Why do I have gas?

Everyone has gas. Burping and "passing gas” is normal. But because it is embarrassing, many people believe they pass gas too often or have too much gas. A person actually having too much gas is rare.

Most of the time, gas in the body is odorless. The odor of passed gas comes from sulfur made by bacteria in the large intestine. Sometimes gas causes bloating or pain. Not everyone has these symptoms. How much gas the body makes and how sensitive a person is to gas in the large intestine have an effect on how uncomfortable one feels.

What can I do about gas?

Changing what you eat and drink can help prevent or reduce gas. If you feel like you have too much gas, you might want to try these things.

1.     Cut down on foods that can cause gas.

The amount of gas caused by certain foods varies from person to person. The only way to know your own limits is to keep track of what you eat and how much gas is causes later. You may want to keep a food diary. Write down what you eat every day and any symptoms you may develop to help determine which foods cause you the most problems.

Foods That May Contribute to Gas Production 

•      Milk Products: Milk, ice cream, cheese

•      Vegetables: Cabbage, broccoli, Brussels sprouts,

•      cauliflower, cucumbers, sauerkraut, kohlrabi, asparagus

•      Root Vegetables: Potatoes, rutabaga, turnips, radishes, onions

•      Fruits: Prunes, apricots, apples, raisins, bananas

•      Cereals & Breads: Cereals, breads, pastries, and all foods containing wheat and wheat products. Check labels

•      Fatty Foods: Pan-fried or deep-fried foods, fatty meats, rich cream sauces and gravies, pastries, and any high-fat food. Check labels

•      Liquids: Carbonated beverages, fizzy medicine 

2.      Drink plenty of water and clear soup but not “fizzy” liquids. 

Try not to drink liquids that can cause gas, like soda and beer.

3.      Eat more slowly and chew your food more.

When you eat fast, you may swallow too much air and this can also cause gas.

This document is intended to provide health related information so that you may be better informed.It is not a substitute for your care team’s medical advice and should not be relied upon for treatment forspecific medical conditions.

© 2017 The General Hospital Corporation.

Primary Care Office lnSite

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

What does the liver do?

Your liver is a large organ inside your body. It is also one of the most important. The liver performs many functions, including changing food into energy and cleaning alcohol and other toxins from the blood. Your liver also makes bile, a yellowish-green liquid that helps with digestion.

What is a liver function test?

A liver function test (LFT) is used to detect, evaluate and monitor liver disease or damage. There are several tests (sometimes called a liver panel) that may be run at the same time on one blood sample. These include tests that measure liver inflammation.

The test is simple and practically painless. A small amount of blood is drawn, usually from a vein inside the elbow.

When are liver tests ordered?

Many patients with early or mild to moderate liver disease have few if any symptoms. In some cases, liver disease is first detected through routine blood testing. Specific liver tests may be ordered when a person has been or may have been exposed to a hepatitis virus; has a family history of liver disease; has excessive alcohol intake; or is taking a drug that can cause liver damage.

Liver tests may also be ordered when symptoms suspicious of a liver condition are noticed. These include: jaundice (yellow-colored skin and eyes), dark urine, or light-colored bowel movements; nausea, vomiting and/or diarrhea; loss of appetite; vomiting of blood; bloody or black bowel movements; swelling or pain in the belly; unusual weight change; or fatigue or loss of stamina.

What will happen if my liver function test results are abnormal?

It  is not unusual for the results of a liver function test to come out abnormal. If this happens in your case, your doctor will probably order another test. Often, the second test shows a normal result and there is no need for further testing. If your doctor is still concerned, he or she may ask for an imaging test such as an ultrasound to find out more about the condition of your liver.

What can I do to prevent the development of fatty liver disease, a common cause of liver inflammation?

There are important things you can do to help prevent fatty liver disease. They include: 

•      Weight loss and exercise. If you are overweight or obese, a diet and exercise program can help prevent the accumulation of fat in your liver. Your doctor can give you information about a healthy weight-loss diet and starting an exercise program

•      Blood sugar control. A healthy diet and exercise can help prevent diabetes from developing. If you have diabetes, it is very important to manage your blood sugar level with diet, medications or insulin. Some diabetes medications can actually help prevent the accumulation of fat in your liver

•      Avoid alcohol. Alcohol can cause liver damage. If you drink alcohol, limit your intake to no more than 1 drink a day for women and no more than 2 drinks a day for men. A drink is a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 11/2 ounce shot of liquor

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team’s medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General Hospital Corporation.

Primary Care Office lnSite

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

What do I need to know about acute neck pain? 

Acute neck pain starts suddenly, increases quickly, and goes away in a few days. The pain may come and go, or be worse with certain movements. The pain may be only in your neck, or it may move to your arms, back, or shoulders. You may also have pain that starts in another body area and moves to your neck.

What causes or increases my risk for acute neck pain?

Acute neck pain is often caused by a muscle strain or ligament sprain. Any of the following may cause acute neck pain:

• Inflammation of discs in your neck

• A condition that affects neck to arm nerves, such as thoracic outlet syndrome or brachial neuritis

• A trauma or injury to your neck, such as being hit from behind in a car (whiplash) or sleeping in a bad position

• Shingles, or an infection such as meningitis

What is abdominal pain?

Abdominal pain is pain that you feel anywhere between your chest and groin. It is also called stomach pain or belly pain. There are many different causes of abdominal pain. If your pain is severe or continues for more than a few days, your doctor may want to examine you and may order tests to help explain why you are having this pain.

In the meantime, here are some steps you can take to begin feeling better：

•   Rest

•   Do not eat solid food until your pain is gone

•   While you have pain: Stay on a clear liquid diet. A clear liquid is one you can see through (water, weak tea, broth or bouillon, ginger ale, jello, Gatorade, apple juice, popsicles or ice chips). Avoid milk or dairy products

•   When your pain is gone: Start a light diet (dry toast, crackers, applesauce, white rice, bananas, broth or bouillon) and increase the diet slowly, as long as it does not bother you. No milk products (including cheese and eggs) and no spicy, fatty, fried or high fiber foods

•   No alcohol, coffee or cigarettes

•   Take your regular medicines unless the doctor told you not to

•   Take any prescribed medicine as directed

•   Do not take medicine containing aspirin or ibuprofen (Advil/Motrin) unless your doctor says to

Call your doctor if:

•   Your pain becomes worse, changes location or feels different

•   You have a fever or shaking chills

•   You keep throwing up or cannot drink liquids

•   You see blood when you throw up or see blood in your bowel movements

•   Your bowel movements become dark or black

•   You move your bowels frequently

•   Your bowel movements stop (become blocked) or you cannot pass gas

•   You have bloody or painful urination

•   Your skin or the whites of your eyes look yellow

•   Your stomach becomes bloated or bigger

•   There is bleeding or discharge from your vagina

•   You feel dizzy or faint

•   Your abdominal pain moves to your chest or your back

This document is intended to provide health related information so that you may be better informed.It is not a substitute for your care team’s medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

PrimaryCare OfficelnSite

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

What do I need to know about pain management after surgery?

 Good control of your pain will help you heal from surgery and return to your normal activities. It will also help you do important activities such as walking and deep breathing. If your pain prevents you from doing these activities, you may be at risk for complications. Examples include a blood clot or pneumonia. Tell your healthcare provider if your pain is not controlled. You may need changes to your medicine or treatment plan. 

What medicines may I need to manage pain? 

You may need any of the following: 

•      Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day

•      NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, alwaysask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions

•      Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation

•      Anxiety medicine decreases anxiety. High levels of anxiety make pain harder to manage

•      Muscle relaxers help decrease pain by relaxing your muscles and preventing spasms

What can I do to manage my pain without medicine? 

Muscle pain can be dull, achy, or sharp. You may have pain and tenderness to the touch as well. It can occur anywhere on your body and is often brought on by exercise. Muscle pain may occur from an injury, such as a sprain, tendonitis, or bone fracture. Muscle pain can also be the result of medical conditions, such as polymyositis, fibromyalgia, and connective tissue disorders. 

DISCHARGE INSTRUCTIONS:

Self care: 

•      Rest as directed and avoid activity that causes pain. You may be able to return to normal activity when you can move without pain. Follow directions for rest and activity. You are at risk for injury for 3 weeks after your symptoms go away 

What is hand, foot, and mouth disease? 

Hand, foot, and mouth disease (HFMD) is an infection caused by a virus. HFMD is easily spread from person to person through direct contact. Anyone can get HFMD, but it is most common in children younger than 10 years.

What are the signs and symptoms of hand, foot, and mouth disease? 

The following signs and symptoms of HFMD normally go away within 7 to 10 days:

•      Fever 

•      Sore throat

•      Lack of appetite

•      Sores or blisters on your tongue, gums, and inside your cheeks that appear 1 to 2 days after a fever starts

•      Rash on the palms of your hands and bottoms of your feet

•      Painful blisters on your hands or feet

How is hand, foot, and mouth disease diagnosed?

 Your healthcare provider will ask how long you have had symptoms and if you have been near anyone who has HFMD. You may also need the following tests:

•      Throat culture: This test may help healthcare providers learn which type of germ is causing your illness. Your healthcare provider will rub a cotton swab against the back of your throat. He will send the swab to a lab for tests

•      Bowel movement sample: A sample of your bowel movement is sent to a lab for tests. The test may show what germ is causing your illness

How is hand, foot, and mouth disease treated? 

HFMD usually goes away on its own without treatment. You may need to drink extra fluids to avoid dehydration. You may also need medicine to decrease a fever or pain. You may need a medical mouthwash to help decrease pain caused by mouth sores.

How do I prevent the spread of hand, foot, and mouth disease? 

You can spread the virus for weeks after your symptoms have gone away. The following can help prevent the spread of HFMD:

•      Wash your hands often. Use soap and water. Wash your hands after you use the bathroom, change a child's diapers, or sneeze. Wash your hands before you prepare or eat food

•      Avoid close contact with others.Do not kiss, hug, or share food or drinks. Ask your child's school or daycare if you need to keep your child home while he has symptoms of HFMD 

•      Clean surfaces well: Wash all items and surfaces with diluted bleach. This includes toys, tables, counter tops, and door knobs

What are the risks of hand, foot, and mouth disease? 

You may get HFMD again. You may not want to eat or drink because of the pain in your mouth and throat. If you do not drink enough fluids, you may become dehydrated. You may lose a fingernail or toenail about 4 weeks after you get sick. The virus may spread and cause meningitis or encephalitis. Meningitis is an infection and swelling of the covering of the brain and spinal cord. Encephalitis is an infection that causes the brain to swell. Encephalitis is rare but can be life-threatening.

When should I contact my healthcare provider? 

•      Your mouth or throat are so sore you cannot eat or drink

•      Your fever, sore throat, mouth sores, or rash do not go away after 10 days

•      You have questions or concerns about your condition or care

When should I seek immediate care? 

•      You urinate less than normal or not at all

•      You have a severe headache, stiff neck, and back pain

•      You have trouble moving, or cannot move part of your body

•      You become confused and sleepy

•      You have trouble breathing, are breathing very fast, or you cough up pink, foamy spit

•      You have a seizure

•      You have a high fever and your heart is beating much faster than it normally does

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.

What is bronchiolitis? 

Bronchiolitis is a viral infection of the bronchioles (small airways) in your child's lungs. It causes the small airways to become swollen and filled with fluid and mucus. This makes it hard for your child to breathe. Bronchiolitis usually goes away on its own. Most children can be treated at home. 

What causes bronchiolitis?

Bronchiolitis is most often caused by the respiratory syncytial virus (RSV). The viruses that cause the flu and the common cold may also cause bronchiolitis. Bronchiolitis may be spread from person to person through coughing, sneezing, or close contact. Germs may be left on objects such as doorknobs, beds, tables, cribs, and toys. Your child can get infected by putting objects that carry the virus into his or her mouth. Your child can also get infected by touching objects that carry the virus and then rubbing his or her eyes or nose. 

What increases my child's risk for bronchiolitis? 

Bronchiolitis most often happens to children younger than 2 years, usually in the fall, winter, or early spring. Your child may get RSV from a school-aged brother or sister or at a daycare center. Your child may be at risk for bronchiolitis if she or she has any of the following: 

•   Born premature (early) or with a low birth weight

•   A weak immune system

•   A heart or lung problem

•   Formula fed or little or no breastfeeding

•   Exposure to secondhand smoke

What are the signs and symptoms of mild bronchiolitis? 

Bronchiolitis begins like a common cold. Symptoms usually go away within 1 to 2 weeks. Some symptoms, such as a cough, may last several weeks. Your child's symptoms may be worse on the second or third day of his or her illness. Your child may have any of the following: 

•   Runny or stuffy nose

•   A fever

•   Fussiness or not eating or sleeping as well as usual

•   Wheezing or a cough

What are the signs and symptoms of severe bronchiolitis? 

•   Very fast breathing (60 to 70 breaths or more in 1 minute), or pauses in breathing of at least 15 seconds

•   Grunting and increased wheezing or noisy breathing

•   Nostrils become wider when breathing in

•   Pale or bluish skin, lips, fingernails, or toenails

•   Pulling in of the skin between the ribs and around the neck with each breath

•   A fast heartbeat

•   Loss of appetite or poor feeding, or being fussier or more irritable than usual

•   More sleepy than usual, trouble staying awake, or not responding to you

How is bronchiolitis diagnosed? 

Your child's healthcare provider will examine your child and ask about his or her symptoms. The provider may measure your child's blood oxygen level with a small sticky strip. A sample of your child's nasal drainage or mucus may be tested for infection. 

How is bronchiolitis treated?

Most children do not need treatment for bronchiolitis. Your child may need to be monitored and treated in the hospital if he or she has severe bronchiolitis. Medicine may be given to decrease pain and fever. If your child has moderate wheezing, medicine may be given to help open your child's airway. 

How can I manage my child's symptoms? 

•   Have your child rest. Rest can help your child's body fight the infection

•   Give your child plenty of liquids. Liquids will help thin and loosen mucus so your child can cough it up. Liquids will also keep your child hydrated. Do not give your child liquids with caffeine. Caffeine can increase your child's risk for dehydration. Liquids that help prevent dehydration include water, fruit juice, or broth. Ask your child's healthcare provider how much liquid to give your child each day. If you are breastfeeding, continue to breastfeed your baby. Breast milk helps your baby fight infection

•   Remove mucus from your child's nose. Do this before you feed your child so it is easier for him or her to drink and eat. You can also do this before your child sleeps. Place saline (saltwater) spray or drops into your child's nose to help remove mucus. Saline spray and drops are available over-the-counter. Follow directions on the spray or drops bottle. Have your child blow his or her nose after you use these products. Use a bulb syringe to help remove mucus from an infant or young child's nose. Ask your child's healthcare provider how to use a bulb syringe

•   Use a cool mist humidifier in your child's room. Cool mist can help thin mucus and make it easier for your child to breathe. Be sure to clean the humidifier as directed

What is arthritis?

Arthritis is a disease that causes inflammation in one or more joints. There are many types of arthritis, such as osteoarthritis, rheumatoid arthritis, and septic arthritis. Some types cause inflammation in the joints. Other types wear away the cartilage between joints. This makes the bones of the joint rub together when you move the joint. Your symptoms may be constant, or symptoms may come and go. Arthritis often gets worse over time and can cause permanent joint damage.

What increases my risk for arthritis? 

•     A family history of arthritis

•     Infection, trauma, or injury to the joint

•     Obesity

•     A disease such as diabetes, heart disease, hypothyroidism, or psoriasis

•     An immune deficiency disorder, such as AIDS or lupus

What are the signs and symptoms of arthritis? 

•     Pain, swelling, or stiffness in the joint

•     Limited range of motion in the joint

•     Warmth or redness over the join

•     Tenderness when you touch the joint

•     Stiff joints in the morning that loosen with movement

•     A creaking or grinding sound when you move the joint

•     Fever

How is arthritis diagnosed? 

•     Blood tests are used to measure the amount of inflammation in your body

What are tension headaches?

Almost everyone has a headache from time to time. Tension headaches are by far the most common kind. People generally describe tension headaches as causing a dull pain in the forehead or at the sides and back of the head. Many people describe a tight feeling, as if a too-small hatband is squeezing the head. Some people also notice tenderness around the head, neck and shoulders. Tension headaches come on gradually and can last for as little as 30 minutes or as long as several hours or even days. The pain is usually mild to moderate. However, tension headaches can lead to other problems such as insomnia, fatigue, irritability, loss of appetite and difficulty concentrating.

What causes tension headache?

The exact cause of tension headache is unknown. In the past, doctors thought that tension headaches were connected to muscle contractions in the face, neck and scalp. They believed that these contractions were caused by tension or stress, thus the name ’tension headache.’ Although stress and lack of sleep are the most frequent triggers of tension headaches, doctors now believe that this kind of headache actually develops from changes in certain brain chemicals such as serotonin and endorphins.

Migraine may trigger tension headaches in people who have both kinds of headaches. Because women are somewhat more likely than men to develop tension headaches, some doctors suspect that there could also be a link with fluctuating estrogen levels. The formal medical name for tension headache is now tension-type headache to show that the connection between tension and these headaches is no longer considered direct.

What can I expect my doctor or nurse to do?

Your doctor or nurse will ask questions about your general health and your family’s health history. Sometimes headaches happen because of other medical problems and your doctor will want to rule out that possibility. You may have a physical exam.

You will also be asked questions about your symptoms - how often you have headaches and what the pain is like. There are three types of tension headaches based on how frequently they occur:

•       Infrequent episodic tension headaches occur one day a month or less and the pain is usually mild

•       Frequent episodic tension headaches occur at least once but no more than 14 days a month and the pain can be mild to moderate

•       Chronic tension headaches occur 15 days or more each month and have been recurring for at least 6 months. The pain may be mild to severe

There are no medical tests to tell you are having tension headaches. The doctor will rely on the physical exam and your description of your symptoms for a diagnosis.

What is the treatment for tension headaches?

The treatment your doctor recommends for you will depend on how severe your headaches are and how often you have them. In most cases, over-the-counter (OTC) medicines are the first thing the doctor suggests. You may find fast, effective relief by taking OTC pain relievers such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), acetaminophen (Tylenol) and naproxen (Naprosyn, Aleve). In some cases, people find more relief with combination medicines such as aspirin or acetaminophen combined with caffeine. People with stomach problems, kidney disease and bleeding conditions should not use aspirin or NSAIDs. 

People with severe chronic tension headaches may require stronger painkillers or preventive medicines to reduce the frequency and severity of headache pain. These include prescription medicines such as isometheptene combinations (Midrin, Duradrin) or butalbital combinations(Fiorinal, Fioricet). In a few cases, the doctor may recommend a group of medicines called triptans, medicines that act on serotonin, one of the chemicals that may be involved in triggering tension headaches.

Doctors sometimes prescribe antidepressants to prevent tension headache, especially the chronic form. These medicines are not painkillers and the doctor is not prescribing them because you are depressed. Instead, certain antidepressants work on headache by stabilizing the levels of brain chemicals such as serotonin, which may be involved in the development of your headaches.

It is important to know that frequent use of some prescription pain relievers could lead to dependency. Using any pain reliever too often may cause a ‘rebound effect’ in which the medicine interferes with the body’s natural painkilling mechanism, causing the pain to return, even stronger than before, once the medicine wears off. Also, some painkillers, prescription and OTC, can interact with other prescription or OTC medicines, so it's a good idea to check with your doctor about the benefits and risks of taking any medicine. Ask your doctor if you are not sure what medicine is right for you.

What can I do to help take care of myself?

Learning a stress management technique, such as meditation or yoga, often helps. Regular exercise is also beneficial. It’s also important to get enough sleep and maintain a healthy diet. Some people find that good posture helps them avoid headaches. Try to avoid sitting, standing or working in one position for long periods of time. Alternative therapies such as biofeedback, relaxation therapy, massage, and acupuncture may also help prevent and/or relieve tension headaches.

When should I call the doctor or nurse?

Seek medical care quickly for a headache that comes on rapidly, is unusually severe, or is far different from other headaches that you have had. Headaches that waken you from a sound sleep, are worse when lying down or worsen over time, come with fever or a stiff neck, follow a head injury, come with disturbed speech, numbness, weakness, blackouts or difficulty remembering things are not typical for a tension headache. Discuss these problems with your doctor promptly.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team’s medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

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