symptomatic treatment. Symptomatic therapy in Israel. Assessment of the patient's condition

Symptomatic treatment is understood to mean all methods of treatment that contribute to the removal or mitigation of the symptoms of the disease and subsequent conditions caused by the disease, but do not eliminate its causes. With multiple sclerosis, symptomatic treatment not only directly alleviates the manifestation of rather unpleasant symptoms, but also indirectly contributes to the implementation of rehabilitation measures, which primarily involve physiotherapy.

The goal of symptomatic treatment is to improve or maintain the patient's motor abilities and prevent complications. Most people with multiple sclerosis will require one or more forms of symptomatic treatment at some time or another. Various manifestations of multiple sclerosis, especially if they are mild, can be reduced with fairly simple techniques, adapting your lifestyle and household habits to new situations caused by the disease, or with the help of therapeutic and restorative procedures as part of rehabilitation. Symptoms of the disease, which are more pronounced and complicate everyday life, often have to be eliminated by medication (Table 10).

Table 10

smart planning

To reduce such often burdensome feelings of fatigue and quickly onset exhaustion can be partly due to the skillful distribution of their duties and the correct daily routine. Physical fatigue often helps with amantadine (PK-Merz), a drug used in Parkinson's disease to prevent slowing down of movement. Antidepressants with an energizing effect (such as Pertofran and Noveril) help with physical and mental fatigue, especially if there is at the same time mild depression, accompanied by a feeling of powerlessness in the morning. However, these agents should be used with caution in bladder disorders with a tendency to produce residual urine, as they may exacerbate this tendency. In these cases, Fluctin can be used. Piracetam (Pirabene, Nootropil) is recommended for attention disorders. However, these drugs should not be taken in the afternoon and evening as they may cause sleep disturbances. Otherwise, this remedy has no side effects and goes well with other medicines. Although multiple sclerosis itself is the most common cause of fatigue and exhaustion in patients, other possible causes cannot be ruled out, for example, iron deficiency, low red blood cells, low thyroid function, changes in blood salts, impaired kidney function, cardiovascular and lung diseases, as well as a generally unhealthy lifestyle, expressed in lack of sleep, irregular and irrational diet and tobacco abuse.

Need medical treatment

In order to prevent spasticity that occurs in the vast majority of patients with multiple sclerosis, it is necessary not only to regularly perform special exercises (physiotherapy exercises), but also to take medication. Baclofen (Lioresal) is prescribed longer and more often. It is very effective and almost always well tolerated by patients. However, high doses of the drug cause a feeling of fatigue. The dose of the drug in each case is prescribed individually, focusing on reducing spasticity, but not allowing the legs to be "cotton". It is often advisable to take a larger dose of the drug at bedtime than during the day to prevent increased spasticity due to the calm position of the legs during sleep. In especially severe cases, it is necessary to use the so-called cerebrospinal fluid catheter (rubber or plastic tube), which is connected to a "pump" introduced to the patient under the skin directly into the cerebrospinal fluid pathway so that the drug enters the spinal cord. A pump filled with Baclofen provides a constant and dosed supply of medication that needs to be added to the pump regularly.

The antispastic drug used for a long time is tizanidine (Sirdalud). He is well tolerated. But sometimes it can also make you feel tired. This drug is weaker in action than Baclofen, it is more appropriate to use it in mild forms of spasticity. In some cases, it is worth using a combination of both drugs, in which case they enhance the effect of each other, more effectively preventing severe spasticity.

Sometimes diazepam (Valium) is used as an antispastic agent, especially if the patient has a tendency to spastic convulsions. Most often, this medicine is used in combination with the drug Baclofen. Diazepam can slightly lower blood pressure, but it makes you feel more tired than other antispastic drugs because it belongs to the group of sedatives (tranquilizers). Long-term use of this drug should be avoided, as it can cause addiction and dependence. If spasticity in the muscle is very severe, botulinum toxin (Dysport drug) can be injected. Its action persists for three months. Because this drug is a poison, it should only be used by neurologists who are familiar with its effects and uses.

Physiotherapy helps

The feeling of weakness and paralysis that occurs with multiple sclerosis can only be eliminated as a result of long-term treatment and intensive treatment prescribed for exacerbation, as well as with the help of physiotherapy procedures. Additional symptomatic treatments do not exist. Medicinal substances that promote protein synthesis and muscle building, the so-called anabolics, do not help with multiple sclerosis, but on the contrary, being hormonal drugs, they can cause dangerous side effects.

Balance disorders that often occur in patients with multiple sclerosis can also be affected only through treatment prescribed during exacerbations and long-term treatment, as well as with the help of physiotherapy. In addition, symptomatic drug treatment in this case is not prescribed. Only a few patients, in whom the imbalance is also associated with a deficiency in the body of vitamin B12 due to dysfunction of the gastrointestinal tract, can this vitamin be administered intramuscularly.

Treat like seasickness

Conditions accompanied by dizziness and resulting damage to the centers of balance can often be prevented with the help of drugs prescribed for motion sickness, especially if the patient with multiple sclerosis has at the same time a tendency to nausea, manifested by movement. The mood enhancer Dogmatil, due to its action on the brainstem, which regulates metabolism, also often in small doses (50-100 mg in the morning and after dinner) has a beneficial effect on the condition of patients with multiple sclerosis. This drug is well tolerated by patients. It is not recommended to take it in the evenings, so as not to cause sleep disturbance. You can also try to use Vertirosan and Betaserc for this purpose.

The feeling of dizziness in patients with multiple sclerosis may also be due to circulatory disorders. In this case, we are not talking about rotational vertigo, but rather a feeling of unsteadiness, especially when standing for a long time and getting up abruptly, as well as vertigo that occurs in the morning, which stops during the day. In this case, circulatory agents such as ergot preparations (Dihydergot) or many other commercially available circulatory drugs (for example, drugs of the Effortil group) help. In any case, it is necessary to perform physical exercises or do physiotherapy procedures, such as baths and other Kneipp hydrotherapy treatments, which stimulate blood circulation. These measures improve the blood supply to the skin and muscles, which in turn favorably affects the motor abilities and the ability to perceive sensations.

Unfortunately, there are still few effective cures for the tremor that occurs in some patients with multiple sclerosis. And in this case, first of all, one should rely more on the results of treatment prescribed for exacerbations and long-term treatment. Some patients are helped by so-called beta-blockers, for example, the substance propranolol (Inderal drug). Since this substance has the ability to greatly reduce pressure, the required amount of it cannot be prescribed to many patients. Mild sedatives (such as Adumbran) help some patients, but they can make you feel tired in high doses. In addition, the systematic use of such funds leads to addiction to them. Lately, I have found that some of my patients are getting better tremors with a new mood-enhancing drug: Fluoxetin (Fluctine). The substance Isoniazid (a 1NH drug), used in the treatment of tuberculosis, also helps reduce tremors in people with multiple sclerosis. However, this remedy is rarely used because taking it in high doses over a long period of time can cause serious side effects, including nerve damage, which can exacerbate the movement and sensory disturbances that occur in multiple sclerosis. Sometimes the drug Delpral helps with tremor.

Accurate diagnosis needed

Bladder dysfunction is an extremely unpleasant consequence of multiple sclerosis, the manifestation of which can be alleviated with the help of a number of drugs. Depending on which elements of the complex system that regulates the process of urination in the spinal cord are damaged, there are various forms of urinary tract dysfunction, which, however, can manifest themselves either alone or in combination with each other. Therefore, in most cases, it is unacceptable to test the effect of a particular drug on yourself, but you should first undergo a neurological examination and study of the functions of the urinary tract in order to establish their violations. During the neuro-urological examination, urodynamics and ultrasound examination of the bladder are performed. It is also important to do urinalysis in order to detect the presence of pathogenic bacteria, and if necessary, treat a urinary tract infection with an appropriate antibiotic.

A urinary tract infection can not only exacerbate the manifestation of an already existing dysfunction of the bladder, but also cause serious complications. Acimethin, acidifying urine (in an acidic environment, pathogenic bacteria do not reproduce well), helps prevent urinary tract infections.

In the event of residual urine formation and difficulty initiating urination, an attempt should be made to reduce the manifestation of urinary tract dysfunction with the help of the so-called bladder training (see below). If it is not possible to improve the process of emptying the bladder with exercise alone, it is recommended to use drugs such as Dibenzyran, Nehydrin or Hydergin. In severe cases, the bladder must be emptied regularly with a catheter (after appropriate training, the patient can easily carry out this procedure on his own). Self-catheterization is better than using a so-called indwelling catheter (a catheter that is inserted into the bladder for a long time; it must be frequently flushed and changed periodically), as pathogenic bacteria can enter through it, causing urinary tract infections. In any case, it is important to try to prevent the formation of residual urine in order to avoid urinary tract infections.

The tendency to urinary incontinence, i.e., involuntary leakage of urine, may be due to the formation of a large amount of urine and an overflowing bladder (when the bladder is full, small portions of urine are reflexively released). Urinary incontinence may also be due to damage to the centers that regulate the process of urination. In this case, you can use the drug Cetiprin. If it is not possible to get rid of urinary incontinence by medication, an indwelling catheter or underpants with special pads should be used. The use of special pads is preferable to an indwelling catheter, since its use is associated with the risk of urinary tract infections. However, pads should be changed frequently because prolonged skin contact with wet pads can cause skin damage and pressure sores. For severe urinary tract disorders, minor surgeries, such as shortening the bladder neck or splitting the internal sphincter, often help.

Often in patients with multiple sclerosis, there is a so-called irritated bladder. At the same time, the urge to urinate becomes more frequent, but the process of emptying the bladder itself occurs normally. In these cases, the use of anticholinergic drugs, such as Ditropan or Tofranil, which belong to the group of antidepressants, and Uroflo helps.

Very often in patients with multiple sclerosis there is a so-called imperative urge to urinate. In this case, we are talking about a limited ability to hold urine for some time after the urge to urinate occurs. Most often, this unpleasant manifestation of the disease can be avoided if you regularly go to the toilet every two hours. Spasticity is often the cause of the urge to urinate; in this case, anti-spastic drugs (eg, Lioresal) are recommended.

People with multiple sclerosis/suffering from urinary incontinence, an irritable bladder, or an urge to urinate, sometimes, fearing involuntary leakage of urine, tend to reduce fluid intake. This is categorically unacceptable, since as a result of a limited intake of fluid in the body, kidney stones form and chronic kidney diseases develop.

Regulate with appropriate dietary changes

Bowel dysfunction often requires symptomatic treatment. Since the use of strong drugs for constipation, such as Dulcolax, can become a habit and, if taken regularly for a long time, damage the walls of the intestines, it is necessary, before taking these drugs, to try to regulate the activity of the intestines in natural ways. Avoid taking laxatives if possible. It is recommended, for example, to include in the menu more dishes rich in ballast substances, drink enough liquid, use mainly vegetable oils in cooking, regularly eat prunes and figs soaked in water. Without a doubt, you can use milk sugar, vaseline oil or castor oil, bitter salt, mineral waters, as well as non-irritating intestinal mucosa and having a laxative effect of suppositories, for example, Lecikarbon, or ready-made medicinal solutions for preparing enemas (Mikroklist, Glysmol). Sometimes you can use drugs that stimulate intestinal motility, such as Prepulsid. It is also useful to regularly massage the intestines (slow continuous pressure stroking of the abdomen in a clockwise direction, starting from the right, approximately at the location of the appendix).

With a tendency to diarrhea, it is necessary to use agents that dehydrate the stool and make it harder; in severe cases, it is necessary to take drugs that inhibit peristalsis.

Use substances that stimulate sexual activity

With disorders of the sexual sphere, especially with the weakening of erection that often occurs in men, only a small amount of drugs helps. In some cases, it is advisable to use substances that stimulate sexual activity and promote blood flow to the pelvic area, for example, the drug Damiamura. After consulting with a urologist and prescribing an appropriate dose, the patient can independently inject papaverine into the penis before sexual intercourse, which in many cases allows one to achieve a sufficiently long erection. The disadvantage of this method is that it is impossible to regulate the duration of erection. Hormonal drugs in this case do not help, since the disorder of sexual function in patients with multiple sclerosis is not caused by a lack of hormones.

Helps treatment prescribed for exacerbations

Symptomatic treatment cannot correct the various forms of visual impairment in multiple sclerosis. Therefore, it is especially important as soon as possible after their occurrence to begin effective treatment prescribed for exacerbation. Glasses do not improve visual acuity after optic neuritis. Double vision can be reduced with the help of special glasses.

Periodically occurring in multiple sclerosis pain in the face, caused by trigeminal neuralgia, in the acute phase, it is necessary to prevent as early as possible with the help of corticosteroid drugs, like an exacerbation manifested by other symptoms. Good results in order to reduce pain helps to achieve the substance carbamazepine (preparations Tegretol CR, Nenrotop). At the initial stage of treatment, these drugs cause patients to feel tired and dizzy, so their dose should be increased gradually, bringing, as a rule, up to three daily doses of one tablet. In rare cases, when these drugs do not bring relief, surgical neutralization of the nerves is recommended, since the pains are very painful and are aggravated by talking and eating. The consequence of the operation is a feeling of numbness on the affected side of the face, which is generally not as unpleasant as severe pain.

During an exacerbation, pain in the body or in the limbs may occur, which should be treated accordingly. With these often very strong, perceived as shooting, stabbing, burning or piercing pains like an electric discharge, the drug carbamazepine helps. You can also use antidepressants, such as Sinquan, or sedatives from the group of so-called neuroleptics, such as Nozinan. Due to their action, the areas of the brain that perceive pain become less sensitive, and the patient feels less pain.

Spasticity of the muscles of the back or limbs in multiple sclerosis can sometimes cause pain of a different nature. In this case, the previously mentioned antispastic agents, for example, Lioresal, help. With paroxysmal spastic convulsions, often manifested in the form of so-called tonic seizures (convulsive seizures that are not accompanied by loss of consciousness), antiepileptic drugs (for example, Epilan) are used. You can also use tranquilizers, primarily Valium, however, they cause a feeling of fatigue.

For mild spastic pain, you can also try using magnesium or calcium preparations.

Conventional treatments

Often with multiple sclerosis, pain in the spine occurs, which is a consequence of impaired movement or lack of physical activity. In general, they are treated in the same way as people without multiple sclerosis: with drugs that relieve muscle tension (for example, Norgesic, Trancopal, Parafon), antirheumatic drugs (for example, Voltaren), administration of combination pain relievers (for example, the drug Dolpasse in combination with a local anesthetic such as Prokain or in combination with a high dose of vitamin B12 or with a pain reliever such as Novalgin), using local infiltration anesthesia (injection of a local anesthetic into the area of the spine where the patient is experiencing pain ) or with the help of physiotherapy procedures (massages, ultrasound therapy).

For all types of pain that occurs with multiple sclerosis, acupuncture can be used, as well as non-aural and laser therapy.

Mental disorders in patients with multiple sclerosis, as mentioned above, occur for various reasons. The form of symptomatic treatment depends on what caused the mental disorder.

Forms of depression, accompanied by frequent awakenings during sleep, a feeling of lethargy and lack of strength (especially in the morning), timidity, lack of appetite (the so-called endogenous depression) are due to reduced metabolism in nerve cells. In this case, treatment with drugs that regulate metabolism is indicated. The most commonly used are so-called tricyclic antidepressants, such as Saroten, Noveril, Anafranil, or combined drugs such as Dianxit or Harmomed. Patients who have a tendency to urinary retention and residual urine formation, as well as those suffering from severe constipation, these drugs are not recommended, as they may increase the manifestation of these symptoms. These patients can be given Fluctin and, under certain conditions, maprotiline (Lyudiomil). For multiple sclerosis patients who suffer from depression and experience severe inner anxiety, it is better to use Sineguan. MS patients who are prone to endogenous depression should take a mild antidepressant (eg, Insidon or Harmomed) during corticosteroid treatment at the time of an flare-up, as cortisone may contribute to depression.

If you have difficulty falling asleep during a course of cortisone treatment, you should take a mild sedative (such as Praxiten or Lexotanil). If the patient is prone to sleep disorders despite no cortisone treatment, before resorting to sedatives and sleeping pills, one should first try to improve sleep in natural ways, for example, using relaxation techniques.

In any case, the causes of depression and other mental disorders in multiple sclerosis should be carefully investigated and clarified, since they are often not a consequence of multiple sclerosis, but manifest as a reaction to the disease. In this case, first of all, psychotherapeutic methods of treatment are recommended. Medical treatment can only serve as an adjunct.

Symptomatic treatments are an important addition to the holistic treatment of multiple sclerosis. Thanks to the symptomatic treatment of the patient, it is possible to get rid of many unpleasant manifestations of the disease and the conditions caused by it. However, drugs should not replace rehabilitation measures that are so important in the treatment of patients with multiple sclerosis, but only supplement them.

a method of applying therapeutic agents aimed at eliminating or reducing the adverse symptoms of a disease. It is not used as an independent method, since the elimination of any symptom is not yet an indicator of recovery or a favorable course of the disease, on the contrary, it can cause undesirable consequences after stopping treatment. This method is used only in combination with others, mainly with pathogenetic therapy. Examples of symptomatic therapy can be: the use of antipyretic drugs at very high body temperature, when the fever can be life-threatening; the use of cough suppressants when it is continuous and can cause oxygen starvation; the use of astringents for profuse diarrhea, when life-threatening dehydration develops; giving irritating the respiratory center and cardiac drugs with a sharp decrease in respiratory movements and heart contractions. Symptomatic therapy is considered by many researchers as a kind of pathogenetic therapy, in some cases it can become one of the decisive factors in the recovery of animals against the background of complex treatment.

Despite the fact that the use of therapeutic agents and pharmacological preparations, taking into account their prevailing action in areas (methods of etiotropic, pathogenetic, regulating neurotrophic functions, substitution and symptomatic therapy), is conditional, it justifies itself in clinical veterinary practice when developing a reasonable treatment plan.

23Replacement (reimbursement) therapy- a method aimed at replenishing the missing ingredients in the body for its normal functioning. As a substitute for a therapist, vitamin and mineral preparations are used, especially for group prevention and therapy in complexes. Treatment with vitamins (vitamin therapy) in case of deficiency in the organ, for which purpose dietic feed, sod. in a large number of vitamins in natural form, and with a lack of vitamins in feed, vitamin preparations are used. Ispol.vit in the form of premixes or additives to compound feeds. Vitamin preparations - both mono- and polyvitam - are used taking into account the state of the stomach and for individual treatment. The mineral component was used, taking into account the availability of macro- and microelements. As a means of replacing a therapy with a mineral, premixes or feed additives in the form of salts of min substances are used - chalk, sodium chloride, iron, iodine, copper, zinc, cobalt. For individual. treatment from environments instead of therapy is recommended transfusion of homogeneous blood, parenteral administration of isotonic liquids (physical solution, Ringer's solution), oral administration of hydrochloric acid or natural gastric juice, hormonal therapy (for example, insulin in case of diabetes, hormone shields of the gland in case of goitre, prednisone or cortisone in case of adrenal insufficiency, pituitary hormone in ketosis).

24. Hormone therapy- the use of hormones and synthetic hormonal preparations for therapeutic purposes. Distinguish substitution,stimulating and inhibitory hormone therapy. Hormone replacement therapy is used for endocrine diseases characterized by complete loss or a significant decrease in the function of the gland (or glands) of internal secretion, in order to eliminate the deficiency of the corresponding hormones (or one hormone) in the body. Hormone replacement therapy is effective only during the period of use of hormones or appropriate hormonal preparations, since it does not eliminate the causes of the disease. Stimulating hormone therapy is used when it is necessary to increase the insufficient functional activity of the endocrine gland or to assess its functional reserves. For this purpose, hormones of the anterior pituitary gland and hypothalamic neurohormones are used. A variety of stimulating hormone therapy is the intermittent administration of hormonal drugs. Hormone therapy (for example, insulin for diabetes, shield hormone for goiter pain, prednisolone or cortisone for adrenal insufficiency, pituitary hormone for ketosis).

25Enzyme therapy- Enzyme preparations of microbiological synthesis find some use for better assimilation of feed nutrients, normalization of digestion. Commercially produced preparations differ from pure enzymes in that they contain not only the main enzyme, but also other enzymes and ballast impurities. Enzymatic preparations include lithosil, intended for ensiling the green mass of grasses. Enzyme preparations are usually included in compound feed or feed mixtures. In addition to those listed means of chemical and microbiological synthesis in animal husbandry to stimulate growth and prevent gastrointestinal diseases, feed antibiotics (bacitrocin, grisin, flavomycin, rumenzin, etc.), as well as probiotics (vitamycin, erycycline, cellbacteria) are used. A homogeneous mixture of microadditives and filler used for enrichment of mixed fodders, is called a premix. The most complex in composition and saturated active substances are premixes for poultry and pigs. Mixtures of protein-vitamin mineral supplements (PVMD) are used to enrich feed mixtures prepared on the farm. They are prepared for certain age groups of animals, they are not used in their pure form. For the prevention and treatment of certain metabolic diseases and other diseases, complex therapeutic and prophylactic additives are used: ketost, alost, carboxylin

26Vitamin therapy and the basics of vitamin preparations used in veterinarians. 27 Vitamin therapy and its use in the treatment of internal infections. Vitamins are vital substances involved in the metabolism of proteins, carbohydrates, lipids, minerals. They provide biochemical processes of oxidation and reduction, carboxylation, synthesis of a number of amino acids. It is known that in the pathogenesis of not only hypo- and avitaminosis, but also in many other diseases, vitamins play a leading role. Ruminant animals and horses are more likely to lack vitamins A, D, E, pigs, poultry, fur animals, dogs, in addition, vitamins of groups B, K, and vitamin C. With a lack of carotenoids and vitamin A in the diet, a weak offspring is born, it is easy prone to gastrointestinal and pulmonary diseases, embryonic mortality increases, osteosynthesis processes are disrupted, animal productivity decreases, and growth of young animals slows down. The elimination of retinol deficiency in the body of animals is achieved by introducing into the diets a sufficient amount of feed rich in carotenoids and vitamin A (hay, haylage, grass, hay, coniferous flour, carrots, milk, skim milk). For this purpose, preparations are widely used: retinol-microvit A-fodder, granuvit A-400, microbial carotene (KMPK), vitamin A oil concentrates. This is accompanied by a violation of mineral metabolism, the development of osteodystrophy, rickets, hypophosphotemia, tetany and other diseases. In birds, along with the development of osteodystrophy, rickets, the process of egg shell formation is disrupted, and the hatchability of chickens is reduced. Its excess in the body causes calcium deposits in the kidneys and other organs. Prevention of hypovitaminosis-D is achieved by including in the diets of hay, haylage, hay cutting, feed of animal origin, as well as calciferol preparations: videin DZ, granuvit DZ, irradiated yeast, concentrates of vitamins D2 and DZ in oil, fish oil, etc. Cereals, root tubers, pulp, pulp, artificially dried herbal flour practically do not contain vitamin D. Lack of vitamin E in the diet leads to the accumulation of peroxides in the body, disruption of vital cell functions, the occurrence of dystrophic changes in the liver, muscles, degeneration of the seminiferous tubules, atrophy of germ cells, increased permeability and fragility of capillaries and other changes. Natural sources of tocopherols are young grass, grass flour, dry chlorella (180 mg/kg), germinated grain, wheat and corn germs. Somewhat less of it is contained in cereal grains, bran, cake. Vitamin E is destroyed under the influence of peroxides and unsaturated fatty acids during feed spoilage. To increase the content of tocopherol in the diets of animals, preparations of this vitamin are used - granuvit E-25, kormovit E-25, capsuvit E-50, vitamin E oil concentrate, multivitamin mixtures. Vitamin E is often used with selenium preparations, since the biological action of these two substances is interdependent and interrelated. With a lack of vitamin K, blood clotting is disturbed, the death of embryos and the mortality of chickens increase, hemorrhagic diathesis is possible in cattle. The clinical manifestation of vitamin K deficiency is observed with the irrational use of coccidiostatics, sulfonamides, nitrofurans, feeding sweet clover, moldy feed. Sources of vitamin K are alfalfa, meadow grasses, grass flour, soybeans, peas, oats, wheat, yellow corn, bran, carrots, potatoes, fodder beets. Of the preparations of vitamin K, vikasol and microgranular preparation K1 are used for prophylactic purposes. A lack of thiamine leads to a violation of carbohydrate and water-salt metabolism, a disorder of the nervous system, the appearance of paresis and muscle paralysis. Birds, fur animals, pigs, and dogs are especially vulnerable to a lack of thiamine. Bran and yeast, cereal grains, milk and other feeds of animal origin are rich in thiamine. Of the preparations of vitamin B1, thiamine chloride, thiamine bromide are used. The lack of riboflavin is accompanied by a decrease in the incubation qualities of eggs and high embryonic mortality, skin lesions, and gastrointestinal upset. To prevent B2 hypovitaminosis, diets include milk and dairy products, baker's yeast, legume fodder meal, fish meal, meat and bone meal, as well as vitamin preparations - fodder granuvit B2, fodder yeast. For the prevention of VZ hypovitaminosis, yeast, grass flour, wheat bran, milk powder, wheat grain, and calcium pantothenate are included in the diet. To prevent a lack of choline (vitamin B4) in the body of animals, the development of fatty degeneration of the liver, and a decrease in the egg production of birds, milk and dairy products, fish meal, legume grains, choline and choline chloride preparations are included in the diets. Prevention of hypovitaminosis B5 is achieved by including wheat bran, chicken eggs, fodder and brewer's yeast, fodder nicotinic acid, nicotinamide in the diet. In order to prevent a lack of pyridoxine (vitamin B6) in diets, the development of skin diseases, plumage, disorders of tryptophan metabolism, reproduction processes and other undesirable phenomena in diets, the content of wheat bran, alfalfa flour, wheat grains is increased, pyridoxine hydrochloride is administered. To prevent cyanocobalamin (vitamin B12) deficiency in diets, feed of animal origin is increased and vitamin B12 feed concentrate is included (pure preparation of vitamin B12 (cyanocobalamin), coenzyme B12 preparation.

28Prophylactic measure in case of protein and carbohydrate deficiency. Protein deficiency is observed with a low protein content in hay and silage, a small percentage of legumes and legumes, and a violation of feed preparation technology. Protein deficiency can be eliminated by introducing high-protein feeds into the diets: legume hay, legume grains, compound feeds, cakes, meal, meat and bone and fish meal, yeast. The problem of feed protein deficiency can be solved by increasing the production of feed grains (soybeans, peas, corn, barley, oats) or the inclusion in diets of fodder hydrolytic yeast, ROS, feed concentrate OTI-3, additives "Belotin", additives from raw hide waste. The main cause of carbohydrate deficiency is the lack of feed containing easily digestible carbohydrates (root crops, sugar or semi-sugar beets, fodder cabbage, turnips, corn, sorghum, potatoes, rutabaga). Prevention is carried out by increasing the stock of fodder root crops. To eliminate energy deficiency, cereal concentrates, molasses, root crops, potatoes, fats of animal and vegetable origin are introduced into diets. As an energy supplement, beef, mutton, pork, bone fat are more often used).

29 Preventive measure in case of mineral deficiency. Minerals do not have energy value, but nevertheless their importance in animal nutrition is exceptionally great. The composition of the animal organism includes almost all known chemical elements, but their content is different. Some of them are present in large quantities - macroelements (calcium, magnesium, sodium, phosphorus, potassium, chlorine, sulfur, etc.), others - in negligible amounts - microelements (manganese, molybdenum, copper, cobalt, zinc, iodine, bromine and etc.). The only source of macro- and microelements for animals is feed and water. Their deficiency or excess in feed is the reason for slowing down growth and development, reducing the fertility and productivity of animals. Diseases have a certain connection with the chemical composition of the feed and water of the area where the animals live. Such diseases are called endemic (from the Latin name "endomos", i.e. local). Deficiency of minerals occurs due to their low content in soil and feed, improper preparation of diets according to the ratio of mineral elements in them, lack of feed containing alkaline elements (K, Na, Ca, Mg), etc. It is convenient to give macronutrients to animals mixed with concentrates, silage, bagasse or crushed root crops. For the prevention and group therapy of diseases that occur with a predominant violation of mineral metabolism, feed phosphates are widely used, calcium supplements, magnesium salts, sulfur preparations, etc. Phosphorus plays an important role in mineral metabolism and bone tissue formation. Concentrated feeds are rich in phosphorus, straw and hay are poor. The absorption of phosphorus is negatively affected by the imbalance of the diet in terms of calcium and digestible protein. The preventive role of calcium is determined by its participation in maintaining acid-base balance, in the formation of the mineral part of the bones, and in activating the protective functions of the body. The absorption of calcium is inhibited by an excess in the diet of potassium, magnesium, oxalic acid, fat, protein and fiber. Calcium is poorly absorbed both with a deficiency and with an excess of phosphorus. With a lack of vitamin D, calcium in the feed is retained in the intestine, forming insoluble phosphate salts, which are excreted in the feces. In lactating animals, a significant amount of calcium is excreted in milk. Leaves and stems of leguminous plants are rich in calcium, there is little of it in concentrated feeds. In the prevention of disorders of phosphorus-calcium metabolism, much attention is paid to balancing diets according to the phosphorus-calcium ratio, which should be 1:1.5 or 1:2. Chalk, limestone, shell rock are added to eliminate the lack of calcium in diets. Magnesium oxide, magnesium carbonate, magnesium sulfate are used to eliminate the negative effects of magnesium deficiency. Sodium sulfate, sodium thiosulfate, and purified sulfur are used from sulfur-containing products.

30 Preventive measure for vitamin deficiency. Vitamins have an impact on biochemical processes, normalize metabolism and increase the protective reactions of the body. Being an integral part of many enzymes, vitamins are involved in the breakdown of carbohydrates and the release of energy contained in them, regulate the metabolism of protein and nucleic acids. With their participation, the breakdown of fats and the formation of fatty acids are carried out, steroid hormones and many other compounds important for the life of the body are synthesized. In clinical veterinary medicine, there are three main forms of pathology caused by a violation of the vitamin balance in the body: hypovitaminosis, polyhypovitaminosis, hypervitaminosis. Ruminants and horses experience often lack of vitamins A, D, E; pigs, dogs, fur-bearing animals and birds - a lack of vitamins of group B, K and C. The main causes of hypovitaminosis are a lack of vitamins in feed, imbalance and uniformity of diets, the use of poor-quality and spoiled feed, a deficiency of macro- and microelements. Essential in the development of polyhypovitaminosis is increased need of the body for vitamins during pregnancy, lactation, intensive growth in young animals, the inability of the body to absorb vitamins supplied with food, which is observed in violation of cellular metabolism, acute and chronic diseases of various etiologies, as well as the binding of vitamins by toxic substances and bacterial toxins. To eliminate vitamin deficiency, it is necessary to establish veterinary control over the quality of feed, as well as include grass meal, haylage, greens, fodder carrots, fodder cabbage, milk, reverse and other feeds in the diet. In some cases, mass fortification is carried out. For this purpose, concentrates of vitamins A, D, E are used: retinol-microvit A-fodder, granuvit A-400, microbial carotene, videin D 3, granuvit D 3, irradiated yeast, fish oil, granuvit E-25, kormovit E-25 , capsuvit E-50, vikasol, microgranular K, thiamine chloride or thiamine bromide, granuvit B 2, vitamin B 12 feed concentrate, coenzyme B 12, vitamin C. Certain drugs (sulfonamides, antibiotics) can also have a negative effect on the vitamin balance

31 Means of etiotropic therapy.Etiotropic (causal) therapy- a method of using therapeutic agents aimed at eliminating or weakening the etiological factor, i.e. cause of the disease. A large group of etiotropic drugs is used to treat patients with inflammatory processes in the body. These include respiratory diseases (rhinitis, bronchitis, pneumonia, pleurisy, etc.), gastrointestinal (stomatitis, pharyngitis, gastroenteritis, etc.), cardiovascular (myocarditis, pericarditis), diseases of the urinary system (cystitis, nephritis, etc.), nervous system (meningitis, encephalitis, myelitis, etc.). As with other diseases (gynecological, surgical, infectious), antimicrobial agents are widely used: antibiotics, sulfonamides, novarsenol, nitrofurans, etc. Etiotropic agents are used exclusively to suppress primary or opportunistic microflora, thereby accelerating recovery. Etiotropic conditionally include specific immune sera, toxoids, bacteriophages, anthelmintics, anti-downy agents, methods of surgical removal of foreign bodies from the mesh or pharynx.

32Method of intraperitoneal injection of drugs. For calves at an early age, solutions of medicinal mixtures are injected into the hungry fossa on both sides, from the 3rd-5th day of life - only on the right. The needle injection site is located in the middle of the line connecting the lateral iliac tubercle with the last rib, below the transverse processes of the lumbar vertebrae by 6-8 cm, depending on the age and weight of the calf. The injection site is carefully trimmed and treated with iodized alcohol or 5% alcohol solution of iodine. To administer the required amount of a sterile mixture, a 100-200-gram syringe (or Bobrov's apparatus) is taken, prepared for intravenous administration, with an appropriate needle (better, a Bobrov needle 65-75 mm long with a mandrin). A needle with a well-fitted mandrel is inserted into the thickness of the skin, slightly rotating, directed from top to bottom, from front to back in the direction of the hind opposite limb or lower leg at an angle of 45 ° through the muscular aponeurosis and peritoneum. When the needle is inserted, a specific sound (crackling) is heard, then the needle is advanced deeper by another 0.5-1 cm, the mandrel is removed and the needle is connected to the Bobrov apparatus or Janet syringe filled with liquid, the temperature of which should be 38-39 ° C. The liquid is introduced gradually, the flow rate depends on the diameter of the needle. In seriously ill calves, the mixture is injected from the abdomen. At the same time, the calf is somewhat lifted by the pelvic limbs, the injection is made, stepping back from the white line to the side by 2-3 cm

33 Technique for inserting and extracting magnet probes. Meliksetyan's magnetic probe insertion technique. The probe consists of a magnetic head, a connecting chain with a rubber cuff, a nylon cord placed in a protective rubber tube, a spherical fuse, a probe inserter and a compass.

Before inserting the probe, the end of the flexible part of the probe, a rubber tube, is separated from the magnetic head, lubricated with petroleum jelly and inserted up to half the length of the tube into the esophagus along the lower nasal passage, then the mouth is opened and an oral wedge (Bayer wedge) is inserted into it between the molars. A probe inserter is inserted through the oropharynx into the initial part of the esophagus, rotated around its axis, grasped the rubber tube and carefully removed through the mouth. A connecting chain with a magnet is screwed to the extracted end of the rubber tube. After that, the back part of the magnetic head is attached to the probe inserter, the rubber tube is stretched and, together with the probe inserter, is inserted through the mouth into the animal's esophagus. The probe guide is taken out. With swallowing movements and contractions of the esophagus, the magnetic head moves to the threshold of the scar, and at the time of the next expansion of the mesh, it descends into it. If the animal does not swallow the probe, then water from a rubber bottle is poured into its mouth to stimulate swallowing. Sometimes the magnetic head does not fall into the mesh, but into the scar. The location of the magnet is set using a compass. Bring it to the area of the xiphoid process. If the compass needle deviates as you move it, then the magnet is in the grid. If there are no deviations of the arrow, then the magnetic head is in the scar. For prophylactic purposes, the probe is left in the grid for 30-60 minutes, for therapeutic purposes (in animals with traumatic reticulitis) - for 20-24 hours.

To remove the probe, an oral wedge is inserted into the animal's mouth, a rubber tube is grasped with a probe hook in the upper part of the esophagus and removed through the mouth. In case of spasm of the gastric part of the esophagus, the magnet should not be forcibly pulled out. It is necessary to pour water from the bottle through the mouth, and the spasm is usually removed.

The magnetic head of the Meliksetyan probe has a lifting force of 300-400 g, so the probe is often not effective enough. Korobov's magnetic probe insertion technique. Professor A. V. Korobov proposed a magnetic probe with a lifting force of the magnet up to 30 kg (ZMU-1). In addition, this probe is much easier to insert. Its kit includes a metal yawner, the tube of which, when inserted, reaches the root of the tongue. It contains a rubber tube, at the end of which a magnet is attached. The magnetic head is inserted through the mouth, and the outer end of the rubber tube is fixed with a metal ring on the outer end of the yawn tube, which does not allow the rubber tube to go into the mesh. The magnet in the grid is left for 5 minutes and removed through the mouth.

In addition to those described above, there is also a Telyatnikov magnetic probe. It is close in all respects to the Korobov probe.

For active prevention of traumatic reticulitis in cattle, a positively proven method of introducing magnets of a certain shape into the animal mesh is used. These are magnetic rings and magnetic traps, or blockers.

34Application of magnet rings and blockers in the wind. Technique of insertion and extraction. The muzzle of the animal is fixed in an elevated position, the mouth is opened and the tongue is pulled out. A rubber or polyethylene tube 3-4 cm in diameter and 70-80 cm long is inserted into the upper part of the esophagus. A ring or a trap is lowered through it. When they enter the esophagus as a result of its peristaltic contractions, they are carried away into the grid, which is verified using a compass.

35 Enemas, their types and uses. An enema is the introduction of liquid into the rectum. 2 ways: hydraulic- Esmarch's mug, tanks, a metal tank with a capacity of up to 20 liters, suspended on a block up to 3 m high, are used as a tank. A through metal tube is fixed at the bottom of the tank, communicating with the tank at one end. The outer free end of the tube is bent upwards, a hermetically sealed glass tube is inserted into it, up to the upper edge of the reservoir. It serves as a control to monitor the fluid flow rate and the amount of water in the tank. A rubber metal hose 5-6 m long is put on another metal tube at the bottom of the tank, the lumen of which is closed with a metal clamp, and the free end is connected to a tip or intestinal tamponator. And pressure- the liquid is injected with the help of appropriate instruments and devices, water is supplied under a certain pressure - hydraulic bullet, water supply. net. According to the volume of liquid injected into the rectum, enemas are divided into macro- and microclysters. cleansing, nourishing, deep, and micro - all types of medicines, with a cat the amount of fluid injected does not exceed 50 ml. Cleansing enema recommended for constipation, lack of defecation. It is carried out with a small amount of glycerin or dissolved soap. These drugs irritate the mucous membrane and nerve endings, as a result, secretion and peristalsis increase, and liquefied feces against the background of increased peristalsis cause an accelerated act of defecation. laxative enema designed for a laxative effect, characterized by increased extravasation and normalization of peristalsis. For this purpose, vegetable oil, vaseline oil, glycerin, solutions of medium salts (2-3%) are used. Up to 2 liters of oil heated to 35 ° C are injected into the rectum of large animals, and 50-300 ml of small animals. After the introduction of oil, the anus is tightly closed with a tail and held for at least 15 minutes. Nutrient enema indicated for sick animals that have no appetite for a long time. Beforehand, they are given a cleansing enema and after 1 hour, with the help of a rubber hose and a funnel, nutrient media heated to body temperature are introduced. During the day, such enemas are done 3-4. deep cleansing enema carried out using the Meyer intestinal tamponator (prevents the reverse flow of water), which causes the flow of water into the posterior and anterior sections of the large intestine. Subaqueous enema-through washing of the gastrointestinal tract. Carried out in dogs for therapeutic purposes, hours 30 minutes after cleansing. A washing siphon enema is prescribed to remove the contents of the intestine and to wash away pus, mucus and toxic products from the mucous membrane of the intestine. warm water 40-42 degrees, weak solutions, cook salt, potassium permaganate solution.

Palliative treatment of acute respiratory viral infections - everything from which it can become "easier".

In fact, the only available treatment for colds at the beginning of 2017 is symptomatic.

What is it

So, you fell ill, assessed the futility of pharmacotherapy and decided to somehow alleviate your condition, even if it does not affect the development of the disease in any way.
No way - this means neither for the worse, nor for the better, neither faster nor slower, without increasing / decreasing the risk of complications: in fact, this is “symptomatic therapy”, i.e. directed only at the symptoms, although from some point of view it may seem pathogenetic. But the impact on pathogenesis does not always mean that it will change the course of the disease, and if this course does not change, then the main action is just symptomatic.

Is symptomatic treatment the cure? Is:
a) there are two chairs, three links: etiotropic therapy (elimination of the cause - antibiotics for bacterial infections), pathogenetic therapy (when the cause is not affected, we act on the mechanisms of the development of the disease - we replenish insulin with a syringe for diabetes), symptomatic therapy - or in addition to the previous paragraphs, or for lack of them (as in this article).
b) in any condition, the reduction of symptoms improves the patient's well-being and quality of life, and often this is already 2/3 of the success.

How it works

First of all, it is worthwhile to clearly understand: some, if not all in some cases, the symptoms of SARS are purely subjective manifestations of the disease. If we objectively measure a high temperature with a thermometer, then this is how bad a person is with it - only the patient himself feels it and this cannot be objectively fixed.
Therefore, it is here that it has the right to exist “And I took *the name of the medicine* and it worked for me!”: you can stop the symptoms with almost anything at your discretion, as long as it gets better, not worse; therefore, you can be treated at least with an alcohol tincture of your own feces, and if you feel better, then this can quite legitimately be called symptomatic therapy. However, the elimination of symptoms does not mean a cure for the disease - since the elimination of manifestations does not affect the course / outcome / prognosis. Improvement of symptoms is only the same “improvement of well-being”.

An even more interesting question arises: does symptomatic therapy then need research and proof at all, because the effect is mostly subjective? Yes, it does: firstly, to weed out potentially dangerous methods, and secondly, to identify the most effective means. Alas, it is not as important / interesting to explore symptomatic therapy as etiological / pathogenetic, but the most important thing is highlighted in the main article, and here it is, a review of everything.

Sore throat

Lollipops, lozenges and others from a sucker: all sorts of Strepsils, Ajisept, Hexaliz, Gorpilz, Geksoral, Grammidin, Lorsept, Angi sept, Anti angina, Astracept, Gorpils, Dinstril, Lightel, Lorisils, Neo-Angin, Rinza, Lorsept, Suprima-ENT , Stopangin, Septolete, Terasil, Travisil, Falimint, Faringosept and many, many other Halls. Regardless of the composition, their main action is to increase the production of saliva, which has a softening effect on an irritated throat; most have anesthetics that relieve pain from a long-suffering throat; some have antiseptics that are supposed to kill evil microbes, but no one knows how effective this is (most likely, not how much). One of the antiseptics (hexatidine) is directly indicated in the literature as having an anesthetic effect. You can choose according to your taste.
Honey, milk, propolis: able to envelop the mucous membrane, reducing irritation.
Throat sprays: Hexoral, Hexangin, Proposol, Stopangin, Maxicold and all that. The situation is absolutely similar to lollipops.
Steam inhalations over potatoes, a kettle or a saucepan are meaningless.
Rubbing with alcohol, vodka, vinegar, urine, fat, oil - may bring relief of symptoms, but are too merciless and dangerous to recommend. Taking paracetamol/ibuprofen will do what these methods are trying to achieve, but safe, proven and convenient.
Melted ice cream and cold juice: they cool the sore throat perfectly and do not threaten anything if the temperature does not go off scale - you need to be afraid of cold drinks BEFORE your throat hurts, after that it doesn’t matter.

Cough

Heroin was invented in 1898 as a cough suppressant.
After his ban, many opioids were synthesized, including antitussives, but opioids are always bad jokes, and nothing really works without them: there is no good evidence that over-the-counter cough medicines with antitussives (guaifenesin and acetylcysteine), antihistamines (diphenhydramine ) and decongestants (ephedrine) are effective for its treatment in both adults and children. In Canada and the United States are prohibited for use in children under 6 years of age. With bromhexine and its metabolite ambroxol, the story is the same. (although with pneumonia and all sorts of bronchiectasis, they quite find application for themselves).

Mustard plasters, jars, pepper plasters and other bullying: any local heating has undeniable local effects in the tissues in the form of vasodilation and a logical increase in blood flow, but it does not have specific magic like penetration from the surface of the skin to the very depths of the chest and lungs - annoying and distracting Action is the most important thing in all of this. Moreover, it is worthwhile to understand that in the treatment of a banal cough during SARS, there is no point in this senseless procedure at all in the square: a cold practically does not affect the lungs. When the lungs are affected, it is either bronchitis or pneumonia, which are already complications of severe SARS. Modern medicine does not consider mustard plasters with friends an effective method of treating cough, referring them to household, i.e. folk methods of treatment.
Herbs: increase sputum production due to an irritant effect on the stomach, this is not associated with a direct thinning effect. Delicious syrup, nothing more.
- Mukaltin: fervent effervescent tablets with an unusual taste of a special herb marshmallow officinalis, it seems that they should also help reflexively help expectoration and reduce coughing, but there is no evidence for this. From the point of view of DM, tasty pills, nothing more.
Dextromethorphan (DXM) and codeine: the former has a modest effect, the latter used to be the gold standard, but then something went wrong. Alas, since the recent 2013, both have almost followed heroin (now only by prescription), because they run away with them and make drugs out of them. , Yes, and do not care.
- Codelac: codeine with herbs (licorice and thermopsis);
- codeine/terpincod: codeine with terpinhydrate (expectorant) is not the best combination, since the antitussive and expectorant effects are generally opposite, one should be used.

Butamirat (sinecod/omnitus) seems to be closer to fuflomycins.
There is nothing to say about rengalin (homeopathy) and other magical miracles.

See below for more about dry cough after recovery.

pace

Everything is clear here from the main article, because bringing down the temperature in most cases turns out to be the most pleasant treatment.
Yes, paracetamol or ibuprofen. No, not aspirin.

Theraflu, coldrex, antigrippin, fervex: simply delicious, convenient and expensive paracetamols. Complementary supplements like phenylephrine and pheniramine/chlorphenamine/diphenhydramine should additionally combat symptoms, but as stated above, does not work with coughs, maybe works for nasal congestion and stuff. Like - accept; the elderly with caution.

Nose

What's wrong with the nose? Wash with saline (including those in fashionable packages) and fill with vasoconstrictors (no more than a week).
Physiotherapy - in the furnace. Insertion of foreign objects, incl. onions, garlic, honey, inhalation of smoke from garlic - there too.

Doctor, what will happen to me?

There will be flour of choice: so many delicious things! What to take?
Of course, you can use everything at once, but then the obvious principle of treating a cold “Less fuss” is violated. Take pills, rinse your nose, throw lozenges from your throat - if this has already improved your condition from the level "I'll die!" then just lay back and relax.

After

After the temperature does not rise steadily for 2-3 days, the general well-being and mood improved, and the throat hurts by 10 percent of the initial level, we can state that this time you unfortunately will not die. Now all the symptoms can rightly be called residual effects and something to do with them.

Weakness, muscle pain, discomfort and all that - no one forbids eating the same paracetamol or ibuprofen as at a temperature, since their action is not limited to antipyretics, these are still painkillers, from which it will become noticeably easier. If weakness with the company lasts for a month or two without changes, smoothly turning into asthenic syndrome, then there is nothing particularly unusual here, but it is worth consulting; sometimes they can give out antidepressants as a gift, this is also normal.
Dry cough is perhaps the king among persistent symptoms, as it can continue for another six months after suffering a cold, especially among vapers and smokers. It feels like “an itchy throat” or nothing at all, you just suddenly start barking coughing for a couple of minutes: it happens because the body ordered to destroy and renew the old virus-damaged mucosa, but a couple of immune commandos remained in place and accidentally makes friendly fire with all sorts of histamine - sort of temporary allergic reaction that can extend all the way to the very lungs, where it will resemble a demo version of asthma. It is logical to treat things of allergic genesis with anti-allergic things: the berodual inhaler comes in perfectly, you can separately beta-adrenergic agonist and m-anticholinergics, you can generally get by with suprastin if it works. These things have side effects and use in children is questionable, so consult in person.

And in general, with the onset of remission (when the temperature has stabilized), you need to break away from the sofa and go for a walk in search of fresh air until your stale back hurts.

Yet

Home reading

Medicines for coughs and colds. Andrew Chetley, "Problem Drugs".

No disease can be cured without eliminating the root cause of the pathological condition. It should be sought in the symptomatology - a complex of external signs of the disease. Symptomatic therapy involves the impact on these manifestations. The most striking examples of such treatment are the use of painkillers, antipyretics, and mucolytic drugs. In addition, symptomatic therapy, as a rule, is included in the treatment course when working with more complex clinical cases - for example, when it comes to oncological pathologies. It can be aimed at eliminating unwanted manifestations of the disease before or after surgery, as well as at the stage of palliative treatment.

Symptomatic therapy in oncology

Symptomatic therapy in oncological practice is commonly understood as a set of measures aimed at eliminating the most serious and dangerous consequences of tumor processes and correcting postoperative complications. In addition, in some cases, symptomatic therapy can also be palliative, that is, it is designed to alleviate the patient's condition and improve his quality of life when a full recovery is not possible.

The need for symptomatic therapy in cancer hospitals arises regardless of the stage of the disease. So, when the tumor is just discovered and does not manifest itself in any way, the patient may begin panic attacks and even depression. Of course, this condition (symptom) requires medical correction. Radical removal of malignant tumors is also accompanied by symptomatic therapy, since the body always "responds" to any outside interference. And finally, symptomatic therapy is necessarily included in the medical protocol at the stage of rehabilitation of cancer patients. After radical treatment, the immune system is weakened, it is required to restore the basic vital functions of the body. And modern drugs to eliminate unwanted symptoms have the necessary corrective effect.

Symptomatic therapy

Symptomatic therapy is designed to eliminate or significantly weaken not only unpleasant, painful subjective sensations for a person, but also various adverse symptoms caused by both hypoxia and the negative consequences of etiotropic and pathogenetic treatment. For these purposes, they use a huge arsenal of medicinal and non-drug methods and means that eliminate or reduce a variety of secondary pathological changes in the body, including excitement, pain, and negative emotions.

metabolic therapy

For many decades, if not more, scientists, practitioners, pharmacologists have been trying to develop drugs that would stabilize the disturbed functions of the body, regardless of the etiological factor, naturally, without replacing this drug with a certain specific therapy. The basis for the implementation of their therapeutic activity is the modulation of metabolic processes, which is manifested by an increase in the adaptive processes of the body. The creation of this group of drugs is based on the following principle: metabolic agents must be natural substrates to one degree or another, or they (drugs) modulate their de novo synthesis. Naturally, the action of metabolic agents should be realized under conditions of a pathological condition. In other words, the indicated group of drugs (metabolics; protectors; antihypoxants; antioxidants) should, under conditions of stress (damage, disease), prevent or reduce the damaging effect of hypoxia, preserve the integrity of oxidative phosphorylation (ATP production) > preserve the target organ and / or the body as a whole .

Metabolic therapy makes it possible to maintain or replace some of the vital functions of the body until their autoregulation is restored, when the restored autoregulatory functions themselves will control the long road to recovery.

In the last century, 40% glucose administered intravenously was used as a metabolic agent with some success, then it was combined with B vitamins, and clinicians of those times used large and sometimes megadoses of these vitamins to treat debilitating diseases. It must be admitted that these measures really significantly improved the condition of patients with myocardial infarction, pneumonia, and severe stress. No less interesting and effective metabolic drug was Cahors - church wine. It had a high energy value, and it was used even in pre-revolutionary Russia. We foresee the skeptical and indignant exclamations of adherents of evidence-based medicine, but it worked, and behind such prescriptions lay the practical experience of many thousands of doctors, thousands of lives saved. This must be treated with respect.

It is necessary to recall the scientific research of alchemists, who many centuries ago used succinic acid as the "elixir of life", which in the 21st century becomes the leading metabolic drug.

Several decades ago, taking into account the pathophysiological processes that occur during hypoxia, Labori proposed the use of a polarizing mixture in critical conditions. The combination of glucose, insulin, potassium and magnesium significantly reduces the damaging effect of hypoxia due to the energy substrate of glucose, the reserves of which are quickly depleted in severe diseases and injuries, the restoration of cell polarity (injection of K + and Mg + into it contributes to the normal functioning of the membrane, prevents / reduces the development calcium paradox), plus the anabolic effects of small doses of insulin. This list goes on and on.

But let's return to today without rejecting and applying in the future the experience of our teachers.

One of the most effective and promising ways to prevent and treat hypoxic / ischemic damage, and therefore, the treatment of various severe pathologies in the practice of intensive care, is the use of antihypoxants - pharmacological agents that weaken or eliminate hypoxic disorders (hypoergosis) by maintaining and increasing energy production in the mitochondrial oxidative phosphorylation system. . The founder of this trend was V.M. Vinogradov, under whose leadership the first "true" antihypoxants were created - gutimin and amtizol, which were successfully used in critical conditions with ischemic and hypoxic disorders. These drugs and drugs that are currently used in clinical practice suppress or weaken the activation of LPO - FRO, which also improves the energy potential of the cell.