Shoulder pain is a common problem, usually caused by strains and sprains of the soft tissues surrounding the shoulder joint. In most cases, the pain gets better with simple treatments you can do at home.What is shoulder pain?Three bones (the upper arm bone, the shoulder blade, and the collar bone) join to form your shoulder. These bones fit into sockets with cartilage, muscles, and tendons protecting the joints (see image).This structure gives your shoulder a wide range of motion. Pain develops when any of the soft tissues or bony structures are over-extended or injured.What causes shoulder pain?The cause of shoulder pain depends on how the pain began and where it is felt. Acute pain after an injury is usually caused by muscle or tendon strains or tears (most commonly a "rotator cuff injury"). Pain in the shoulder not due to an acute event often begins gradually and may come and go. This type of pain can have many causes, including:• Tendon, ligament or muscle strains• Chronic tears (rotator cuff)• Inflamed bursae (bursitis)• Arthritic changes damaging the cartilage or causing impingement and inflammationFractures of the bones of the shoulder (arm, collar, shoulder blade) are uncommon because it requires significant trauma to break a shoulder bone. However, older people and people with osteoporosis can develop fractures with less trauma.How is shoulder pain treated?Most shoulder pain can be controlled with simple home treatments.• Rest and activity changes:   ○ Avoid any movement that causes pain.   ○ Avoid moving your arm higher than chest level.   ○ Do not lift, carry, or pull heavy objects.   ○ Sleep on the non-painful side with a flat pillow under your armpit to protect the shoulder that hurts.   ○ If recommended, use a sling to immobilize your shoulder for a few days.• Ice:   ○ To help reduce pain and swelling, apply ice (wrapped in a towel or sealed in a plastic bag) 3-5 times a day for 15-30 minutes. Use ice for the first 1-2 days or until pain and swelling subside.• Pain medicine:   ○ In most cases, over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve) are enough to control shoulder pain. Prescription medicines are rarely needed and can cause side effects.Do I need X-rays or other imaging tests to help diagnose shoulder pain?It is not in most cases. Your clinician can usually tell what is causing your shoulder pain. He/She can rule out less common causes based on your medical history and physical exam.Does exercise help relieve shoulder pain?The exercise that promotes range of motion and strengthens the shoulder can help speed the healing process. Once pain and swelling begin to ease, you can try a gentle pendulum exercise. The motion shouldn't cause pain (see Figure).Codman (pendulum) exercisesDo this exercise for 5-10 minutes, 3-4 times per day. Move gently at first.• Bend over from the waist• Let the sore arm hang loosely• Swing in forward-back, side-to-side, and circular patterns if this causes pain, stop doing it.Do I need to see a physical therapist or doctor who specializes in shoulder pain?The simple treatments described above help most people get better. People with severe pain and swelling, or symptoms that aren't improving after 2-4 weeks, may be referred to a physical therapist. Most physical therapies are given several times a week for a few weeks with subsequent home exercises.For people with chronic shoulder problems due to arthritis, bursitis, or tendonitis, a steroid shot into the painful area by an orthopedic surgeon or arthritis specialist can provide relief while the natural healing process takes place. For pain that was not improving and thought due to a rotator cuff injury, referral to an orthopedic surgeon is appropriate.What can I do to prevent shoulder pain from coming back?Exercises can help maintain range of motion and strengthen the shoulder muscles.Your clinician can give you instructions for exercises to prevent and treat shoulder pain. Brisk walking and/or swimming are also good activities to help prevent shoulder pain. You can make simple changes in your daily routine, such as:• Avoid tucking your phone between your ear and shoulder when you talk. If you are on the phone a lot, use a headset.• Take frequent breaks at work. Shrug your shoulders up and down. Pull your shoulder blades together, and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.• Lift and carry the right way. When you are lifting something, bend at your knees, keeping your back neutral, and your head and shoulders up. Avoid carrying bags on one shoulder for a long period. Use a cross-body bag or a backpack-style bag to distribute weight more evenly- and be sure to wear the backpack correctly with both arms through the shoulder loops.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 InSiteDeveloped by the MGH Laboratory of Computer Science and Division of General Internal MedicineClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Family Medicine Clinical ServiceClick the link for more information on Orthopaedics and Sports Medicine Clinical ServiceClick the link for more information on Rehabilitation Clinical Service

What is osteoarthritis?Osteoarthritis is the most common form of arthritis. It affects the joints and the tissue (cartilage) around the joints that help absorb shock when you move. Osteoarthritis may cause pain, but redness and swelling, symptoms of rheumatoid arthritis and other autoimmune diseases, are not signs of osteoarthritis.What happens to the joints when you have osteoarthritis?The cartilage protecting the joints can break down and wear away. Over time, this allows the bones at the joint to rub together. The rubbing causes pain, swelling, and stiffness. After a while, the joint may lose its flexibility.What causes osteoarthritis?Osteoarthritis develops slowly, usually through normal wear and tear on the joints. Some risk factors are:• Being overweight• Getting older• Family history• Stresses on the joints from some kinds of work and some sports• Old injuriesWhat are the symptoms of osteoarthritis?People with osteoarthritis usually have at least some joint pain and stiffness. The pain occurs most often in the hands, knees, hips, and spine. Other common symptoms are:• Stiffness after getting out of bed or sitting for a long time• Swelling or tenderness in one or more joint(s)• A crunching feeling or sound in the affected joint(s)How does my doctor know I have osteoarthritis?There is no special test that can tell you have osteoarthritis. Your doctor may look at:• Your medical history• The results of your physical exam• X-rays • Other tests such as blood tests or exams of the fluid in the jointsWhat can I do to manage the symptoms of osteoarthritis?Managing your symptoms relies mainly on things you can do at home.• Lose weight. Every pound you lose takes pressure off your knees and hips.• Exercise. Staying active will help control your symptoms. Your doctor may recommend specific exercises or physical therapy.• Try nondrug pain relief techniques, such as   ○ hot and cold packs   ○ braces and canes• Take over-the-counter medicines, such as Tylenol, Advil, or Aleve, to help control pain.• Some people find relief with complementary medicine, although scientific evidence is lacking. Acupuncture and massage may be helpful. Glucosamine chondroitin supplements and capsaicin cream are other alternatives.Sometimes, doctors recommend injections into the joint to help control pain.When no other treatment works, joint replacement surgery may be recommended in some cases.Osteoarthritis cannot be cured, but you can manage your symptoms, control pain, and stay active.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.© 2017 The General Hospital Corporation. Primary Care Office InSitedeveloped by the MGH Laboratory of Computer Science and Division of General Internal MedicineClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Orthopaedics and Sports Medicine Clinical ServiceClick the link for more information on Family Medicine Clinical ServiceClick the link for more information on Rehabilitation Clinical Service

Neck pain is a common problem that may be triggered by poor posture, a mild neck injury, or just age-related wear and tear. In most cases, the pain gets better with simple treatments you can do at home.What is neck pain?Everyone gets pain in the neck from time to time. Neck pain can occur anywhere in your neck, from the bottom of your head to the top of your shoulders. It can spread to your upper back or arms. Your neck may feel sore or stiff. The pain might limit how much you can move your head and neck.Neck pain is rarely the sign of a serious illness. Most people feel better within a few days to a couple of weeks.What causes neck pain?Some common causes of neck pain are:• Muscle tightness due to poor posture or stress• Inflammation and muscle spasms caused by neck strain or injury• Wear and tear related to aging• Accidents causing whiplash, a quick forward and backward movement that strains the neckAs you get older, you are more likely to develop neck pain. Neck pain may be the result of age-related changes in the vertebrae, discs, muscles, and ligaments of the neck. Even simple daily activities, such as working at a computer or reading in bed, can strain your neck.How is neck pain diagnosed?Your clinician will ask you questions, go over your medical history, and do a physical exam. X-rays are not usually necessary, especially at first. If your neck pain does not improve after a few weeks, your clinician may order imaging tests to find out what is causing the pain.How is neck pain treated?Most neck pain responds well to simple treatments you can do at home.• Ice. To help reduce inflammation and muscle spasms, first apply ice (wrapped in a towel or sealed in a plastic bag) to the area where your neck hurts. Leave the ice in place for 15-20 minutes so cold can penetrate the tissues. Repeat every 4-6 hours until symptoms improve.• Heat. Once the inflammation has gone down, heat can help soothe tight muscles and make it easier for you to do exercises that will strengthen your neck.   ○ Stand in a hot shower and let the water flow over your neck.   ○ A hot bath can also be helpful, as long as your tub allows you to soak your neck in a comfortable position.   ○ Warm a moist towel in the microwave and apply it to your neck for 10-15 minutes.• Pain medications. In most cases, over-the-counter pain relievers such as acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve) are enough to control neck pain. Muscle relaxants may help with stiffness and limited range of motion for some people, but they require a prescription and can cause side effects.• Massage. If your neck muscles are still tight after a week or two of icing and using heat, try massaging both sides of your neck and the upper back muscles. You may want to warm up your neck with a hot towel before the massage begins. Ask a family member or friend to massage your neck while you lie on your stomach or sit backward in a padded chair, resting your head on the chair for support. You can also give yourself a neck massage using hand pressure or an electric hand-held massager.• Exercise. Once the acute pain lets up, your doctor will probably recommend gentle stretching exercises to increase flexibility, strength, and range of motion.Here are a few good neck exercises:• Neck bending. Gently move your chin toward your chest as far as it is comfortable. Hold for a few seconds, feel the stretch, then return to the neutral position. Repeat 5 times.• Neck rotation. Slowly turn your head to the right. Place tension on your chin with your fingertips. Hold for a few seconds and return to the center. Repeat to the left.• Neck tilting. Tilt your head to the right, trying to touch your ear to the tip of your shoulder. Place tension on the temple with your fingertips. Hold for a few seconds and return to the center. Repeat to the left. Repeat (both sides) 4 more times.• Head half-rolls. Relax your arms at your sides and gently roll your head from left to right several times. Feel the stretch in your neck muscles. Relax and repeat 5-10 times• Shoulder rolls. Relax the arms and gently roll both shoulders in a circular motion. Feel the stretch as you move slowly. Repeat 5-10 times• Vertical shoulder stretches. In a seated or standing position, take hold of one wrist and pull the arm overhead. Keep the shoulder, and back muscles relaxed. Hold for a few seconds, then repeat on the other side. Repeat for a total of 5 times on both sidesWhat kind of neck pain can be the sign of a more serious health problem?Neck pain accompanied by a headache and fever could be a symptom of meningitis, an infection of the membranes around your brain. Severe pain after an injury could mean a broken bone or torn ligament. Other symptoms that might suggest a serious problem include pain that radiates beyond your neck, numbness or tingling in your fingers, weakness in an arm or leg, and any change in bladder or bowel habits. Call your doctor right away if you develop any of these symptoms.What can I do to prevent neck pain from coming back?Poor posture causes a lot of neck pain. Simple changes in your daily routine can help.• Travel safely. If you drive long distances, stop and get out of the car at least every two hours. When you travel in a car, plane, or train, place a small pillow or rolled towel between your neck and a headrest to keep the normal curve in your neck.• Maintain a good neck posture. Adjust the seat of your computer/desk chair so that the monitor is at eye level, your knees are slightly lower than your hips, and your arms rest comfortably on the chair's armrests.• Avoid tucking your phone between your ear and shoulder when you talk. If you are on the phone a lot, use a headset.• Take frequent breaks at work. Shrug your shoulders up and down. Pull your shoulder blades together, and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.• Sleep well. Avoid sleeping with too many pillows or falling asleep in front of the television with your head on the arm of a couch. Choose a pillow that supports the natural curve of your neck. Replace your pillow every year. If you read in bed, use a wedge-shaped pillow or portable "mini-desk" to keep your neck in a neutral position.• Lift and carry the right way. When you are lifting something, bend at your knees, keeping your back neutral, and your head and shoulders up. Avoid carrying bags on one shoulder for a long period. Use a cross-body bag or a backpack-style bag to distribute weight more evenly- and be sure to wear the backpack correctly, with both arms through the shoulder loops.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 InSiteDeveloped by the MGH Laboratory of Computer Science and Division of General Internal MedicineClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Family Medicine Clinical ServiceClick the link for more information on Orthopaedics and Sports Medicine Clinical ServiceClick the link for more information on Rehabilitation Clinical Service

WHAT YOU NEED TO KNOW:What is a laceration? A laceration is an injury to the skin and the soft tissueunderneath it. Lacerations happen when you are cut or hit by something.They can happen anywhere on the body.What are the signs and symptoms of a laceration? Lacerations can be many shapes and sizes. The open skin may look like a cut, tear, or gash. The wound may hurt, bleed, bruise, or swell. Lacerations in certain areas of the body, such as the scalp, may bleed a lot. Your wound may have edges that are close together or wide apart. You may have numbness around the wound. You may have decreased movement in an area below the wound.How is a laceration diagnosed? Tell your doctor about how you got your laceration.He will examine your laceration and decide what treatment you need. An x-ray, ultrasound, CT, or MRI may show foreign objects in the wound. Foreign objects include metal, gravel, and glass. The tests may also show damage to deeper tissues. You may be given contrast liquid to help the injured area show up better in the pictures. Tell the doctor if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the doctor if you have any metal in or on your body.How will my laceration be treated? The treatment you will need depends on how large and deep the laceration is, and where it is located. It also depends on whether your child has damage to deeper tissues. You may need any of the following:• Pressure may be applied to stop any bleeding.• Wound cleaning may be needed to remove dirt or debris. This will decrease the chance of infection. Your doctor may need to look in your laceration for foreign objects. He may give you medicine to numb the area and decrease pain. He may also give you medicine to help you relax.• Wound closure with stitches, staples, tissue glue, or medical strips may be needed. Your doctor may need to give you medicine to numb the area and decrease pain. He may also give you medicine to help you relax. These may help the wound heal and prevent infection. Stitches may decrease the amount of scarring you have. Some lacerations may heal better without stitches.• Medicine to treat pain or prevent infection may be given. You may also be given a tetanus shot. Your doctor will decide if you need a tetanus shot. Wounds at high risk for tetanus infection include wounds with dirt or saliva in them. You should get a tetanus shot within 72 hours of getting a laceration or wound. Tell your doctor if you have had the tetanus vaccine or a booster within the last 5 years.• Surgery may be needed if your laceration needs a lot of cleaning or removal of foreign objects.When should I seek care immediately?• You have heavy bleeding or bleeding that does not stop after 10 minutes of holding firm, direct pressure over the wound.• Your stitches come apart.When should I contact my doctor?• You have a fever or chills.• Your laceration is red, warm, or swollen.• You have red streaks on your skin coming from your wound.• You have white or yellow drainage from the wound that smells bad.• You have pain that gets worse, even after treatment.• 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.Click the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Family Medicine Clinical ServiceClick the link for more information on Surgery Clinical Service

What is acute low back pain?Low back pain is a very common medical problem. It involves pain at the base of the lower back, and it can affect the buttocks and upper thighs, too. ”Acute" low back pain means new pain that has lasted less than one month.What causes low back pain?Your chance of having back pain is increased by things like not getting enough exercise, being overweight, having a physically demanding job, cigarette smoking, and simply getting older.Most back pain occurs at the bottom of the spine because this area holds most of your weight and keeps you standing up straight. The major parts of your back include bones, muscles, nerves, discs (which sit between the bones of your spine, keeping them separated and absorbing shock) and ligaments (which hold the bones together, provide support, and help with movement). Some of the nerves branch out from between the bones. Some go to your back and others go down your legs. This is why back problems can cause leg pain, too.   Most low back pain is "non-specific”， which means that the exact cause can’t be easily identified. While it’s often due to the muscles, ligaments and/or bones, there isn’t a specific problem. Sometimes, the cause can be identified, especially when the back pain spreads into one or both legs, most commonly due to (1) sciatica due to a disc problem, which is more common in people younger than 50, or (2) spinal stenosis, a type of arthritis more common in people over 60.1. Sciatica (say it：”sy”at-ih-cah") is a specific type of low back pain that most commonly spreads into one leg. The pain is usually sharp or burning, and it’s felt down the back or side of the leg, typically below the knee, to the foot or ankle. Most people with sciatica also have pain in their back. The most common cause of sciatica is a bulging or herniated （”burst”） disc that pinches a nerve along the spinal column. However, many people with no symptoms at all also have a bulging disc, so a disc bulge doesn't necessarily cause symptoms.2. Spinal stenosis is a specific type of low back pain usually caused by arthritic changes in the back in older patients. Bony deposits called “spurs “grow along the bones of the back. Sometimes they close in on the spinal canal, the space where nerve roots branch off from the spinal cord. This makes the space more narrow, a condition called spinal stenosis. This can also put pressure on the nerves, causing pain. The pain from spinal stenosis can occur in the lower back or buttocks alone, or it can go into the groin or one or both legs. The legs may feel numb, tingling, or heavy. Walking worsens the pain. It can make you feel clumsy and afraid of falling. Unlike most other types of back pain, sitting down usually relieves the pain and lying down can make the pain worse.How will my clinician figure out what’s causing my pain?Your clinician will listen to you describe your symptoms, do a physical exam, and ask you questions. These questions may include:• Have you had back problems before?• What makes the pain better or worse?• Exactly where do you feel the pain?• Do you have numbness or weakness that makes it hard to move around?• What you were doing around the time your pain started? (Don’t worry if you can’t remember what you were doing. Most back pain isn’t caused by a specific event or injury.)In most cases, this will give your clinician enough information to identify common issues and rule out rare but serious issues. It will also help your clinician to decide the first steps of treating your pain.Will x-rays or other tests be helpful?X-rays, MRIs, and other imaging tests don’t usually show anything that would change the first steps of treating your pain. This is partly because the muscle and ligament strains that cause most pain can't be seen on x-rays. Getting imaging tests doesn't help people with acute low back pain feel better any faster. Your clinician may have you get imaging or blood tests if he or she is concerned about serious issues.What is the treatment for acute low back pain?Acute low back pain usually starts getting better on its own over a few days or  weeks. The goals of treatment are to control pain and to avoid things that make it worse or prevent it from getting better. Although back pain may be making you feel miserable right now, it’s important to know that there are simple things you can do to manage your pain and help speed up your body’s own healing process:• Don’t spend too much time in bed. When your pain is really bad, lying down for brief periods on a firm surface can help ease the pain. The best way is to lie on your back with a small pillow under your knees to raise them slightly. You can also lie on your side with your knees slightly bent.• Avoid sleeping on your stomach. This position can strain your lower back.• (For spinal stenosis) Try sitting. If you have spinal stenosis, you may find that sitting helps to ease your pain more than lying down.• Keep doing your usual activities -with sensible modifications. As the pain eases up, you should resume your usual activities, with several important reminders:    ▪  Walk! It’s the best and safest activity.    ▪  Gradually return to more strenuous activity such as lifting, climbing or jogging over a few days. Increase your level of activity as your pain lets up.    ▪  Pay attention to what makes your pain a lot worse -and don’t do it!    ▪  Avoid sitting or standing still for long periods of time.    ▪  Make sure your seats at home, in your car, and at work provide good support for your back.    ▪  Get up regularly (every 20 to 30 minutes) and walk around to loosen up your back.• Take medicines to control the pain. Over-the-counter anti-inflammatory painkillers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are usually enough to ease acute low back pain and make it bearable.• Visit a physical therapist or chiropractor if the pain isn't getting better. If your pain doesn't go away after about 2 weeks, or if it gets worse, your clinician may refer you to a physical therapist for treatments and exercises. Seeing a chiropractor can also be helpful. If you’ve had long periods of pain before, it may help to go for physical treatments sooner rather than later.What should I do if the pain doesn't go away? What if l have new symptoms?Call your clinician if your back pain gets worse despite treatments or you have new pain, numbness or weakness in your legs, changes in your bladder or bowel function, a fever, or other new symptoms.Otherwise, contact your clinician if your pain does not get better after 2 to 3 weeks. Your clinician may want to see you again or may decide to refer you to a physical therapist or other specialist.How can I keep the pain from coming back?Once the acute pain is almost gone, you may want to change your focus to preventing future pain. Here are the most important things you can do:• Increase your fitness level. Focus on activities that improve endurance, flexibility, and back strength. Activities that are good for your back include walking, stationary bicycling, and swimming or walking in a pool that is at least 4-5 feet deep. Almost any activity is better than just sitting around! Your goal is to exercise 3 or 4 times a week (but even 1 or 2 times can make a big difference).Wear shoes that provide good support and comfort. If you are already used to exercising, you may want to work out for longer periods or more often. Whatever you can do will help. The key is to choose something you enjoy and to fit it into your routine so you'll stick with it!• Do some exercises specifically for the back Exercises that strengthen stomach muscles or increase flexibility can help. Your clinician can give you a list of simple stretches and exercises to do regularly.Having back pain once means that you are more likely to have it again later. You may not be able to eliminate future back pain altogether, especially if your pain is due to arthritic problems such as spinal stenosis, but there is a lot you can do to make yourself more resilient, decrease your pain and improve your well-being. 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.2017 The General Hospital Corporation.Primary Care Office lnSiteDeveloped by the MGH Laboratory of Computer Science and Division of General Internal MedicineClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Rehabilitation Clinical ServiceClick the link for more information on Orthopaedics and Sports Medicine Clinical Service

Have you ever felt discomfort during exercise like shortness of breath, chest pain, numb and sharp pain on your arm or lower jaw?Actively participating in a variety of sports is becoming a healthy lifestyle. However, along with the increase of the exercise intensity, the risks of sports-related cardiovascular problem also increases. There are more and more reports of sudden cardiac death (SCD). Our advice for amateurs and professional athletes is to do a cardiopulmonary exercise testing to rule out the risk of latent cardiovascular diseases, to prevent the risk of sudden death, and to reach a better exercise effect.What is the sudden cardiac death (SCD)?Most cases of sudden cardiac death (SCD) are caused by malignant arrhythmia, which is often ventricular Tachycardia (VT) or ventricular Fibrillation (VF). For individuals with heart diseases like hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, competitive sports can increase VT/VF risks.Even though SCD rarely happens, once it does it can lead to disastrous consequence. Among young SCD victims, although the causes of death in most cases are unclear, many of them have undiagnosed cardiovascular diseases. Therefore, it is necessary to have a screening as soon as possible and take preventive measures suggested by doctors to lower the SCD risk.What diseases are the origins of SCD risk?For those with basic cardiovascular disease, competitive and recreational sports can increase the SCD risk. The risk is related to the severity of basic disease and exercise intensity. Among group under the age of 35, SCD is mostly caused by basic structural heart disease; among those above 35, the SCD is more likely to be caused by coronary disease. In daily life, it is advisable to pay particular attention to the screening of relevant diseases.What symptoms during exercise should be taken seriously?Pay attention to the exercise-related chest pain, especially lasting one. If you feel shortness of breath, numbness and sharp pain on the left arm or lower jaw that you have never experienced, you should be careful. In addition, unusual weariness should not be ignored. If you find that you cannot run as far as before, please see a doctor as soon as possible.How to do the screening?Like the screening of other diseases, the screening of heart disease before exercise aims to identify SCD risk and mainly improve the prognosis through exercise restriction/adjustment or other specific therapies for basic disease.The screening methods depend on age and expected intensity of exercise, competitive or recreational. Normally it includes initial risk assessment, standard 12- lead ECG, and exercise stress test.Initial risk assessment: Based on consultation, analysis on available material, patient’s medical background, doctor will develop further examination plan.Examination plan: Standard 12-lead ECG and exercise stress testStandard 12-lead ECG: One of the most extensive examinations in clinical applications that can show the electrical activities of the heart.Exercise stress test: It includes treadmill test or CPET (Cardiopulmonary Exercise Test). It increases cardiopulmonary load through exercise (treadmill or bicycle) to observe the changes in the ECG during exercise and the functional change of the cardiopulmonary system.Safety assessment: The doctor assesses the safety of exercise according to the result of your examinations, and proposes a further examination/treatment plan.Please follow doctor’s guidance to choose the package you needClick the link for more information on Cardiovascular Medicine Clinical Service

What You Need to KnowIn this form of arthritis, one or more of your joints gets painful, red, and swollen for several days. Treatment can include medication, drinking more fluids, and changing what you eat.What is gout ?Gout is a painful and sometimes disabling form of arthritis. It involves the joints, the places where bones connect. Gout affects more men than women. You are more likely to develop gout if you are overweight or if you have high blood pressure, high cholesterol, or diabetes.What are the symptoms of gout ?Gout causes attacks of pain that come and go without warning. Symptoms are different for every person, but the most common are:• Severe, sudden pain in one or more joints (the big toe is often the first place where it's felt)• Swollen joints• Red or purplish, tight, shiny skin over joints Warmth over the joint• Hard lumps (nodules) under the skin, especially near jointsWhat causes gout ?Gout is caused by crystal deposits in the joints. These deposits form when levels of uric acid (a normal waste product) become too high in the blood. Reasons for this may include:• Genetics - the body naturally produces too much uric acid• Eating foods or drinking beverages with high amounts of a chemical named purine, such as meat, poultry, fish, beer, and drinks sweetened with fructose• Fasting• Dehydration• Certain medications• Kidney disease - the kidneys have a hard time flushing uric acid out of the bodyHow will my clinician figure out if I have gout ?Your clinician will ask you questions and do a physical exam. Your clinician may also take a small sample of fluid from a joint that hurts you. This sample will be sent to a lab where it will be tested for the kind of crystal deposits that cause gout.How is a gout attack treated ?Treatment depends on your age, your overall health, and your medical history. It also depends on the degree to which gout has developed and what kinds of medicines you can take safely. Treatment may include:• Medications (best if taken at the first signs of an attack)    ◦ Non-steroidal anti-inflammatory medicines (NSAIDs)    ◦ Colchicine    ◦ Corticosteroids (pills or injection)• Resting the joint• Applying an ice pack What can I do to reduce gout attacks ?To help prevent future attacks, options include:Lifestyle changes• Lose weight if you are overweight (but avoid diets designed for quick or extreme weight loss, which can increase your uric acid levels)• Avoid food and drink that is high in purine (Please refer to Low Purine Diet below)• Drink lots of fluids (but not alcoholic drinks) to help flush uric acid from your body• Eat a balanced diet• Exercise regularlyPreventive medicationsIf you have frequent gout attacks, your clinician may suggest medication to help prevent them. Options include:• Drugs that cut down how much uric acid your body produces (such as allopurinol or febuxostat)• Drugs that increase how much uric acid your kidneys flush out (such as probenecid)Take these preventive drugs as prescribed. Even if you have an attack, don't stop-keep taking them according to instructions.Low-Purine DietYour doctor has recommended a low-purine diet for you. Purine (pyur-een) is a substance that the body breaks down into uric acid. Too much uric acid can lead to problems, including kidney stones and gout. Maintaining a healthy weight with regular exercise and a balanced diet will also help prevent and/or reduce symptoms of gout.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.© 2017 The General Hospital Corporation. Primary Care Office InSiteClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Rheumatology and Immunology Clinical Service

Your child has had a mild head injury. It does not appear serious at this time. Sometimes symptoms of a more serious problem (bruising or bleeding in the brain) may appear later. Therefore, during the next 24 hours watch for the WARNING SIGNS listed below.Home Care:1) It is okay to let your child go to sleep when tired. During the next 24 hours, Wake Him Up Every Three to Four Hours to check for the signs below.2) If there is swelling of the face or scalp, apply an ice pack  (ice cubes in a plastic bag, wrapped in a towel) if tolerated. Do this for 20 minutes every 1-2 hours until the swelling starts to go down.3) You may use acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) to control pain, unless another pain medicine was prescribed. [Note: in case of chronic liver or kidney disease or stomach ulcer or GI bleeding, talk with your doctor before using these medicines.] Do not use ibuprofen in children under six months of age.Follow Up with your doctor or this facility if you do not start to improve within the next 24 hours.Retrun Promptly or contact your doctor if any of the following occur:-- Repeated vomiting, particularly projectile-- Unusual drowsiness or unable to awaken as usual-- Unequal pupils-- Confusion or change in behavior-- Convulsion (seizure)-- Increasing scalp or face swelling-- Redness, warmth or pus at the site of injuryClick the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Pediatrics Clinical ServiceClick the link for more information on Family Medicine Clinical Service

How to Care for Your Wound after It’s Treated with Topical SkinAdhesiveDermabond* Topical Skin Adhesive is a sterile, liquid skin adhesive that holds wound edges together. The film will usually remain in place for 5 to 10 days, then naturally fall off your skin.The following will answer some of your questions and provide instructions for proper care for your wound while it is healing:Check Wound ApperanceSome swelling, redness, and pain are common with all wounds and normally will go away as the wound heals. If swelling, redness, or pain increases or if the wound feels warm to the touch, contact a doctor. Also contact a doctor if the wound edges reopen or separate.Replace BandageIf your wound is bandaged, keep the bandage dry.Replace the dressing daily until the adhesive film has fallen off or if the bandage should become wet, unless otherwise instructed by your physician.When changing the dressing, do not place tape directly over the Dermabond adhesive film, because removing the tape later may also remove the film.Avoid Topical MedicationsDo not apply liquid or ointment medications or any other product to your wound while the Dermabond adhesive film is in place. These may loosen the film before your wound is healed.Keep Wound Dry And ProtectedYou may occasionally and briefly wet your wound in the shower or bath. Do not soak or scrub your wound, do not swim, and avoidperiods of heavy perspiration until the Dermabond adhesive has naturally fallen off. After showering or bathing, gently blot your wound dry with a soft towel. If a protective dressing is being used,apply a fresh, dry bandage, being sure to keep the tape off the Dermabond adhesive film.Apply a clean, dry bandage over the wound if necessary to protect it.Protect your wound from injury until the skin has had sufficient time to heal.Do not scratch, rub, or pick at the Dermabond adhesive film. This may loosen the film before your wound is healed.Protect the wound from prolonged exposure to sunlight or tanning lamps while the film is in place.If you have any questions or concerns about this product, please consult your doctor.Click the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Family Medicine Clinical Service

Your wound was repaired with an adhesive film called Dermabond.The wound will need a little care at home.The Dermabond film will fall off in 5 to 10 days.Exposure to water may make the Dermabond fall off too soon.Call your doctor if the edges of the wound open or pull apart.Avoid tanning lamps and prolonged exposure to sunlight.BandagesNo bandage is needed but if you use one, change it daily until the adhesive film falls off. Also, change the bandage if it gets wet or dirty.Teach your child not to scratch or pick at the film. This may loosen the film before the wound is healed. If you keep the wound covered, your child will be less likely to pick or scratch the film.Do not apply any ointments, lotions or creams over the Dermabond film. This may loosen the film before the wound had healed.Do not put tape on top of the film. The film could come loose when you remove the tape.Cleaning The WoundYou do not need to clean the wound with soap or water. If the wound gets wet, gently blot the wound dry with a soft towel.Do not soak or scrub the wound.Signs Of InfectionThere is a chance the wound may get infected. If you think it is infected, call your child’s doctor or return to the Emergency Department or Urgent Care.Watch for these signs of infection:  --Increasing redness around the wound.  --Increasing pain or tenderness.  --Yellow or green discharge or drainage from the wound.  --Increased swelling.  --Foul odor from the wound.  --Fever.  --Red streaks that start at the wound and travel towards the body.Avoid activities that produce heavy sweating until the Dermabond film has fallen off. Your child may go back to school or child care. Please tell the teacher of the limits on your child’s activities. Your child should avoid contact sports, bike riding, swimming, tree climbing, skating and skateboarding, physical education class, and other rough play. Swimming is not allowed for 7 days.When To Call The DoctorCall your child’s doctor or return to the Emergency Department or Urgent Care if you see any signs of infection.Call your child’s doctor to arrange a follow-up appointment if needed.Other AdviceMany things affect, how a wound heals. Proper cleansing, proper nutrition, direction of the wound, exposure to UV rays and susceptibility to thick scarring can affect the look of your child’s healed wound. The final scar may not settle for a few years after the injury.After the Dermabond has fallen off, you may apply lotions to the healed skin. You may use lotions such as aloe vera, shea butter, cocoa butter, vitamin E oil or over-the-counter scar-reducing creams. Before going outdoors, use a sunblock lotion with an SPF of 15 or higher. It is important to apply sunscreen often to the healed wound for up to 2 years. For healed wounds on the head, a hat should be worn to protect the area from the sun and UV rays.Click the link for more information on Emergency Medicine Clinical ServiceClick the link for more information on Pediatrics Clinical ServiceClick the link for more information on Family Medicine Clinical Service