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1 The HealthyLife Maage Your Pai Self-Care Guide helps you idetify ad describe differet types of pai. It presets twety-five methods to treat pai. It also helps you decide whe to maage pai o your ow ad whe to seek medical care. Topics Iclude: Abdomial Pai Arm Pai & Had Pai Back Pai Chest Pai Fibromyalgia Pai Headaches Foot Pai Leg Pai Shigles Pai Sprais, Strais & Sports Ijuries Pai Maagemet Resources Amog Others Sample. Do ot reproduce. Lear More: Go to to get reliable health iformatio o thousads of topics i Eglish ad Spaish for: Health News Drugs & Supplemets Dictioary Health & Welless Medical Ecyclopedia Directories

2 HealthyLife Maage Your Pai by Do R. Powell, Ph.D. ad the America Istitute for Prevetive Medicie Note: This guide ca help you make iformed choices about your health. It does ot replace medical advice or treatmet. Follow your doctor s or health care provider s advice. Cotributors ad Reviewers Susa Schooley, M.D., Medical Director, Detroit Regio ad Chair, Departmet of Family Medicie, Hery Ford Medical Group, Detroit, MI ad Medical Director, America Istitute for Prevetive Medicie, Farmigto Hills, MI James Kohleberg, M.D., Iteral Medicie, Joh R Medical Cliic, Madiso Heights, MI ad William Beaumot Hospital, Royal Oak, MI Jeaette Karwa, R.D., Director, Product Developmet, America Istitute for Prevetive Medicie, Farmigto Hills, MI Da Mayer, M.D., Professor, Emergecy Medicie, Albay Medical College ad Attedig Physicia, Emergecy Departmet, Albay Medical Ceter, NY Adria Watha, Maager, Graphic Desiger, America Istitute for Prevetive Medicie, Farmigto Hills, MI This guide is oe of may self-care books ad programs offered by the America Istitute for Prevetive Medicie. The goal of all of these is to help idividuals reduce health care costs ad improve the uality of their lives. For more iformatio, cotact: America Istitute for Prevetive Medicie Northwester Hwy., Suite 350 Farmigto Hills, MI Fax: aipm@healthylife.com Web site: For free health iformatio, go to: Self-Care Guide Sample. Do ot reproduce. 2014, 1 st ed., America Istitute for Prevetive Medicie. All rights reserved.

3 Telephoe Numbers & Iformatio Emergecy Medical Service (EMS): Police: Suicide Prevetio Lifelie: TALK (8255) Poiso Cotrol Ceter: Local Poiso Cotrol: Doctors / Health Care Providers Name Specialty Phoe Number Hospital: Pharmacy: Employee Assistace Program (EAP): Health Isurace Iformatio Compay: Phoe Number: Address: Policyholder s Name: Policy Number: What to Tell Your Doctor / Provider Use this summary whe you call or visit a provider. Also see pages 6 to 11. Where it hurts: How much it hurts (0 = o pai 10 = hurts the worst): Whe it started: The pai comes ad goes The pai lasts all the time Other symptoms with the pai: What helps the pai: What makes it worse: Medicies I take: Treatmets other tha medicie I used: Medicatio allergies: Itroductio Table of Cotets What Is Pai?... 4 Pai Facts... 4 Types of Pai... 5 Idetify ad Be Able to Explai Your Pai Methods to Maage Pai...11 Whe is Medical Care Needed for Pai? Abdomial Pai Arm Pai & Had Pai Back Pai Chest Pai Ear Pai Fibromyalgia Pai Foot Pai Headaches Leg Pai & Akle Pai Neck Pai & Shoulder Pai Shigles Pai Ski Ijuries & Woud Pai Sprais, Strais & Sports Ijuries Toothaches Pai Maagemet Resources People experiece pai i differet ways. What matters is how pai affects you. Maagig pai makes it easier to do your day-to-day activities ad better cope with illess ad ijury. Use this guide to: Lear about pai ad how much it affects your life. Idetify ad be able to explai your pai. Idetify causes of pai that could threate life or result i the loss of a limb. Fid out ways to treat ad maage your pai. Fid out about pai maagemet resources. Sample. Do ot reproduce.

4 What Is Pai? Types of Pai Pai is your awareess of hurt or discomfort ad how you perceive it. This applies whe you feel physical or emotioal pai. The feelig of physical pai starts i erve receptor cells that are below your ski ad i orgas iside your body. These erve cells sed a sigal to erves i your spial cord ad from there to your brai. Pai ca be a sig that somethig is wrog, such as a ski ijury, a ifectio, or a illess. It ca rage from a mild discomfort to pai that is extreme ad severe. Emotioal pai is ofte described as distress, metal aguish, or a broke heart. Physical pai ad your emotios iteract with each other. Your emotios have a direct impact o how you feel pai. You ca use your emotios ad your mid to help you maage pai. Pai Facts Pai ca affect may aspects of your daily life. About 75 millio persos livig i the U.S. have chroic or recurret pai. Pai affects more persos i the U.S. tha diabetes, heart disease, ad cacer combied. Pai is oe of the most commo reasos people seek medical care. Chroic pai costs over $100 billio dollars a year i medical costs, disability paymets, lost productivity, ad retraiig workers. Acute Pai This type of pai usually starts suddely. It ca rage from mild to severe ad is caused by aother problem or evet. Examples are: A temporary illess, such as a earache, the flu, or a sore throat A ijury, such as a broke boe, or a bur, a sprai or strai Surgery or other medical procedure Labor ad delivery Whe the cause of the pai is treated with success, the pai goes away. Chroic Pai With this type, pai sigals keep firig i the ervous system for weeks, moths, or years. The pai ca come ad go or persist. It ca rage from mild to severe. The cause of chroic pai is ot always kow, but it may be due to or related to a umber of reasos. These iclude: Arthritis Back problems Cacer or chemotherapy for cacer Headaches that persist Back pai is a Medical coditios that cause problems with erve sigals, such as diabetes ad multiple sclerosis commo medical problem. Other chroic health coditios, such as fibromyalgia ad sickle cell aemia A past ijury or illess Chroic pai ca iterfere with your daily activities ad affect the way you eat, sleep, work, relate to others, ad ejoy life i geeral. Whe you have chroic pai, it is commo to be irritable, worried, agry, ad depressed. Havig chroic pai ad depressio icreases the risk of suicide. The eed to stop the pai ca lead to: Uprove treatmets that could be harmful Overuse ad/or addictio to pai relievig medicies. Drug use. Repeated surgeries Sample. Do ot reproduce.

5 Idetify ad Be Able to Explai Your Pai 1. Where does it hurt? Circle areas of the body ad/or place a check mark (3) i the boxes showig where you have pai. Aswerig the uestios below will help you idetify your pai ad be able to explai it to your doctor or health care provider. Pages 7 to 10 i this guide allow you to aswer these uestios oe at a time. Your aswers also help you idetify thigs that trigger your pai ad how it affects your daily life. Make a copy of this chart. Take your aswers with you to show your doctor or health care provider. Questios to Aswer 1. Where does it hurt? 2. How much does it hurt? 3. Whe did the pai first start? 4. How log have you had it? 5. Does it last all the time or does it come ad go? 6. Does it occur with ay other problems or symptoms? 7. What makes the pai worse? 8. What medicies have you take to relieve the pai? 9. What treatmets other tha medicies have you used? 10. How has the pai affected your life? Your Aswer Head Neck Shoulder(s) Arm(s) Elbow(s) Wrist(s) Had(s) Figer(s) Back Chest Abdome Groi Hip(s) Leg(s) Kee(s) Akle(s) Foot Toe(s) Sample. Do ot reproduce. 2. Does it last all the time or does it come ad go?

6 3. Ca you explai the pai? To help explai your pai, check off ay of the words listed below that describes what your pai feels like. After each word you check off, write a umber for how much it hurts. Use the pai scale o page 9. Word to Explai the Pai Achig All over Beatig Comes ad goes Crushig Dull Gawig Like mestrual cramps Log-lastig Peetratig Pichig Pressig Pulsig Scaldig Shootig Splittig Stabbig Suffocatig Tearig Throbbig Tiglig How Much It Hurts 1 (mild) 10 (severe) (See page 9.) Words to Explai the Pai Agoizig Aoyig Burig Crampig Cuttig Excruciatig Itese Local (what area of the body?) Naggig Piercig Poudig Prickig Radiatig Sharp Sore Sueezig Stigig Taut Teder Tight Wrechig How Much it Hurts 1 (mild) 10 (severe) (See page 9.) 4. How much does it hurt? Pai scales are used to help you rate your pai. The higher the umber, the stroger the pai. Usig the faces ad wordig below, choose a umber from 1 to 10 that describes your pai. No Pai Mild Pai Moderate Pai Severe Pai Worst Pai It does It hurts It hurts a It hurts It hurts a It hurts ot hurt. a little bit. little more. eve more. whole lot. the worst. I ca igore Keeps me Keeps me Severely Ca t do the pai. from doig from limits aythig ormal cocetratig my activity tasks Pai relievers Mild pai medicie Prescribed, stroger to are ot eeded. relieves or lowers strogest medicie lowers pai. or oly partly lowers pai. 5. Whe did the pai first start? O (Day of the week) (Moth) (Day) (Year) 6. How log have you had it? days weeks years 7. Does it occur with ay other problems or symptoms? Sample. Do ot reproduce. List other symptoms you have with the pai:

7 8. What makes the pai worse? (Doig certai activities, sittig for too log, eatig, ot eatig, heat, takig or ot takig medicie, etc.) 9. What medicies have you take to relieve the pai? Over-the-Couter Medicies & Supplemets (Pills, topical oitmets, herbs, etc.) Name of Item Amout Used How Ofte? Prescribed Medicies Name of medicie Dose Prescribed by: 10. What o-medicie treatmets have you used? 11. How has the pai affected your life? Chage i activity level, ability to work, chage i mood, sleep habits, relatioships, ejoyig life, etc.) 25 Methods to Maage Pai You have may optios to maage pai. A brief summary of 25 methods is listed from A to Z o this page ad the ext 2 pages. 1. Acupucture. A traied therapist iserts hair-thi eedles at specific areas just below the ski (acupoits) to stimulate the body s self-healig abilities. Electroacupucture adds wires to the eedles to stimulate erve edigs. Some researchers believe this activates edorphis. 2. Biofeedback. This is a process of learig how to cotrol ad chage iteral fuctios to maage pai ad other coditios. Biofeedback devices measure your breathig, heart rate, blood pressure, or other fuctios. Through traiig i relaxatio or imagery, you lear to alter bodily fuctios to feel more relaxed ad to help maage pai. 3. Cogitive-behavioral therapy (CBT). This helps a perso idetify ad the modify thoughts ad behaviors that focus o pai. 4. Cold treatmet. Examples are placig a ice pack, a bag of froze vegetables, or a cold washcloth o the area that aches. Apply cold treatmet for 20 miutes at a time. For pai from a acute ijury, use cold treatmet for the first 48 hours. 5. Couselig. This ca be idividual, family, or group therapy that provides emotioal support ad teaches ways to idetify ad deal with stress ad emotios that icrease pai. 6. Dietary supplemets. Examples are capsaici for arthritis pai ad giger to reduce iflammatio. Note: Follow your doctor s advice for dietary supplemets. 7. Distractio. This focuses your attetio o somethig other tha the pai, such as watchig a movie, workig o a hobby or project, ad helpig others. 8. Electrical stimulatio called TENS. (This is trascutaeous electrical erve stimulatio). This uses a device that seds getle electrical impulses through the ski at certai pai sites of the body to block pai sigals before they reach the brai. Sample. Do ot reproduce

8 9. Edorphis. These are paikillig proteis that occur aturally i the body. The word edorphi is a Greek term that meas the morphie withi. Brisk walkig, ruig, ad other aerobic exercises may release edorphis. The edorphis lower pai. 10. Exercise. Stretchig ad flexibility. These help with rage of motio ad reduce stiffess i joits that could lead to pai. 11. Heat treatmet. Examples are a heat pack, a hot water bottle, a heatig pad (set o low), or warm shower water o the area that hurts. Apply heat treatmet for 20 miutes at a time. For pai from a acute ijury, use heat treatmet after usig cold treatmet for 48 hours. 12. Hyposis. This uses refocusig techiues to block or trasform pai. 13. Massage. This gives a temporary relief of pai due to muscle stiffess ad muscle spasms. 14. Medicatios Over-the-couter (OTC) Oral pai relievers. Examples are acetamiophe, aspiri, ibuprofe, ad aproxe sodium. These also reduce fever ad, except for acetamiophe, reduce swellig. Topical cremes, lotios, oitmets, ad gels. These offer temporary relief for localized areas of pai, such as figers ad kees due to arthritis. Substaces i these iclude methol, eucalyptus, capsaici, ad salicylates. 15. Meditcatios Prescribed Opioids. Examples are codeie, hydrocodoe (Vicodi), memperidie (Demerol), morphie, ad oxycodoe (OxyCoti). No-opioids. These iclude osteroidal ati-iflammatory drugs (NSAIDS), such as piroxicam (Feldee), aproxe, ad ambumetoe (Relafe). These are commoly prescribed for arthritis pai. Adjuvats. These iclude atidepressats, aticovulsats, atimigraie drugs, muscle relaxats, ad corticosteroids. They may be prescribed alog with other medicatios that relieve pai. Local aesthetics Prescribed medicies come i may forms. These iclude pills, liuids, ski patches, suppositories, ad oes that are ijected or ifused. Pai medicie ca also be give usig a machie that you cotrol. You push a butto whe you feel pai. It is set up so you ca t get too much pai medicie. This is called Patiet Cotrolled Aalgesia (PCA). Most ofte, it is used i the hospital ad health care facilities. 16. Occupatioal therapy. This is learig how to do activities of daily livig while maagig pai. 17. Physical therapy. This focuses o improvig mobility, flexibility, stregth ad edurace through physical exercises ad assistive devices. 18. Placebos. These use the power of suggestio that a pill, etc., without actual medicie, will treat the pai because a perso believes it will. 19. Prayer. This is a spiritual way to meditate, which helps to lower heart rate ad decreases muscle tesio. Coectig to a higher power is a way to cope with pai ad deal with thigs that caot be chaged. 20. Relaxatio. Examples are deep breathig ad progressive muscle relaxatio. 21. Self-Soothig. This is givig compassio ad reassurace to yourself like whe a mother soothes a child who is i pai or is distressed. It is givig yourself permissio to accept the pai ad tryig to stay calm ad relaxed, eve i the midst of your pai. It also icludes seekig physical comfort, such as takig a warm bath. 22. Support groups. These allow emotioal support ad a shared uderstadig for dealig with pai. 23. Surgery. This may be eeded to correct a physical problem that causes pai. 24. Tai Chi. This form of exercise uses slow, getle movemets to improve balace ad icrease flexibility. 25. Yoga. This uses breathig exercises, postures, ad movemets to uite the body, mid, ad spirit. It also improves blood pressure ad circulatio. The Arthritis Foudatio recommeds doig tai chi for pai relief. Sample. Do ot reproduce

9 Whe is Medical Care Needed for Pai? This guide helps you choose whe to seek medical care for pai ad whe you ca treat it o your ow. Commo health coditios that ivolve pai are foud o pages Fid the oe(s) that apply to you o page 3 i the Table of Cotets ad go to the pages they are o. Read about the health coditio(s), sigs ad symptoms, causes, ad treatmets. Read the Questios to Ask. Start at the top. Aswer YES or NO to each uestio util you get to oe of the istructios listed below: Get Medical Care Fast If your symptoms direct you to this symbol, get medical care without delay. For problems that could threate life, call or go to a hospital emergecy departmet. (Ask your doctor for a list of reasos you should get these levels of care.) If symptoms do ot threate life, call your doctor or health care provider right away or go to a urget care ceter. Fid out if your health isurace reuires you to use a certai ambulace service. Abdomial Pai The abdome is the body regio betwee the lower ribs ad the pelvis. May vital orgas make up this body regio. It is divided ito four sectios called uadrats. Each of these has certai orgas. Sigs & Symptoms See Doctor Abdomial aortic aeurysm If your symptoms direct you to this symbol, you should be see by Appedicitis your doctor for a medical evaluatio. Cotact your doctor to fid out how soo you eed to be see. The term doctor is used for a umber of Blocked arteries or oes with poor blood flow health care providers: Cacer Irritable bowel sydrome Your physicia A walk-i cliic Your psychiatrist Celiac disease (IBS) Physicia assistats (P.A.s), urse practitioers (N.P.s), ad Costipatio Kidey stoes certified urses (C.N.s) who work with your doctor Your urse advice lie Your home health care provider Croh s disease Mestrual cramps i females Diverticulosis ad diverticulitis Call Doctor Ovaria cysts i females Call your doctor or health care provider ad state the problem for Food poisoig Pacreatitis advice o what to do. Gallstoes Pregacy complicatios Use Self-Care Heart attack (see pages 28 ad 30) Reflux of stomach acids You ca probably take care of the pai yourself. Use the Self-Care / Heartbur Prevetio measures that are listed. If these do ot brig relief or if Stomach ulcers Hepatitis your pai worses, call your doctor. Ifectios, such as oes i the digestive tract ad uriary tract Mild to severe ad dull to sharp pai Acute (sudde) pai or chroic pai The type of pai, its locatio, ad other symptoms poit to the cause. Causes There are may causes of abdomial pai. Some of these are: Four sectios of the abdome Sample. Do ot reproduce.

10 Treatmet Treatmet depeds o the cause. The key is to kow whe it s just a mior problem, like a mild stomachache or whe it s somethig worse. Pai that persists ca be a sig of a medical coditio or illess. Very severe abdomial pai usually eeds medical care right away. Questios to Ask With abdomial pai, are ay sigs ad symptoms of a heart attack listed o pages 28 ad 30 preset? With abdomial pai, are ay of these problems preset? You vomit without stoppig or you vomit blood or material that looks like coffee grouds. You vomit, have a fever ad shakig chills, ad feel pai i oe or both sides of your mid-back or shoulders. You have dry mouth, excessive thirst, little or o uriatio, ad dry ski that does t sprig back after you pich it. Your stools have blood or are tarlike ad black i color. You had a recet ijury to the abdome. Pai is so bad that you ca t move or it gets a lot worse whe you move. With abdomial pai, do you have ay of these problems? The pai spreads to the back, chest, or shoulders. You feel a mass i the abdome that throbs or pulsates. Your abdome is very teder whe touched. You do t kow why your abdome is swolle, but it keeps gettig worse. Is pai i the abdome very severe or sudde, extreme, ad costat? Flowchart cotiued o ext page Call 911! Are all of these symptoms of appedicitis preset? You have ot had your appedix removed. Pai ad tederess started i the upper part of your stomach or aroud your belly butto ad moved to the lower right part of your abdome. The pai ca be sharp, severe, ad felt more whe the lower right abdome is touched. Nausea, vomitig, or o appetite Fever With abdomial pai, are these symptoms of kidey stoes preset? The pai started i your side before it moved to your abdome or groi. Pai persists o matter what positio you are i. It is paiful to pass urie. Your urie is bloody, cloudy, ad/or has a foul odor. You pass urie ofte, but oly pass small amouts. You are uable to pass urie. With abdomial pai, do you have ay of these problems? The whites of your eyes or your ski looks yellow. Pai recurs i your upper abdome ad it is temporarily relieved by atacids. Severe diarrhea or costipatio lasts for more tha a week. Ski o the abdome is sesitive or you have a ski rash o oe side of the abdome. You have a bulge ad/or discomfort (whe pressed) aywhere i the abdome. You have pai or burig whe you pass urie. You have pai ad a vagial discharge. Do you pass urie more ofte tha usual or is your urie bloody or cloudy? Sample. Do ot reproduce. Is swellig or discomfort i the groi made worse whe you cough or lift heavy objects? Flowchart cotiued o ext page 16 17

11 With abdomial pai, do you have ay of these problems? Cotiued belchig, ausea, gas, or gurglig oises Pai worses whe you bed over or lie dow. Self-Care / Prevetio Fid a comfortable positio. Relax. Take a over-the-couter pai medicie as directed o the label. Apply a heatig pad set o low (adults oly). Use a hot water bottle or heat pack o the area that aches. Wear loose-fittig clothes. Do t exercise too hard. For more iformatio, cotact: Use a hot water bottle or heat pack o the area that aches. Croh s & Colitis Foudatio of America Natioal Istitute of Diabetes & Digestive & Kidey Diseases (NIDDK) www2.iddk.ih.gov Sigs & Symptoms Arm Pai & Had Pai Pai ragig from dull to severe. Icreased pai with movemet. Numbess. Weakess. Tederess. Stiffess. Swellig. Causes There are may causes of arm ad/or had pai. Commo causes are: Repeated use of tools that vibrate Arthritis. Repetitive motio ijuries (RMIs), such as the had ad wrist carpal tuel sydrome. ca lead to RMIs. Circulatio problems, such as agia ad a heart attack Ski rashes. Ski wouds. Ifectios. Ijuries, such as sprais, strais, ad broke or dislocated boes Other symptoms with the pai ad how log they have occurred help diagose the cause. See, also, Neck Pai & Shoulder Pai o pages ad Sprais, Strais & Sports Ijuries o pages Treatmet Treatmet depeds o the cause ad how severe the problem is. Questios to Ask Are ay sigs ad symptoms of a heart attack listed o pages 28 ad 30 preset? Sample. Do ot reproduce. If you have bee diagosed with agia, do you have achig i oe or both arms ad chest pai that do ot respod to prescribed medicie? Or does the pai ot go away i miutes? Flowchart cotiued o ext page Call 911! Call 911!

12 Did you have a serious ijury that caused arm or had pai ad/or are ay of these sigs preset? A boe sticks out or boes i the ijured area make a gridig soud. The ijured body part looks crooked or the wrog shape. After a crushig ijury, pai icreases. You ca t move the ijured body part or put weight o it. The ijured area is blue, pale, umb, or feels cool, but the same limb o the other side of your body does ot. Do you have ay of these problems? Burig pai i a figer, especially at ight ad/or whe you bed your wrist ad figers upward the dowward Shootig pais from your had to your wrist ad sometimes to your forearm. Numbess ad tiglig i your first 3 figers ad thumb Had pai, umbess, ad tiglig for more tha 2 weeks You have t bee able to make a fist for over a week. Do you have ay of these problems? Your shoulder hurts, is stiff, ad is hard to move. You have pai, tederess, ad limited motio i your shoulder, arm, or had. Tederess ad pai over a elbow Pai whe you twist your arm or had, such as whe you use a screwdriver or play teis A weak grip Ay sig of a ifectio listed o page 57? Do you have pai ad stiffess i joits with these problems i your figers? Puffiess, hardeig, ad thickeig of the ski Your ski looks shiy or waxy or blue i color. Coldess ad umbess Flowchart cotiued o ext page Call 911! Do you have ay of these problems? A growth o your wrist that feels tight, hard, ad paiful Your hads tur pale, the red, ad get paiful ad umb whe exposed to the cold ad/or whe you are stressed. Pai i your arm or had wakes you from your sleep. Have you started to have a hard time writig with a pe or pecil, opeig a jar, or buttoig a blouse or shirt? Self-Care / Prevetio To Help Treat Arthritis Follow your doctor s advice for exercise, medicatios, ad the use of supplemets, such as glucosamie, chodroiti, ad flaxseed oil. Follow a healthy diet. If you are overweight, lose weight gradually (1-2 pouds a week). Losig weight too fast ad fastig raise uric acid levels ad icrease the risk for gout. Protect your joits from ijuries. Wear kee pads, etc. Do t put too much stress o your joits. Take regular pauses ad breaks from activities that do this. To Help Prevet Osteoarthritis Get to ad stay at a healthy weight. Do regular physical activity, but do t overdo it. If you feel pai, stop. Prevet falls ad sports ijuries. (Use tips uder Prevetio o page 61.) Sample. Do ot reproduce

13 For Carpal Tuel Sydrome (CTS) This is much easier to treat ad less likely to cause future problems if it is foud early. Oce CTS is diagosed, treatmet icludes: Prevetig further damage Wearig a wrist brace, split, etc. as advised by your doctor. This may eed to be wor durig the day ad while you sleep. Takig OTC medicies to reduce pai ad swellig. Physical therapy A physical therapist ca show you what Occupatioal therapy exercises to do at work ad at home to treat Cortisoe shots i the wrist area CTS. Surgery, if eeded For more iformatio, cotact: Arthritis Foudatio Natioal Istitute of Arthritis ad Musculoskeletal ad Ski Diseases (NIAMS) Back Pai Sigs & Symptoms Back pai ca be sharp, dull, acute or chroic. There may also be swellig i the back area. Causes The most commo cause is muscle strai of the lower back. Other causes iclude back ijuries, osteoarthritis, osteoporosis, ad bladder ifectios. Treatmet Sittig too log ca Most backaches caused by straied muscles ad stiffe back muscles. ligamets ca be treated with self-care. (See Self- Care / Prevetio o page ) Other causes eed a medical evaluatio ad treatmet specific to the problem. The goals of treatmet are to treat the cause, relieve the pai, promote healig, ad avoid re-ijury. Questios to Ask Is the back pai extreme ad felt across the whole upper back? Did it come o suddely (withi about 15 miutes) without a reaso, such as a ijury or back strai? (These may be symptoms of a dissectig aortic aeurysm.) Are ay of these problems preset? The back pai was sudde with a crackig soud. The pai occured with passig out ad/or severe abdomial pai. The pai came after a recet fall, ijury, or violet movemet to the back ad you are havig a hard time movig your arm or leg. You also have umbess or tiglig i your legs, feet, toes, or hads, ad/or loss of bladder or bowel cotrol. Sample. Do ot reproduce. Flowchart cotiued o ext page 22 23

14 Do ay of the followig describe or occur with back pai? The pai came o all of a sudde after beig i a wheelchair or a log stay i bed. You are over 60 years old. The pai is severe (but ot a result from a fall or ijury to the back) ad has lasted for more tha 5-7 days. There is a sese of weakess, umbess, or tiglig i the feet or toes. You have burig or pai whe you pass urie. Your urie is bloody or cloudy or you pass urie more ofte tha usual. The back pai travels dow the leg(s), especially below the kee(s). It hurts more whe you move, cough, seeze, lift, or strai. With back pai, do you have ay of these problems? Fever, joit stiffess, ad joit pai Fever, redess, heat, or swellig i affected joits Fever, crackig or gridig souds with joit movemet The pai is felt o oe side of the small of your back, just above your waist, ad you feel sick. Self-Care / Prevetio Relieve the Pai Take a over-the-couter medicie for pai. Acetamiophe will help the pai, but ot the swellig. Do t overdo it after takig a paikiller. You ca hurt your back more ad the it will take loger to heal. Activity Cotiue your regular activities as much as you ca, but stop activities that icrease pai. Rest the back if you must, but do t rest i bed more tha 1 to 2 days eve if your back hurts a lot. Your back muscles ca get weak if you do t use them or if you stay i bed loger tha 2 days. Rest should oly be used for persos with severe limitatios (due mostly to leg pai). Other Tips Get comfortable whe you lie dow, stad, ad sit. For example, whe you lie o your back, keep your upper back flat, but your hips ad kees bet. Keep your feet flat o the bed. Tip your hips dow ad up util you fid the best spot. Put a pillow uder your kees or lie o your side with your kees bet. This will take pressure off your lower back. Whe you get up from bed, move slowly, roll o your side, ad swig your legs to the floor. Push off the bed with your arms. Cold Treatmet Cold helps with bruises ad swellig. For the first 48 hours after back symptoms start, apply a cold pack (or bag of ice) to the paiful area. Lie o your back with your kees bet ad put the cold pack uder your lower back. Do this for 5 to 10 miutes at a time, several times a day. Heat Treatmet Heat makes blood flow which helps healig. Heat also helps relieve muscle spasm. Do t use Apply ice or a cold pack heat o a back strai util 48 or more hours after for the first 48 hours after back symptoms start. Use cold treatmet first symptoms start. (see Cold Treatmet above). If used sooer, heat ca make the pai ad swellig worse. Use a moist heatig pad, a hotwater bottle, hot compresses, a hot tub, hot baths, or hot showers. Use heat for 10 miutes at a time. Do this several times a day. Be careful ot to bur yourself. Braces or Corsets Braces ad corsets help to support your back ad keep you from movig it too much. They do what strog back muscles do, but they wo t make your back stroger. Sample. Do ot reproduce. Massage Massage wo t cure a backache, but it ca loose tight muscles

15 Spial Maipulatio This treatmet, usually doe by a chiropractor or osteopath, uses the hads to apply force to adjust the spie. This may be helpful for some people the first moth they have low back symptoms. Cosult your doctor about spial maipulatios. Your health isurace pla may ot cover costs. Or, it may reuire a referral from your doctor before it pays aythig for spial maipulatio. More Tips Try some mild stretchig exercises (i the morig ad afteroo) to make your stomach ad back muscles stroger. Ask your doctor for his or her advice o exercisig. Yoga may help. Do t sit i oe place loger tha you eed to. It strais your lower back. Sleep o a firm mattress. Do t sleep o your stomach. Sleep o your back or side with your kees bet. If your back pai persists or does t get better o its ow, see your doctor to evaluate your eeds. Your doctor may refer you to a chiropractor, physical therapist, or physiatrist (a physical therapy doctor). Liftig Do s ad Do ts to Prevet Back Strai Liftig Do s Wear good shoes with low heels, ot sadals or high heels. Stad close to the object you wat to lift. Plat your feet suarely, shoulder width apart. Bed at the kees, ot at the waist. Keep your kees bet as you lift. Pull i your stomach ad rear ed. Keep your back as straight as you ca. Hold the object close to your body. Lift slowly. Let your legs carry the weight. Proper liftig Get help or use a dolly to move somethig that is too big or very heavy. Liftig Do ts Do t lift if your back hurts. Do t lift if you have a history of back trouble. Do t lift somethig that s too heavy. Do t lift heavy thigs over your head. Do t lift aythig if you re ot steady o your feet. Do t bed at the waist to pick somethig up. Do t arch your back whe you lift or carry. Do t lift too fast or with a jerk. Improper liftig Do t twist your back whe you are holdig somethig. Tur your whole body, from head to toe. Balace the load. Do t lift somethig heavy with oe had ad somethig light with the other. Do t try to lift oe thig while you hold somethig else. For example, do t try to pick up a child while you are holdig a bag of groceries. Put the bag dow or lift the bag ad the child at the same time. Sciatica Sciatica is iflammatio of the sciatic erve, which starts i the lower spie ad goes dow the back of the legs. Pressure o the erve (from tight muscles, heriated disk, etc.) causes a sharp pai that ca be felt i a buttock ad may exted to the thigh, kee, or foot. To prevet sciatica: Do t strai the muscles i your lower back. (See Liftig Do s ad Do ts to Prevet Back Strai o page 26 ad this page.) Do exercises to stregthe your stomach muscles. These exercises help make your back stroger. Treatmet for mild sciatica is rest, heat, ad a over-the-couter medicie for pai. Physical therapy may be helpful. I some cases, surgery to repair a heriated disk may be eeded. Sample. Do ot reproduce. For more iformatio, cotact: Natioal Istitute of Arthritis ad Musculoskeletal ad Ski Diseases (NIAMS)

16 Sigs & Symptoms Chest pressure, sueezig, burig, tightess, or pai (may spread to the arm, eck, back, tooth, or jaw) Chest discomfort with: Shortess of breath; sweatig; ausea, fast or ueve pulse; lightheadedess; faitig Chest pai that does ot respod to medicie for a perso with agia or heart problems Severe chest pai ad extreme pai felt across the upper back (ot just o oe side) that came o withi 15 miutes without a ijury, back strai, etc. The pai ca spread to the abdome. A kife-like sesatio from the chest area to the back Dizziess ad faitig Chest pai that gets worse whe takig deep breaths ad occurs with ay of these coditios: Sudde shortess of breath ad several problems breathig Rapid heartbeat Cough with bloody sputum Sudde oset of chest pai with calf pai Recet surgery or illess with prologed bed rest or a very log trip by car, bus, trai, or plae Chest Pai What It Could Be Dissectig aortic aeurysm. This is a tear i the mai artery from the heart. Blood clot(s) to the lugs What to Do Heart Attack. Call 9-1-1! (See, also, Other Heart Attack Warig Sigs o page 30.) Call or go to the emergecy departmet of a hospital! Do ot take aspiri. Call or go to the emergecy departmet of a hospital! Sigs & Symptoms What It Could Be What to Do Sudde ad sharp chest pai or tightess with breathig Icreasig shortess of breath Sueezig, pressure, idigestio feelig, or pai (ofte dull) i the chest. The pai may spread to the arm, eck, jaw, or back. Symptoms come o or are made worse by stress or physical exertio. They ease with rest. The pai is o oly oe side of the chest ad is ot affected by breathig. A burig feelig ad a ski rash are at the site of the pai. Vague pai i the chest (if ay). Shortess of breath; chroic fatigue; cough with phlegm or blood; ight sweats; appetite loss; weight loss; ad fever. Burig feelig i the chest or just above the stomach that comes ad goes before, durig, or after eatig. It gets worse whe you bed over or lie dow. Chest pai that worses with deep breaths, coughig, or touchig the chest or ribs Collapsed lug. Trauma to the chest is the mai cause Agia Shigles Heartbur or hiatal heria. Note: This could also sigal agia or a heart attack. (See pages ) Pleurisy. The membrae that surrouds the lugs is iflamed. Muscle strai or rib ijury. Call or go to the emergecy departmet of a hospital. Take medicie as prescribed. If symptoms do ot go away i miutes, call or go to the emergecy departmet of a hospital! See Shigles Pai o page 54. Tuberculosis See doctor. (TB). Chroic lug ifectio with a certai bacteria. Use prescribed treatmet for heartbur or hiatal heria or cosult doctor. Sample. Do ot reproduce. See doctor for diagosis. See Sprais, Strais & Sports Ijuries o page 59, too.

17 Sigs & Symptoms What It Could Be What to Do Chest pai with fever ad coughig up gree, brow, yellow, or gray mucus. Sudde, sharp pai below the left ipple that lasts less tha a miute or so. Pai ad teder feelig i the upper part of the chest. The pai gets worse whe pressure is applied to the area. It ca get worse with deep breaths, too. Flu, peumoia, brochitis, or other upper respiratory ifectio. Precordial catch sydrome. This harmless, recurret problem usually occurs i youg adults. Costochodritis. This is iflammatio where the ribs attach to the breastboe. Other Heart Attack Warig Sigs See doctor. Uusual chest, abdomial, or stomach pais Dizziess; ausea; trouble breathig; jaw or arm pai without chest pai Fast or ueve heartbeat or pulse Sweatig for o reaso; pale, gray, or clammy ski Sigs more likely to occur i wome tha i me are a ueasy feelig i the chest with: Uexplaied or extreme axiety Uusual fatigue or weakess Flutterig heartbeats Severe idigestio that does t go away with a atacid See doctor for diagosis. Try daily stretchig exercises to reduce gettig these pais. See doctor for diagosis. Take a OTC medicie for pai ad swellig. Apply a heatig pad set o low or a hot water bottle to the area of pai. Sigs & Symptoms Ear Pai Mild to severe ear pai Feelig of fulless or discomfort i the ears Tuggig at the ear ad restlessess i childre Causes The most commo cause of ear pai is a plugged Eustachia tube. This goes from the back of the throat to the middle ear. The pai is due to fluid or pressure i the plugged tube. This is caused by a ifectio of the middle ear, a cold or sius ifectio, or allergies. Other thigs that ca cause ear pai iclude chages i air pressure i a plae, somethig stuck i the ear, too much earwax, tooth problems, ad a ruptured eardrum. Treatmet Treatmet icludes pai relievers ad methods to dry up or clear the blocked ear caal. Self-care ca be used to treat may earaches. Severe ad/or costat ear pai eeds a medical diagosis. Ofte, atibiotics are ot eeded for middle ear ifectios i childre. Let your child s doctor decide if ad whe a atibiotic should be prescribed. Questios to Ask Did ear pai start after a blow to the ear or recet head trauma? With ear pai, do ay symptoms of meigitis occur? Severe, persistet headache Stiff eck (ca t touch the chi to the chest) Lethargy Seizure Red or purple rash that does t fade whe the ski is pressed I a ifat, bulgig of the fotaelle (soft spot of the skull) Sample. Do ot reproduce. Flowchart cotiued o ext page

18 With ear pai, do ay of these problems occur? Vomitig Fever Sticky, gree, or bloody discharge from the ear The ear pai is severe or worses whe wigglig the ear lobe. Sesitivity to the light Does a child show these sigs, especially after a cold or other respiratory ifectio, air travel, or if the child has had ear problems? Costat pullig, touchig, or tuggig at the ear(s) No respose to a whistle or a loud clap Fever Cryig that wo t stop. Or, the child acts craky ad restless, especially at ight or whe lyig dow. Ear(s) that are hot ad hurt whe touched Does pai persist, is it more tha mild, ad does it occur after ay of the followig? A mild ear ijury or blowig the ose hard or may times A small object (or isect) is i the ear ad caot safely be removed. A cold, sius, or upper respiratory ifectio Exposure to extremely loud oises, such as rock cocerts, heavy machiery, etc. With pai, do you also have hearig loss, rigig i the ears, dizziess, or ausea? Does the pai occur with jaw pai, a headache, ad a clickig soud whe you ope or close your mouth? Self-Care / Prevetio To Reduce Ear Pai Place a warm washcloth ext to the ear. Or put a ice bag or ice i a wet washcloth over the paiful ear for 20 miutes. Take a over-the-couter (OTC) medicie for pai, as directed. To Ope Up the Eustachia Tubes ad Help Them Drai Sit up. Prop your head up whe you sleep. Yaw. Chew gum or suck o hard cady. (Do ot give to childre uder 5 years old.) This ca help with pressure chages that take place durig air travel ad whe wakig up with ear pai. Whe travelig by air, stay awake whe the plae takes off ad lads. Wear earplugs that lower up to 25 decibels (db) of soud. Take a steamy shower. Use a cool-mist vaporizer, especially at ight. Drik plety of cool water. Getly, but firmly, blow through your ose while holdig both ostrils closed util you hear a pop. This ca be doe several times a day. If okay with your doctor, take a decogestat. (Do ot give decogestats ad other OTC medicies to treat colds, coughs, ad flu symptoms to childre uder 4 years old.) Whe you give a baby a bottle, hold the baby i a upright positio. To Treat a Mild Case of Swimmer s Ear Shake the head to expel trapped water. Clea ad dry the outer ear caal getly. Use a clea facial tissue. Twist each corer ito a tip ad getly place each tip ito the ear caal for 10 secods. Repeat with the other ear usig a ew tissue. Do ot remove earwax. Use a OTC product, such as Swim-Ear, as directed. To Help Prevet Ear Pai Do t put cotto-tipped swabs, bobby pis, etc. i your ears. Do t blow your ose with too much force. If you ca, avoid places that have very loud oises (costructio sites, etc.). Wear earplugs whe exposed to loud oises. Keep the volume o low whe usig earphoes with ipods, etc. If someoe else ca hear the music, the volume is too loud. Do t swim i dirty water. Swim o the surface ot udereath the water. Wear wax or silicoe earplugs. Wear a bathig cap. Sample. Do ot reproduce. For more iformatio, cotact: Natioal Istitute o Deafess ad Other Commuicatio Disorders (NIDCD)

19 Fibromyalgia Pai Foot Pai Fibromyalgia is a chroic, arthritis-like illess that affects muscles, ot joits. Sigs & Symptoms Chroic widespread pai i 11 or more of 22 teder poits. The pai ca be severe ad lasts for at least 3 moths. Fatigue. Disturbed sleep. Axiety. Depressio. Memory lapses. Problems cocetratig. Gas. Costipatio. Diarrhea. Causes The exact cause is ot kow. These factors may Teder poits of play a role: fibromyalgia A illess caused by a ifectio. Emotioal or physical trauma. Hormoal factors. Wome are affected more ofte tha me. Brai chemicals ad/or muscles do t fuctio like they should. Treatmet Treatmet icludes exercise therapy, medicatios to treat symptoms, ad massage therapy. Questios to Ask Does a perso with fibromyalgia have severe pai, depressio, or axiety? Is prescribed treatmet ot helpig? Self-Care / Prevetio Follow the treatmet pla advised by your doctor for exercise, medicatio, etc. Use biofeedback. Use relaxatio techiues. Meditate. Take warm baths. Use a heatig pad. Massage sore muscles. Sigs & Symptoms Pai from a fall or ijury to your foot (ot just a toe) with ay of these problems: Severe bleedig. Your foot is misshaped. You ca t move your foot. Your foot looks blue or pale ad is cold ad umb. Your foot is so paiful ad/or swolle that you ca t put ay weight o it. Sudde oset of pai i your feet ad legs. The ski o your feet rapidly chages color: White, red, blue, grayish, or black. A foot woud with: Fever; redess, tederess, or warmth; swellig; pai; ad/or pus. Severe pai i a foot joit, ofte the big toe. The pai is ot due to a ijury. The joit hurts a lot whe aythig touches it. The area is red, swolle, ad teder. Joit pai ad morig stiffess i joits that lasts more tha 1 hour. Fatigue. Pai i oly oe toe after a ijury to the toe. What It Could Be Peripheral vascular disease Ifectio Gout Rheumatoid arthritis Broke or spraied toe What to Do Broke boe(s) i Get medical care the foot (ot just fast! a toe) Get medical care fast! See doctor. See doctor. See doctor. Sample. Do ot reproduce. Use tips For Ijuries o page 38.

20 Sigs & Symptoms What It Could Be What to Do Self-Care / Prevetio Ope sores (ulcers) o the toes. Pai o the istep ad cold, pale ski which improves with rest. Tederess ad pai uder heel boe Sharp ad burig pai o the ball of the foot. Paiful growth o the ball or heel of the foot. Black piholes or spots i the ceter. The big toe poits iward or outward. A boy bulge at side of the big toe. Thickeed ski. Possible fluid build-up ear the big toe. Stiffess or pai. Red, sometimes fluid-filled sores causes by shoes that rub the foot. Charley horse or muscle spasm i the foot. Ofte, this occurs at bedtime. Pai ad curled or claw-like positio i a toe (usually the 2 d toe). A cor forms o the top of the toe. Buerger s disease Heel spurs Morto s euroma Platar wart Discomfort, pai, tederess, Igrow toeail ad/or redess uder the corer of a toeail ad earby ski. Buio Pai betwee the heel ad the ball Platar Fasciitis. of the foot (due to walkig, ruig, This is a problem or puttig weight o the foot). i the foot arch. Blisters Foot cramp Hammertoe See doctor. See doctor. Use tips For Morto s Neuroma o page 39. Use tips For Platar Warts o page 39. Use tips For Igrow Toeails o page 38. Use tips For Buios o page 37. Use tips For Platar Fasciitis o page 39. Use tips For Blisters o page 37. Use tips For Foot Cramps o page 37. Use tips For Hammertoes o page 37. For Blisters Do t break a blister. If it breaks o its ow, apply a atibacterial spray or oitmet ad cover the area with a badage or sterile dressig. Do t cut away or pull off the broke blister s loose ski. This protects the ew ski below it. For Buios Do t wear high heels or shoes with arrow toes. Wear sadals. Use moleski or paddig to separate overlapped toes. Try arch supports to reduce pressure. Use rig-shaped pads over a buio. Cut out a old pair of shoes to wear i the house. Soak your feet i warm water. If eeded, take a over-the-couter (OTC) pai reliever, as directed. For Foot Cramps Stretch the foot muscles. Pull the foot back ito a flexed positio. Push the foot ito the floor. For Heel Spurs Use a cushio or heel cup uder the heel. Do ot jog or ru. Avoid prologed stadig. Lose weight, if overweight. Roll a teis ball uder ball of the foot. Put ice o the heel for 10 miutes. Remove it for 10 miutes. Repeat may times. If eeded, take a OTC pai reliever, as directed. Sample. Do ot reproduce. For Hammertoes Wear wide, roomy shoes. Chage shoes durig the day. Try athletic shoes. Massage the toes or get a foot rub. Use small pads over the ceter of the toe to lesse pressure

21 For Igrow Toeails To Treat a Igrow Toeail Soak your foot i warm, soapy water for 5-10 miutes, 1-3 times a day. Getly lift the ail away from the reddeed ski at the outer corers with the top of a ail file. Soak a small piece of cotto i a atiseptic, such as Betadie. Place if just uder the outer corers, if you ca. Repeat the previous 3 steps, daily, util the ail begis to grow i correctly ad pressure is relieved. Wear roomy shoes durig this time. Aother method is to cut a V ito the top ceter of the ail. This may help the ail grow out from the edges. To Prevet a Igrow Toeail Cut ails straight across. Do t cut the ails shorter at the sides tha i the middle. {Note: If you have diabetes or circulatio problems, follow your doctor s advice about clippig your toeails.} File the ails if they re sharp after clippig them. Wear shoes ad socks that fit well. For Ijuries Use R.I.C.E. {Note: Tape a ijured toe to the toe ext to it for 7-10 days.} Rest the ijured area for hours. Ice the area as soo as possible ad keep doig so for 10 miutes every 2 hours for the first 48 hours. Use a ice pack, ice i a heavy plastic bag with a little water, a bag of froze vegetables, etc. Compress the area. Wrap with a elastic badage. Do ot cut off blood flow. Remove the badage every 3-4 hours, for miutes each time. Elevate the area above heart level, if possible. Place it o a pillow, folded blaket, stack of ewspapers, etc. For Mior Ifectios Soak the foot i warm, soapy water for 20 miutes, 4-6 times a day. Pat the ifected area dry. Use extra care if you have peripheral vascular disease. Make sure the water is ot hot. Apply a OTC atibiotic oitmet, such as Neospori. Cover it with a sterile cloth or badage. For Morto s Neuroma Wear wide shoes with soft isoles. Put pads or arch supports i your shoes to help take pressure off the area. Take a OTC medicie for pai, as directed. For Platar Fasciitis Rest the foot as much as you ca. Use R.I.C.E. (See page 38.) Take a OTC medicie for pai ad swellig, as directed. Wear shoes with a solid arch support. Be fitted for orthotic shoe iserts, if advised. Stretch the sole of the foot daily. Stad o a step o the balls of your feet. Hold o to the rail. Slowly lower the heel of the foot that hurts util you feel a stretch. Hold for secods. Repeat 10 times. For Platar Warts Do ot pick at platar warts. Try salicylic acid plasters or other over-the-couter products, such as Wart-Off. Follow package directios. Use cushios i shoes. Wash your hads after touchig warts to avoid re-ifectio. Wear sadals i the shower or public areas, such as pools. To Help Prevet Foot Pai Wear shoes that fit well. Do t wear shoes with poited toes or oes that fit too tightly. Wash ad dry your feet daily. Keep your feet moisturized. Ispect your feet every day for early sigs of problems. Elevate your feet to rest them. Persos with diabetes ad/or circulatio problems eed to take special care of their feet. Good foot care ca prevet some foot ifectios. It may be ecessary for a health care professioal to cut the toeails. Sample. Do ot reproduce. {Note: If self-care measures do ot help or if your foot pai gets worse, cotact your doctor.} 38 39

22 Headaches A headache is pai or discomfort i the head, scalp, or eck. Most headaches are ot due to serious problems. Sigs, Symptoms & Causes of Commo Headaches For Tesio or Muscular Headaches A dull ache i the forehead, above the ears, or at the back of the head Pai i the eck or shoulders Tesio headache Most headaches are this type. Muscles i the shoulders, jaw, eck, or scalp become tese or cotract. This ca be a respose to stress, depressio, axiety, overwork, or lack of sleep. For Cluster Headaches Sharp, burig, ad itese pai o oe side of the head. The pai is so severe; you ca t lie dow or keep still. Pai i or o the sides of the eyes. The eyes water. Pupils look smaller. Eyelids droop. Cluster headache The cause is ot kow. These headaches are four times more commo i me tha i wome. Heavy drikers ad smokers are at a icreased risk for cluster headaches. Cluster headaches usually occur oce or twice a year. They attack i groups, every day for a week or more at a time. Cluster headaches ca last from 15 miutes to 3 hours. They ca iterrupt sleep. For Migraie Headaches Oe side of the head may hurt more tha the other. Nausea or vomitig Light hurts the eyes. Noise bothers you. The headache is worse with activity. After the headache, some people have a draied feelig with tired, achig muscles. Others feel great. Migraie headache Migraies ca occur with or without a aura. With a aura, spots or flashig lights occur 10 to 30 miutes before the headache. These headaches happe whe blood vessels i the head ope too wide or close too tight. They occur more ofte i females tha i males. For Sius Headaches Pai i the forehead, cheekboes, ad ose. The pai is worse i the morig. Pai icreases whe you bed over or touch your face. Stuffy ose Symptoms occur whe fluids i the ose do t drai well. This builds up pressure i the siuses. A cold, allergies, or airplae travel ca cause a sius headache. Sius headache Other Commo Causes of Headaches Aalgesic reboud from regular or repeated use of over-the-couter or prescribed pai relievers Caffeie withdrawal. Cigarette smoke, pollutio, etc. Eatig or drikig somethig very cold, such as ice cream. {Note: It helps to warm the ice cream for a few secods i the frot of the mouth.} A symptom of a health problem, such as allergies, detal problems, the flu, ad visio problems, such as earsightedess. Low blood sugar. Huger. Sesitivity to certai foods ad driks. (See Foods & Driks That May Cause Headaches o page 42.) Serious Causes of Headaches Rarely, a headache ca be a symptom of a serious health problem, such as: Broke blood vessel or aeurysm. Stroke Brai ifectio, such as meigitis. (See symptoms of meigitis o page 31.) Brai tumor Giat cell (temporal) arteritis. This is chroic iflammatio of certai blood vessels, ofte i the temple regio. Glaucoma Piched erve i the eck Sample. Do ot reproduce

23 Foods & Driks That May Cause Headaches Alcoholic beverages, especially red wie Aspartame (artificial sweeteer i NutraSweet ) Baaas (if more tha ½ of oe/day); Citrus fruits (if more tha ½ cup/day). Caffeie from coffee, tea, cola, other soft driks, chocolate, or some medicatios. Suddely stoppig caffeie itake. Cured meats, such as frakfurters Food additives, such as MSG Hard cheeses like aged cheddar or provoloe Nuts. Peaut butter. Oios. Sour cream. Soy sauce. Viegar. Less ofte, a headache is a symptom of a serious health problem that eeds medical care without delay. Examples are acute glaucoma ad stroke. Childre s Headaches Headaches ted to last less time tha they do i adults. Sometimes, a upset stomach ad vomitig occur. Headaches come i groups. These may be spaced moths apart. Childre s headaches that come oce i awhile ca be treated with ibuprofe or acetamiophe. Make sure to use the right type ad dose for the child s weight. Do t give aspiri to ayoe youger tha 19 years of age due to its lik to Reye s Sydrome. If the child complais of head pai o a regular basis, take the child to his or her doctor. Treatmet Self-care ca treat headaches caused by tesio, fatigue, ad/or stress. Certai over-the-couter medicies ad prescribed medicies ca treat migraie headaches. Headaches that are symptoms of health problems are relieved whe the coditio is treated with success. Questios to Ask Is the headache liked with ay of these problems? A serious head ijury or passig out A blow to the head that causes severe pai, elarged pupils, vomitig, or cofusio Symptoms of meigitis listed o page 31 ad the headache is severe Is the headache liked with ay of these problems? Severe pai i ad aroud oe eye Blurred visio or double visio Slurrig of speech Metal cofusio Persoality chage A problem movig the arms or legs Uusual sleepiess Has the headache come o fast ad does it hurt much more tha ay headache i the past? Are ay of these problems preset? The headache has lasted more tha 2-3 days ad the pai keeps gettig worse ad lasts loger. Nausea or vomitig occurs with a headache that does t go away or that recurs. Symptoms of a cluster headache or migraie headache listed o page 40 occur. A pregat female, has swellig of the legs, hads, ad/or face with the headache. The headache occurs i a perso with high blood pressure. The headache is ot relieved by OTC pai relievers ad occurs with sigs ad symptoms of a sius ifectio: - Fever - Stuffy ose. Gree, yellow, or bloody-colored asal discharge - Foul smellig or tastig postasal drip - Swellig aroud the eyes, ose, checks, ad forehead - Pai betwee the ose ad lower eyelid - Cheek or upper jaw pai Sample. Do ot reproduce. Flowchart cotiued o ext page 42 43

24 Do you have a headache at the same time of a day, week, or moth, ad do OTC pai relievers ot help the pai? OR Do you take pai relievers more tha 3 times a week for at least 3 weeks for headaches or did you get headaches oly after takig a ew medicie? Self-Care / Prevetio Do t smoke. If you smoke, uit. Try to stop the headache whe it starts. Take a OTC medicie for pai, as directed. Massage the back of your eck with your thumbs. Work from the ears toward the ceter of the back of your head. Also, rub getly alog the sides of your eyes. Getly rub your shoulders, eck, ad jaw. Get a massage. Take a warm bath or shower. Place a cold or warm washcloth or OTC hot or cold pack over the area that aches. Relax. Picture a calm scee i your head. Meditate or breathe deeply. Exercise o a regular basis. Get adeuate rest. Try usig a differet pillow ad/or sleep positio. If you grid your teeth, tell your detist or doctor. Keep a diary of whe, where, ad why headaches occur. Avoid Foods & Driks That May Cause Headaches listed o page 42.) To help prevet headaches ad ausea caused by a hagover, try a OTC product, such as Chaser-Freedom From Hagovers. For a hagover: After drikig alcohol, take a OTC pai reliever. Eat solid foods. Rest or sleep. Have 2 or more glasses of water before you go to sleep. Drik 2 or more glasses of water whe you wake up. For more iformatio, cotact: Natioal Headache Foudatio 888.NHF.5552 ( ) Leg Pai & Akle Pai Pai i the legs or akles ca rage from mild to severe. The type ad amout of pai depeds o the cause. Sigs & Symptoms Pai, redess (may have shades of red, purple, ad blue), or swellig i oe akle or leg. May be followed by severe shortess of breath that came o all of a sudde. May iclude coughig up blood or pik-frothy sputum. Chest pai. Swellig of both akles at the same time. Shortess of breath. May have a dry cough or a cough with pik, frothy mucus. Muscle pai i oe or both legs. Fatigue i the thighs, calves, ad feet which improves with rest. Ope sores o the lower leg, akles, or toes. Weak or o pulse i the affected limb. Cold or umb feet. Pale, bluish-colored toes. Ay of the sigs that follow occur after a leg or akle ijury. A boe sticks out or boes i the ijured limb make a gratig soud. The ijured limb looks deformed, crooked, or the wrog shape. You lose feelig i the ijured limb. The ski uder the affected ijured area is cold ad blue. The limb is very paiful ad/or swolle or you ca t bear weight o the limb or move it. What It Could Be Deep-vei thrombosis (DVT) with or without a blood clot to the lug Heart failure Peripheral vascular disease Broke boe or dislocatio What to Do Get medical care fast! Get medical care fast! Get medical care fast! Get medical care fast! Sample. Do ot reproduce

25 Sigs & Symptoms What It Could Be What to Do Sigs & Symptoms What It Could Be What to Do Pai i the leg or akle after a ijury that does ot keep you from movig the limb Sudde, severe pai i a toe, kee, or akle joit. The joit area is swolle, red, or purplish i color. It also feels warm ad is very teder to the touch. Leg pai that spreads from the lower back. Pai or stiffess i the kees. Bowig of the legs or other boe deformity. Uexplaied boe fractures. May have headache, dizziess, hearig loss, ad/or rigig i the ears. Pai, stiffess, ad sometimes swellig of the kee or akle joits. Ofte, the joit has gotte teder over moths or years ad may look elarged or deformed. Dry mouth ad dry eyes. Pai, stiffess, ad swellig, usually i both kees or akle joits. The joit looks deformed. Weakess ad fatigue. Sprai, strai, or sport ijury. Other overuse ijury. Pai with fever, redess, tederess, Ifectio. Could warmth, ad pus at a woud site. A also be Cellulitis. red streak up the leg (rarely). Gout Sharp pai from a buttock dow the Sciatica leg. Leg umbess ad tiglig. Rheumatoid arthritis Osteoarthritis See Sprais, Strais & Sports Ijuries o page 59. See doctor (right away for a red streak up the leg). See doctor. Paget s disease. See doctor. This is a boe disorder that progresses slowly. Most persos with this disease do ot develop symptoms. See Sciatica o page 27. See doctor. See doctor. Leg or akle pai with gradual loss of height; stooped posture; backache; ad/or past boe fractures, especially i the wrists ad hips. Pai or itchig i the legs with swolle ad twisted veis that look blue ad are close to the surface of the ski. The veis bulge ad feel heavy. Swellig i the legs ad akles. Muscle or joit pai ad chroic swellig of the kee joits. These problems develop moths or years after a deer-tick bite ad a bullseye red rash with pale ceters. Pai ad swellig aroud the kee joit. The pai gets worse with movemet. Fever (maybe). Sudde, sharp, tighteig pai i the leg, ofte the calf. The muscle feels hard to the touch. The pai subsides after a miute or so ad the muscle relaxes. Self-Care / Prevetio For Pai, i Geeral Osteoporosis Varicose veis Lyme disease Arthritis, bursitis, or a ligamet ijury Leg cramp See doctor. See doctor. See doctor. See doctor. Use tips For Leg Cramps o page 48. Sample. Do ot reproduce. Take a over-the-couter (OTC) medicie for pai as directed o the label. If the pai is ot better after a few doses, call your doctor. Use a heatig pad (set o low), a hot pack, or a moist, warm towel o the area of pai. If the pai is due to a ijury, do t use heat for 48 hours. Use R.I.C.E. (See page 38.) 46 47

26 For Paget s Disease If eeded, take a OTC medicie for pai as directed o the label. Take other medicies as prescribed by your doctor. Get regular checkups to detect hearig loss. To Help Prevet Leg Pai & Akle Pai Get to ad stay at a healthy weight. Get regular exercise to keep akle ad leg muscles strog. Before you exercise, stretch ad warm up your muscles. Whe you are doe, cool them dow. Protect your kees. Use kee pads whe you garde or keel. Always lad o bet kees whe jumpig. Avoid deep kee bed exercises. Do t wear high-heeled shoes. Keep your shoes i proper shape. Take good care of your feet. For Leg Cramps Walk o the leg. Shake the leg ad the elevate it. Sit with your leg flat o the floor. Flex your foot upward, the toward your kee. Reach for your toes ad pull them toward your kee. This stretches the calf muscles. Have someoe massage the cramped muscle getly, but firmly. Apply a heatig pad (set o low); a hot pack; or a moist, warm towel to the muscle cramp. Rub the muscle that is crampig. Rub upward from the akle toward the heart. {Note: Do ot rub a leg if you suspect phlebitis or thrombosis.} To Prevet Leg Cramps Get good sources of calcium, potassium, ad magesium. See lists below. Take calcium, potassium, ad magesium supplemets as advised by your doctor. Drik plety of water ad other fluids. Limit driks with caffeie. Avoid driks with alcohol. Doig these thigs ca help prevet dehydratio which could cause leg cramps. Warm up your muscles before you exercise. Cool dow your muscles whe you are doe. With your doctor s okay, wear elastic stockigs while you are awake. Before you go to bed, stretch your calf muscles. Here s oe way: Stad a arm s legth away from a wall. Lea agaist the wall with the palms of your hads. Bed your left kee. Keep your right leg straight behid you. Keep both feet flat o the floor ad your back straight. Lea forward. Feel your right calf muscle stretch. Hold the stretch as you cout to 10 slowly. Repeat, switchig leg positio. Aother way to stretch your calf muscles is to ride a statioary bicycle for a few miutes. Take a warm bath before bedtime. Sleep with loose-fittig blakets ad ight clothes. Keep your legs warm. If you have severe leg cramps or get them ofte, tell your doctor. Ask if ay medicatio you take could cause leg cramps ad what you should do. Good Sources of Calcium Nofat milks Calcium-fortified cereals ad juices Cheeses Collard grees, broccoli, ad spiach Yogurts Tofu, if calcium is used i processig Good Sources of Potassium Citrus fruits ad juices Baaas Avocados Bra cereals Fish Potatoes Good Sources of Magesium Nuts, especially peauts Whole-grai breads ad cereals Dried beas Wild rice Black-eyed peas Tofu Sample. Do ot reproduce

27 Neck Pai & Shoulder Pai Sigs & Symptoms The pai ca be mild to severe. It ca be felt i oe spot, i a large area, or travel to aother area. Movemet ca cause the pai or make it worse. Stiffess ad/or swellig may occur. Causes Overuse ad wear ad tear o eck ad shoulder muscles ad joits Neck fracture or strai Broke or dislocated shoulder Poor posture. Awkward sleepig positios. Sleepig o a soft mattress. Tesio ca cause eck Piched erve. Pai from a piched erve muscles to go ito spasms. usually rus dow oe side of the arm. Froze shoulder. This ca result from lack of use due to pai from a ijury. At first, pai occurs with movemet. Over time, the pai gets better, but stiffess remais. Tor rotator cuff. This is a tear i a tedo that holds the shoulder i place. Symptoms are pai at the top ad outer sides of the shoulders, especially whe you raise or exted your arm. You may also feel or hear a click whe the shoulder is moved. Tediitis. This is swellig of a tedo (tissue that coects a muscle to boe). Left utreated, tediitis ca tur ito froze shoulder. Wry eck is a similar problem. Bursitis. This is swellig of the sac (bursa) that surrouds the shoulder joit. Bursitis ca be caused by ijury, ifectio, overuse, arthritis, or gout. A whiplash ijury Osteoarthritis Ifectios that cause swolle lymph odes i the eck Treatmet Treatmet for shoulder pai ad/or eck pai depeds o the cause. Emergecy medical care is eeded for: A serious ijury A broke boe A heart attack Meigitis. This is a ifectio of the membraes that surroud the brai. (See symptoms of meigitis o page 31.) Questios to Ask With shoulder pai or eck pai, do you have ay of these problems? A serious head or eck ijury Ay sigs ad symptoms of a heart attack listed o pages 28 ad 30 Ay symptom of meigitis listed o page 31 After a ijury to the eck or shoulder do you have ay of these problems? The shoulder popped out of place. A burig, shootig pai or weakess is felt i a shoulder. The shoulder looks misshaped. The pai is very severe. Your arm is umb ad ca t be moved at all. Do you have ay of these problems? Severe or persistet pai, swellig, or spasms i a shoulder Paiful ad stiff shoulder that is very hard to move at all Pai, tederess, ad limited motio i the shoulder Throbbig shoulder pai or umbess that goes dow the shoulder ito the arm A possible whiplash ijury after beig hit from behid Fever ad redess or swellig aroud the shoulder Sample. Do ot reproduce. Flowchart cotiued o ext page 50 51

28 Do you have both of these sigs of a gallbladder attack? Pai i the right shoulder Pai i the right upper abdome Is your eck pai or shoulder pai severe eough to iterfere with sleep? Or, does the pai ot get better after usig self-care for 7 days? Self-Care / Prevetio For Pai Take a OTC medicie for pai ad/or swellig. To relieve tesio ad improve circulatio, take walks. Start with 3 to 5 walks a day, each lastig 5 to 10 miutes. Gradually icrease walkig times. For Bursitis, Tediitis, or a Ijury That Does Not Appear Serious Use R.I.C.E. (See page 38.) Try liimets ad balms. These provide a coolig or warmig sesatio, but oly mask the pai. They do ot promote healig. To Treat Neck Pai from a Whiplash Ijury or Piched Nerve If you are ridig i a motor vehicle that is hit from the rear, you may have a whiplash ijury. Cosult your doctor for diagosis ad treatmet. These thigs ca help ease eck discomfort: Rest as much as you ca by layig o your back. Use cold ad hot packs. Improve your posture. Whe you sit, use a chair with a straight back. Make sure your buttocks go all the way to the chair s back. Whe you stad, pull i your chi ad stomach. Use a cervical (eck) pillow or a rolled had towel uder your eck. Avoid activities that may aggravate your ijury. Cover your eck with a scarf if you go outside whe the weather is cold. Ways to Prevet Shoulder Pai & Neck Pai Avoid repeated activities that twist or put strai o the eck ad shoulders. Whe you do repeated tasks, use proper posture, euipmet, ad techiues. Wear seat belts i vehicles. Use protective gear whe you take part i sportig evets. Do t dive ito shallow water. Do t sleep o your stomach. You may twist your eck i this positio. Use a firm polyester pillow, a eck (cervical) pillow, or a rolled towel uder your eck. Practice good posture. Stad straight. Do t let your shoulders slump, your head droop, or your lower back slouch. Whe you carry thigs, such as a shoulder bag, switch from oe shoulder to the other. Do t prop a telephoe betwee your ear ad shoulder. Stretch ad warm up before activities that reuire joit movemet, such as sports. If you are out of coditio, stregthe your muscles gradually. Do exercises to keep the muscles i your shoulder ad eck strog ad flexible. For example: Sit straight i a chair. Flex your eck slowly forward ad try to touch your chi to your chest. Hold for 10 secods. Go back to the startig positio. Repeat 5 times. Look straight ahead. Slowly tilt your head to the right tryig to touch your right ear to your right shoulder. Do ot raise your shoulder to meet your ear. Hold for 10 secods ad straighte your head. Repeat 5 times o the right side ad the o your left side. Lateral bed of the eck Sample. Do ot reproduce

29 Shigles Pai Shigles (herpes zoster) is a ski coditio. It is triggered by the chicke pox virus, which is thought to lie dormat i the spial cord util later i life. Most ofte, shigles occurs i people over 50 years old. Sigs & Symptoms Pai, itchig, or a tiglig feelig before a rash of paiful red blisters appears. Most ofte, the rash appears o oe side of the body or o oe side of the face. Fever ad geeral weakess ca occur. The blisters crust over. The crusts fall off, Shigles rash. (Photo courtesty of the Public usually withi 3 weeks. Health Image Library (PHIL) of the Ceters for Disease Pai ca persist i the area of the rash. This Cotrol ad Prevetio) usually goes away withi 1 to 6 moths. Chroic pai called postherpetic euralgia (PHN) ca last loger, eve for years. The older you are, the greater the chace that this is the case. The recovery time may also take loger. Blidess ca occur if the eye is affected. Cause The virus that causes chicke pox varicella zoster virus (VZV) causes shigles. To get shigles, you must have had chicke pox. You are more likely to get shigles after a illess or takig medicie that lowers the immue system. Stress or trauma ca also icrease the risk for shigles. Treatmet Most cases of shigles are mild, but if you thik you might have shigles, see your doctor right away! He or she ca prescribe: A oral ativiral medicie. This ca make symptoms less severe ad help you get better sooer. To help, this medicie eeds to be started withi hours after the rash first appears. Medicie for pai. This icludes OTC pai relievers ad capsaici topical cream. Pai that persists after sores have healed may be treated with prescribed medicies. These iclude a atiseizure medicie called gabapeti, a ski patch called Lidoderm, ad a tricyclic atidepressat. Questios to Ask Are ay of these problems preset with a rash of paiful blisters? The eye is affected. Blisters itch all the time or are very paiful. Fever ad/or geeral weakess occurs. You have a chroic illess, such as diabetes or HIV/AIDS. You take medicatios that weake the immue system. You are over age 60. Self-Care / Prevetio A vaccie may help prevet gettig shigles. It ca also reduce the pai due to shigles. The vaccie is advised for persos age 60 ad older. Uless your doctor has prescribed pai medicie, take a over-thecouter oe (OTC), as directed. Do t wear clothig that irritates the ski area where sores are preset. Keep sores ope to the air. Util the blisters are completely crusted over, do ot go ear childre or adults who have ot yet had the chicke pox. Do ot go ear persos who have a coditio which weakes their immue system. Examples are cacer, HIV/AIDS, ad chroic illesses. They could get chicke pox from exposure to shigles. Wash blisters. Do t scrub them. To relieve itchig, apply calamie lotio to the affected area. You ca also use a paste made of 3 teaspoos of bakig soda mixed with 1 teaspoo of water. Wear loose-fittig Avoid drafty areas. clothes over the rash area. Put a cool compress, such as a cold cloth dipped i ice water, o the blisters. Do this for 20 miutes at a time. Drik lots of liuids. Sample. Do ot reproduce.

30 Ski Ijuries & Woud Pai Sigs & Symptoms Cuts slice the ski ope. This causes bleedig ad pai. Scrapes are less serious tha cuts, but more paiful because more erve edigs are affected. Puctures are stab wouds. This causes pai, but may ot result i bleedig. Bruises cause black ad blue or red ski. As they heal, the ski turs yellowish-gree. Pai, tederess, ad swellig also occur. Causes For Cuts, Scrapes & Puctures The cause ca be ay object that peetrates the ski. This icludes cut glass, a spliter, steppig o a ail or tack, fallig o pavemet, etc. For Bruises Commo causes are falls or beig hit by some force. Bruises result whe broke blood vessels bleed ito the tissue uder the ski. Persos who take blood-thiers bruise easily. Treatmet Treatmet depeds o the cause ad how severe the ski ijury is. Simple wouds ca be treated with self-care. A atibiotic treats a bacterial ifectio. Medical care, such as stitches, may be eeded for deep cuts or oes loger tha a ich. Questios to Ask With a ijury, do ay of the followig occur? Loss of cosciousess. Severe bleedig or blood spurts from the woud. (Apply direct pressure o the woud site while seekig care.) Bleedig cotiues after pressure has bee applied for more tha 10 miutes (or after 20 miutes for a mior cut). A deep cut or pucture appears to go dow to the muscle or boe ad/or is located o the scalp or face. A cut is loger tha a ich ad is located o a area of the body that beds, (e.g., the elbow, kees, etc.). The ski edges of the cut hag ope. Does ay sig of a ifectio occur? Fever ad/or geeral ill feelig Redess. Or, red streaks exted from the woud site. Icreased swellig, pai, or tederess at or aroud the woud Do you have ay of these problems? The cut or pucture is from a dirty object, a rusty ail, or a object i the soil. A pucture wet through a shoe, especially a rubber-soled oe. Bruises appear ofte ad easily, take loger tha 2 weeks to heal, or occur more tha 3 times a year for o kow reaso. Visio problems occur with a bruise ear the eye. Self-Care / First Aid For Severe Bleedig Without delay, apply direct pressure to the woud usig a sterile dressig or clea cloths. {Note: If the cut is large ad the edges of it gape ope, pich the edges of the woud while you apply pressure.} Call or take the perso to the earest hospital emergecy departmet. Do ot remove a object that is stuck i a woud. Pack it i place with paddig. Put tape aroud the paddig so it does t move. If bleedig cotiues before gettig medical help, put extra cloths, etc. o top of existig oes. Keep puttig pressure o the woud util bleedig stops or util medical help takes over. The most importat thig to do is to apply pressure o the bleedig site. Sample. Do ot reproduce. Flowchart cotiued o ext page 56 57

31 For Mior Cuts ad Scrapes Clea i ad aroud the woud thoroughly with soap ad water. Press o the cut for up to 10 miutes to stop the bleedig. Use sterile, wet gauze or a clea cloth. Dry gauze ca stick to the woud. Do t use a badage to apply pressure. If still bleedig, lift the part of the body with the cut higher tha the heart, if possible. After the bleedig has stopped ad whe the area is clea ad dry, apply a first-aid cream. Put oe or more badages o the cut. The edges of the cut ski should touch, but ot overlap. Use a butterfly badage if you have oe. Use butterfly Keep a scrape clea ad dry. Cover it with gauze badages to brig ad first-aid tape. Chage this every 24 hours. cut edges of ski together. For Puctures that Cause Mior Bleedig Let the woud bleed to clease itself. Remove the object (e.g., spliter). Use clea tweezers. Hold a lit match or flame to the eds of the tweezers to sterilize them. Let them cool ad wipe the eds with sterile gauze. Clea the woud area, daily, with soapy water. Dry it well ad apply a atibacterial cream. Do this for several days. For Bruises Apply a cold pack to the bruised area as soo as possible (withi 15 miutes of the ijury). Keep the cold pack o for 10 miutes at a time. Apply pressure to the cold pack. Take it off for 30 to 60 miutes. Repeat several times for 2 days. Rest the bruised area ad raise it above the level of the heart, if practical. Two days after the ijury, use warm compresses for 20 miutes at a time. Do ot badage a bruise. Try to avoid hittig the bruised area agai. Sprais, Strais & Sports Ijuries Sigs & Symptoms For Sprais A sprai happes whe you overstretch or tear a ligamet. (This is fibrous tissue that coects boes.) A joit is affected, but there is o dislocatio or fracture. Symptoms are rapid pai, swellig, bruisig, ad a warm feelig at the ijured site. For Strais A strai is a ijury to the muscles or tedos. (These are tissues that coect muscles to boes.) Symptoms are pai, tederess, swellig, ad bruisig. For Sports Ijuries Sports ijury symptoms deped o the ijury. They iclude pai, tederess, swellig, ad bruisig. Boes may be broke or dislocated. Sample. Do ot reproduce