Doctor and former Secretary of Health of SP says that situation requires speech therapists, adapted diet and muscle therapy to prevent new infections and drowning
Health monitoring of the former president (PL) would be safer under house arrest at this time, according to an assessment by the infectious disease doctor, former Secretary of Health of São Paulo (2020-2022).
For the specialist, the main clinical challenge in the case involves possible swallowing disorders – a more common condition in elderly patients and which can be aggravated by the history of abdominal surgeries resulting from the stab wound suffered in 2018. According to him, this context requires daily monitoring by speech therapists, constant adjustment of the diet and monitoring of the muscles involved in eating.
“House arrest is a medical necessity at this time so that he can be monitored by healthcare professionals who can constantly test his feeding capabilities..”
According to Gorinchteyn, dysphagia (difficulty swallowing) can cause food, liquids or even saliva to go into the airways instead of the esophagus.
“When we think of aspiration pneumonia, we are talking about a situation in which some content – food, liquid or saliva – ends up being aspirated and ends up in the lung. And this leads to an infection”, he explained about the current clinical situation.
In these cases, the right lung is usually the most affected due to the anatomy of the airways. In the specific case of Jair Bolsonaro, however, the tests indicated involvement of both lungs.
Adapted diet and daily monitoring
According to the doctor, patients with this type of condition need constant reevaluation, based on interaction with professionals and exams.
Speech therapists assess and monitor swallowing capacity and advise on adjustments to the consistency of food and liquids to reduce the risk of aspiration and drowning. Respiratory physiotherapy is also used to preserve the muscles involved in breathing and help prevent further pulmonary complications.
According to the doctor, this care becomes even more important with advancing age, which brings relevant physiological changes.
“One of the main ones is the loss of muscle mass. This not only affects skeletal muscles, those that move arms and legs, but also other muscles, such as those involved in swallowing and bowel function..”
Without adequate monitoring, he says, swallowing disorders can progress quickly. Therefore, he says that, from a medical point of view, house arrest would be important to stabilize the clinical condition.
According to Gorinchteyn, the restriction of space in the prison environment, the difficulty in immediately adapting the diet and the lack of constant monitoring can increase the risk of new infections or aspiration episodes.
He also states that restricted mobility in the prison environment tends to accelerate muscle atrophy, especially in elderly patients. The depression faced by the former president, he says, can worsen this process, as the resulting prostration reduces movement and contributes to a faster loss of muscle mass.
Antibiotics and current care
Regarding Bolsonaro’s current condition, Gorinchteyn explains that aspiration pneumonia usually causes not only a lung infection, but also a broader inflammatory response in the body. In Bolsonaro’s case, this inflammatory response also affected kidney function.
“In certain cases, what is observed is a more diffuse, systemic inflammatory response, which may end up compromising other organs in addition to the lung, such as the kidney..”
Clinical monitoring includes assessment of the presence of fever and inflammatory markers in the blood. One of the main ones is CRP (C-reactive protein).
“If the patient continues to have a fever or if the CRP remains elevated or rising, this may indicate that the initial antibiotic may not be adequately covering the infection..”
In these situations, the medical team can expand antibiotic coverage to target other possible infectious agents. This is what the medical bulletin released this Sunday (15 March) reported to have happened to the former president.
Even so, if the patient remains clinically stable and has no fever, changing the antibiotic can be part of the monitoring and treatment adjustment protocol, without necessarily indicating a worsening of the condition, said Gorinchteyn.
