Why get vaccinated?

Haemophilus influenzae type b (Hib) disease is a serious bacteria disease. It usually affects children under 5 years old. It can also affect adults with certain medical conditions.

Your child can get Hib disease by being around other children or adults who may have the bacteria and not know it. The germs spread from person to person. If the germs stay in the child's nose and throat, the child probably will not get sick. But sometimes the germs spread into the lungs or the bloodstream, and then Hib can cause serious problems. This is called invasive Hib disease.

Before Hib vaccine, Hib disease was the leading cause of bacterial meningitis. Meningitis is an infection of the lining of the brain and spinal cord. It can lead to brain damage and deafness. Hib disease can also cause:

•    Pneumonia

•    Severe swelling in the throat, making it hard to breathe

•    Infections of the blood, joints, bones, and covering of the heart

•    Death

Hib vaccine can prevent Hib disease. Since use of Hib vaccine began, the number of cases of invasive Hib disease has decreased by more than 99%. Many more children would get Hib disease if we stopped vaccinating.

Hib vaccine

Several different brands of Hib vaccine are available. Your child will receive either 1 to 4 doses, depending on which vaccine is used and the vaccine start age.

3 doses are given with interval of 1 to 2 months before the age of 6 months old, and 4^thdose after the age of 1 year old.

Hib vaccine may be given at the same time as other vaccines. Hib vaccine may be given as part of a combination vaccine. Combination vaccines are made when two or more types of vaccine are combined together into a single shot, so that one vaccination can protect against more than one disease.

Children over 5 years old and adults usually do not need Hib vaccine. But it may be recommended for older children or adults with asplenia or sickle cell disease, before surgery to remove the spleen, or following a bone marrow transplant. It may also be recommended for people 5 to 18 years old with HIV. Your doctor or the person giving you the vaccine can give you more information.

Some people should not get this vaccine 

•    Hib vaccine should not be given to infants younger than 6 weeks of age

•    A person who has ever had a life-threatening allergic reaction after a previous dose of Hib vaccine, or has a severe allergy to any part of this vaccine, should not get Hib vaccine. Tell the person giving the vaccine about any severe allergies

•    People who are mildly ill can get Hib vaccine. People who are moderately or severely ill should probably wait until they recover. Talk to your healthcare provider if the person getting the vaccine isn't feeling well on the day the shot is scheduled

Risks of a vaccine reaction

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own. Serious reactions are also possible but are rare.Most people who get Hib vaccine do not have any problems with it.

After vaccination, please stay in clinic observation area for 30 minutes.

Mild problems following Hib vaccine

•    Redness, warmth, or swelling where the shot was given

•    Fever

These problems are uncommon. If they occur, they usually begin soon after the shot and last 2 or 3days.

Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare. Fever estimated at 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance ofa vaccine causing a serious injury ordeath. Older children, adolescents, and adults might also experience these problems after any vaccine:

•    People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears

•    Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely

What if there is a serious reaction?

What should I look for?

Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

If you think it is a severe allergic reaction or other emergency that can't wait, call 120 or get the person to the nearest hospital. Otherwise, call your doctor.

Where can I get more information?

•    Jiahui Health

Contact number: 400-868-3000

•    Shanghai Municipal Center for Disease Control & Prevention 

Contact number: 021-62758710

Why get vaccinated?

Hepatitis B is a serious disease that affects the liver. It is caused by the hepatitis B virus. Hepatitis B can cause mild illness lasting a few weeks, or it can lead to a serious, life long illness. Hepatitis B virus infection can be either acute or chronic.

Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis B virus. This can lead to:

•    Fever, fatigue, loss of appetite, nausea, and/or vomiting

•    Jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements)

•    Pain in muscles, joints, and stomach

Chronic hepatitis B virus infection is a long-term illness that occurs when the hepatitis B virus remains in a person's body. Most people who go on to develop chronic hepatitis B do not have symptoms, but it is still very serious and can lead to:

•    Liver damage (cirrhosis)

•    Liver cancer

•    Death

Chronically-infected people can spread hepatitis B virus to others, even if they do not feel or look sick themselves. Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. People can become infected with the virus through:

•    Birth (a baby whose mother is infected can be infected at or after birth)

•    Sharing items such as razors or toothbrushes with an infected person

•    Contact with the blood or open sores of an infected person

•    Sex with an infected partner

•    Sharing needles, syringes, or other drug-injection equipment

•    Exposure to blood from needle sticks or other sharp instruments

Hepatitis B vaccine can prevent hepatitis B and its consequences, including liver cancer and cirrhosis.

Hepatitis B vaccine

Hepatitis B vaccine is made from parts of the hepatitis B virus. It cannot cause hepatitis B infection. The vaccine is usually given as 3 doses over a 6-month period. Infants should get their first dose of hepatitis B vaccine at birth, second dose at first month and third dose at six month. All children and adolescents younger than 19 years of age who have not yet gotten the vaccine should also be vaccinated.

Hepatitis B vaccine is recommended for unvaccinated adults who are at risk for hepatitis B virus infection, including:

•    People whose sex partners have hepatitis B

•    Sexually active persons who are not in a long-term monogamous relationship

•    Persons seeking evaluation or treatment for a sexually transmitted disease

•    Men who have sexual contact with other men

•    People who share needles, syringes, or other drug-injection equipment

•    People who have household contact with someone infected with the hepatitis B virus

•    Health care and public safety workers at risk for exposure to blood or body fluids

•    Residents and staff of facilities for developmentally disabled persons

•    Persons in correctional facilities

•    Victims of sexual assault or abuse

•    Travelers to regions with increased rates of hepatitis B

•    People with chronic liver disease, kidney disease, HIV infection, or diabetes

•    Anyone who wants to be protected from hepatitis B

There are no known risks to getting hepatitis B vaccine at the same time as other vaccine.

Some people should not get this vaccine 

Tell the person who is giving the vaccine:

•    If the person getting the vaccine has any severe, life-threatening allergies. If you ever had a life-threatening allergic reaction after a dose of hepatitis B vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated. Ask your health care provider if you want information about vaccine components

•    If the person getting the vaccine is not feeling well. If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you

Risks of a vaccine reaction

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible. Most people who get hepatitis B vaccine do not have any problems with it.

After vaccination, please stay in clinic observation area for 30 minutes.

Minor problems following hepatitis B vaccine include

•    Soreness where the shot was given

•    Temperature of 99.9°F or higher

If these problems occur, they usually begin soon after the shot and last 1 or 2 days.Your doctor can tell you more about these reactions.

Other problems that could happen after this vaccine

•    People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your provider if you feel dizzy, or have vision changes or ringing in the ears

•    Some people get shoulder pain that can be more severe and longer-lasting than the more routine soreness that can follow injections. This happens very rarely

•    Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

What if there is a serious reaction?

What should I look for?

Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

If you think it is a severe allergic reaction or other emergency that can't wait, call 120 or get the person to the nearest hospital. Otherwise, call your doctor.

Where can I get more information?

•    Jiahui Health

Contact number: 400-868-3000

•    Shanghai Municipal Center for Disease Control & Prevention 

Contact number: 021-62758710

Why get vaccinated?

Hepatitis A is a serious liver disease. It is caused by the hepatitis A virus (HAV). HAV is spread from person to person through contact with the feces (stool) of people who are infected, which can easily happen if someone does not wash his or her hands properly. You can also get hepatitis A from food, water, or objects contaminated with HAV.

Symptoms of hepatitis A can include:

•    Fever, fatigue, loss of appetite, nausea, vomiting, and/or joint pain

•    Severe stomach pains and diarrhea (mainly in children)

•    Jaundice (yellow skin or eyes, dark urine, clay-colored bowel movements)

These symptoms usually appear 2 to 6 weeks after exposure and usually last less than 2 months, although some people can be ill for as long as 6 months. If you have hepatitis A you may be too ill to work.

Children often do not have symptoms, but most adults do. You can spread HAV without having symptoms.

Hepatitis A can cause liver failure and death, although this is rare and occurs more commonly in persons 50 of age or older and persons with other liver diseases, such as hepatitis B or C.

Hepatitis A vaccine

Hepatitis A vaccine is an inactivated (killed) vaccine. The vaccine comes indifferent adult and children/adolescents dosage variety. You will need 2 doses for long-lasting protection. These doses should be given at least 6 months apart.

Children are routinely vaccinated between their first and second birthdays (12 through 23 months of age). Older children and adolescents can get the vaccine after 23 months. Adults who have not been vaccinated previously and want to be protected against hepatitis A can also get the vaccine.

You should get hepatitis A vaccine if you: 

•    Are traveling to countries where hepatitis A is common

•    Are a man who has sex with other men

•    Use illegal drugs

•    Have a chronic liver disease such as hepatitis B or hepatitis C

•    Are being treated with clotting-factor concentrates

•    Work with hepatitis A-infected animals or in a hepatitis A research laboratory

•    Expect to have close personal contact with an international adoptee from a country where hepatitis A is common

 Ask your healthcare provider if you want more information about any of these groups.There are no known risks to getting hepatitis A vaccine at the same time as other vaccines.

Some people should not get this vaccine 

Tell the person who is giving you the vaccine:

•    If you have any severe, life-threatening allergies.If you ever had a life-threatening allergic reaction after a dose of hepatitis A vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get vaccinated. Ask your health care provider if you want information about vaccine components

•    If you are not feeling well. If you have a mild illness, such as a cold, you can probably get the vaccine today. If you are moderately or severely ill, you should probably wait until you recover. Your doctor can advise you

Risks of a vaccine reaction

With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own, but serious reactions are also possible. Most people who get hepatitis A vaccine do not have any problems with it.

After vaccination, please stay in clinic observation area for 30 minutes.

Minor problems following hepatitis A vaccine include

•    Soreness or redness where the shot was given

•    Low-grade fever

•    Headache

•    Tiredness

If these problems occur, they usually begin soon after the shot and last 1 or 2 days.Your doctor can tell you more about these reactions.

Other problems that could happen after this vaccine

•    People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your provider if you feel dizzy, or have vision changes or ringing in the ears

•    Some people get shoulder pain that can be more severe and longer lasting than the more routine soreness that can follow injections. This happens very rarely

•    Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

What if there is a serious reaction?

What should I look for?

Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes. Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

If you think it is a severe allergic reaction or other emergency that can't wait, call 120 or get the person to the nearest hospital. Otherwise, call your doctor.

Where can I get more information?

•    Jiahui Health

Contact number: 400-868-3000

•    Shanghai Municipal Center for Disease Control & Prevention 

Contact number: 021-62758710

Why get vaccinated?

Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria. Diphtheria and pertussis are spread from person to person. Tetanus enters the body through cuts or wounds.

DIPHTHERIA causes a thick covering in the back of the throat.

•    It can lead to breathing problems, paralysis, heart failure, and even death

TETANUS (Lockjaw) causes painful tightening of the muscles, usually all over the body.

•    It can lead to “locking” of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in up to 2 out of 10 cases

PERTUSSIS (Whooping Cough) causes coughing spells so bad that it is hard for infants to eat, drink, or breathe. These spells can last for weeks.

•    It can lead to pneumonia, seizures (jerking and staring spells), brain damage, and death

Diphtheria, tetanus, and pertussis vaccine (DTaP) can help prevent these diseases. Most children who are vaccinated with DTaP will be protected throughout childhood. Many more children would get these diseases if we stopped vaccinating. DTaP is a safer version of an older vaccine called DTP.

Who should get DTaP vaccine and when?

Children should get 4 doses of DTaP vaccine, one dose at each of the following ages:

•    3 months

•    4 months

•    5 months

•    18-24 months DTaP may be given at the same time as other vaccines

Both the (4-in-1) DTaP-Hib and (5-in-1) DTaP-Polio-Hib vaccines contain the DTaP vaccine.For details, please consult your doctor.

DTaP-Hib vaccine is administered at the age 3, 4, 5 and 18 months.

DTaP-Polio-Hib vaccine is administered at the age of 2, 3, 4 and 18 months.

Some children should not get DTap vaccine or should wait

•    Children with minor illnesses, such as a cold, may be vaccinated. But children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine

•    Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose

•    Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose

•    Talk with your doctor if your child: 

  ○      Had a seizure or collapsed after a dose ofDTaP

  ○      Cried non-stop for 3 hours or more after a dose of DTaP

  ○      Had a fever over 105°F after a dose of DTaP

Ask your doctor for more information. Some of these children should not get another dose of pertussis vaccine, but may get a vaccine without pertussis, calledDT.

Older children and adults

DTaP is not licensed for adolescents, adults, or children 7 years of age andolder. But older people still need protection. A vaccine called Tdap is similar to DTaP. A single dose of Tdap is recommended for people 11 through 64 years of age. Another vaccine, called Td, protects against tetanus and diphtheria, but not pertussis. It is recommended every 10 years. 

What are the risks from DTaP Vaccine?

Getting diphtheria, tetanus, or pertussis disease is much riskier than getting DTaP vaccine. However, a vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of DTaP vaccine causing serious harm, or death, is extremely small.

After vaccination, please stay in clinic observation area for 30 minutes.

•    Fever (up to about 1 child in 4)

•    Redness or swelling where the shot was given (up to about 1 child in 4)

•    Soreness or tenderness where the shot was given (up to about 1 child in 4)

These problems occur more often after the 4^th and 5^th doses of the DTaP series than after earlier doses. Sometimes the 4^th or 5^th dose of DTaP vaccine is followed by swelling of the entire arm or leg in whichthe shot was given, lasting 1–7 days (up to about 1 child in 30).

Other mild problems

•    Fussiness (up to about 1 child in 3)

•    Tiredness or poor appetite (up to about 1 child in 10)

•    Vomiting (up to about 1 child in 50)

These problems generally occur 1–3 days after the shot.

•    Seizure (jerking or staring) (about 1 child out of 14,000)

•    Non-stop crying, for 3 hours or more (up to about 1 child out of 1,000)

•    High fever, over 105°F (about 1 child out of 16,000) 

Severe problems (very rare)

•    Serious allergic reaction (less than 1 out of a million doses)

•    Several other severe problems have been reported after DTaP vaccine. These include:

  ○       Long-term seizures, coma, or lowered consciousness

  ○       Permanent brain damage

These are so rare it is hard to tell if they are caused by the vaccine.

Controlling fever is especially important for children who have had seizures, for any reason. It is also important if another family member has had seizures. You can reduce fever and pain by giving your child an aspirin-free pain reliever when the shot is given, and for the next 24 hours, following the package instructions.

What if there is a serious reaction?

What should I look for?

Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, orbehavior changes. Signs of a severe allergic reaction can includehives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should Ido?

If you think it is a severe allergic reaction or other emergency that can't wait, call 120 or get the person to the nearest hospital. Otherwise, call your doctor.

Where can I get more information?

•    Jiahui Health

Contact number: 400-868-3000

•    Shanghai Municipal Center for Disease Control & Prevention 

Contact number: 021-62758710

What is a trigger point? 

Trigger points are often called muscle knots. They are a tight lump in an area of muscle that can cause pain.

Where might trigger points occur? 

You may have trigger points in your neck, shoulders, or upper and lower back. You may have them in your head or jaws. You may also have them in your buttocks or legs. You may only have one trigger point or you may have many in the different areas of your body.

What causes trigger points?

Trigger points may be caused by muscle injury. They may also form if you use the muscle too much, or you have repeated minor stressto the muscle. Minor stress may result from things such as poor posture and sleep position. Emotional stress may also cause trigger points. This can happen when stress makes you tense certain muscles, such as those in your shoulders and neck.

What are the signs and symptoms of trigger points? 

•    Pain: Trigger points can cause deep, aching pain. They may cause pain only when the trigger point is pressed. They may also cause constant pain, or pain during movement of the muscle. Pain may spread away from the trigger point. Pain may also occur in another part of your body. For example, a trigger point in your neck may cause eye pain. This is called referred pain

•    Decreased range of motion: Range of motion is how much you can move a joint, such as your shoulder or knee. A trigger point can shorten a muscle. This can reduce the range of motion of a nearby joint

•    Muscle weakness: The pain caused by a trigger point may weaken the muscle

•    Other signs and symptoms: You may be dizzy or hear ringing in your ears. Your skin over the trigger point may turn red. Your skin may tingle and be sensitive to the touch. Trigger points may also cause your mouth may make extra saliva and your eyes may make extra tears

How are trigger points diagnosed?

Your doctor will ask about your health history. He will also ask you to describe your pain. You may need certain tests to rule out other conditions. Your doctor will look for a hard lump in your muscle. He may press on or squeeze the tissue over this lump. He will do this to see if the muscle twitches(quick movements) and if you have any pain. These signs help your doctor know if you have a trigger point. You may also need tests to make sure your pain is not related to a more serious condition. Tests include:

What is sciatica? 

Sciatica is a condition that causes pain along your sciatic nerve. The sciatic nerve runs from your spine through both sides of your buttocks. It then runs down the back of your thigh, into your lower leg and foot. Any place along your sciatic nerve may be compressed, inflamed, irritated, or stretched and cause symptoms.

What causes sciatica? 

Sciatica may be related to certain activities, poor posture, and physical or psychological stress. Any of the following may cause or increase your risk of sciatica: 

•    Disc problems: A slipped disc (soft cushion in between the bones of the spine) is the most common cause of sciatica. The disc may press on the sciatic nerve. One bone in your spine may slip over another, or you may have narrowing of the spinal column

•    Muscle injury: This may happen after you twist or lift a heavy object. Swelling from sprained or irritated muscles in the buttocks, thighs, or legs press on the sciatic nerve

•    Obesity or pregnancy: Extra weight increases pressure on your back and legs

•    Trauma: Direct blows on the buttocks, thighs, or legs, car accidents, or falls may injure the sciatic nerve

•    Diseases of the spine: Arthritis, osteoporosis, cancer, or infection of the spine may also affect the sciatic nerve

What are the signs and symptoms of sciatica? 

The symptoms of sciatic may be short-term or long-term:

•    Pain that goes from the lower back into your buttocks and down the back of your thigh

•    Numbness or tingling in your buttocks and legs

•    Muscle weakness, difficulty moving or controlling your leg or foot

•    Leg pain that increases with standing, sitting, or squatting 

How is sciatica diagnosed? 

Your doctor will ask about other health conditions you may have. He may ask you about your job, history of back pain, diseases, or surgeries you have had. He will examine you and move your legs to see what increases pain. You may also need any of the following:

What do I need to know about cough and cold medicines? 

Over-the-counter (OTC) cough and cold medicines contain 1 or more ingredients used to decrease cough and cold symptoms. OTC cough medicine may contain an antitussive, expectorant, or both. Antitussives decrease cough by blocking your child's cough reflex. Expectorants thin mucus to help clear it from your child's airway. Cold medicines may have any combination of a cough medicine, antihistamine, decongestant, and pain medicine. Antihistamines may help reduce runny nose and sneezing. Decongestants may help to reduce nasal congestion (stuffiness). Pain medicines also help to decrease a fever.

Who should not take OTC cough and cold medicines? 

Children under the age of 4 years should not take OTC cough and cold medicines. Do not give medicines that contain aspirin to children under 18 years of age. Your child could develop Reye syndrome if he or she takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen. 

How do I safely give OTC cough and cold medicines to my child? 

•    Ask if you can give OTC cough and cold medicine to children 4 to 6 years old. Your child's doctor may recommend another medicine or treatment

•    Choose a cold medicine that decreases only the symptoms your child has. Some cold medicines may have ingredients that your child does not need

•    Do not combine cough and cold medicines together or with pain medicine. Different cold medicines may contain the same ingredient. For example, cold medicines may contain acetaminophen. When you give your child more than one type of medicine, your child may get too much of the same ingredient

•    Do not combine cough and cold medicines with prescription medicines unless your child's doctor says it is okay. When you give your child these medicines together they may not work correctly. It may also increase your child's risk for side effects

•    Read the directions on the label. Find out if the medicine is right for your child's age and how much to give to your child. The dose for your child's weight or age should be listed. Do not give your child more than the recommended amount. Do not give your child medicine that is meant for an adult. Write down when you give your child each dose

•    Use the measuring tool that came with the medicine. Donot use another measuring tool, such as a kitchen spoon. You may give your child too much or too little medicine if you use other measuring tools

What else can I do to keep my child safe? 

•    Keep OTC cough and cold medicines in locked cabinets. This can help prevent an overdose of medicine. It can also prevent children younger than 4 years from taking cough and cold medicine

•    Talk to your older child about abuse of OTC cough and cold medicine. Teens sometimes take large amounts of OTC cough and cold medicines to feel high. Abuse of OTC cough and cold medicines can lead to an overdose. Watch for signs of cough and cold medicine abuse, such as slurred speech or trouble walking. Monitor the amount of cough and cold medicines in your home. Tell your child about the risks of cough and cold medicine abuse, such as damage to his or her organs

•    Throw away expired medicine. Expired medicine may not work correctly 

What do I need to know about OTC cough and cold medicine overdose?

 An overdose means your child has had too much cough and cold medicine. An overdose can become life-threatening. Your child may have any of the following if he or she has had an overdose of OTC cough and cold medicine: 

•    Blurred vision, dilated pupils, or severe headache

•    Nausea, vomiting, diarrhea, or constipation

•    Anxiety, irritability, restlessness, or hallucinations

•    Slurred speech, trouble thinking, or unusual behavior

•    A fast heartbeat, irregular heartbeat, or trouble breathing

•    Seizures, loss of consciousness, or not waking up

What should I do if I think my child took too much OTC cough and cold medicine? 

Go to hospital immediately. 

Call 120 if: 

•    Your child has a seizure

•    Your child has trouble breathing

•    Your child sees or hears things that are not there

When should I seek immediate care? 

•    Your child's heartbeat is faster than usual

•    Your child is anxious, irritable, or restless

•    Your child's speech is slurred and he or she has trouble thinking 

•    Your child has nausea, or he or she is vomiting

•    Your child has blurred vision or dilated pupils

When should I contact my child's doctor? 

•    Your child has a severe sore throat with a fever, headache, rash, nausea, or vomiting

•    Your child's fever lasts longer than 3 days

•    Your child's cough lasts longer than 1 week

•    Your child has wheezing when he or she coughs or breathes

•    Your child has headache that does not go away

•    Your child has a rash or hives

•    You have questions or concerns about your child's condition or care

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. 

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics. 

Congratulations! You're pregnant! To give your baby a good possible start, take especially good care of yourself during your pregnancy. Here are answers to questions newly pregnant women often ask. This information will help you understand what you should and should not do until you see your doctor.

What do I do first?

Make an appointment with an obstetrician as soon as possible. Your primary care practitioner can help you with referrals. At your first visit, the obstetrician will take a medical history and perform a physical exam including a pelvic exam. If you are due for a TCT (Pap) it will be performed as well. He or she will also take blood and urine samples to test for blood type, anemia, viral infection, and other important information. If you are beyond a month after conception, a transvaginal ultransound examination will also be performed to evaluate the initial health of your pregnancy. After this first visit, you will probably see your doctor once a month for the first 7 months, and then more frequently towards the end of your pregnancy.

Do I need any special diet or vitamins?

Start taking a multivitamin immediately if you are not already doing so. You can get prenatal vitamins at the drug store, without a prescription. A vitamin supplement is not a substitute for a nutritious diet, however. It's important to eat balanced nutritious meals. Every day, try to have:

•    3 servings daily of high protein food (meats, eggs, seafood, peas or beans)

•    4 servings daily of milk products (milk, cheese, cottage cheese or yogurt) 

•    4 servings daily of breads, cereals, pasta or rice

•    3-4 servings of fruit and vegetables

•    At least eight 8-ounce glasses of water or other fluids (avoid excessive caffeinated beverages such as coffee, tea, cola)

Do not diet unless your obstetrician advises you to do so.  Our nutritional experts at our Wellness Center are also available to assist you with nutritional plans designed specifically for pregnant women.

Walking and swimming are good ways to get exercise while you are pregnant. Other sports, such as tennis and running, are fine, too, as long as you were used to them before you became pregnant and you avoid overexertion. Our fitness experts at our Wellness Center are also available to assist you with exercise programs designed specifically for pregnant women.

Can I travel?

Air travel is safe throughout an uncomplicated pregnancy. Make sure that you take frequent breaks at least every two hours to get up and walk around. While you are seated in a car or plane, always wear a seatbelt (fastened low and use a shoulder harness if ridig in a car).

Sexual intercourse is perfectly safe during an uncomplicated pregnancy.

Are cats safe to keep in the house?

Most obstetricians feel that pet cats are fine; however you should avoid cleaning out the litter box yourself because of the rare, but possible transmission of toxoplasmosis. Good hand washing is always recommended.

What do I need to avoid?

•    Smoking has been linked to premature births, low birth weights, and increased risk of miscarriages and stillbirths, and delayed mental and physical development. If you smoke, STOP

•    Alcohol use is correlated with an increase risk of miscarriages and premature births. Heavy drinking is associated with Fetal Alcohol Syndrome, which is a pattern of serious mental and physical defects. To be safe, avoid all alcohol until you discuss this with your doctor. Although it is possible that a safe level of alcohol intake may be safe, there is no known proven level that has been definitively shown to be safe

•    Some fish may contain levels of mercury that could be harmful to a developing baby. Avoid swordfish, king mackerel, shark and tilefish. Dairy products containing unpasteurized milk can make you sick when you're pregnant. Stay away from soft cheeses including brie, feta, camembert, blue-veined cheeses such as Roquefort, and Mexican-style cheeses such as queso blanco, queso fresco and queso de hoya

•    Medications, including all over-the-counter remedies such as aspirin, cold medicines, nose sprays, douches, etc., should be avoided unless you ask your obstetrician first. An occasional Acetaminophen (Tylenol) for headaches or pseudoephedrine for severe sinus congestion is permissible if necessary. Please refer to our expanded list of safe medications in your pregnancy handbook

•    All illicit drugs should always be avoided

•    X-rays may be used when medically indicated. A lead shield should be used to cover your abdomen and pelvis. Current airport scanning technology is believed to be safe

•    Deet insect repellent is safe, and mosquito bites should be avoided to prevent transmission of Zika Virus which can be very dangerous to a developing pregnancy

What symptoms might I expect early in the pregnancy?

 •    Morning sickness is the common name for nausea and vomiting of early pregnancy. More than half of all pregnant women report some kind of morning sickness. No one knows exactly why this happens, but hormonal and metabolic changes, digestive    troubles, and emotional factors all likely play a role. Most women have the symptoms only in the morning but some women have  it all day long or only later in the day. In most cases, eating crackers or dry popcorn can help. Avoid greasy foods and large amounts of fluids when nauseated. Also try eating smaller, more frequent meals. Contact your doctor if nausea and vomiting become severe or persist

•    Frequent urination commonly occurs early on in pregnancy. It is probably caused by hormonal changes and, as the pregnancy progresses, by pressure on the bladder. Since urinary tract infections are also more common in pregnant women, be sure to let your doctor know if you have a burning sensation when urinating or feel as if you can't fully empty your bladder

•    Constipation and hemorrhoids also occur early on in pregnancy. Try eating high fiber foods and lots of fluids to help soften your stools

What are signs of trouble?

If you develop pelvic or abdominal pain, or bleeding from the vagina, call your obstetrician immediately.

You are starting out on a great adventure. Take care of yourself, relax, and enjoy this special time in your life. Good luck and congratulations!

This document is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2018 The General Hospital Corporation.

Primary Care Office InSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What are nutrition tips for relief of diarrhea? 

There are diet changes you can make to help relieve or stop diarrhea. These changes include limiting or avoiding foods and liquids that are high in sugar, fat, fiber, and lactose. Lactose is a sugar found in milk products. Milk products can cause diarrhea in people who are lactose intolerant. You should also drink extra liquids to replace fluids that are lost when you have diarrhea. Diarrhea can lead to dehydration. 

Which foods and liquids should I limit or avoid? 

•    Dairy: 

  ○   Whole milk

  ○   Half-and-half, cream, and sour cream

  ○   Regular(whole milk) ice cream 

 •    Grains: 

  ○   Whole wheat and whole grain breads, pasta, cereals, and crackers

  ○   Brown and wild rice

  ○   Breads and cereals with seeds or nuts

  ○   Popcorn

 •    Fruit and vegetables: 

  ○   All raw fruits, except bananas and melon

  ○   Dried fruits, including prunes and raisins

  ○   Canned fruit in heavy syru

  ○   Prune juice and any fruit juice with pulp

  ○   Raw vegetables, except lettuce 

  ○   Fried vegetables

  ○   Corn, raw and cooked broccoli, cabbage, cauliflower, and collard greens 

 •    Protein: 

  ○   Fried meat, poultry, and fish

  ○   High-fat luncheon meats, such as bologna

  ○   Fatty meats, such as sausage, bacon, and hot dog

  ○   Beans and nuts

 •    Liquids: 

  ○   Sodas and fruit-flavored drinks

  ○   Drinks that contain caffeine, such as energy drinks, coffee, and tea 

  ○   Drinks that contain alcohol or sugar alcohol, such as sorbitol 

Which foods and liquids may I eat and drink? 

Most people can tolerate the foods and liquids listed below. If any of them make your symptoms worse, stop eating or drinking them until you feel better. If you are lactose intolerant, avoid milk products.

•    Dairy: 

  ○   Skim or low-fat milk or evaporated milk

  ○   Soy milk or buttermilk 

  ○   Low-fat, part-skim, and aged cheese

  ○   Yogurt, low-fat ice cream, or sherbert

 •    Grains: (Choose foods with less than 2 grams of dietary fiber per serving) 

  ○   White or refined flour breads, bagels, pasta, and crackers

  ○   Cold or hot cereals made from white or refined flour such as puffed rice, cornflakes, or cream of wheat

  ○   White rice

 •    Fruit and vegetables: 

  ○   Bananas or melon

  ○   Fruit juice without pulp, except prune juice

  ○   Canned fruit in juice or light syrup

  ○   Lettuce and most well-cooked vegetables without seeds or skins 

  ○   Strained vegetable juice

 •    Protein: 

  ○   Tender, well-cooked meat, poultry, or fish

  ○   Well-cooked eggs or soy foods (cooked without added fat)

  ○   Smooth nut butters

 •    Fats: (Limit fats to less than 8 teaspoons a day) 

  ○   Oil, butter, or margarine, or mayonnaise

  ○   Cream cheese or salad dressings

 •    Liquids: 

  ○   For infants, breast milk or formula

  ○   Oral rehydration solution 

  ○   Decaffeinated coffee or caffeine-free teas

  ○   Soft drinks without caffeine

What other guidelines should I follow? 

•    Drink liquids as directed. You may need to drink more liquids than usual to prevent dehydration. Ask how much liquid to drink each day and which liquids are best for you. You may need to drink an oral rehydration solution (ORS). An ORS helps replace fluids and electrolytes that you lose when you have diarrhea

•    Eat small meals or snacks every 3 to 4 hours instead of large meals. Continue eating even if you still have diarrhea. Your diarrhea will continue for a few days but should gradually go away

CARE AGREEMENT:

You have the right to help plan your care. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

What do I need to know about narcotics?

A narcotic is a type of medicine used to treat pain. Examples of narcotics are codeine, oxycodone, and fentanyl.

Why is it important to manage my pain? 

Pain can cause changes in your physical and emotional health, such as depression and sleep problems. Pain control and management may help you rest, heal, and return to your daily activities.

What are the side effects of narcotic medicines?

The most common side effect is constipation. Drink more liquids and eat high-fiber foods to help prevent constipation. Ask your doctor what liquids are right for you and how much you should drink. Also ask for a list of foods that contain fiber. Other side effects include nausea, sleepiness, and itchiness. You may need to take your narcotic medicine with food to decrease nausea. Ask your doctor other ways to manage side effects.

Why it is important that I take narcotic medicines as directed? 

•    Health problems such as trouble breathing, liver or kidney damage, or stomach bleeding may occur. Any of these problems can become life-threatening

•    Acetaminophen or ibuprofen may be included in some narcotic medicines. Too much of these medicines can cause liver or kidney damage, or stomach bleeding. These problems can become life-threatening

•    Dependence means your body needs the medicine to keep it from going through withdrawal

•    Tolerance means the medicine does not control pain as well as it used to. You need higher doses of the medicine to get pain relief

•    Addiction means you are not able to control the use of the medicine. You use it when you do not have pain and you have cravings for the medicine

What do I need to know about narcotic safety? 

•    Take your medicine as directed.Ask if you need more information on how to take your medicine correctly. Follow up with your doctor regularly. You may need to have your dose adjusted. Do not use narcotic medicine if you are pregnant or breastfeeding. Narcotic medicines can be transferred to your baby through your blood and breast milk

•    Give your doctor a list of all your medicines. Include any over-the-counter medicines, vitamins, and herbs. It can be dangerous to take narcotics with certain other medicines, such as antihistamines

•    Keep your medicine in a safe place. Store your narcotic medicine in a locked cabinet to keep it away from children and others

•    Do not drink alcohol while you use narcotics. Alcohol use with a narcotic medicine can make you sleepy and slow your breathing rate. You may stop breathing completely

•    Do not drive or operate heavy machinery after you take narcotic medicine. Narcotic medicine can make you drowsy and make it hard to concentrate. You may injure yourself or others if you drive or operate heavy machinery while taking your medicine

Call 120 or have someone call 120 for any of the following: 

•    You are breathing slower than normal, or you have trouble breathing

•    You cannot be woken

•    You have a seizure

When should I seek immediate care? 

•    Your heart is beating slower than usual

•    Your heart feels like it is jumping or fluttering

•    You have trouble staying awake

•    You have severe muscle pain or weakness

•    You see or hear things that are not real

When should I contact my doctor? 

•    You are too dizzy to stand up

•    Your pain gets worse or you have new pain

•    Your pain does not get better after you use your narcotic medicine

•    You cannot do your usual activities because of side effects from the narcotic

•    You are constipated or have abdominal pain

•    You have questions or concerns about your condition or care

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. 

© 2017 Truven Health Analytics LLC All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.