed compressing emptied calf veins. Thus it may well be said that thrombophlebitis is the internal counterpart of the bed-sore. We may one day regard a thrombosis to be as much a sign of nursing mismanagement as we do the ordinary bed-sore to-day.
It is significant that Hunter, Sneedon, and others, performing post-mortem examinations of the veins of the calf in middle-aged and elderly people who had been in bed a considerable time, found thrombosis of the calf veins in 530, of the cases.
Skin.-The frequency and dangers of bed-sores are too well known to need much comment. A large bed-sore in a heavy patient, especially an incontinent one, is a nightmare to the nursing staff, and the pressure points on the heels are often a source of great pain and misery to the patient even if the skin is still unbroken.
Muscles and Joints.-The contraction of some muscles and the stretching of others are complications of rest which may cause considerable crippling. Foot-drop is of course the commonest, and stiffness and flexion of the knee-joints probably the next.
The weakness and wasting of the general skeletal musculature and the restriction of the excursion of the, joints are often manifest in the hobbling, painful gait of the convalescent patient.
Bones.-When bones are not used the calcium drains from them, and this disuse osteoporosis can be a serious matter, especially in the elderly. Fractures for that reason may take longer to heal, and the absence of weight-bearing is another reason for delayed union. This is shown by George Perkins's recently published cases where the broken ends of bone, when splinted by a metal plate, did not heal until the plate accidentally broke and the resulting increase in weight-bearing led to rapid bony union. The advantages of the Smith-Petersen pin over older methods of managing intra-capsular fractures of the femur are largely due to the shorter time in bed.
Renal Tract.-The drain of calcium from the bones that I have just mentioned causes an increased liability to urinary calculi, and both kidney and bladder stones are sometimes in part due to bed rest. Far commoner than this is retention of urine. A patient, particularly a male, with a perfectly normal urinary tract can find difficulty in using a bottle-probably because of the horizontal position of the body coupled with the nervousness and embarrassment felt on attempting this unnatural, uncomfortable, and unfamiliar method of micturition. (the discharge of urine) In older people this difficulty may lead to acute retention with overflow or to simple incontinence.
Bed-sores may develop and keep the patient to bed, so initiating a vicious circle of bedridden incontinence. Prolonged incontinence leads to a deterioration of hygienic morale, and a patient may continue to be incontinent from sanitary sloth rather than urological disease. Getting a patient out of bed may turn him from an incontinent person to a clean one. Alimentary Tract.-This too is not immune from the bad effects of rest in bed. After a few days minor dyspepsias and heartburn may be noticed; the appetite is often lost.
Constipation occurs almost invariably, and even if not of grave significance is often a grievous worry to the patient. Its causes are, first, the absence of muscular movement; secondly, the change of environment (no one can say why this causes constipation, but it does); and, thirdly and most important, the difficulties of evacuating the bowel in a hospital bed-pan. On a bed-pan the patient is unable to use his abdominal muscles and his nearness to fellow-patients discomforts him. Precariously engaged in balancing himself, he sits there, poised unhappily above his own excrement in great dissatisfaction and distress.
The constipation of bed rest is most harmful in the aged, where retained scybala may lead to a diarrhoea which marks the underlying obstruction. Retention with overflow is nearly as common at the back as in front. Quite often complete intestinal obstruction can develop from retained faeces, and when enemata fail to shift the scybala digital removal has to be practised-a procedure as unpleasant for the evacuator as for the evacuee.
Nervous System.-It is well known that, particularly in the ataxic diseases such as disseminated sclerosis or tabes dorsalis, even a short spell in bed may produce a deterioration of 'mobility which takes weeks to overcome, and any length of time in bed may leave a patient bedridden many years before the natural course of the disease would have made him so.
Mental Changes.-Lastly, consider the mental changes, the demoralizing effects of staying in bed. At the start it may produce fussiness, pettiness, and irritability. The patient may acquire an exaggerated idea of the seriousness of his illness and think, " Surely I must be very ill if I am kept in bed ? " At a later stage a dismal lethargy overcomes the victim.
He loses the desire to get up and even resents any efforts to extract him from his supine stupor. The end result can be a comatose, vegetable existence in which, like a useless but carefully tended plant, the patient lies permanently in tranquil torpidity.
Even the insomnia and nocturnal restlessness so common in hospital patients may be related to the abuse of rest. Too much sleep during the day means too little sleep at night. You may notice that many patients who disturb the ward at night are flat on their backs snoring during the day. They lie in bed with nothing much to do, and we cannot blame them for taking frequent cat naps. I am sure that many hours of half-sleeping and dozing are less beneficial than a few hours of deep sleep, and I believe they encourage a certain confusion of mind.
So much for the commoner hazards of the bed. There are many I have omitted. I have not mentioned the loss of education in children who are long in bed, nor spoken of the dangerous dust that arises during bed-making, but even those evils I have outlined may help to show that rest in bed is anatomically, physiologically, and psychologically unsound.
Look at a patient lying long in 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 from his seat,
the urine leaking from his distended bladder,
and the spirit evaporating from his soul.
I have painted a gloomy and unfair picture: it is not as bad as all that. There is much comfort and healing in the bed, and rest is essential in the management of many illnesses. My object has been to disclose the evils of overdose, and I want now to indicate briefly how some of them may be avoided or overcome.
DEC. 13, 1947 DANGERS OF GOING TO BED 967 968 DEC. 13, 1947 DANGERS OF GOING TO BED MEDICAL JOURNAL
First, bed rest should be prescribed and not assumed-that is to say, a sister should not confine the patient to bed without the doctor's ordering it. Secondly, doctors should revise their attitude to rest where it is unsound. In a chronic ward of which I once had charge I found a lady who had been in bed for 17 years with a diagnosis of nervous debility and whitlow. She had survived this remarkable hibernation with little damage, and though she was very upset when I ordered her up she became a different person when she was fully ambulant.
It may well be, too, that our attitude to rest in more acute cases could be modified. Rheumatic-fever cases are often kept flat on their backs for a considerable time, although there is no evidence that this modifies the incidence of heart complications and there is good evidence that the work of the heart is increased by the supine position.
Patients with coronary thrombosis traditionally have six weeks in bed, but the evidence that this diminishes the incidence of complications is slender. Indeed, Sir James Mackenzie, who had frequent angina after cardiac infarction in 1908, never spent more than a few days in bed, but continued playing golf till his exercise tolerance at last became too small. He lived an active and useful life for 17 years after his first attack.
John Powers, of Cooperstown, New York, reported on 100 consecutive patients who were allowed to sit in a chair and walk on the first day after major operations. He compared them with an equal number who remained in bed for 10 to 15 days and found fewer complications in the first group.
Further, the early ambulant cases were back at work within 4.8 weeks as compared with 8.7 weeks in the control group. All these facts encourage us to review the traditional amounts of bed rest that we order our patients.
The third way of avoiding the dangers of bed lies in altering the equipment and arrangement of a ward. There should be a day-room attached to every ward and lockers for patients to keep their ordinary clothes in. Too often a sister puts all her patients back to bed as a housewife puts all her plates back in the plate-rack-to make a generally tidy appearance. Too often patients stay in bed because, shuffling round in slippers and dressing-gown, they are cold and uncomfortable. They would welcome a warm day-room with chairs and books.
Some heart cases ought to be allowed to spend most of the day in arm-chairs and to sleep the night in them if they feel much more comfortable that way. For those that have to be in bed a commode might be allowed as an alternative to a bed-pan in most cases. More liberal attention should be paid to breathing exercises, limb-moving, and occupational therapy both to prevent complications and to distract the patient from going to sleep out of sheer boredom.
"Teach us to live that we may dread Unnecessary time in bed.
Get people up and we may save Our patients from an early grave." Source: British Medical Journal http://www.bmj.com/content/2/4536/967
Who is Doctor Richard Asher? https://en.wikipedia.org/wiki/Richard_Asher#Notable_articles
I first read about this, before I got involved in the Internet while researching the effects of gravity on our circulation.
While it is almost beyond our imagination that people would choose to do this to themselves in the belief that it would somehow reconcile themselves with their gods is beyond my level of comprehension. Nevertheless I am grateful that this act has illustrated the beneficial driving force behind life, the force that drives our circulation, the force that powers all of our vital function and indeed the circulation in every living organism on this planet and beyond. That force is gravity!
Yet science and medicine for whatever reason, remains ignorant to this fact. Indeed they erroneously consider gravity to be the weakest force. Gravity cannot be measured against any other force, because gravity is not like any other force and therefore comparing dissimilar forces is a waste of time. For example, what has created those other forces? The answer of course is gravity!
The medical profession advises people that have a broken arm, for example, to raise it in a sling and keep the hand up near the chest. When the plaster cast is removed after 6-8 weeks, the arm exhibits extensive muscle loss when compared to the uninjured arm and requires physiotherapy, all of which places a heavy burdon on both patient and the Health Services.
This in fact happend to my son's arm, where he broke his wrist and complied with the Doctors advice. He of course followed the path mentioned above. 1 Year later Jimmy breaks the same wrist again, but this time require an extra 2 weeks in plaster due to having a metal plate inserted.Add a comment
Lesley's Progress,Friday 22-Sep-2000
I first met Lesley in March 2 000. Lesley informed me of her medical conditions which were obviously severe due to the discomfort in her face as she struggles to sit comfortably. Her complexion appears pale and her hair looks dry and dull lacking lustre with evidence of greying. Lesley added that her hair becomes oily and requires frequent washing. Her nails show no signs of half moons and are lined. Perspiration at night and in the daytime is a regular problem resulting in often waking with the bedding soaked.
Her eyes are often watery. Blood pressure is High. Lesley has been diagnosed with: Osteoporosis Osteoarthritis Lumberspondulosis. Lesley smokes twenty cigarettes a day and coughs intermittently since she developed asthnma 5 years ago.
Long sight is good but poor short range sight. Excessive Perspiration which increases during coughing. Complete - blackouts sometimes resulting in a fall. Lesley who aged 53 years suffers from very intense pain 24 hours a day seven days a week and only manages two hours of sleep at night due to severe discomfort and night-time-urination urgency 3 to four times per night.
In the months that followed Lesley's condition was observed to deteriorate rapidly and often became the topic of conversation at the table of our friends in Brixham. Her spine is becoming more distorted leaving her arched forward and unable to straighten up due to intense pain. Turning over in bed presents real problems and involves raising her knees and levering herself over in three stages.
Lesley's Brother has to help her out of bed every morning due to her further deterioration at night and a problem with her balance on rising from bed.
Dressing has become increasingly more difficult due to Leslie being unable to raise her arms above shoulder height and unable to flex her shoulders back. Her lower spine and left side are where she experiences most discomfort and pain. From her right hip down the outside of her leg to her toes is affected constantly by a sharp pain also though less severe than the left side Walking This presents a considerable challenge when even a fifty yard walk uphill aided by a walking stick for support and to assist with balance requires a rest for two to three minutes due to intensified pain in spine and legs. Her asthma is also aggravated and her breathing becomes laboured.
Watching Lesley navigate a small kitchen reveals the severity of her mobility problem. She mostly sits and complains about her pain and discomfort. Lesley informed me that she no longer has a bath and uses a shower because she cannot get in and out of the bath anymore.
Carrying shopping further aggravates her discomfort. Her R/ hand has always been weak with pins and needle type sensation. Opening screw caps with her right hand is not possible. R/hand thumb sometimes devoid of sensation. Weather When the weather is warm and humid it causes problems with her asthma. When the weather is cold and wet in the Winter she is in more severe pain than normal.
Medication: Morphine Tylex Salbutamol Beckatide Hormone replacement therapy- H.R.T. Lesley eventually raised her bed by six inches at the head end on the 27th June 2 000.
Inclined Bed Therapy Notes:
Week 1 Found I am able to get out of bed on my own.
Week 2 Slept better but spent a night at friends and slept flat. I experienced severe pain resulting with my brother having to help me out of bed in the morning. The pain lasted the whole day and the medication did not work.
Week 3 No pain in legs at night and daytime pain improved but during the day it becomes progressively worse but not quite so bad as before. I am walking more but with additional aches due to increased activity. Perspiration unchanged.
Week 4 Meeting with Lesley. Lesley's appearance appears to have changed her complexion looks healthy with more colour her hair looked shiny and more body. She also noticed that her hair is becoming less oily.
She appears to be more upright in her posture and expresses less pain in her face when she moves around. She is standing longer and is obviously more active than before.
Her medication remains unchanged yet she mentions that she is in far less pain than before she raised her bed.
Heather, her friend commented that she had been forgetting to use her walking stick. Judy my wife also noticed her carrying her stick. She overdone the walking while her family were visiting. She walked about a mile involving climbing a steep hill from Brixham to her home. Lesley could not have done this before she raised her bed.
20th July "I saw my doctor today and took your information to him. He replied; 'This is the famous bed I have heard about'.
Week 5 "I do not have much pain now and have reduced my medication by half. I can now walk up the hill without stopping". "I sometimes forget to take my walking stick with me. One day I had walked to the top of the hill and then sent my Brother back for my stick which I had left at my friend's house". "My sleeping has improved to between 3 and 4 hours". "I have no pain in my legs whatsoever when retiring to bed and I can turn easier not so much of a struggle". "
My Brother still helps me out of bed on the odd morning. This is a vast improvement for me though my balance is still poor in the mornings". "I can now lift my arms above my head and flex my shoulders back". Which she demonstrated with ease saying; "I have not been able to do this for fifteen years"!
I watched Lesley's movement with friends and have noticed that she is not complaining about pain and is now more agile navigating the garden and home with comparative ease. She also is sitting more upright than before.
Saturday 21-Oct-2000 Lesley's progress:
I met Lesley again today she is definitely looking healthier her fingernails now shine and have fewer ridges in them and her face appears to be rejuvenating, backed up by comments from her family. She has no pain in her face now and is continuing to improve on her walking. One other thing she and her brother noticed was that an old facial scar of some twenty-four stitches which she obtained from a car accident has almost completely vanished and the age lines on her face are definitely less obvious.
A recent stay at her families home up north resulted in her sleeping on a flat bed for a week. Almost immediately she could tell the difference and her old pains returned. She also found it more difficult to get going in the mornings. An examination and scan on Lesley's spine has revealed that all of the discs in her lumber region have collapsed and there is no fluid cushioning between the discs.
We are hoping to see a marked improvement with the discs but this is going to take time. Lesley also suffers from short site problem and has to wear spectacles to read. When asked if she could read a newspaper without glasses she replied definitely not. However when asked to read a paper out loud she could and this is not the only case of eyesight improvements!
Lesley also says that she can now see the television without glasses. There should be other eyesight improvements among the people who are helping with this study and I am hoping to receive confirmation from others in order to re-approach the Royal National Institute for the Blind RNIB who have turned me away previously- turning a blind eye if you like to something which most definitely will help people to recover from many eye conditions.
Socks? Lesley wears ankle socks and this affects the circulation in her legs. The skin above the sock line looks healthy and very different to the skin below the sock line which looks dehydrated and scaly. I advised her to leave her socks off altogether and to begin to wear good cotton trainer socks which come just level with her shoes. I have found this to be of great benefit to myself.
Re: Lesley's Progress,Sunday 7-Jan-2001 07:31:50,,7th Jan 01 Lesley stayed with friends over the Christmas Period and slept flat for a week. She has developed a frozen shoulder since sleeping flat and is experiencing severe pain in her spine. Once again the pain in her face tells the story better than a thousand words. The damage caused through sleeping flat is improving since she returned home and began using her sloping bed.Add a comment
Dare To Dream is Tony Moran's motto. Tony reveals how Inclined Bed Therapy (IBT) http://inclinedbedtherapy.com helped his dreams to come true when against all the odds he became the new Cruiserweight Boxing WBF World Champion. His opponent Sandy Robb is a 3 times ABA champion, who fought with everything he had over 12 gruelling rounds at a pace that any 32 year old boxer would be proud of. But Moran, who is now 42 and giving away 10 years to Robb, fought like a 25 year old and was as fit and active in round 12 as he was in the first round. He moved around the ring jabbing with precision and unleashing powerful combination punches that would have knocked out a lesser man.
During 12 rounds, https://youtu.be/F0FicS5TBus Moran under advice from Andrew K Fletcher, stood in the corner, ignoring the seconds advise to sit down, he also lowered his hands wherever possible due to a new understanding of how gravity plays a vital role in our circulation.Add a comment
Feeling a little worse or noticing new aches and pains before feeling better is certainly not the case with the vast majority of people involved with this study.
However, each of us is different and as with any treatment or therapy, there is an initial adjustment period within the first month or so. This can cause backache and a stiff neck. Also muscles may tighten and ache as if you have been working out in a gym.
When a person with a neurological condition like multiple sclerosis or spinal cord injury is experiencing an increase in pain, the person could perceive that an initial worsening is occurring. However, if a nerve pathway is to become functional it has to carry bad messages as well as good messages to and from the brain. For example: Personally, I experienced pain in two areas of my mouth and a visit to the dentist confirmed that there were two cavities below the gum line, which had been there for several years. I asked why I had not experienced pain before from them and he replied that the nerves in the teeth often cease to function and this is why people with severely damaged teeth experience little to no discomfort. He also pointed out that when we age our taste and smell senses can become less effective due to the same degenerative processes.
During the first pilot study into multiple sclerosis, some people found that food began to taste better than before they began the study. For some, this meant an increase in eating habits and lead to an inevitable weight increase.
If we are truly seeing the reversal of neurological conditions, one should expect some pain before a gain. It might be worth considering that one could go back through MS by way of a reverse of its onset, which could mean experiencing both positive and negative symptoms, which have not been experienced for several years.
The pilot study showed this to be the case and many people experienced increased pain and /or spasm, tingling, pins and needles, hypersensitivity, burning and even visual disturbances, prior to regaining either a function or an increase in sensitivity.
"This was also the case with complete spinal cord injury, which to all accounts should not be possible. Four months, appears to be the time it takes for nerves to begin to respond in SCI's and CP MS. I see no reason why ALS should not follow this pattern.
Unexpected weight gain.
Several of us, including myself, found that we gained around fourteen pounds over several years, but with a big difference to normal weight gain, our clothes fitted better and even became loose, which meant we had increased in weight but decreased in size. The only reasonable answer is that the extra weight must have been an increase in fluid, bone and muscle density. This appears to be backed up by experiences while swimming and one complete recovery by a lady with osteoporosis of the spine.
Another consideration is that people seldom complain about feeling well and usually realise on reflection that something has improved. However if an increase in pain comes along, then all focus is usually on the pain, which should pass within a short period.
Some people sleeping on an incline, during the pilot study experienced relapses, but there were notable differences, by way of a reduction of severity and duration. It was also noted that previous relapses resulted in a net loss, whereas inclined relapses showed no net loss of either function or sensitivity.
We are winning this battle! But please send in those vital reports, the war has only just begun!
AndrewAdd a comment
Research relating to spinal cord injury using inclined bed therapy (IBT)