- Email: [email protected]
Counselling
Survey of Nebulised Medication in a Surgical Environment MADAM - We are in the process of evaluating the use of nebulised medication in a surgical environment. This is a procedure which has evolved in the Royal Isle of Wight County Hospital, where I am most of the time, on my own in charge of the physiotherapy for intensive care unit, the accident and emergency department, and orthopaedic and surgical wards. The out of hours input with postoperative respiratory problems is unlimited,
Counselling MADAM - After reading Madeline Brown's letter in Physiotherapy (March) and the reply by Lorraine de Souza and Julia Segal (April), could I suggest that perhaps physiotherapists do not feel they need counselling themselves and therefore do not seek counselling courses? Members of the caring professions find it very difficult to ask for help for themselves. In a new group with which I am involved, providing 'support for the caring professions', only four physiotherapists have so far attended. There have been numerous social workers, including detached youth workers, and only the 'token' teacher, nurse and policeman at the meetings. As the April letter said: 'Working with people with any disability is at times stressful and anxiety-provoking' and 'There is no assumption (within the NHS) that it is perfectly acceptable, normal and healthy to seek such counselling as a professional for oneself'. Is it the word 'counselling' which is so daunting? Should we just think of it as 'listening', as Madeline Brown suggests? MARGARET A PAGE GradDipPhys MCSP Bournemouth
especially as the Island has an overload of senior citizens. The majority of these seem to retire here because of their 'chest problems'. As we have some experience with asthmatics, we decided that perhaps we should use preventive treatment more, on the same principle as the physicians, for selected patients undergoing major surgery and who have a high risk respiratory factor: for example, if they:
the premed) and 48 hours post-operative cover is around €7, which is cheaper than our out-of-hours visits.
0 Were chesty children. 0 Had a history of respiratory problems. 0 Smoked. 0 Had a recent history of chest infection.
MADAM - On reading and re-reading Mr Grieve's letter 'Please call off the Cyriax contention' (Physiotherapy, April 19891, I have gradually become aware of a rather two-edged nature to its import. That Dr Cyriax should be accorded 'respect, admiration and gratitude' is, I wholeheartedly agree, only proper. On the other hand I cannot dismiss the fruits of two decades' intense and meticulous clinical observation and logical deduction as mere 'notions'. Rather, the conclusions drawn the backbone of Dr Cyriax's work - made order of diagnostic and therapeutic chaos, and continue so to do. Nor can I see why, in order to embrace these conclusions, it should be necessary for us fo 'take leave of our clinical wits'; on the contrary, my clinical wits (of which I feel firmly in possession) have caused me to embrace them. Dr Cyriax was not a man to rest on his laurels; indeed, even when his fundamental work was completed, he never stopped inquiring, observing, learning and teaching, and the Cyriax Organisation continues his work in the same vein. 'Cyriax' is not entrenched in the past, but advancing towards the future.
A final clinical assessment by a doctor and a simple reversibility test decided whether preventive treatment was necessary. We found if we administered a bronchodilator alone to these patients they became very productive, but if we added a modicum of nebulised steroid (3 ml Becotide - 150 micrograms) the peak flows increased, but we were not so much bothered with sputum production. This proved much more comfortable for the patient and reduced the necessity for post-operative physiotherapy. The secret is to select the patients carefully, and we are in the process of improving this. We have the facility for all suspect patients to have lung function tests and I would envisage this happening with elective major surgery four weeks before operation, by the anaesthetist. This gives us time to educate the patient and bring the lungs to optimum conditions. We would probably use metered dose inhalers and we prefer Ventolin and Becloforte, although we have used nebulised Ventolin in the home, followed by Becloforte when the compliance with metered dose inhalers is poor. The cost for a pre-operative dose (with
This issue of Physiotherapy contains the last of a series of articles on 'Pain and Stress'; the others on this theme were published last month. In 1983 a similar symposium was published on 'Incontinence', and the articles are still available reprinted in booklet form (€1 including postage from the Journal Department). However, the time has come when some of the concepts in these papers need updating, and we should add new material reporting recent work on the subject. We are therefore calling for papers on any aspect of incontinence to form a new symposium on the subject. In the first instance please send a summary of the article to the editor at 14 Bedford Row,
'26
ELISABETH M BELL MCSP Superintendent Physiotherapist Royal Isle of Wight County Hospital Ryde
Cyriax for the Future
NIGEL HANCHARD MCSP Senior Lecturer for The Cyriax Organisation York
London WClR 4ED, by June 30 a t the latest, marking the envelope 'Symposium'. The summaries will be considered individually and as a group, and if they fit well together the authors will be sent guide lines on presentation and asked to complete their papers by the end of the summer. The articles will then be assessed in their complete form and processed for publication in the usual way. Incontinence is a persistent challenge and physiotherapists have a significant part to play in its control so please let us know about your experience and expertise by formulating the summary for a paper as soon as possible.
physiotherapy, June 1989, vol75, no 6
Counselling MADAM - After reading Madeline Brown's letter in Physiotherapy (March) and the reply by Lorraine de Souza and Julia Segal (April), could I suggest that perhaps physiotherapists do not feel they need counselling themselves and therefore do not seek counselling courses? Members of the caring professions find it very difficult to ask for help for themselves. In a new group with which I am involved, providing 'support for the caring professions', only four physiotherapists have so far attended. There have been numerous social workers, including detached youth workers, and only the 'token' teacher, nurse and policeman at the meetings. As the April letter said: 'Working with people with any disability is at times stressful and anxiety-provoking' and 'There is no assumption (within the NHS) that it is perfectly acceptable, normal and healthy to seek such counselling as a professional for oneself'. Is it the word 'counselling' which is so daunting? Should we just think of it as 'listening', as Madeline Brown suggests? MARGARET A PAGE GradDipPhys MCSP Bournemouth
especially as the Island has an overload of senior citizens. The majority of these seem to retire here because of their 'chest problems'. As we have some experience with asthmatics, we decided that perhaps we should use preventive treatment more, on the same principle as the physicians, for selected patients undergoing major surgery and who have a high risk respiratory factor: for example, if they:
the premed) and 48 hours post-operative cover is around €7, which is cheaper than our out-of-hours visits.
0 Were chesty children. 0 Had a history of respiratory problems. 0 Smoked. 0 Had a recent history of chest infection.
MADAM - On reading and re-reading Mr Grieve's letter 'Please call off the Cyriax contention' (Physiotherapy, April 19891, I have gradually become aware of a rather two-edged nature to its import. That Dr Cyriax should be accorded 'respect, admiration and gratitude' is, I wholeheartedly agree, only proper. On the other hand I cannot dismiss the fruits of two decades' intense and meticulous clinical observation and logical deduction as mere 'notions'. Rather, the conclusions drawn the backbone of Dr Cyriax's work - made order of diagnostic and therapeutic chaos, and continue so to do. Nor can I see why, in order to embrace these conclusions, it should be necessary for us fo 'take leave of our clinical wits'; on the contrary, my clinical wits (of which I feel firmly in possession) have caused me to embrace them. Dr Cyriax was not a man to rest on his laurels; indeed, even when his fundamental work was completed, he never stopped inquiring, observing, learning and teaching, and the Cyriax Organisation continues his work in the same vein. 'Cyriax' is not entrenched in the past, but advancing towards the future.
A final clinical assessment by a doctor and a simple reversibility test decided whether preventive treatment was necessary. We found if we administered a bronchodilator alone to these patients they became very productive, but if we added a modicum of nebulised steroid (3 ml Becotide - 150 micrograms) the peak flows increased, but we were not so much bothered with sputum production. This proved much more comfortable for the patient and reduced the necessity for post-operative physiotherapy. The secret is to select the patients carefully, and we are in the process of improving this. We have the facility for all suspect patients to have lung function tests and I would envisage this happening with elective major surgery four weeks before operation, by the anaesthetist. This gives us time to educate the patient and bring the lungs to optimum conditions. We would probably use metered dose inhalers and we prefer Ventolin and Becloforte, although we have used nebulised Ventolin in the home, followed by Becloforte when the compliance with metered dose inhalers is poor. The cost for a pre-operative dose (with
This issue of Physiotherapy contains the last of a series of articles on 'Pain and Stress'; the others on this theme were published last month. In 1983 a similar symposium was published on 'Incontinence', and the articles are still available reprinted in booklet form (€1 including postage from the Journal Department). However, the time has come when some of the concepts in these papers need updating, and we should add new material reporting recent work on the subject. We are therefore calling for papers on any aspect of incontinence to form a new symposium on the subject. In the first instance please send a summary of the article to the editor at 14 Bedford Row,
'26
ELISABETH M BELL MCSP Superintendent Physiotherapist Royal Isle of Wight County Hospital Ryde
Cyriax for the Future
NIGEL HANCHARD MCSP Senior Lecturer for The Cyriax Organisation York
London WClR 4ED, by June 30 a t the latest, marking the envelope 'Symposium'. The summaries will be considered individually and as a group, and if they fit well together the authors will be sent guide lines on presentation and asked to complete their papers by the end of the summer. The articles will then be assessed in their complete form and processed for publication in the usual way. Incontinence is a persistent challenge and physiotherapists have a significant part to play in its control so please let us know about your experience and expertise by formulating the summary for a paper as soon as possible.
physiotherapy, June 1989, vol75, no 6