1. Thermometer
2. Vaporizer: Cool air is safer if spilled; otherwise, there is no difference in effectiveness between a hot and cold vaporizer
3. Children’s acetaminophen (Children’s Tylenol)
4. Children’s ibuprofen
5. An antihistamine/decongestant that can be purchased without a prescription such as: PediaCare, Sudafed, etc.
6. Infant nasal aspirator
7. Syrup of Ipecac: This is used for accidental ingestion of poisons or medications. It is purchased at the pharmacy without a prescription. Call physician or Poison Control Center before using. The Poison Control number is: 1-800-942-5969.

1. Thermometer
2. Aspirin, ibuprofen, or acetaminophen
3. An adult antihistamine/decongestant that can be purchased without a prescription such as: Dimetapp, Sudafed, etc.

Antibiotics are of no help in curing viral colds or flu-like illnesses. Their usefulness is only in treating the complications of viral infections or bacterial infections. For this reason, these medications are not used in the early stages of a simple cold. When an antibiotic is prescribed, the bottle should always be finished or used as long as the doctor advises. If antibiotics are started, the general rules for expected recovery time are as follows:

1. In the first twenty-four hours after starting antibiotics, little if any improvement (sometimes symptoms may even worsen).
2. Thirty-six to forty-eight hours after starting antibiotics, some improvement is expected.
3. After forty-eight hours, there should be some definite signs of improvement; that, is less temperature and generally feeling better. If not improving after forty-eight hours of antibiotics, call the office to receive further instructions.

Normal Temperature

Before investigating fever, it is important to consider normal temperature. The body’s normal temperature is 98.6 (oral), typically varying 1-2 degrees in a twenty-four hour period. It is lowest in the early morning and highest between 4-8 pm. Temperature can be influenced by exercise, ingestion of hot liquids, hot weather, overdressing and hot baths/showers.

Various thermometers can be used to take a temperature. Regular glass or digital may be best for infants and young children. Ear thermometers are more expensive and are more appropriate for older children and adults. Practice using a thermometer until you feel comfortable with it.

Temperature can be measured with a thermometer at three body sites: oral, rectal or axillary. An oral temperature is taken for 3 minutes with the thermometer resting under the tongue and the mouth closed. Axillary temperatures are taken under the arm for 5 minutes. Rectal temperatures are taken for 3 minutes. The three sites show slight variation in results. An oral temperature is generally 0.5 degrees C lower than rectal temperatures.

Fever is a means for the body to respond to illness or injury. It is commonly seen in bacterial or viral infections, some allergic reactions, autoimmune diseases or serious illness.

Practically speaking a child or adult is said to have a fever when temperature is > 100 degrees oral or > 101 degrees rectal. When it is elevated, the body calls "out the troops" to fight the "invader." When suppressing a fever with an antipyretic, like Tylenol or Ibuprofen, you may be working against the body’s natural defenses.

Some people fear fever will cause brain or other organ damage. Studies have found such anxiety to be irrational except in the critically ill or metabolically fragile. Fever is a self limited sign or symptom that rarely causes harm and seems to be part of the body’s adaptive response to infection.

It is important to remember that normalization of temperature may not be an important or necessarily desirable objective of fever therapy. Bringing a fever down 1 or 2 degrees may help the child or adult feel more comfortable and able to "fight the invader."

Treatment needs to be based on the whole picture of the child or adult with fever. A lower temperature does not necessarily mean that the person is better. Conversely, a higher evening temperature does not mean the person is worse.

Since fever can be a common sign of illness, people need to understand when to call Geneva Family Practice. Some guidelines are listed below:

1. A child less than three months of age.
2. Severe headache, stiff neck, swelling of the throat or mental confusion with the fever.
3. Nausea, vomiting, irritability, listlessness or sensitivity to light with fever.

Less immediate calls: (using your judgment, may wait until daytime.)

1. Fever of 103 degrees F or higher.
2. Fever lasting longer than 36-48 hours.
3. Fever accompanied by recurrent shaking or chills.
4. Exposure to a highly contagious disease, like strep throat or influenza.
5. No apparent symptoms except temp of 101 degrees F lasting more than 3 days or a fever of 99 degrees F to 100 degrees F for several weeks.
6. Rash with a fever.
7. Fever not responding to treatment.

Since temperature elevation, seen as a fever, is not generally harmful and may be beneficial, use of antipyretic therapy (i.e. Tylenol, Ibuprofen) should be determined by the child or adult’s discomfort with the fever. Some basic measures, that may be helpful, include: 1.) Taking care to dress the child or adult lightly, avoiding overdressing or over bundling, 2.) Offer lukewarm baths, not colder for twenty minutes as needed, 3.) drinking plenty of fluids 4.) Use antipyretic medication.

The first choice for antipyretic medication is Tylenol, acetaminophen which helps reduce temperature elevation and discomfort. The following table gives doses for younger children. It may be given orally or rectally ever 4 to 6 hours as needed.

The safest way to give a dose is by the number of milligrams. If the package directions do not give dosages for young children, then use the table.

For older children and adults, see package directions.

Ibuprofen is an equally effective alternative to Tylenol, but has slightly more side effects. It is given every 6-8 hours as needed. Aspirin should never be given to anyone younger than 18 years of age as it can cause a potentially life-threatening disease called Reye’s syndrome.

Febrile Seizures are usually caused by a rapid rise in body temperature but not by the degree. It may be the first sign your child has a fever.

While febrile seizures are scary for parents, they do not cause lasting problems for the child. Children typically outgrow this type of seizure after age 5 years.

If your child has a febrile seizure, place him on his side and remove sharp or hard objects nearby. Loosen any tight clothing, especially near the neck. Do not put anything in his mouth. Have him seen by our office or the emergency room as soon as possible.

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Acetaminophen is a non-aspirin product suitable for children and adults in treating fever, aches, and pain. The following table gives dosages for younger children. Since products may vary in the concentration of active ingredient, please check each product’s package for directions.

The safest way to give a dose is by the number of milligrams. If the package directions do not give dosages for young children, then use this table.

Age                  Weight          Dosage         Drops     Syrup    Chewable

0-3 months      6-11 lbs.       30-40 mg     0.4 ml

4-11 months    12-17 lbs.     60-80 mg     0.8 ml     ½ tsp.    1 tab

12-23 months  18-23 lbs.     90-120 mg   1.2 ml     ¾ tsp.    1 ½ tab

2-3 years         24-35 lbs.    120-160 mg                 1 tsp.     2 tabs

4-5 years         36-47 lbs.    180-240 mg                 1½ tsp. 3 tabs

For older children and adults, see package directions.

Follow the same general principles as with a child. You may use aspirin, ibuprofen, or acetaminophen as indicated on the package directions.

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Sneezing is nature’s way of clearing the nose. Mucus that drains down the back of the throat may produce:

1. Coughing, especially when in bed and when arising.
2. Vomiting from drainage going into the stomach.
3. Sore throat.
4. Laryngitis (hoarseness) from drainage into the voice box.
5. Bronchitis from drainage into the chest.

1. Use the vaporizer (hot or cold). When the nose is stuffy, the child breathes through the mouth, bypassing the natural way of humidifying air flowing across the nasal membranes. The vaporizer keeps secretions loose so they may be coughed or sneezed out of the respiratory passages.
2. In addition to the vaporizer, you may use an infant nasal aspirator and/or saline nose drops. The aspirator may be helpful to remove mucous from the nose.  One with a plastic guard at the tip will help protect the inner nose from injury. If the baby/child is very congested or has thick nasal secretions, try the saline nose drops before using the aspirator. Lay the child face up on the floor between your thighs to have easy access and restraint. Block one side of the nose with your finger and place 1 or 2 drops of saline into the open nostril. Repeat in the other nostril. Then follow with use of the aspirator as above.
3. When the aspirator and vaporizer do not help, a congested nose may treated by first aspirating, then placing one drop of Neo-Synephrine ⅛ or ¼ % nose drops in each side of the nose. Allowing the drops to work for twenty to thirty seconds and then re-aspirating and applying one more drop often times will remove otherwise difficult mucus. Do not use nose drops longer than one week. For infants less than six months, use Neo-Synephrine ⅛% strength. For greater than six months, use the ¼% strength.
4. May use an antihistamine/decongestant such as PediaCare (available without prescription) four times a day. This will help cut down secretions.
5. If nasal drainage persists or is not clear (i.e. yellow or green), call the office (during office hours, when possible).

1. Use the vaporizer.
2. May use an antihistamine/decongestant purchased at the pharmacy. Follow the directions on the package.

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Knowing what to do for an earache is often perplexing. Some earaches are significant and can mean infection; others are not serious and only mean mild congestion. Older children will complain of ear pain, but younger children may only be fussy and irritable, running a fever or pulling at the ear. An office examination may be needed if the ear pain is severe, the ear is draining, there is associated fever or the earache persists more than 24 hours.

Temporary Treatment for an Earache: Use Tylenol or ibuprofen for pain. May use a decongestant such as Sudafed. Check with physician’s office in the morning.

Treatment for plugged ear "without pain": If accompanied by nasal congestion, try oral decongestant such as Sudafed. If there is no congestion and you have a history of wax build-up, you may try a medicine for wax build-up such as Debrox, which is available without a prescription. If symptoms persist, contact the office.

"Swimmer’s ear": If the earache is associated with or occurs in summer or after swimming, this may be an outer ear infection. Often the ear canal is swollen and movement of the outer ear may cause discomfort in this type of earache. If you have a history of swimmer’s each, you may try over the counter ear drops.

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VOMITING

Vomiting, or loss of stomach contents, occurs most frequently with diarrhea as part of seasonal "stomach flu". It may also follow food intolerance, intestinal obstruction, strep throat, swallowing foreign bodies, etc. The recommended treatment for children is 5 ml (1 tsp) of oral rehydration fluid (see below in dehydration) every two to five minutes until vomiting stops. Another option is 1 oz of liquid every 20-30 minutes until vomiting ceases. Adults may adopt a similar regimen. Once the vomiting stops, use guidelines for maintenance below.

If the vomiting is projectile, is accompanied by severe pain or blood in the vomitus or stool, or is related to injury, please contact us.

A child or adult can typically start back on solid foods 4 to 6 hour after rehydration starts, if it is successful. A mixed diet, especially one rich in carbohydrates, is recommended. Pasta, crackers, bread, bagels, rice or cereal are possible options. Milk is okay to use. If large, foamy, explosive bowel movements occur after starting milk, lactose intolerance may be involved. Lactobacillus casei, available in health food stores, may be given twice a day to help stop diarrhea. Antidiarrheal medications should not be used in children. Adults may use Immodium if absolutely necessary.

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Diarrhea is commonly associated with viral illnesses, especially rotavirus. Bacteria, parasites, ingested poisons or intestinal obstruction may also cause diarrhea. It is characterized by watery, loose bowel movements that may be seen 5-7 times or more in a day. Lab work is sometimes necessary, especially if there is dehydration involved, has occurred after recent travel or has blood in the bowel movements. Otherwise, it may be treated using the guidelines outlined below for oral rehydration.

DEHYDRATION

Dehydration can occur, especially in young children and the elderly, when what a person is taking in is not keeping up with what is being lost with vomiting or diarrhea. If a person has significant vomiting and/or diarrhea, is under one year of age or is showing signs of moderate or severe dehydration, please call us:

MILD DEHYDRATION: Increased thirst, urinating less often, slightly dry lips

MODERATE DEHYDRATION: Very thirsty, significantly less urination (>8 hours), very dry lips and mouth, absence of tears, sunken eyes, listlessness, irritability

SEVERE DEHYDRATION: Blue or cold extremities, rapid pulse or breathing, less responsive or lethargic

If the person has just started with vomiting or diarrhea, or is mildly dehydrated please start oral rehydration as described below. Doing so will usually prevent progression to more severe dehydration.

ORAL REHYDRATION: (For vomiting and/or diarrhea)

Preferred fluids for rehydration:  Rehydralyte® (Ross)

Less appropriate fluids(because of salt, sugar content):  cola, water, ginger ale, apple juice, chicken broth or Gatorade

If the person is dehydrated, do not use other fluids or food until the child is rehydrated. Breast feeding is okay to continue. A child will be rehydrated over 4-6 hours usually. An adult will be rehydrated over several hours. Once rehydrated, a person can begin hydration maintenance.

Recommended fluids for hydration maintenance:

Pedialyte® (Ross)

Infant formula (to alternate with above fluids)

We recommend small sips over the hour, rather than a large amount all at once. If there is vomiting after drinking, wait 20 minutes and try again. Use sips first, then try 1 oz. with gradual increases in amounts over several hours. With children, put fairly exact amounts in their cup or bottle (i.e. 1 oz. vs full bottle). Children cannot consciously regulate their intake. If they’re thirsty, they may take the whole bottle or cup, which may be too much for the stomach to take at once.

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Coughing is the natural way of clearing the breathing passages just as sneezing is the way to clear the nose. Coughing is therefore helpful. To completely stop all coughing would be harmful. Only "bad coughs" should be suppressed. A "bad cough" is one that is so frequent that it interferes with resting or becomes tiring during the daytime. You may treat a cough by:

1. Using a vaporizer (hot or cold).
2. Encourage adequate fluid intake to keep well hydrated and the secretions loose.
3. Give Robitussin-DM. This is a nonprescription cough medicine. The dose is on the bottle. For those under three years of age, give ¼ to ½ teaspoon every four hours as needed.
4. Use an antihistamine/decongestant medicine (i.e. PediaCare® in children and Dimetapp or Benylin Cough Syrup in adults). Remember that most night time coughing with nasal congestion is from post nasal drip and is best treated by the use of an antihistamine or nasal aspiration and vaporization.
5. If a cough persists beyond several days, is associated with fever or you have a lot of fowl sputum, then contact the office for advice.

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There are two types of sore throats-those that are caused by bacteria (example: Strep throat) and those caused by viruses (example: cold viruses, mononucleosis). About half of sore throats are caused by viruses. Unfortunately, we have no "cure" for viruses. Antibiotics do not help, although other medications may ease the symptoms until the body can make its own antibodies to fight the virus.

1. If the sore throat is minor, short-lasting and has no associated fever, the chances are that it is not a Strep throat, and therefore no antibiotic treatment is needed.
2. If the sore throat is accompanied by cold symptoms (stuffy nose and nasal drainage), try treating with PediaCare® for children (see dosage directions under APPENDIX A) or Co-Tylenol for adults. Older children and adults may use throat lozenges (Cepacol or Chloraseptic ) and a gargle which will help sore throat pain.
3. If the sore throat lasts more than 24 hours and is accompanied by fever, swollen tonsils or there appears to be pus or white spots, then call the office for advice.

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Cold compresses or ice will help any larger swollen bites. Calamine lotion will help itching. Benadryl or Chlor-Trimeton tablets (purchased at the pharmacy), orally for adults or syrup, chewables for children, will relieve swelling and itching. If there is trouble breathing or other systemic effects occur (i.e. hives) check with the physician.

Impetigo shows up as crusted lesions, usually starting on the face. It is spread by touching and then scratching another area of the body. It is contagious by direct contact only. Children should be kept home from school until under treatment 24 hours. Treatment for mild cases consists of washing with soap and water using a wash cloth or gauze pads to loosen crusts, then applying an antibiotic ointment such as Bacitracin or Neosporin (over-the-counter) to the areas. Repeat this 3-4 times daily until the rash clears. Try the soap, water, antibiotic ointment treatment on any suspicious rash. It can’t hurt and will often clear the rash.

If the rash is persistent, severe, or you doubt it is impetigo, an examination should be scheduled to be certain of the cause. Further specific treatment can then be instituted.

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Any period of unconsciousness lasting more than a few seconds warrants examination by a physician. Otherwise, the injured person may be observed; the physician should be contacted if any of the following signs are noted:

1. The patient is unusually sleepy or "dopey" during the day, is confused, has a loss of memory or has a personality change. In children, allow for normal nap time.
2. The patient is difficult to arouse. During the first 24 hours after injury the patient, should be awakened every 2-3 hours, including during the night.
3. Persistent nausea, vomiting or stiff neck occurs.
4. Patient cannot see clearly from both eyes, complains of blurred or double vision, dizziness, or loss of balance.
5. Headache lasting more than 24 hours, or becoming worse.
6. The pupil of one eye (the black spot in the center of the eye) becomes noticeably larger than the other.
7. Patient has a convulsion.

The first 24 hours after a head injury are the most "critical". Careful observation should be carried out for 3-5 days. If a youngster is involved in sports, clearance from a physician should be obtained before returning to sports.

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In majority of cases, the bleeding source is a small vessel which has been torn or has broken on the nasal septum (middle skin segment between the nasal openings). Children commonly have them due to winter and dry heat, viruses, and nose picking.

Treatment: Place patient in upright sitting position. Compression of the entire lower, soft portion of the nose between the index finger and thumb for five minutes usually works. If this fails, a small piece of cotton soaked in a decongestant nose drop or spray (i.e., Neosynephrine) can be placed inside the affected nostril and external compression applied again. If these measures are repeated and fail, a physician’s examination is necessary.

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If an injury occurs or there is pain or blurred vision, an examination is necessary.

"Pink eye" is an infection of the outer membrane of the eye. It is characterized by redness, mattering and "sticking" shut after sleeping. It is contagious only by direct contact, and if in a child, he/she should be kept home from school until treatment is underway. If mild, treatment may consist of wet cotton wiping of the closed eye to get rid of excess matter. If persistent or more severe, then call the office.

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This disease is characterized by "blisters on red bases": scattered over the body. This is a viral illness which can be prevented with a vaccine for children 1 year of age and older. Some children may have a very mild case with only a few pox, while others can be very miserable with extensive lesions involving the eyelids, mouth, etc. This is a viral illness and no curative treatment is available. Itching can be helped with an oatmeal or a baking soda bath (one or two cups of baking soda in a shallow tub of cool water splashed over the body). Calamine lotion is helpful. If the itching is not controlled, use Benadryl syrup. Tylenol may be of help for fever or generalized discomfort. Aspirin should be avoided because of a suspected relationship to Reye’s Syndrome.

Bathe the child twice daily to avoid secondary infection of the pox which could result in scarring. Cut the child’s nails short. Since adults may experience severe symptoms; they should contact the office.

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Burns from any source, including sunburn, are divided into three categories: 1^st, 2^nd and 3^rd degree, depending on the depth of the burn. With any burn, the patient should have an up-to-date tetanus vaccine with 5 years. All burns, even 1^st degree, can easily become infected. Patients should watch for any increase in redness or tenderness after the initial injury. If either of these develop, the burn should be seen by a physician to prevent more damage around the burn site.

First degree burns just cause redness and usually dryness at the outer layers of skin. These can be quite painful, but heal well in a short time. Treatment for 1^st degree burns requires cleaning with cold water and mild soap. After cleaning, use cold compresses or ice to minimize the injury to the skin and for pain control. Cold compresses and/or ice can even be used through the day following the initial burn. In the case of sunburn, a soothing lotion such as aloe vera may provide some relief of discomfort.

Second degree burns usually cause blistering, redness and the burn area is moist. If just a small area is burned, the 2^nd degree burn may be treated using the same procedure as with a 1^st degree burn. If the blistered area pops, the skin over this area may be removed and then this area should be cleansed with mild soapy water. Also, if available, an antibiotic cream should be applied to the burn area. Again, Tylenol, aspirin or ibuprofen may be used for pain and ice and/or cold compresses applied. If 2^nd degree burns are over ½ inch in size, they should be seen by a physician.

Third degree burns go through all the layers of the skin. They usually look shiny and white or charred. Areas of 3^rd degree burns are usually not painful because all the nerve endings have been destroyed. All of these burns should be seen by a physician.

Facial burns should be watched closer than most burns because damage may occur to the throat or upper respiratory tract and may not be noticed right away. If any trouble with breathing or hoarseness develops after a burn, the patient should be seen by a physician right away.

Children may get burned from bathwater, irons, cigarettes, hot stoves, formula, or curling irons. Please take appropriate safety measures to prevent such burns.

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Vaginal yeast infections are the most common type of vaginal infections. Symptoms may include thick, white discharge and vaginal itching, which often occurs after the use of an antibiotic. There are many over-the-counter antifungal creams that can used intravaginally such Vagistat, Femstat, Monistat, Gyne-Lotrimin. It is very important to use the medication for the prescribed amount of time (from 1 to 7 days depending on the product). If using the above medications does not help, an office appointment is usually needed.

Other vaginal infections such as trichomoniasis, chlamydia, bacterial vaginosis will require an office examination for proper testing and treatment. Do not douche prior to coming to the office, as it will obscure the findings making the diagnosis difficult.

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These infections are characterized by frequent urination, burning sensation while urinating and sometimes blood in the urine. Antibiotics are needed to treat the infection. Call the office during office hours and appropriate treatment can be given.

As soon as symptoms begin, do the following:

1. Drink large amounts of fluids, especially water. This dilutes the urine so bacteria have a difficult time multiplying.
2. Drink cranberry juice as this keeps the bacteria from clinging to the bladder walls.
3. Tylenol or ibuprofen may be used for discomfort.
4. Avoid caffeine or soda as these only aggravate the bladder further.

**If you have symptoms of a urinary tract infection and also fever and low backache, please call the office immediately.

***Also, it is very rare for men to experience urinary tract infections, so it is advisable for men to make an appointment for evaluation if the above symptoms are present.

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For pediatric dosages, go to our list.

Analgesics help to relieve minor aches, headaches, muscle pain, and post-immunization reactions. Acetaminophen (TYLENOL®) and ibuprofen (Motrin®) are effective pain and fever relievers and both are available without a prescription for relieving pain in children.

Antipyretics reduce fever. Acetaminophen (TYLENOL®) and ibuprofen (Motrin®) are effective fever and pain relievers and both are available without a prescription for lowering fever in children.

Antihistamines dry up secretions of the respiratory tract and can minimize the allergy symptoms of a runny nose, congestion, sneezing, and itching. Antihistamines may cause drowsiness and excitability, and they can in appropriately thicken mucus in respiratory conditions.

Decongestants help unclog nasal passages and clear congestion. Decongestant nose drops or sprays may cause a rebound effect, making the congestion worse. Oral medications containing a decongestant do not have a rebound effect but may cause rapid heart beat or other effects.

Expectorants help loosen mucus in the lungs so it can be coughed up and expelled. They are often sold in products with a cough suppressant.

Cough Suppressants, or antitussives, relieve the irritation of dry, unproductive coughs. Suppressing a cough for several days can cause a buildup of mucus in the lungs, so these drugs generally should be used only briefly.

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