KAISER PERMANENTE
HEALTHWISE
H A N D B O O K


A Self-Care Guide For You And Your Family

A Healthwise Publication



KAISER PERMANENTE





Your Family's Important Medical Information

For quick reference, use this page to record your family's medical record numbers, important phone numbers, and medication information.

Emergency Numbers:

Fire, Police, Medical, Ambulance: 911

Poison Control

Other


REMEMBER...

Whenever you call for advice or an appointment, be ready with:

Medical Record Numbers and Medical Providers


Family
Member
Medical
Record Number
Medical
Provider
Telephone Num
for Appointments
Telephone Num
for Advice





























































Health Plan Customer Service: 800 955 9940
Pharmacy:

Health Education Center:

24-Hour Refill Recorder:

Zero-Hour Refill Recorder:

Appointment Cancellation Number:

Medications

Family
Member
Name of
Medication
Strength/
Dosage
How Often is it
Taken or Used?
List Allergies
to Medications































































The Permanente Medical Group, Inc.
Kaiser Foundation Health Plan, inc.
Northern California Region
1950 Franklin Street
Oakland, California 94612-2998


KAISER PERMANENTE

Dear Health Plan Member,

We are delighted to offer you the enclosed Kaiser Permanente Healthwisee Handbook as an additional benefit of membership. Members who use this book tell us that it is an extremely useful tool in helping them care for themselves and their families.

As the comerstone of an exciting new health education program, the Handbook is designed to help you increase your confidence in managing common health problems in partnership with us. The Handbook provides information on over 180 health problems, including everything from headaches to ingrown toenails. For helpful hints on convenient home treatment or sound advice on when to call for professional help, check out the Handbook. It also contains the answers to many questions you might have about how to stay healthy, including what screening tests to have, how to start an exercise program, and how to eat healthfully. So whether it's allergies or AIDS, backache or bums, rashes or relaxation, runny nose or runner's knee-you'll find a wealth of good information right at your fingertips in this home health guide.

The Kaiser Pennanente Healthwise Handbook is a comprehensive, easy-to-understand guide that has been reviewed and revised by hundreds of Kaiser Permanente physicians and professional staff members. Take a few minutes now to glance through it - we think you will find it of interest even when you are well. And, when you are sick, knowing what's in the book can help you quickly decide on the most appropriate care for yourself and your family. Keep the book handy - perhaps by your telephone along with your local Kaiser Permanente Health Care Directory.

Your Kaiser Perrnanente health care team will always be there when you need us. We value our role as your "partner in health" and look forward to helping you and your family stay healthy.



W.H. Caulfield, MD
Executive Director
The Permanente Medical Group, Inc.


Richard G. Barnaby
President and Chief Operating Officer
Kaiser Foundation Health Plan, Inc. and
Kaiser Foundation Hospitals and
Interim President, California Division






KAISER PERMANENTE
HEALTHWISE
H A N D B O O K


A Self-Care Guide For You
And Your Family

Donald W. Kemper

The Healthwise Staff

The Kaiser Permanente Physicians and Staff of Northern California





A Healthwise Publication
Healthwise, Incorporated, Boise, Idaho
(A not-for-profit organization)










KAISER PERMANENTE






Standard Healthwise cover design by Beth Workman

Kaiser Permanente cover concept by Seventeenth Street Studios, current Kaiser Permanente cover design and illustrations by Kathy Locke of Locke Veach Communications Group

Illustrations by Consuelo Udave, June Perry, Mac Browning, and Sascha Hutchings

Copyright 1976, 1991, 1994 by Healthwise, Incorporated, P.O. Box 1989, Boise, Idaho 83701.

All rights reserved. This book or any part thereof may not be reproduced in any form or by any means without written permission from the publisher.

First Edition, 1976 Kaiser Permanente Edition (First Printing), 1994 Kaiser Permanente Revised Edition, 1997 Second Printing, 1998

Readers may reproduce pages I and 2 for their personal use only. Reproduction of those pages for resale is strictly prohibited.

ISBN: 1-877930-45-8

Library of Congress Catalog Card Number: 89-84789

Printed in the United States of America





Table of Contents


To Our Readers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
About Healthwise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Kaiser Permanente Staff Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Healthwise Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Ask-the-Doctor Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part I: Self-Care Basics

Chapter 1: Using the Kaiser Permanente System . . . . . . . . . . . . . . . . . . .

Getting the Care You Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Questions? Problems? Suggestions? We're Here to Help . . . . . . . . . . . . . .
Your Personal Health Care Provider . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appointments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
What to Do in an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pharmacy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Your Kaiser Identification Card . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Receiving Care Outside the Kaiser Foundation System . . . . . . . . . . . . . . . . . .

Chapter 2: The Wise Medical Consumer . . . . . . . . . . . . . . . . . . . . . . . .

Work in Partnership With Your Doctor/Nurse Practitioner . . . . . . . . . . . .
Take Part in Every Medical Decision . . . . . . . . . . . . . . . . . . . . . . . . . . .
Become Skilled at Obtaining Medical Care . . . . . . . . . . . . . . . . . . . . . . . . .

Chapter 3: Staying Healthy and Preventing Disease . . . . . . . . . . . . . . . . . . . .

Ten Ways to Stay Healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Immunizations . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .
Immunization Schedule Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Screening and Early Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Tests for Early Detection Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Vital Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fever . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . .. . . . . .
High Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II: Health Problems
Chapter 4: Abdominal Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Abdominal Problems Chart . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . .. . . . . . .
Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .
Consitpation . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . .. . . . .
Dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Heartburn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hemorrhoids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Irritable Bowel Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Nausea and Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Stomache Flu and Food Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vii
ix
x
xii
xiv
1
2


3


3
4
4
5
6
7
8
9
9
10

11

11
14
18

25

25
26
27
30
31
32
35
36


39
40
41
42
43
45
46
47
48
50
51
55






To Our Readers

No book can replace the need for doctors - and no doctor can replace the need for people to care for themselves. The purpose of this book is to help you and your doctors work together to manage your health problems.

The Healthwise Handbook includes basic guidelines on how to recognize and cope with over 180 of the most common health problems. These guidelines are based on sound medical information from leading medical and consumer publications, with review and input from doctors, nurses, pharmacists, physical therapists, and other health professionals. We have worked to present the information in a straightforward way that is free from medical jargon. We hope you find it easy to read and easy to use.

While this book does not eliminate the need for professional medical help, it does provide a better basis for you to work with your doctors to prevent and jointly care for health problems. If you receive professional advice in conflict with this book, look first to your health professional. Because your doctor is able to take your specific history and needs into consideration, his or her recommendations may prove to be the best. Likewise, if any self-care advice fails to provide posi- tive results within a reasonable period, you should consult a health professional.

This book is as good as we can make it, but we cannot guarantee that it will work for you in every case. Nor will the authors or publishers accept responsibility for any problems that may develop from following its guidelines. This book is only a guide; your common sense and good judgment are also needed.

We are continually adding to and improving this book. If you have a suggestion that will make this book better, or if you have a story about how self-care guidelines in the Healthwise Handbook helped you, please write us at Healthwise Handbook Suggestions, c/o Healthwise, P.O. Box 1989, Boise, ID 83701, call us at 1-800-706-9646, or visit our web site at www.healthwise.org.

We wish you the best of health.




viii




About Healthwise

Healthwise is a nonprofit organization working to help people do a better job of staying healthy and taking care of their health problems. Since its founding in 1975, Healthwise has won awards of excellence and recognition from the Centers for Disease Control, the U.S. Department of Health and Human Services, the American Society on Aging, and the World Health Organization. Our clients range from volunteer organizations and church groups to Fortune 500 companies, major unions, state governments, hospitals, insurers, and health maintenance organizations.

Healthwise Program - This nationally replicated program gives consumers the resources and skills to improve the quality of care provided at home and helps them decide when to call a health professional. Program components include the Healthwise Handbook (available in English and Spanish) and self-care workshop (live or video-based).

Healthwise for Life Program - This program meets the self-care and medical consumer needs for older adults, retirees, and MediCare participants. Program components include the award-winning Healthwise for Life: Medical Self-Care for Healthy Aging handbook and Healthwise for Life workshop (live or video-based).

Partnership Program - This training and orientation program helps health professionals learn how they can better support their patients' self-care efforts (CME credits).

Healthwise Knowledgebase Software - This computer-based source of consumer health information is used by managed care organizations, health clinics, nurse call centers, and as a part of online services. The Knowledgebase has comprehensive, useful, understandable, and medically accurate information on health problems, medical tests, treatments, medications, and support groups. See our web site for a demo: www.healthwise.com.

International Programs - Healthwise programs have been implemented in South Africa, Canada, the United Kingdom, and Switzerland.

It's About Time: Beffer Health Care in a Minute (or two) - This 32-page booklet offers quick, easy-to-use action steps that promote good doctor-patient relationships.

Pathways - The Pathways features a guilt-free approach to health changes in 10 areas, including stress, nutrition, fitness, smoking, alcohol and other drugs, and relationships. The handbook Pathways: A Success Guide to a Healthy Life is the cornerstone of the Pathways workshop.

Growing Wiser - The book Growing Wiser: The Older Person's Guide to Mental Wellness and Growing Wiser Workshops focus on memory improvement, mental vitality, coping with loss and life change, maintaining independence, and self-esteem for older adults.

For more information on our programs and publications, please contact Healthwise at P.O. Box 1989, Boise, ID 83701, 1-800-706-9646, or visit our web site at www.healthwise.org.



ix





Acknowledgements

This edition of the Healthwise Handbook combines the best of old and new. The original 1976 1st Edition was written and edited with major contributions from Kathy McIntosh and Toni Roberts. Since then, scores of people have helped to improve and update the book. Their combined work resulted in the book's winning of the American Health Book Award.

Starting with the 10th Edition, we conducted exhaustive research on every topic, carefully reviewed and evaluated reader suggestions, and reorganized and updated it. Over 20 new topics have been added and many sections are completely rewritten. We hope you like it.

Special thanks go to Diana Stilwell, MPH, who coordinated the research and medical reviews, wrote many of the updates, and edited the entire book. Molly Mettler was also a major contributor to the writing and editing and shares with Diana responsibility for the quality of the book. The design, layout, and produc- tion work of Andrea Blum, Terrie Britton, and Elaine Wencl, the layout work of Carrie Wiss and Sue Armstrong, and the editorial and proofreading assistance of Jean Miller and Jane Woychick are greatly appreciated. Many thanks also go to Cindy Hovland, who provided invaluable assistance. Terrance L. Smith, PhD, was the editor of this revised edition.

This book would not have been possible without the extensive help and guidance from health professionals. Steve Schneider, MD, was the principal medical reviewer for this edition. The following other health professionals were also particularly helpful.

Physicians

Janet Aguilar, MD
Richard Aptaker, DO
Bruce Davis, MD
Gail Eberharter, MD
Michael Felder, MD
Andrew Fox, MD
Steven Freedman, MD
William Fuchs, MD
Marty Gabica, MD
Matthew Handley, MD
Elisabeth Kelley, MD
Edwin Matthes, DDS James T. Pozniakas, MD Cajsa Schumacher, MD Warren Scott, MD Stanford Shoor, MD David Sobel, MD, MPH Gary Stein, MD William Teubl, MD Marti W. Nelson, MD Michael Weiss, MD, MPH

Nurses

Marian Broida, RN
Gene Drabinski, RN
Judy Dundas, RN
Jayne Hanich, RN
Randi Holland, RN
Sherri Rickman, RN
Margo Sturgis, RN, GNP
Susan Van Houten, RN, BSN
Susie Whittinghill, RN
The staff of Employee Managed
Care Corporation

Physical Therapist

Lynn Johnson, PT, ATR

Health Educators

Bob Gorsky, PhD
Joan Greathouse, MED
Jim Giuffre, MPH

Nutritionist

Ruth Schneider, RD, MPH



We also wish to thank those health professionals and consumers whose review, suggestions, and input on previous editions were the foundation for the current book.

Most of all, we would like to thank the hundreds of thousands of medical consumers who use the Healthwise Handbook. It is your actions that reward us the most and inspire us to constantly look for ways to improve this handbook.

Funding for the original development of the Healthwise Handbook was provided by the W.K. Kellogg Foundation of Battle Creek, Michigan.



Donald W. Kemper
April 1997



xi




Kaiser Permanente Staff Acknowledgements


This book has benefitted from careffil review by hundreds of Kaiser Permanente physicians, nurses, and other staff. This revision would simply not have been possible without the generous advice and contributions of several colleagues.

Joyce 0. Arango, DrPH
Ann Banchoff, MSW, MPH
Timothy Batchelder, MD
Andrea Bickart, NP
Steven Black, MD
Patricia G. Engasser, MD
Ira Fielding, MD
Patricia M. Forman, MPH
Ira Golditch, MD
C. Dan Henderson, MD
Raymond Hilsinger, MD
Susan Kayman, DrPH, RD
Robert Klein, MD
Craig Koch, MD
Roger F. Lake, MD
Robert LaPerriere, MD
Spenser Larsen, MD
Felicity McNichol, MD
Dennis Mills, MD
Albert M. Palitz, MD
Pamela Peters, PhD
Vincent Quintana, MD
David S. Sobel, MD, MPH
William Sueksdorf, MD
Stanley Tillinghast, MD, MPA
Janet Venturino
Carol Weed, MD
Madelyn Weiss, MD
Deborah Zahn

In addition, important contributions were made by:

Michael Allerton, MS
Hernan Alvarado, MD
Stephanie Anderson, MED
Helen Armstrong, MD
Kristina Austin, MD
Arleen Ballin, MA, PT
Linda C. Bartlett, MD
Alfred Baumann, MD
Robert Bonar, MD
Stephen Borchers, MD
Richard Brahm, MD
Henry M. Brodkin, MD
George Bulloch, MD
Laura Butcher, MD
Sharon Caldwell
Luis A. Chardon, MD
Kenneth Clay, RN
Charles Clemons, MD
Ruth J. Crane, MD
Kelly L. Crawford, MD
Francis J. Crosson, MD
Robin A. Dea, MD
Judy Derman, MS
Patty Donahue-Carey, ACCE
John Doyle, MD
Laurie Doyle, MPH
Paul Feigenbaum, MD
Trudee Ferree, RN
Janet Franklin, MPH
John Freedman, MD
Meg Freedman
David Freeman, MD
Hans Ernst, MD
Richard Fury, MD
Gordon Garcia, MD
Bradley Gascoigne, MD
Mark Gasparini, MD
Scott Gee, MD
Mark Glasser, MD
Bonnie Gieschen
Zoe Goldman



xii





Steve Goldstein, PT
Martin Gon, MD
Nancy Gonzalez-Caro, MPH
Lynn Gordon, MPH
William Gottfried, MD
Naomi Granvold, MD
Mimi Haley
John Hardy, MD
Lorinda Hartwell, DrPH
Gloria Hing, MD
Mary Hobbs, MPH
Sarah Idelson
Lewis Ivey, MD
Steven Jones, MD
Jeffrey Karlin, DPM
Kathleen Kearney, PhD
Kevin Keck, MD
Virginia Keefer, RN
Carl Keene, MD
Elisabeth Kelly, MD
Ron Kemper
Janet Keremitsis, MD
Harold W. Korol, MD
Pamela Kotler, PhD
Angela Kraft, MD
Elizabeth Kubiak, MD
Peter Levine, MD
Sharon Levine, MD
Bruce Locke, MD
Nicola Longmnir, MD
Lawrence B. Lusk, MD
Pat Lyons, RN, MA
Jeffrey Malone, MD
Ferdy Massimino, MD
Sharie Nereu, MPH
Kaytie Osterloh, PT
John G. Poochigian, MD
Caren Quay, MLS
Kenneth Raap, DPM
John Ribaudo, MD
Kara Riley-Paull, MD
Vivian Rittenhouse
David Rosen, MD
Cecilia Runkle, PhD, MPH
John R. Rosenberg, MD
Jack E. Rozance, MD
Suketu Sanghvi, MD
Marc S. Schiff, MD
Thomas Sharpton, MD
Michael J. Sheridan, MD
Steven N. Shpall, MD
John Shrum, MD
Anna-Lisa Silvestre, MPH
Karen Simpson, MD
Dot Snow, MPH
Gary Stein, MD
Joel Teisch, MD
Mark Thompson, PhD
Jennifer Torresen, MPH
Ximena L. Valdes, MD
Suzie Waterbury, PT
Frederick Wilkinson, MD
Timothy Wong, MD
Lorraine Young, MD
Joe Zimmerman, MD

Many people not listed here also gave of themselves in numerous ways. We wish to thank everyone at Kaiser Permanente who from the outset supplied enthusiasm and support for the Self-Care Program.

Steven M. Freedman, MD
Family Practice
Martinez


Pamela J. Larson, MPH
Regional Department
of Health Education



xii




Introduction

The Healthwise Handbook can help you improve your health and lower your health care costs. We hope it is a book you will turn to time and again as health problems arise.

The book is divided into four sections:

Self-Care Basics. What you need to know to be a wise medical consumer.

Health Problems. Prevention, treatment, and when to call a doctor for over 180 common illnesses and injuries.

Staying Healthy. Tips and techniques for dental health, fitness, stress management, nutrition, and mental wellness.

Self-Care Resources. How to manage medications and what you need to have on hand in your home to cope with health problems.

Most people will not read through the book from cover to cover in one sitting. It is more of a topic-by-topic book. Look up what you need when a problem or interest develops.

We do recommend that you read pages 1 and 2 and three special chapters right away:

Page 1, The Healthwise Approach, is a process to follow every time a health problem arises. Page 2, the Ask-the-Doctor Checklist, will help you get the most out of every doctor visit.

Chapter 2, The Wise Medical Consumer, offers important information you can use to improve the quality and lower the cost of the health care you need.

Chapter 3, Staying Healthy and Preventing Disease, discusses the impor- tant things you can do to protect your health and prevent disease.

Chapter 20, Your Home Health Center, lists medications, supplies, equipment, and resources you may wish to keep on hand.

The rest of the information in the book is there when you need it. We have enjoyed writing this book and keeping it up to date. We hope it will help you succeed in better managing your health problems.



xiv




The Healthwise Approach


Step 1. Observe the problem.

Step 2. Learn more about it.

Step 3. Make an action plan.

Step 4. Evaluate your progress.


1





Ask-the-Doctor Checklist

Before the visit:

During the visit:

Write down:

For drugs, tests, and treatments, ask: (See pages 15 to 18.)

At the end of the visit, ask:

2