Home Emergency Guide - Dorling Kindersley DK

100 FAMILY ILLNESS Disturbed/impaired vision Visual disturbances might include blurred vision or ACTION seeing double. You may also see flashing lights or floating spots. These disturbances may be caused by !DIAL 911 OR CALL EMS a problem in one or both eyes or by damage to the You may have areas in the brain that process visual information. damaged the part If your vision deteriorates suddenly, you should of the brain that is consult your doctor immediately. responsible for vision. Do you have ACTION Have you injured your head in the START pain in the GO TO ANOTHER CHART past 48 hours? affected eye? Eye pain or irritation, Recent head p.98 injury Pain No head injury No pain How long has your vision ACTION Do you have diabetes? been disturbed MAKE AN APPOINTMENT Yes or impaired? TO SEE YOUR DOCTOR Less than A cataract (clouding of 24 hours the lens of the eye) can cause blurred vision in 24 hours older people. or longer What kind No of visual disturbance or How old impairment are you? have you been experiencing? ACTION 50 or over Under 50 Blurred vision SEE YOUR DOCTOR WITHIN 24 HOURS Increasing difficulty in Damage to blood focusing on vessels in the retina nearby objects due to diabetes or high blood sugar levels can Other lead to blurred vision. disturbance

DISTURBED/IMPAIRED VISION 101 What is the ACTION ACTION nature of your !DIAL 911 OR CALL EMS CALL YOUR DOCTOR NOW disturbed or You may have impaired vision? blockage of a blood You may have a vessel that supplies the migraine. However, Sudden loss of all brain or eye. Another the possibility of or part of the possibility is a detached another disorder needs vision in one or retina, which needs to be ruled out. both eyes prompt treatment. • Rest in a darkened Blurred vision quiet room until Seeing flashing symptoms improve. lights or • If you also have floating spots a headache, take an Double vision analgesic such as acetaminophen. None of the above CONSULT YOUR DOCTOR ACTION if you have had previous migraines. CALL YOUR DOCTOR NOW • Avoid red wine, if you cannot identify a possible cause for chocolate, and mature your disturbed or cheese – all possible impaired vision from migraine triggers. this chart. ACTION ACTION !DIAL 911 OR CALL EMS SEE YOUR DOCTOR This may be due to bleeding in the brain, WITHIN 24 HOURS such as with a stroke or subarachnoid Your symptoms may hemorrhage (ruptured be a side effect of the artery near the brain). medication. Another possibility is a weakness or paralysis • Stop taking any over- of the muscles that control the movement the-counter medicines of the eyes, causing but continue to take double vision. prescribed medication unless advised to stop by your doctor. ACTION Are you ACTION currently taking MAKE AN APPOINTMENT any medication? SEE YOUR DOCTOR TO SEE YOUR WITHIN 24 HOURS OPHTHALMOLOGIST Medication if you cannot identify You may be developing No medication a possible cause for presbyopia (gradual your disturbed or loss of the eyes’ ability impaired vision from to focus on near this chart. objects).

102 FAMILY ILLNESS Earache Pain in one or both ears is a distressing symptom, ACTION especially for children. Earache is usually caused by an infection in the outer or middle ear. Mild SEE YOUR DOCTOR discomfort, however, may be due to wax blockage. WITHIN 24 HOURS Consult your doctor if you suffer from earache, particularly if it is persistent. A severe or recurrent You may have otitis middle-ear infection may damage hearing. media (middle-ear infection) with a START Does pulling ACTION perforated eardrum; the earlobe otitis externa (outer- make the MAKE AN APPOINTMENT ear infection) is pain worse? another possibility. TO SEE YOUR DOCTOR Increases pain • Take an analgesic Your earache is Pain is no worse probably due to otitis such as acetaminophen. externa (infection of the outer ear) or a boil ACTION in the ear canal. MAKE AN APPOINTMENT • Take an analgesic TO SEE YOUR DOCTOR such as acetaminophen. if the discomfort persists for longer than ACTION Is there 24 hours. Barotrauma a discharge (ear damage or pain TRY SELF-HELP MEASURES caused by pressure from the changes) may be the A cold may often be affected ear? cause of your pain. accompanied by mild earache. Persistent or Discharge Did the pain severe earache is likely start during or to be due to otitis media No discharge (middle-ear infection). immediately Do you have after an airplane • Take a decongestant a runny or stuffy nose? flight? to relieve stuffiness and an analgesic, such as Yes During or acetaminophen, to immediately relieve discomfort. No after flight CONSULT YOUR DOCTOR Unrelated to air travel if the pain is severe or if it persists for ACTION longer than 2 days. SEE YOUR DOCTOR WITHIN 24 HOURS if you cannot identify a possible cause for your earache from this chart.

EARACHE • SORE THROAT 103 Sore throat A raw or rough feeling in the throat is a symptom ACTION that most people have from time to time. A sore throat is often the first sign of a common cold and is MAKE AN APPOINTMENT also a feature of other viral infections. You can treat TO SEE YOUR DOCTOR a sore throat yourself at home unless you also have other, more serious symptoms. However, if your You may be suffering sore throat persists or is severe, consult your doctor. from infectious mononucleosis. START Do you have Do you have a fever – a swelling in your Do you have any of these? temperature of groin and/or 100.4°F (38°C) armpits ? General aches and pains or above? Yes Runny nose Fever No Headache No fever ACTION Cough ACTION MAKE AN APPOINTMENT TO SEE YOUR DOCTOR None of TRY SELF-HELP MEASURES the above You may have either Activities such as tonsillitis or pharyngitis ACTION smoking or breathing (inflamed throat). smoke, shouting, and TRY SELF-HELP MEASURES loud singing are likely to • Follow the advice cause throat irritation. You probably have for soothing a sore a severe cold or flu. • Follow the advice throat (p.164). • Follow the advice for soothing a sore Before the onset throat (p.164). of your sore for bringing down a fever (p.164). CONSULT YOUR DOCTOR throat, had you been doing any CONSULT YOUR DOCTOR if your symptoms worsen, change, or are of these? if your symptoms no better in 2 days. worsen, change, or are Smoking heavily no better after 2 days. or breathing smoke ACTION Shouting or TRY SELF-HELP MEASURES singing loudly You may have a cold. None of the above • Follow the advice for soothing a sore throat (p.164). CONSULT YOUR DOCTOR if you are no better within 2 days.

104 FAMILY ILLNESS Hoarseness or loss of voice The sudden onset of hoarseness or huskiness of the ! Persistent change voice is a common symptom of upper respiratory in the voice tract infections that involve the larynx or vocal cords. Such infections are almost always caused by It is important to seek viruses. Hoarseness and loss of voice that develop medical advice if you develop gradually are most commonly caused by overuse of hoarseness or any other voice the voice, smoking, or, rarely, cancer of the larynx. change that lasts for more than 2 weeks, since the slight possibility of cancer of the larynx needs to be ruled out. START How long Do you use your ago did the voice a lot; for hoarseness or example, are loss of voice you a singer develop? or teacher? Over a Normal ACTION week ago voice use MAKE AN APPOINTMENT Within the Regular loud TO SEE YOUR DOCTOR past week voice use Regular overuse of Have you had ACTION your voice can lead any of the to chronic laryngitis following TRY SELF-HELP MEASURES or vocal cord nodules (small, noncancerous symptoms in the You probably have lumps found on the past week? acute viral laryngitis. vocal cords). Runny nose • If you smoke, stop. • If you smoke, stop. and/or sneezing • Try inhaling steam • Try inhaling steam Cough from a bowl of hot from a bowl of hot water (p.165) to relieve water (p.165) to relieve Sore throat your hoarseness. your hoarseness. None of • Rest your voice as • Rest your voice as the above much as possible. much as possible. CONSULT YOUR DOCTOR Before the onset of hoarseness, if you do not feel had you been better within 2 days using your voice or if any other symptoms develop. more than usual? More voice use than usual Normal voice use

HOARSENESS OR LOSS OF VOICE 105 Do you smoke, ACTION ACTION or have you MAKE AN APPOINTMENT MAKE AN APPOINTMENT smoked in the TO SEE YOUR DOCTOR past? TO SEE YOUR DOCTOR Hypothyroidism Yes Heavy smoking over a (underactivity of the long period of time thyroid gland) can No can result in laryngitis. cause a husky voice. ACTION • If you smoke, stop. • Rest your voice as TRY SELF-HELP MEASURES much as possible. Excessive use of the Another possibility is voice can inflame the cancer of the larynx, vocal cords. which is more common in regular smokers. • If you smoke, stop. • Try inhaling steam ACTION Do you have any of the from a bowl of hot CALL YOUR DOCTOR NOW following? water (p.165) to relieve your hoarseness. Breathing in dust, Fatigue fumes, or smoke can • Rest your voice as inflame the airways. Increased skin dryness or much as possible. ACTION roughness CONSULT YOUR DOCTOR TRY SELF-HELP MEASURES Feeling the cold more than if your voice is no Being in a smoky better within 2 days atmosphere can inflame you used to or if any other the vocal cords. symptoms develop. Unexplained • If you smoke, stop. weight gain Did either of • Try inhaling steam the following General hair apply before from a bowl of hot thinning the onset of water (p.165) to relieve hoarseness? your hoarseness. None of the above You inhaled dust, • Rest your voice as chemical fumes, ACTION much as possible. or smoke MAKE AN APPOINTMENT from a fire CONSULT YOUR DOCTOR TO SEE YOUR DOCTOR You spent if your voice is no if you cannot identify time in a smoky better within 2 days a possible cause for or if any other your hoarseness or loss atmosphere symptoms develop. of voice from this chart. Neither

106 FAMILY ILLNESS Coughing (adults) For children under 12, see p.108 ! Coughing up blood A natural defence mechanism, coughing is the body’s If you cough up sputum that way of clearing the airways of inhaled particles or contains streaks of blood on secretions. Persistent coughing may be due to infection one occasion only, the most or inflammation in the lungs or to the effects of likely cause is a small tear in irritants such as tobacco smoke. Persistent coughing the lining of the windpipe; if should be investigated by your doctor. you feel well, you need not be concerned. However, if How long Do you have you have more than one such a fever – a episode, there may be a more START have you had serious cause; you should see temperature of a doctor without delay. a cough? 100.4°F (38°C) ACTION Less than or above? 48 hours TRY SELF-HELP MEASURES Fever Over 48 hours A cough is the body’s No fever way of clearing the lungs. Are you Are you currently taking coughing up CONSULT YOUR DOCTOR any prescribed sputum? if your cough continues medication? for more than 1 hour. Sputum Medication Are you No sputum a smoker? No medication Smoker ACTION ACTION Nonsmoker MAKE AN APPOINTMENT MAKE AN APPOINTMENT ACTION TO SEE YOUR DOCTOR TO SEE YOUR DOCTOR MAKE AN APPOINTMENT You may have asthma TO SEE YOUR DOCTOR Your symptoms may or another chronic be a side effect of the lung disorder. Lung if you cannot identify a medication. cancer is unlikely but possible cause for your should be ruled out. cough from this chart. • Continue to take the medication unless advised to stop by your doctor.

Do you have ACTION COUGHING (ADULTS) 107 either of the following? CALL YOUR DOCTOR NOW ACTION Pain on You may have TRY SELF-HELP MEASURES breathing pneumonia. You may have acute Shortness • Take acetaminophen bronchitis. of breath to help reduce your • Take acetaminophen Neither fever and pain. to reduce your fever Have you Have you and chest pain. inhaled any of coughed up these in the last • Drink plenty of fluids. sputum? • If you smoke, stop. few hours? Sputum CONSULT YOUR DOCTOR Particle of food No sputum if your symptoms Tobacco smoke worsen or if you are ACTION no better within 2 days. Dust, fumes, or smoke from a fire CALL YOUR DOCTOR NOW ACTION None of Inflammation of the TRY SELF-HELP MEASURES the above airways can result from breathing in any You may have a viral ACTION of these substances. illness such as a severe cold or flu. TRY SELF-HELP MEASURES Do you have either of the • Follow the advice Smoke can irritate following? the lungs. for bringing down a Runny nose fever (p.164). • Move into a well- Sore throat • Try inhaling steam ventilated area. Neither from a bowl of hot ACTION water (p.165) to relieve ACTION your symptoms. MAKE AN APPOINTMENT TO SEE YOUR DOCTOR MAKE AN APPOINTMENT MAKE AN APPOINTMENT TO SEE YOUR DOCTOR TO SEE YOUR DOCTOR You may have chronic lung damage from Asthma or possibly if you are no better smoking or possibly heart failure may be in 2 days or if other lung cancer. the cause of your symptoms develop. symptoms. • Stop smoking. ACTION • If you smoke, stop. TRY SELF-HELP MEASURES You probably have a viral infection, such as a cold. • Try inhaling steam from a bowl of hot water (p.165) to relieve your symptoms. MAKE AN APPOINTMENT TO SEE YOUR DOCTOR if you are no better in 2 days or if other symptoms develop.

108 FAMILY ILLNESS Coughing (children) For adults and children over 12, see p.106 ! Danger signs Coughing is a normal reaction to irritation in the Dial 911 or call EMS if your throat or lungs. Most coughs are due to minor child is coughing and has any infections of the nose and/or throat, but a sudden of the following symptoms: onset of coughing may be caused by choking. • Blue-tinged lips or tongue. Coughing is unusual in babies less than 6 months • Abnormal drowsiness. old and may indicate a serious lung infection. • Inability to produce sounds. • Inability to drink. How long has How old is • Excessively rapid breathing. your child? START your child been ACTION Under 6 months coughing? CALL YOUR DOCTOR NOW 6 months Started or over Your baby may have suddenly a few a serious lung infection such as bronchiolitis minutes ago (inflamed small airways in the lungs). Started more than a few • Keep your baby minutes ago sitting up, if possible in a steamy bathroom. Is it possible that Is your child’s Does the cough your child is breathing have either abnormally of these choking on food or a small object? rapid or noisy characteristics? (see p.71)? Possible Comes in fits Abnormally ending with Unlikely rapid a whoop ACTION Noisy Is accompanied TRY SELF-HELP MEASURES Neither by vomiting An inhaled object may ACTION Neither be the cause of the coughing. Follow the GO TO ANOTHER CHART ACTION first-aid advice for choking (pp.22–24). Breathing problems SEE YOUR DOCTOR (children), p.112 WITHIN 24 HOURS !DIAL 911 OR CALL EMS if the object is not Your child may dislodged immediately. have pertussis (whooping cough).

Does your ACTION COUGHING (CHILDREN) 109 child have a runny nose? MAKE AN APPOINTMENT ACTION TO SEE YOUR DOCTOR Most of the time TRY SELF-HELP MEASURES or very often Your child may have an allergy or possibly Your child probably Has developed enlarged adenoids. has a viral illness, such a runny nose as a cold or flu. within the past Does your child have a fever – • Follow the advice few days a temperature of 100.4°F (38°C) for bringing down a No runny nose fever (p.164). or above? When does •Try inhaling steam the coughing Fever from a bowl of hot occur? No fever water (p.165) or sitting in a steamy bathroom. Mainly at night Are there smokers in the CONSULT YOUR DOCTOR After exercise home or might your child have if symptoms worsen, if When out in been smoking? your child is no better the cold in 2 days, or if other None of Smokers in symptoms develop. the above the home Child might ACTION ACTION smoke TRY SELF-HELP MEASURES SEE YOUR DOCTOR WITHIN 24 HOURS Neither Your child probably has a cold. Your child’s symptoms ACTION may be due to asthma. •Try inhaling steam SEE YOUR DOCTOR • Discourage your WITHIN 24 HOURS from a bowl of hot water (p.165) or sitting child from activities if you cannot identify in a steamy bathroom. that provoke coughing. a possible cause for your child’s cough CONSULT YOUR DOCTOR • Avoid unnecessary from this chart. if symptoms worsen, if exposure to dust, your child is no better pollen, or animal fur. in 2 days, or if other symptoms develop. ACTION TRY SELF-HELP MEASURES Your child’s cough may be a response to being in a smoky atmosphere or to his or her own smoking. • Make sure that no one smokes in the house and avoid taking your child into a smoky atmosphere. • If you suspect that your child may be smoking, encourage him or her to stop.

110 FAMILY ILLNESS Shortness of breath (adults) For children under 12, see p.112 ! Danger signs Feeling short of breath is to be expected after strenuous Dial 911 or call EMS if either exercise. Breathing should return to normal after you or someone you are resting. If you are short of breath at rest or following with has one or both of normal activities, such as getting dressed, you the following symptoms: should consult your doctor because your symptom • Sudden and severe may be due to a serious heart or lung disorder. shortness of breath. • Blue-tinged lips. START Is breathing ACTION While waiting for medical painful? help, loosen any restricting GO TO ANOTHER CHART clothing and help the Painful person sit upright. Not painful Chest pain, p.134 Do you have Have you been How quickly did either of the wheezing? the shortness of following? Wheezing breath start? Swollen ankles No wheezing Gradually, Cough with over a few days sputum on ACTION most days or longer GO TO ANOTHER CHART Neither Suddenly, Wheezing, p.114 within the past Do you have any of the ACTION 48 hours following? !DIAL 911 OR CALL EMS Do any of the Waking at You may have a following night feeling pulmonary embolism apply? (blood clot in the lung). breathless You have recently had surgery Frothy pink or white sputum You have recently been immobile Temperature due to injury or of 100.4°F a long trip (38°C) or above You have had a baby within the None of the above past 2 weeks None of the above

SHORTNESS OF BREATH (ADULTS) 111 ACTION ACTION ACTION SEE YOUR DOCTOR MAKE AN APPOINTMENT MAKE AN APPOINTMENT WITHIN 24 HOURS TO SEE YOUR DOCTOR TO SEE YOUR DOCTOR You may have chronic You may have lung You may have heart failure, which disease caused by inflammation of the causes fluid to gather in inhaling damaging lungs due to an allergy. the lungs and tissues. dusts or gases. •If you smoke, stop. Do you have, or ACTION •Avoid strenuous have you ever had, regular SEE YOUR DOCTOR exercise and stressful exposure to or WITHIN 24 HOURS situations. contact with the You may be anemic, ACTION following? but a blood test will be needed to confirm MAKE AN APPOINTMENT Dust or fumes the diagnosis. TO SEE YOUR DOCTOR Grain crops, • Get plenty of rest. You may have chronic caged birds, bronchitis or lung or animals Do you have damage from smoking. any of the Neither following? • If you smoke, stop. • Avoid exposure to Did the Faintness or shortness of fainting smoke, pollution, dust, breath start dampness, and cold. straight after a Paler skin stressful event? than normal • Exercise lightly. Yes Undue fatigue ACTION No None of CALL YOUR DOCTOR NOW the above ACTION You may have fluid on ACTION the lungs (pulmonary CALL YOUR DOCTOR NOW edema) caused by SEE YOUR DOCTOR acute heart failure. You may have had a WITHIN 24 HOURS panic attack, but this ACTION needs to be confirmed if you cannot identify by a doctor. a possible cause for CALL YOUR DOCTOR NOW your shortness of • If you have had breath from this chart. You may have a lung infection, such as such attacks before, pneumonia, especially if breathing into a bag you also have a cough. may relieve symptoms (p.168). • Take acetaminophen to reduce fever.

112 FAMILY ILLNESS Breathing problems (children) For adults and children over 12, see p.110 ! Danger signs Noisy or rapid breathing and shortness of breath Dial 911 or call EMS if your indicate breathing problems. Such problems may child’s breathing rate is not be obvious in children, who may simply avoid excessively rapid (see advice exertion. A child with severe difficulty breathing on checking your child’s needs urgent hospital treatment. Breathing problems breathing rate, p.71) and that occur suddenly also need immediate attention. if breathing problems are accompanied by any of the START How long has Is it possible following symptoms: your child had that your child • Blue-tinged lips or tongue. is choking on • Abnormal drowsiness. breathing food or a small • Inability to swallow, talk, problems? or produce sounds. object? Started ACTION suddenly, a few Possible TRY SELF-HELP MEASURES minutes ago Unlikely An inhaled object may Started more be causing difficulty than a few breathing. Follow the minutes ago first-aid advice for choking (pp.22–24). ACTION Are any of the danger signs !DIAL 911 OR CALL EMS CALL YOUR DOCTOR NOW listed in the if object is not dislodged immediately. The cause of these box above symptoms could be a present? ACTION serious lung infection such as bronchiolitis Danger signs !DIAL 911 OR CALL EMS (inflamed small present Your child may have airways in the lungs). a serious respiratory No danger signs problem. • Keep your baby How old is • If your child stops sitting up, if possible your child? in a steamy bathroom. breathing, follow the Under 6 months first-aid advice for giving rescue breaths (pp.16–17). 6 months or over

BREATHING PROBLEMS (CHILDREN) 113 Does your child Does your ACTION have any of child suffer from repeated CALL YOUR DOCTOR NOW the following? episodes of any of the These symptoms may Noisy breathing following? be due to croup (inflammation of the Barking cough Wheezing windpipe). Shortness Coughing • Sit with your child of breath at night in a steamy bathroom None of Coughing after to relieve breathing the above exercise difficulties. Does your child Coughing after • Encourage your child have a fever – going out in a temperature the cold to drink plenty of fluids. of 100.4°F (38°C) None of • Ensure that your or above? the above child sits quietly and Fever avoids exertion. No fever ACTION ACTION SEE YOUR DOCTOR WITHIN 24 HOURS CALL YOUR DOCTOR NOW Your child may have Your child may have a developed asthma. lung infection, such as pneumonia. Another • Keep your child possible cause is bronchiolitis (inflamed rested and warm. small airways in the lungs), particularly • Minimize contact in young children. with any possible • Give your child triggers, such as dust, pollen, or animal fur. liquid acetaminophen to reduce fever. • Avoid exposing your • Offer frequent drinks. child to smoke. • Increase the humidity • Avoid using perfume in your child’s room by putting a bowl of water and air fresheners. near a radiator. ACTION SEE YOUR DOCTOR WITHIN 24 HOURS if you cannot identify a possible cause for the breathing problems from this chart.

114 FAMILY ILLNESS Wheezing For children under 12, see p.112 ACTION A whistling or rasping sound on exhaling occurs when the air passages become narrowed. The most CALL YOUR DOCTOR NOW common causes are inflammation due to infection, asthma, or inhaled dust. In rare cases, a narrowing You could be having of the airways may be due to a tumor. If you have an asthma attack. persistent wheezing, you should see your doctor. • If you have a reliever START Has the Do you have wheezing come either of the inhaler, use it now. following? on suddenly • Stay calm and sit in within the past Frothy pink or white sputum a comfortable position. few hours or gradually over Waking at Are you short days or weeks? night feeling of breath? Sudden onset breathless Short of breath Gradual onset Neither Not short of breath Do you have ACTION a fever – a ACTION CALL YOUR DOCTOR NOW temperature of SEE YOUR DOCTOR 100.4°F (38°C) There is a possibility WITHIN 24 HOURS of fluid on the lungs or above? caused by heart failure. You may be having a mild asthma attack. Fever Do you cough up sputum? • Use a reliever drug No fever Most days if you have one. ACTION Seldom • Try to avoid polluted SEE YOUR DOCTOR or never WITHIN 24 HOURS or smoky atmospheres. You may have acute ACTION bronchitis. MAKE AN APPOINTMENT • Take acetaminophen TO SEE YOUR DOCTOR to reduce your fever. Your symptoms may be caused by chronic • If you smoke, stop. bronchitis or lung damage from smoking. ACTION SEE YOUR DOCTOR WITHIN 24 HOURS if you cannot identify a possible cause for your wheezing from this chart.

WHEEZING • DIFFICULTY SWALLOWING 115 Difficulty swallowing Any difficulty swallowing is usually the result of a Do you get a sore throat due to infection. Self-treatment should burning pain ease the soreness and allow normal swallowing. in the center However, persistent difficulty swallowing may be of the chest in due to a disorder of the stomach or esophagus, the either of these tube connecting the throat to the stomach, and situations? should be investigated by your doctor. When you START Is your Which of the bend forward throat sore? following applies? When you Sore lie down Not sore Food seems to stick high up in Neither Is it possible that you have the chest ACTION swallowed You have MAKE AN APPOINTMENT something a feeling of TO SEE YOUR DOCTOR sharp, such as something being a fish bone? stuck in the throat You probably have an inflamed esophagus Possible Neither due to acid reflux. Unlikely ACTION Does either of the following ACTION MAKE AN APPOINTMENT TO SEE YOUR DOCTOR apply? GO TO ANOTHER CHART Anxiety disorders The difficulty Sore throat, p.103 may be a cause of swallowing is this type of difficulty getting worse ACTION swallowing. You have CALL YOUR DOCTOR NOW ACTION lost weight Something may have MAKE AN APPOINTMENT Neither either scratched your TO SEE YOUR DOCTOR throat or become ACTION lodged in it. if you cannot identify a possible cause for your SEE YOUR DOCTOR difficulty swallowing WITHIN 24 HOURS from this chart. You may have a narrowed esophagus caused by acid reflux, but cancer of the esophagus is possible.

116 FAMILY ILLNESS Vomiting (adults) For children under 12, see p.118 ! Danger signs Irritation or inflammation of the digestive tract is the Dial 911 or call EMS if your most common cause of vomiting. But vomiting may vomit contains blood, which also be triggered by conditions affecting the brain may appear in any of the or by an inner-ear disorder, or it can be a side effect following forms: of medication. If you suffer from frequent episodes • Bright red streaks. of vomiting, you should consult your doctor. • Black material that resembles coffee grounds. • Blood clots. START Have you ACTION suffered from other episodes MAKE AN APPOINTMENT of vomiting? TO SEE YOUR DOCTOR Previous ACTION You may have a episodes digestive tract disorder. CALL YOUR DOCTOR NOW Single episode Do you have You may have acute a headache? glaucoma (a painful, rapid rise in fluid pressure in the eye), especially if your vision is also blurred. Do you have Do you have Headache pain in the pain in or abdomen? No headache around an eye? Severe pain Do you have Eye pain any of the Mild pain following? No eye pain No pain Temperature of ACTION 100.4°F (38°C) ACTION !DIAL 911 OR CALL EMS or above CALL YOUR DOCTOR NOW You may have had a stroke. Your symptoms Diarrhea You could have a may also be caused by serious abdominal labyrinthitis (inflamed Dizziness condition, such as inner ear). appendicitis. None of • You can minimize the above the symptoms of labyrinthitis by lying down or moving as little as possible.

! Vomiting and Have you VOMITING (ADULTS) 117 medications eaten or drunk ACTION If you are taking any oral any of the medication, including oral following? TRY SELF-HELP MEASURES contraceptives, an episode of vomiting may reduce An unusually You probably have the effectiveness of the large or gastritis (inflammation drug because your body rich meal of the stomach lining). cannot absorb the active ingredients. If you use oral A large • Take over-the-counter contraceptives, you will amount of need to use an additional antacids to neutralize form of contraception such alcohol the acid in the stomach. as condoms for some time after the vomiting has Food that may • Eat small meals at stopped. Follow the have been instructions provided with regular intervals. the oral contraceptives or contaminated consult your doctor if you • Stop drinking alcohol are not sure what to do. None of You should also see your the above until you are better. doctor if you are taking any other prescribed medicine • If you smoke, stop. and have been vomiting. CONSULT YOUR DOCTOR if you are no better in 2 days or if other symptoms develop. ACTION ACTION Are you taking any medication? GO TO ANOTHER CHART TRY SELF-HELP MEASURES Medication Headache, p.84 You may have food poisoning. No medication ACTION • Follow the advice ACTION TRY SELF-HELP MEASURES for preventing SEE YOUR DOCTOR You may have a case dehydration (p.165). WITHIN 24 HOURS of gastroenteritis. CONSULT YOUR DOCTOR if you cannot identify • Follow the advice a possible cause for if you are no better your vomiting from for preventing in 2 days or if other this chart. dehydration (p.165). symptoms develop. CONSULT YOUR DOCTOR ACTION if you are no better SEE YOUR DOCTOR in 2 days or if other WITHIN 24 HOURS symptoms develop. Your symptoms may be a side effect of the medication. • Stop taking any over- the-counter medicines but continue to take prescribed medication unless advised to stop by your doctor.

118 FAMILY ILLNESS Vomiting (children) For adults and children over 12, see p.116 ! Danger signs Children vomit as a result of many illnesses, Dial 911 or call EMS if including ear infections and urinary and digestive your child’s vomiting is tract disorders. Anxiety or excitement may also accompanied by any of cause vomiting. Rarely, vomiting may be due to the following symptoms: an infection or injury to the brain. If vomiting is • Greenish yellow vomit. persistent, consult your child’s doctor urgently. • Abdominal pain for 4 hours. • Flat, dark-red or purple Has your child ACTION spots on skin that do not fade when pressed. START had a recent !DIAL 911 OR CALL EMS • Refusal to drink or feed Your child may have (in babies) for over 6 hours. head injury? a concussion. • Abnormal drowsiness. • Sunken eyes. Head injury • Do not allow your • Dry tongue. • Not urinating during No head injury child to eat or drink. the day for 3 hours (if child is under 1 year old) or 6 Does your child How old is hours (in an older child). have any of your child? • Black or bloodstained feces. the following? Under 3 months Apart from the vomiting, is your Severe 3 months baby generally headache or over not well, i.e. Drowsiness ACTION feverish or or confusion CALL YOUR CHILD’S drowsy? Dislike of DOCTOR NOW bright light Not well These symptoms may Pain when indicate a serious Well bending neck abdominal condition. ACTION None of Does your child the above seem to have CALL YOUR CHILD’S abdominal pain? DOCTOR NOW ACTION Yes These symptoms may !DIAL 911 OR CALL EMS have numerous causes. Your child may have No However, any infant meningitis (inflamed under 3 months who membranes around does not seem well and the brain). vomits needs prompt medical attention.

What are the ACTION VOMITING (CHILDREN) 119 characteristics of BRING YOUR CHILD TO ACTION the vomiting? THE DOCTOR WITHIN TRY SELF-HELP MEASURES Frequent and 24 HOURS This type of effortless after vomiting in an infant This type of vomiting may be the result of a is rarely serious and has feeding digestive tract problem, several possible causes. such as pyloric stenosis, Forceful after in which the stomach •Always burp your several feedings outlet becomes abnormally narrowed. baby after feeding. Occasional, not associated with Does your CONSULT YOUR CHILD’S child have feeding diarrhea? DOCTOR if your infant does not seem well or ACTION Diarrhea is failing to gain weight. TRY SELF-HELP MEASURES No diarrhea ACTION Babies often vomit for Does your child CALL YOUR CHILD’S no particular reason. It have any of is no cause for concern DOCTOR NOW if your if the baby seems well the following? child is under 6 months and is gaining weight. old. He may have a Pain when case of gastroenteritis. • Be sure to burp your urinating • Make sure older baby after each feeding. Renewed bedwetting children drink plenty CONSULT YOUR CHILD’S or daytime of clear fluids. “accidents” DOCTOR if your baby CONSULT YOUR CHILD’S seems sick or vomits Temperature frequently. of 100.4°F DOCTOR if your child is no better within 24 ACTION (38°C) or above hours or if any other symptoms develop. CALL YOUR CHILD’S None of the above ACTION DOCTOR NOW Your child may have a lung ACTION BRING YOUR CHILD TO infection such as THE DOCTOR WITHIN 24 pertussis, bronchiolitis, BRING YOUR CHILD TO or pneumonia. THE DOCTOR WITHIN HOURS He may have a urinary tract infection. Did vomiting 24 HOURS if you cannot follow violent identify a cause for • Give plenty of fluids your child’s vomiting coughing? from this chart. to drink. Followed ACTION coughing BRING YOUR CHILD TO No coughing THE DOCTOR WITHIN 24 HOURS Your child may have an infection such as acute otitis media (an infection of the middle ear) or a urinary tract infection. • Give liquid acetaminophen to relieve pain and fever.

120 FAMILY ILLNESS Abdominal pain (adults) For children under 12, see p.124 ! Danger signs Mild abdominal pain is often due to a stomach or Dial 911 or call EMS if you bowel upset that will clear up without treatment. have severe abdominal pain However, severe or persistent abdominal pain, that lasts for longer than especially if it is accompanied by other symptoms, 4 hours and is associated may indicate a more serious problem that should with any of the following be investigated by your doctor. additional symptoms: • Vomiting. START Have you had How severe • Fever. more than is the pain? • Swollen or tender abdomen. one episode • Feeling faint, drowsy, or of pain? Severe confused. • Blood in the urine or feces. Single Mild or continuous moderate Do you have diarrhea? episode Are any danger signs Diarrhea Recurrent episodes present? No diarrhea ACTION Danger signs ACTION MAKE AN APPOINTMENT No danger signs SEE YOUR DOCTOR TO SEE YOUR DOCTOR ACTION WITHIN 24 HOURS You may have a urinary tract problem or a TRY SELF-HELP MEASURES You may have digestive tract disorder. gallstones, especially You may have a case if you have suffered ACTION of gastroenteritis. from nausea and vomiting following !DIAL 911 OR CALL EMS • Drink plenty of a fatty meal. You may have a serious abdominal clear fluids or over- • Take an analgesic condition, such as the-counter rehydration appendicitis. solutions to prevent such as acetaminophen dehydration. to relieve symptoms. CONSULT YOUR DOCTOR • Avoid eating foods if you are no better that are high in fat. in 2 days or if other symptoms develop.

ACTION Do any of the ABDOMINAL PAIN (ADULTS) 121 following CALL YOUR DOCTOR NOW apply? ACTION You may have kidney Pain is related MAKE AN APPOINTMENT stones, especially if you to eating TO SEE YOUR DOCTOR have been vomiting. Pain is relieved You may have • Drink plenty of by antacids nonulcer dyspepsia (a recurrent and persistent fluids to flush the Pain comes on form of indigestion) or stones into the urine. when lying or gastroesophageal bending over reflux, in which acid • Save any urine you from the stomach is None of regurgitated into the pass, particularly if the above esophagus. you pass a stone. Do you have • Eat small meals at • Take acetaminophen either of the following? regular intervals. to relieve discomfort. Pain when • Avoid eating shortly What kind of urinating pain have Urinating more before going to bed. you been often than • Reduce your intake of experiencing? usual alcohol, coffee, and tea. Pain that starts Neither in the back and • If you smoke, stop. Are you may move to female or ACTION the groin male? GO TO ANOTHER CHART Pain in the center of the Female Chest pain, p.134 upper abdomen Male ACTION Pain in the upper right SEE YOUR DOCTOR abdomen that WITHIN 24 HOURS may spread to You may have cystitis the back or a urine infection that has spread to one Pain mainly or both kidneys. below the waist • For both conditions, None of the above take an analgesic such as acetaminophen. ACTION • Drink 1 pint SEE YOUR DOCTOR WITHIN 24 HOURS (500 ml) of fluid every hour for 4 hours. if you cannot identify a possible cause for • Drinking cranberry your abdominal pain from this chart. juice may relieve the burning sensation. ACTION GO TO ANOTHER CHART Abdominal pain (women), p.122

122 FAMILY ILLNESS Abdominal pain (women) First refer to abdominal pain, p.120 ! Abdominal pain Several disorders specific to women can cause during pregnancy discomfort or pain in the lower abdomen. Many of Intermittent, mild abdominal these conditions are related to the reproductive tract pains are common throughout (ovaries, uterus, or fallopian tubes) or to pregnancy. pregnancy due to stretching Abdominal pain that occurs during pregnancy of the muscles and ligaments should always be taken seriously. of the abdomen. Abdominal pain that occurs in early Do you have ACTION pregnancy can be due to complications, such as START pain when you SEE YOUR DOCTOR miscarriage or an ectopic pregnancy. In later pregnancy, urinate? WITHIN 24 HOURS pain is most commonly caused by the onset of labor. Rarely, Yes You may have cystitis. partial separation of the placenta from the wall of No • Take an analgesic the uterus may occur. • If you develop severe pain, such as acetaminophen. call your doctor at once. • Drink 1 pint Have you had sexual (500 ml) of fluid every intercourse hour for 4 hours. in the past 3 months? • Drinking cranberry Yes juice may help relieve the burning sensation. No ACTION Are you Did your last pregnant? menstrual period CALL YOUR DOCTOR NOW occur at the time More than 14 You could be having weeks pregnant you expected? a late miscarriage or placental abruption Less than 14 On time (separation of the weeks pregnant placenta from the Missed or late wall of the uterus). Do not think so • Rest in bed until you ACTION receive medical advice. CALL YOUR DOCTOR NOW Pain at this stage may indicate a threatened miscarriage or an ectopic pregnancy. • Rest in bed until you receive medical advice.

ABDOMINAL PAIN (WOMEN) 123 Do you have ACTION Do you have an either of the intrauterine following? SEE YOUR DOCTOR contraceptive device (IUD)? Abnormal WITHIN 24 HOURS vaginal IUD You may have pelvic discharge inflammatory disease, Fever in which there is an infection in the Neither of reproductive organs. the above • Your partner may Have you passed also need to have tests for infection. menopause? Premenopausal Is the pain No IUD related to your Postmenopausal ACTION menstrual cycle? MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Occurs just before and/or This particular form of during a period contraception can cause increased menstrual Occurs briefly pain, particularly for in midcycle the first few cycles after insertion. Unrelated ACTION MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Some women regularly have pain associated with their ovulation. However, other possible causes do need to be ruled out. ACTION ACTION ACTION CALL YOUR DOCTOR NOW MAKE AN APPOINTMENT GO TO ANOTHER CHART TO SEE YOUR DOCTOR There is a possibility Menstrual pain, p.156 of an ectopic pregnancy. if you cannot identify a possible cause for • Rest in bed until you your lower abdominal pain from this chart. receive medical advice.

124 FAMILY ILLNESS Abdominal pain (children) For adults and children over 12, see p.120 ! Danger signs Many children suffer from abdominal pain at some Dial 911 or call an ambulance time, and some children have recurrent episodes. if your child’s abdominal pain Usually, the cause is not serious, and the pain is accompanied by any of the subsides in a few hours without treatment. In rare following symptoms: cases, abdominal pain is a symptom of a serious • Greenish yellow vomit. disorder that requires prompt medical attention. • Pain in the groin or scrotum. • Blood in the feces. Does your child ACTION • Pain has been continuous for more than 4 hours. START have severe !DIAL 911 OR CALL EMS Your child may have ACTION pain in either a strangulated hernia or of the following a testis that is twisted !DIAL 911 OR CALL EMS within the scrotum. Your child may have places? a serious abdominal • Do not allow your condition, such as Groin appendicitis. child to eat or drink. • Do not allow your Scrotum Does your child have any of child to eat or drink. Neither the following? ACTION ACTION Continuous !DIAL 911 OR CALL EMS !DIAL 911 OR CALL EMS pain for more Your child may have If your child is under than 4 hours an obstruction of the 5 years, he or she may intestine. have intussusception Blood in (a rare condition the feces • Do not allow your causing an intestinal obstruction). In older Greenish yellow child to eat or drink. children, the cause of vomit these symptoms may Does your be food poisoning. None of child have the above diarrhea? • Do not allow your No diarrhea child to eat or drink. Diarrhea

ABDOMINAL PAIN (CHILDREN) 125 Has pain been Does your ACTION relieved by child have either of the any of the MAKE AN APPOINTMENT following? following? TO SEE YOUR DOCTOR Vomiting Sore throat Recurrent abdominal pain in children can Passing gas sometimes be related or stools to anxiety. Neither Cough ACTION Runny nose Has your child suffered from TRY SELF-HELP MEASURES None of similar bouts of the above abdominal pain Young children often over the past have abdominal pain Does your few weeks? in association with a child have any cold or flu. Previous of the abdominal pain • Give your child following? No previous liquid acetaminophen Pain when pain to relieve pain. urinating ACTION • Inhaling steam from Temperature of 100.4°F (38°C) SEE YOUR DOCTOR a bowl of hot water WITHIN 24 HOURS (p.165) may help. or above if you cannot identify !DIAL 911 OR CALL EMS Renewed a possible cause for if your child bedwetting your child’s abdominal develops danger signs or daytime pain from this chart. (see box opposite). “accidents” ACTION None of the above CALL YOUR DOCTOR NOW ACTION if your child is under 1 year. He or she may SEE YOUR DOCTOR have gastroenteritis. WITHIN 24 HOURS • Give older children Your child may have a urinary tract infection. plenty of clear fluids to drink. • Give your child CONSULT YOUR DOCTOR plenty of clear fluids to drink. if an older child is no better within 24 hours or if other symptoms develop.

126 FAMILY ILLNESS Swollen abdomen Enlargement of the abdomen is usually due to ACTION weight gain or poor muscle tone from lack of exercise. A swollen abdomen may also result from a GO TO ANOTHER CHART disorder of either the digestive system or the urinary system. If you have abdominal swelling that has Abdominal pain come on rapidly, you should consult your doctor (adults), p.120, or irrespective of any other symptoms you may have. Abdominal pain (children), p.124 How long has Do you have abdominal ACTION START your abdomen pain? MAKE AN APPOINTMENT been swollen? Severe pain TO SEE YOUR DOCTOR Less than Mild pain You may be suffering 24 hours from excessive gas or No pain constipation, possibly Longer than due to irritable bowel 24 hours syndrome. ACTION Do any of the Is the pain following relieved by TRY SELF-HELP MEASURES apply? passing gas or having a bowel A swollen abdomen Your ankles movement? may be the the first are swollen sign of an unsuspected Relieved pregnancy, especially You could be if you have been using pregnant Unrelieved contraception or if your menstrual periods You have ACTION tend to be irregular. difficulty urinating GO TO ANOTHER CHART • If you think that You urinate Swollen ankles, p.148 you might be pregnant, only small perform a home volumes ACTION pregnancy test. None of SEE YOUR DOCTOR ACTION the above WITHIN 24 HOURS MAKE AN APPOINTMENT The swelling could be TO SEE YOUR DOCTOR due to an abnormally full bladder caused if you cannot identify a by a blockage at the possible cause for your bladder outlet. abdominal swelling from this chart.

SWOLLEN ABDOMEN • ANAL AND RECTAL PROBLEMS 127 Anal and rectal problems The anus is the opening of the lower large intestine ACTION (rectum) to the outside. Discomfort during bowel movements may be due to a disorder of the rectum, MAKE AN APPOINTMENT the anus, or the skin around the anus. Rectal or anal TO SEE YOUR DOCTOR bleeding is often due to hemorrhoids but can also be an early symptom of cancer. Consult your doctor if You may have a you have any bleeding or persistent discomfort. pinworm infestation. START Have you ACTION Do you have noticed either of the bleeding from SEE YOUR DOCTOR following? the anus? WITHIN 24 HOURS White “threads” Bleeding in your feces Although hemorrhoids No bleeding are a likely cause, Itching is worse there is a slight in bed at night possibility of cancer of the colon, rectum, Neither or anus that needs to be excluded. ACTION Do you have Do you have TRY SELF-HELP MEASURES either of the itching around following? You may have the anus? hemorrhoids, but Pain in or itching can also occur around the Itching for no obvious reason. anus or rectum No itching • Try using an over-the- Sore area in the crease above Do you have counter hemorrhoid the anus small, irregular, preparation to relieve the itching. Neither fleshy lumps around the anus? CONSULT YOUR DOCTOR ACTION Yes if the itching continues SEE YOUR DOCTOR for more than 3 days. WITHIN 24 HOURS No ACTION You may have a pilonidal sinus (small MAKE AN APPOINTMENT pit at the top of this TO SEE YOUR DOCTOR crease, which can result in an abscess). It is possible that you have genital warts. • Soak the affected ACTION area in warm water. MAKE AN APPOINTMENT TO SEE YOUR DOCTOR if you cannot identify a possible cause for your anal or rectal problem from this chart.

128 FAMILY ILLNESS Diarrhea (adults) For children under 12 years, see p.130 ! Dehydration Diarrhea is the frequent passing of abnormally loose A person with bad diarrhea or watery feces, and is usually a result of infection. can become dehydrated if However, persistent diarrhea may be caused by a fluids are not replaced quickly serious gastrointestinal disorder. You should consult enough. The symptoms of your doctor if diarrhea continues for more than dehydration include confusion 2 days or if it recurs. or drowsiness, a dry mouth, loss of elasticity in the skin, Have you Have you had and failure to urinate for several bouts several hours. Elderly people START noticed blood are particularly at risk. Follow of diarrhea the advice for preventing in your feces? over the past dehydration on p.165, but few weeks? seek urgent medical help if a Blood person has severe symptoms. Yes No blood Has the diarrhea No been alternating ACTION ACTION with bouts of SEE YOUR DOCTOR constipation? WITHIN 24 HOURS MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Constipation You may have an and diarrhea intestinal infection, You probably have such as amebiasis, irritable bowel Diarrhea alone or ulcerative colitis syndrome, especially (ulceration of the if you have suffered ACTION rectum and colon). abdominal pain and However, the slight excessive gas. TRY SELF-HELP MEASURES possibility of cancer However, the slight of the colon or rectum possibility of cancer of You may have food needs to be excluded. the colon or rectum poisoning. needs to be excluded. Have you recently • Follow the advice consumed food • Avoid large meals, or water that for preventing may have been spicy, fried, and fatty dehydration (p.165). contaminated? foods, and milk products. CONSULT YOUR DOCTOR Possible • Cut down on coffee, if you are no better in 2 days or if any other tea, soda, and beer. symptoms develop. Unlikely

Have the attacks ACTION DIARRHEA (ADULTS) 129 of diarrhea SEE YOUR DOCTOR ACTION occurred since WITHIN 24 HOURS a visit abroad? MAKE AN APPOINTMENT You may have picked TO SEE YOUR DOCTOR Foreign travel up an intestinal infection, such as You may have an No foreign giardiasis, during intolerance of a specific travel your travels abroad. food or foods. Do you have Is your diarrhea ACTION recurrent pain associated with in the lower MAKE AN APPOINTMENT either of the TO SEE YOUR DOCTOR abdomen? following? Anxiety disorders can No Eating be a cause of diarrhea. particular foods Yes ACTION Period of stress ACTION MAKE AN APPOINTMENT Neither TO SEE YOUR DOCTOR MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Your symptoms may be a side effect of the You may have an medication. intestinal disorder. • Stop taking any over- Do you have either of the the-counter medicines following? but continue to take prescribed medication Nausea or unless advised to stop vomiting by your doctor. Temperature of 100.4°F ACTION Are you (38°C) or above currently taking TRY SELF-HELP MEASURES any medication? Neither You probably have Medication gastroenteritis or food poisoning. No medication • Follow the advice ACTION for preventing MAKE AN APPOINTMENT dehydration (p.165). TO SEE YOUR DOCTOR CONSULT YOUR DOCTOR if you cannot identify a possible cause for if you are no better in your diarrhea from 2 days or if any other this chart. symptoms develop.

130 FAMILY ILLNESS Diarrhea (children) For adults and children over 12, see p.128 ! Danger signs Diarrhea is the abnormally frequent passage of loose Dial 911 or call EMS if your or watery feces. Breast-fed babies may pass loose child also has any of feces several times a day, and this is normal. If your the following symptoms: child has diarrhea, he or she should drink plenty of • Abnormal drowsiness. clear fluids to avoid dehydration. If symptoms do • Severe abdominal pain or not improve, consult your doctor. abdominal pain that lasts for 4 hours or more. How long has Does your • No urination during the day child have any for 3 hours (if under 1 year) START your child had or 6 hours (in an older of the child). diarrhea? following? • Refusal to drink or feed (in babies) for over 6 hours. Less than Abdominal pain • Blood in the feces. 3 days Temperature of Is your child 3 days or more 100.4°F (38°C) currently taking any medication? ACTION or above Medication CALL YOUR DOCTOR NOW Vomiting No medication if your child is under 6 None of months. He or she may the above Is your have gastroenteritis. child gaining ACTION weight and CONSULT YOUR DOCTOR growing at a MAKE AN APPOINTMENT normal rate if your child is over 6 TO SEE YOUR DOCTOR (see growth months and not better charts, p.71)? within 24 hours or if Persistent constipation any other symptoms can lead to feces Yes develop. trickling from the anus, which may be mistaken No • Follow the advice for diarrhea. for preventing What is the dehydration (p.165). appearance of Was your child the feces? constipated Uniformly before the onset runny of diarrhea? Contains pieces Constipated of food Not constipated

ACTION Was your baby DIARRHEA (CHILDREN) 131 given any of SEE YOUR DOCTOR the following ACTION WITHIN 24 HOURS before the onset TRY SELF-HELP MEASURES Your child’s symptoms of diarrhea? may be a side effect of Foods that are new to the drug. Unfamiliar your baby may cause foods digestive upsets. • Stop giving any over- Sugary foods • Withhold the food the-counter medicines or sweetened but continue to give that seems to be prescribed medication drinks causing the trouble unless advised to stop for at least 1 week. by your doctor. Neither CONSULT YOUR DOCTOR How old is ACTION your child? if your baby is no SEE YOUR DOCTOR better in 24 hours or Under WITHIN 24 HOURS if he or she develops 12 months other symptoms. if you cannot identify 12 months a possible cause for ACTION to 3 years your child’s diarrhea from this chart. TRY SELF-HELP MEASURES Over 3 years Is your child Sugar in food and ACTION experiencing drink can cause unusual stress, diarrhea in babies. TRY SELF-HELP MEASURES anxiety, or • Avoid giving your Young children often excitement? fail to chew and digest baby sweetened foods food properly, which Stress or and drinks. can lead to so-called anxiety “toddler’s diarrhea.” CONSULT YOUR DOCTOR Excitement • Follow the advice if your baby is no Neither better in 24 hours or for preventing if he or she develops dehydration (p.165). ACTION other symptoms. CONSULT YOUR DOCTOR SEE YOUR DOCTOR ACTION WITHIN 24 HOURS if symptoms persist or TRY SELF-HELP MEASURES if your child develops if you cannot identify other symptoms. a possible cause for Psychological stress or your child’s diarrhea unusual excitement ACTION from this chart. can cause diarrhea in children. The symptoms MAKE AN APPOINTMENT will normally stop as TO SEE YOUR DOCTOR soon as the cause has disappeared. It is possible that your child has a condition CONSULT YOUR DOCTOR affecting the digestive tract, such as food if there is a long-term intolerance or celiac cause of anxiety in disease (gluten allergy). your child’s life or if he or she develops other symptoms.

132 FAMILY ILLNESS Constipation Some people have a bowel movement once or twice ! Blood in the feces a day; others do so less frequently. If you have fewer Blood can appear in the feces bowel movements than usual or if your feces are as red streaks or in larger small and hard, you are constipated. The cause is amounts. It can also make often a lack of fluid or fiber-rich foods in the diet. the stools look black. Small If constipation occurs suddenly or persists despite amounts of blood in the a change in your diet, consult your doctor. feces are usually caused by minor anal problems, such as START How long Do you have hemorrhoids, but you should have you pain in your always consult your doctor if suffered from rectum or anus you notice blood in the feces constipation? when you because it is vital that other causes, such as colorectal For a few defecate? cancer, are excluded. weeks or less Pain Do you have For several intermittent months or years No pain bouts of Does either of ACTION cramping pain the following in the lower MAKE AN APPOINTMENT apply? TO SEE YOUR DOCTOR abdomen? You regularly Pain on defecation Pain ignore the can cause or worsen urge to constipation. You may No pain defecate have hemorrhoids or an anal fissure (tear in ACTION You regularly the lining of the anus). use stimulant TRY SELF-HELP MEASURES ACTION laxatives Your constipation is TRY SELF-HELP MEASURES probably due to a lack Neither of fiber or fluid in Your bowel reflexes your diet and possibly ACTION may have become to lack of exercise. sluggish as a result of MAKE AN APPOINTMENT being ignored. • Include more fiber- TO SEE YOUR DOCTOR • Include more fiber- rich foods in your diet. Regular use of rich foods in your diet. • Avoid eating too stimulant laxatives, such as senna, can • Increase your daily much processed food. seriously disrupt the normal functioning fluid intake. • Increase your daily of the bowels. CONSULT YOUR DOCTOR fluid intake. if your symptoms have • Do not ignore the not improved within 2 weeks. urge to defecate. CONSULT YOUR DOCTOR if your symptoms have not improved within 2 weeks.

ACTION Are you taking CONSTIPATION 133 any medication? MAKE AN APPOINTMENT ACTION TO SEE YOUR DOCTOR Medication MAKE AN APPOINTMENT Irritable bowel No medication TO SEE YOUR DOCTOR syndrome is a possible cause, especially if Do any of the Your symptoms may your constipation following be a side effect of the alternates with bouts apply? medication. of diarrhea. However, other causes, such as You are • Stop taking any over- cancer of the colon, pregnant rectum, or anus, may the-counter medicines need to be ruled out. You have been but continue to take drinking less fluid prescribed medication Do you have unless advised to stop any of the than usual by your doctor. following? You have changed ACTION Fatigue your diet TRY SELF-HELP MEASURES Increased dryness None of or roughness the above Constipation is quite of the skin common in pregnancy. ACTION Feeling the cold • Include more fiber- more than you TRY SELF-HELP MEASURES rich foods in your diet. used to Lack of fluid in the bowel as a result of an • Avoid eating too Unexplained inadequate fluid intake weight gain or excessive fluid loss much processed food. can cause constipation. General hair • Increase your daily thinning • Drink plenty of fluid intake, but avoid None of fluids, especially if the caffeine and alcohol. the above weather is hot. • Do not ignore the ACTION CONSULT YOUR DOCTOR urge to defecate. MAKE AN APPOINTMENT if your symptoms have TO SEE YOUR DOCTOR not improved within CONSULT YOUR DOCTOR 2 weeks. Hypothyroidism if your symptoms have (underactivity of the ACTION not improved within thyroid gland, which 2 weeks. causes many body MAKE AN APPOINTMENT functions to slow TO SEE YOUR DOCTOR ACTION down) is a possibility. if you cannot identify TRY SELF-HELP MEASURES a possible cause for your constipation from A change in your this chart. regular diet, especially when traveling, can make you constipated. • Include more fiber- rich foods in your diet. • Avoid eating too much processed food. • Increase your daily fluid intake. • Do not ignore the urge to defecate. CONSULT YOUR DOCTOR if your symptoms have not improved within 2 weeks.

134 FAMILY ILLNESS ACTION Chest pain !DIAL 911 OR CALL EMS You may have a Pain in the chest, or any discomfort felt in the front blood clot in the lung. or back of the ribcage, is most often due to minor disorders such as muscle strain or indigestion. Do any of the However, you should dial 911 or call EMS if you following have a crushing pain in the center or left side of your apply? chest, if you are also short of breath or feel faint, or if the pain is unlike any pain you have had before. You have recently had What kind of Are you short of breath? surgery START pain are you Short of breath You have recently experiencing? been immobile Not short due to injury Crushing of breath or illness Spreading from ACTION You have had a the center of the baby within the chest to the neck, CALL YOUR DOCTOR NOW past 2 weeks arms, or jaw Recurrent chest pain could be an indication None of Neither of of angina, especially if the above the above pain in the chest occurs with exertion and Is pain related Does the pain disappears with rest. to breathing? subside after you rest for a Have you had Related to few minutes? this pain breathing before? Pain subsides Not related Previous to breathing Pain persists episodes of this ACTION ACTION kind of pain !DIAL 911 OR CALL EMS !DIAL 911 OR CALL EMS Never before You may be having a You may be having a heart attack. heart attack. • While waiting, chew • While waiting, chew half an aspirin, unless half an aspirin, unless you are allergic to it. you are allergic to it.

Do you have ACTION CHEST PAIN 135 a fever – a CALL YOUR DOCTOR NOW ACTION temperature of 100.4°F (38°C) You may have a CALL YOUR DOCTOR NOW partially collapsed lung. or above? You may have a chest Does either of infection, such as Fever the following pneumonia. No fever apply? • Take an analgesic Is the chest You have had such as acetaminophen sore to touch? a chest injury to reduce fever and chest pain. Sore to touch You have been exercising • Drink lots of fluid. Not sore to touch Neither ACTION Does the pain ACTION TRY SELF-HELP MEASURES have any of the following SEE YOUR DOCTOR You have probably WITHIN 24 HOURS strained and/or bruised features? a muscle. Related to You may have a lung eating or to infection or pleurisy. • Take an analgesic particular foods Relieved by • Take an analgesic such as acetaminophen antacids and rest for 24 hours. Brought on such as acetaminophen by bending or to relieve pain and fever. CONSULT YOUR DOCTOR lying down None of • If you have a fever, if the pain has not the above improved after this time. drink lots of fluid. ACTION ACTION MAKE AN APPOINTMENT MAKE AN APPOINTMENT TO SEE YOUR DOCTOR TO SEE YOUR DOCTOR if you cannot identify You may have a possible cause for recurrent indigestion your chest pain from or heartburn caused this chart. by acid reflux. ACTION !DIAL 911 OR CALL EMS You may be having a heart attack. • While waiting, chew half an aspirin, unless you are allergic to it.

136 FAMILY ILLNESS ACTION Palpitations MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Abnormally fast or irregular heartbeats, or palpitations, are often caused by anxiety or by You may have stimulants, such as caffeine and nicotine. hyperthyroidism (an Palpitations may also occur as a side effect of overactive thyroid medication or because of a heart disorder. Call your gland) or you might be doctor immediately if palpitations are frequent or suffering from anxiety. persistent or if you have other symptoms. ACTION START Do you have Do you have any of the any of the TRY SELF-HELP MEASURES following? following? These symptoms may Shortness of Weight loss be due to anxiety. breath with increased • Try some relaxation Chest appetite discomfort exercises (p.169). Feeling Feeling faint on edge CONSULT YOUR DOCTOR or passing out Increased if your symptoms None of sweating continue for 2 days. the above Bulging eyes ACTION ACTION None of TRY SELF-HELP MEASURES !DIAL 911 OR CALL EMS the above You may have a • Avoid caffeine and serious arrhythmia Do any of the (abnormal heart following nicotine because these rate or rhythm) due apply? can disturb your to an underlying heart rhythm. heart disorder. You have had a lot of coffee, tea, CONSULT YOUR DOCTOR ACTION or soda if your symptoms SEE YOUR DOCTOR continue for 2 days. You have been WITHIN 24 HOURS smoking more Have you been feeling tense Your symptoms may than usual or stressed? be a side effect of the medication. You are taking Feeling under medications stress • Stop taking any over- None of the No increase the-counter medicines above in stress but continue to take prescribed medication ACTION unless advised to stop by your doctor. MAKE AN APPOINTMENT TO SEE YOUR DOCTOR if you cannot identify a possible cause for your palpitations from this chart.

PALPITATIONS • POOR BLADDER CONTROL 137 Poor bladder control If urinating is painful, see p.138 ! In.ability to urinate Inability to control urination may result in leakage Inability to urinate, even of urine or difficulty urinating. These symptoms though the bladder is full, may be due to a bladder, nerve, or muscle disorder. is a serious symptom. It In men, an enlarged prostate gland is a common may be the result of an cause. Urinary tract infections can also cause obstruction or damage leakage of urine, especially in elderly people. to nerves that supply the bladder, or it may be a START Are you ACTION side effect of certain drugs. female or You should call your MAKE AN APPOINTMENT doctor immediately. male? TO SEE YOUR DOCTOR ACTION Female You may be suffering from an irritable bladder. MAKE AN APPOINTMENT Male TO SEE YOUR DOCTOR Do you have ACTION either of the Some drugs, particularly following? those that act on urine MAKE AN APPOINTMENT production or on the A strong urge nervous system, can TO SEE YOUR DOCTOR to urinate with affect bladder control. little urine passed You may have an • Stop taking any over- enlarged prostate gland, Leakage of urine especially if you are when you cough, the-counter medicines over 55, or a narrowing but continue to take of the urethra (tube that sneeze, or run prescribed medication empties the bladder). unless advised to stop Neither by your doctor. Are you currently taking any medication? Do you have ACTION Medication either of the following? TRY SELF-HELP MEASURES No medication Difficulty You probably have ACTION starting to stress incontinence. MAKE AN APPOINTMENT urinate • Try Kegel exercises: TO SEE YOUR DOCTOR Weak urinary contract, hold, and if you cannot identify stream relax pelvic floor a possible cause for muscles 10 times, your poor bladder Neither several times a day control from this chart. to strengthen them. CONSULT YOUR DOCTOR if the condition does not improve in 1 month.

138 FAMILY ILLNESS Painful urination Pain or discomfort while urinating is usually caused Checking the by inflammation of the urinary tract, often due to appearance of urine infection. Frequent painless urination can be due to diabetes or kidney problems and should be The appearance of urine varies investigated by your doctor. Discolored urine can considerably. For example, accompany this type of pain but may not indicate urine is often darker in the disease (see Checking the appearance of urine, right). morning than later in the day. Some drugs and foods may START Do you have ACTION also cause a temporary color either of the change in the urine. Beets, following? CALL YOUR DOCTOR NOW for example, may turn the urine red. A change in your Pain in the back You may have urine can indicate a disorder. just above pyelonephritis (infection Very dark urine may be a the waist of the kidneys). sign of liver disease, such as acute hepatitis, while red or A temperature • Take an analgesic cloudy urine may be due to of 100.4°F bleeding or an infection such as acetaminophen. in the kidney or bladder. (38°C) or above Do you have • If you are not sure about Neither any of the following? the cause of a change in the Have you felt appearance of your urine, the need to Lower consult your doctor. urinate more abdominal pain frequently ACTION than usual? Blood in the urine SEE YOUR DOCTOR Increased WITHIN 24 HOURS frequency Cloudy urine You may have cystitis. No increased None of frequency the above • Take an analgesic such as acetaminophen. • Drink 1 pint (500 ml) of fluid every hour for 4 hours. • Drinking cranberry juice may help relieve the burning sensation. Are you female or male? Female Male

Have you Do you have PAINFUL URINATION 139 noticed an unusual soreness or ACTION itching in the vaginal genital area? discharge? TRY SELF-HELP MEASURES Soreness Thick, white You may have vaginal discharge thrush. Itching Yellowish green • If you have had Neither discharge thrush before, try using No unusual an over-the-counter discharge antifungal preparation recommended by your pharmacist. CONSULT YOUR DOCTOR if this is the first time you have had these symptoms. ACTION ACTION ACTION SEE YOUR DOCTOR MAKE AN APPOINTMENT SEE YOUR DOCTOR WITHIN 24 HOURS TO SEE YOUR DOCTOR WITHIN 24 HOURS You may have cystitis. if you cannot identify or go to a clinic that a possible cause for specializes in sexually • Take an analgesic your symptoms from transmitted diseases. this chart. You may have a such as acetaminophen. vaginal infection, such ACTION as bacterial vaginosis • Drink 1 pint (500 ml) or trichomoniasis, or SEE YOUR DOCTOR an STD, such as of fluid every hour for WITHIN 24 HOURS gonorrhea. 4 hours. or go to a clinic that ACTION • Drinking cranberry specializes in sexually transmitted diseases. MAKE AN APPOINTMENT juice may help relieve You may have an STD, TO SEE YOUR DOCTOR the burning sensation. such as gonorrhea or nongonococcal if you cannot identify Do you have urethritis. a possible cause for an unusual your symptoms from discharge from this chart. your penis? Discharge No discharge

140 FAMILY ILLNESS Back pain Mild back pain is usually caused by poor posture, ! Danger signs sudden movement, or lifting heavy objects, all Dial 911 or call EMS if you of which may strain the back. Back pain is also have back pain that is common in pregnancy. Persistent or severe back associated with one of pain may be the result of a more serious problem. the following symptoms: You should consult your doctor if pain is severe • Difficulty controlling or does not improve after 48 hours. your bladder. • Difficulty controlling START Did the pain Do you have your bowels. in your back either of the • Sudden pain above waist come on after following? with shortness of breath. either of the • Difficulty moving. following? Pain in the back just above the Did the pain An injury or fall occur after any waist of the following? A sudden, awkward A temperature Lifting a movement of 100.4°F heavy weight Neither (38°C) or above A coughing fit Neither Strenuous or unusual Have you ACTION noticed either of physical activity the following? CALL YOUR DOCTOR NOW None of Difficulty You may have the above moving a leg pyelonephritis (infection of the kidneys). ACTION Numbness or tingling in a leg • Take an analgesic TRY SELF-HELP MEASURES Neither of such as acetaminophen. You have probably the above strained a back muscle ACTION and/or bruised your back by overstretching CALL YOUR DOCTOR NOW a muscle. You may have pinched • Rest and take a nerve in your back or damaged your spine. analgesic such as acetaminophen. • Place a covered hot- water bottle or heat pad against your back for additional relief. CONSULT YOUR DOCTOR if you are no better within 24 hours.

Does either of ACTION BACK PAIN 141 the following SEE YOUR DOCTOR ACTION apply? WITHIN 24 HOURS MAKE AN APPOINTMENT Pain makes any You may have TO SEE YOUR DOCTOR movement fractured a vertebra as difficult a result of osteoporosis You may have or have sciatica, caused osteoarthritis. Pain shoots by a slipped disk. from the spine ACTION down the back How old are you? MAKE AN APPOINTMENT of the leg TO SEE YOUR DOCTOR 45 or over Neither You may have Under 45 ankylosing spondylitis ACTION (a form of arthritis ACTION affecting the back of the TRY SELF-HELP MEASURES pelvis and the vertebrae SEE YOUR DOCTOR of the spine), especially You have probably WITHIN 24 HOURS if you are male. strained some of the muscles or sprained You may have ACTION some of the ligaments fractured a vertebra as in your back. a result of osteoporosis. CALL YOUR DOCTOR NOW • Take an analgesic Does either of New back pain or a the following worsening of existing such as acetaminophen. back pain may indicate apply? the start of labor. • Place a covered hot- You are over 60 Are you in the water bottle or a heat last 3 months pad against your back You have recently of pregnancy? to ease the pain. been immobile due to illness Pregnant CONSULT YOUR DOCTOR or injury Not pregnant if you do not feel any Neither better in 2 or 3 days ACTION or if any other symptoms develop. MAKE AN APPOINTMENT TO SEE YOUR DOCTOR Have you been suffering from if you cannot identify increasing pain a possible cause for and stiffness your back pain from this chart. for several months? Yes No

142 FAMILY ILLNESS Neck pain or stiffness Pain and/or stiffness in the neck is usually due to ! Danger signs a minor problem that does not require treatment, Dial 911 or call EMS if you such as a muscle strain or a ligament sprain. have neck pain associated However, if the pain occurs with fever, meningitis is with any of the following: a possibility. Neck pain or stiffness becomes more • Difficulty controlling common as people grow older; and may then be your bladder. due to a disorder of the neck bones and joints. • Difficulty controlling your bowels. START How long have Have you • Severe headache. you had pain jolted or injured • Drowsiness or confusion. and/or stiffness • Dislike of bright light. in the neck? your neck, for example in a car ACTION Less than accident or fall? 24 hours !DIAL 911 OR CALL EMS Neck injury You may have 24 hours damaged your spine. or longer No neck injury • Follow the first-aid Which of the Have you following noticed any of advice for spinal the following? injuries (p.46). describes your symptoms? Pain, numbness, ACTION or tingling in an Pain and stiffness TRY SELF-HELP MEASURES worsening over arm or leg many months Your neck is probably Difficulty moving strained and/or bruised Neck pain with an arm or leg from overstretching numbness or pain a muscle. in the arm/hand Loss of bladder control • Take an analgesic Neither None of such as acetaminophen ACTION the above and rest lying down. MAKE AN APPOINTMENT ACTION • A heat pad or TO SEE YOUR DOCTOR MAKE AN APPOINTMENT covered hot-water You may have TO SEE YOUR DOCTOR bottle placed against osteoarthritis of the your neck may provide upper spine, especially if you cannot identify additional pain relief. if you are over the a possible cause for age of 45. your neck pain or CONSULT YOUR DOCTOR stiffness from this chart. if you are no better in 24 hours.

Do you have Does either of NECK PAIN OR STIFFNESS 143 any of the the following following? ACTION apply? Temperature SEE YOUR DOCTOR of 100.4°F Pain is severe WITHIN 24 HOURS enough to (38°C) or above prevent Your neck pain may movement be due to pressure Severe on a nerve as a result headache Pain shoots of a slipped disk or Drowsiness down one osteoarthritis of the or confusion arm from upper spine. Dislike of the neck bright light ACTION Nausea or Neither vomiting TRY SELF-HELP MEASURES None of Can you feel any the above tenderness or You may have strained swelling at the your neck over- ACTION stretching a muscle. sides or the back !DIAL 911 OR CALL EMS of the neck? • Rest your neck as You may have meningitis (infection Yes much as possible by inflaming membranes lying down. around the brain). No • Take a nonsteroidal ACTION ACTION anti-inflammatory drug, GO TO ANOTHER CHART MAKE AN APPOINTMENT such as ibuprofen, to TO SEE YOUR DOCTOR ease the pain. Lumps and swellings, p.80 if you cannot identify • Keeping your neck a possible cause for your neck pain or warm with a heating stiffness from this chart. pad or covered hot- water bottle may help. CONSULT YOUR DOCTOR if you are no better in 3 days. Did either of the following apply in the 24 hours before the onset of pain? You exercised unusually strenuously You sat or slept in an awkward position Neither

144 FAMILY ILLNESS Arm or hand pain If you have joint pain, see p.146 ACTION Pain in the arm or hand is often caused by injury or a problem in the neck or shoulder. Rarely, pain MAKE AN APPOINTMENT in the arm is due to a heart attack or a serious TO SEE YOUR DOCTOR neck disorder. Consult your doctor if the pain is severe, recurrent, or persistent. You may have repetitive strain injury. • Take an analgesic such as acetaminophen. START Did the pain Is the pain ACTION start during associated or soon after with any of !DIAL 911 OR CALL EMS either of the the following? You may be having following? a heart attack. Chest tightness An injury or fall • While waiting, chew Shortness Repetitive of breath half an aspirin, unless arm or hand you are allergic to it. movements Nausea, sweating, or feeling faint ACTION Neither None of MAKE AN APPOINTMENT ACTION the above TO SEE YOUR DOCTOR CALL YOUR DOCTOR NOW What are You may have the features inflammation of a if you are in severe of the pain? tendon or polymyalgia, pain. You may have in which muscles either fractured a bone Localized in upper become inflamed, or damaged a muscle. arms or shoulders particularly if you are over 60 years old. • Follow the first-aid Extends from the wrist into ACTION advice for a broken the palm and arm (p.44). SEE YOUR DOCTOR lower arm WITHIN 24 HOURS TRY SELF-HELP MEASURES Shoots down You may have a pinched if not in severe pain. the length of nerve in your neck. • Follow the first-aid the arm ACTION advice for sprains and None of MAKE AN APPOINTMENT strains (p.47). the above TO SEE YOUR DOCTOR ACTION if you cannot identify a possible cause for MAKE AN APPOINTMENT your arm or hand pain TO SEE YOUR DOCTOR from this chart. You may have a compressed nerve in the wrist (carpal tunnel syndrome).

ARM OR HAND PAIN• LEG PAIN 145 Leg pain If you have joint pain, see p.146 ACTION Leg pain due to a strained muscle or torn ligament usually goes away without treatment. Pain may SEE YOUR DOCTOR also result from a problem in the lower back or WITHIN 24 HOURS in the blood vessels in the leg. If your leg is also swollen, hot, or red, see your doctor at once. Your symptoms may be caused by cellulitis START Did the pain ACTION (infection of the skin start during or and underlying TRY SELF-HELP MEASURES tissue) or superficial soon after thrombophlebitis either of the You may have strained (inflamed surface vein). following? a muscle. ACTION An injury or fall • Follow the first-aid MAKE AN APPOINTMENT Unusual advice for sprains and TO SEE YOUR DOCTOR exercise strains (p.47). You may have a muscle Neither What are the cramp, but, if the pain features of occurs with exercise ACTION the pain? and disappears with rest, you may have CALL YOUR DOCTOR NOW Affects a small claudication due to area that is also narrowing of the blood if you are in severe vessels in the leg. pain. You may have red and hot either fractured a bone ACTION or damaged a muscle. Sudden tightening of calf muscles MAKE AN APPOINTMENT • Follow the first-aid TO SEE YOUR DOCTOR Constant pain in advice for a broken the calf, which Varicose veins are a leg (p.45). may be swollen possible cause. TRY SELF-HELP MEASURES Shooting pain Does sitting down the back down with your if not in severe pain. feet up relieve of the leg • Follow the first-aid the pain? Heavy, advice for sprains and aching legs Yes strains (p.47). None of No ACTION the above ACTION CALL YOUR DOCTOR NOW ACTION MAKE AN APPOINTMENT You may have deep MAKE AN APPOINTMENT TO SEE YOUR DOCTOR vein thrombosis TO SEE YOUR DOCTOR (blood clot in a vein if you cannot identify in your leg). You may have sciatica. a possible cause for your leg pain from this chart.

146 FAMILY ILLNESS How many joints are Joint pain affected? If your ankle is swollen painlessly, see p.148 One joint Pain in a joint may be caused by injury or strain and often disappears without a cause being found. More than one Gout or a joint infection can cause a joint to become red, hot, and swollen. Joint pain may also ACTION be a reaction to an infection or due to arthritis. Consult your doctor if pain is severe or persistent. CALL YOUR DOCTOR NOW START Have you Do you have You may have septic injured either of the arthritis (infected joint) following? or gout. the joint? Hot joint(s) • Rest the painful joint. Injury • Take ibuprofen at the Red joint(s) No injury recommended intervals. Neither Does either of • Drink lots of fluid. the following ACTION Does moving apply? CALL YOUR DOCTOR NOW the joint affect You cannot You may have fractured the pain? move the joint a bone, strained or torn a muscle, or torn Considerably The joint appears a ligament. worsens it misshapen or swollen • Follow the first-aid Slightly worsens it or no change Neither advice for a broken arm or leg (pp.44–45). Did the pain come on ACTION ACTION gradually over TRY SELF-HELP MEASURES MAKE AN APPOINTMENT months or years? TO SEE YOUR DOCTOR You have probably Yes strained a ligament You may have around the joint. osteoarthritis. No • Follow the first-aid • Take an analgesic advice for sprains and such as acetaminophen. strains (p.47). • Put a covered hot- CONSULT YOUR DOCTOR water bottle or heating if the joint is no better pad on the joint. in 24 hours.

Have you ACTION JOINT PAIN 147 recently had either of the SEE YOUR DOCTOR ACTION following? WITHIN 24 HOURS SEE YOUR DOCTOR An infection Certain bacterial WITHIN 24 HOURS with a rash infections of the An infection intestines and genital Some viral illnesses, without a rash tract can lead to such as rubella reactive arthritis (short- (German measles), Neither term inflammation can cause joint pain, of the joint). but if you have been ACTION bitten by a tick, an ACTION infection such as Lyme SEE YOUR DOCTOR disease could be the WITHIN 24 HOURS MAKE AN APPOINTMENT cause of the pain. TO SEE YOUR DOCTOR You may have Is the problem rheumatoid arthritis. You may have a frozen in a child shoulder. under 12? • Take an analgesic • Take an analgesic Under 12 such as ibuprofen. such as acetaminophen 12 or over Which joint to ease the pain. or joints are ACTION • Rest your shoulder. affected? SEE YOUR DOCTOR ACTION WITHIN 24 HOURS Shoulder TRY SELF-HELP MEASURES Most childhood hip Hip problems are not Your symptoms are serious, but some need Neck probably a result of prompt treatment to overuse, although prevent lasting damage Other joint(s) recent viral illness may to the joint. also be the cause. ACTION ACTION • Rest the painful GO TO ANOTHER CHART MAKE AN APPOINTMENT joint(s). TO SEE YOUR DOCTOR Neck pain or stiffness, p.142 • Take an analgesic if you cannot identify a possible cause for such as acetaminophen your joint pain from to ease the pain. this chart. CONSULT YOUR DOCTOR if your condition is no better in 2 days.

148 FAMILY ILLNESS Are you pregnant? Swollen ankles Pregnant If you have a painful swollen ankle, see p.146 Slight, painless swelling of the ankles is most often Not pregnant caused by fluid accumulating in the tissues after long periods of sitting or standing still, but it may be due ACTION to heart, liver, or kidney disorders. Ankle swelling is common during pregnancy. If swelling persists or if TRY SELF-HELP MEASURES you have other symptoms, consult your doctor. Swelling can persist or START Are both Have you been recur for several weeks ankles suffering from following an injury. affected? increased • If the injury occurred shortness of Both ankles within the past 2 days, breath? follow the first-aid One ankle advice for sprains and Shortness strains (p.47). Is the calf of of breath the affected • For a less recently leg either of No shortness the following? of breath sustained injury, try resting the limb for Swollen ACTION 48 hours. Tender SEE YOUR DOCTOR CONSULT YOUR DOCTOR WITHIN 24 HOURS Neither if swelling persists You may be suffering despite rest or if the from heart failure, in ankle is painful, which fluid accumulates tender, or inflamed. around the body. Other possible causes are a liver or kidney problem. ACTION Have you injured your ankle CALL YOUR DOCTOR NOW within the past You may have deep vein few weeks? thrombosis (blood clot in a vein in your leg). Recent injury No recent injury

Does either of ACTION SWOLLEN ANKLES 149 the following CALL YOUR DOCTOR ACTION apply? NOW Retaining TRY SELF-HELP MEASURES Your face or excessive amounts fingers are of fluid may be a You may have varicose symptom of pre- veins, which can cause swollen eclampsia, which, if fluid to accumulate in severe, can be serious. the ankles. You have gained over 5 lb (2.3 kg) ACTION • Avoid standing still in the past week TRY SELF-HELP MEASURES for long periods. Neither Swollen ankles are • Walk as much as Did your ankles common during become swollen pregnancy, particularly possible. during either of in the last 3 months. the following? • When sitting down, • Avoid standing still A long train, try to keep your feet car, or bus trip for long periods. raised above hip level. Airplane flight • Put your feet up • Wear support hose. Neither whenever possible. CONSULT YOUR DOCTOR ACTION CONSULT YOUR DOCTOR if the swelling worsens or if other symptoms TRY SELF-HELP MEASURES if your face and/or develop. fingers become swollen Hours of inactivity will or if you start to put Do you have lead to accumulation of on weight rapidly. prominent fluid in the ankles and increases the risk of ACTION veins in one or developing a blood clot. both legs MAKE AN APPOINTMENT affected by • Clear excess fluid by TO SEE YOUR DOCTOR swelling? taking a brisk walk. Your symptom may be Prominent veins a side effect of the drug. • Avoid sitting or No prominent • Stop taking any over- veins standing still for long periods. the-counter medicines ACTION but continue to take • When seated, keep prescribed medication MAKE AN APPOINTMENT unless advised to stop TO SEE YOUR DOCTOR your legs raised. by your doctor. if you cannot identify Are you a possible cause for currently taking your swollen ankles any medication? from this chart. Medication No medication