Depression is a condition that affects the way you feel, think, and act. It causes symptoms such as low energy, loss of interest in daily activities, and sadness or grouchiness that goes on for a long time. Depression is very common and affects men and women of all ages.

Depression is a medical illness caused by changes in the natural chemicals in your brain. It is not a character flaw, and it does not mean that you are a bad or weak person. It does not mean that you are going crazy.

It is important to know that depression can be treated. Counselling, medicines, and self-care can all help. Many people do not get help because they are embarrassed or think that they will get over the depression on their own. But some people do not get better without treatment.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Learn about counselling

In many cases, counselling can work as well as medicines to treat mild to moderate depression. Counselling is done by licensed mental health providers, such as psychologists, social workers, and some types of nurses. It can be done in one-on-one sessions or in a group setting. Many people find group sessions helpful.

Cognitive-behavioural therapy is a type of counselling. In this treatment therapy, you learn how to see and change unhelpful thinking styles that may be adding to your depression. Counselling and medicines often work well when used together.

Learn about antidepressant medicines

Antidepressant medicines can improve or end the symptoms of depression. You may need to take the medicine for at least 6 months, and often longer. Keep taking your medicine even if you feel better. If you stop taking it too soon, your symptoms may come back or get worse.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. Talk to your doctor if you have problems with your medicine or if you do not notice any improvement after 3 weeks.

Antidepressants can make you feel tired, dizzy, or nervous. Some people have dry mouth, constipation, headaches, sexual problems, an upset stomach, or diarrhea. Many of these side effects are mild and go away on their own after you take the medicine for a few weeks. Some may last longer. Talk to your doctor if side effects bother you too much. You might be able to try a different medicine. If you are pregnant or breastfeeding, talk to your doctor about what medicines you can take.

To manage depression

• Be physically active. Getting 2½ hours of exercise each week is good for your body and your mind. Begin slowly if it is hard for you to get started. If you already exercise, keep it up.
• Plan something pleasant for yourself every day. Include activities that you have enjoyed in the past.
• Get enough sleep. Talk to your doctor if you have problems sleeping.
• Eat a balanced diet. If you do not feel hungry, eat small snacks rather than large meals.
• Do not drink alcohol, use illegal drugs, or take medicines that your doctor has not prescribed for you. They may interfere with your treatment.
• Spend time with family and friends. It may help to speak openly about your depression with people you trust.
• Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine.
• Do not make major life decisions while you are depressed. Depression may change the way you think. You will be able to make better decisions after you feel better.
• Think positively. Challenge negative thoughts with statements such as “I am hopeful”; “Things will get better”; and “I can ask for the help I need.” Write down these statements and read them often, even if you don’t believe them yet.
• Be patient with yourself. It took time for your depression to develop, and it will take time for your symptoms to improve. Do not take on too much or be too hard on yourself.
• Learn all you can about depression from written and online materials.
• Check out behavioural health classes to learn more about dealing with depression.
• Keep the number for your nurse call line or your provincial suicide prevention hotline on or near your phone. If you or someone you know talks about suicide or feeling hopeless, get help right away.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You feel you cannot stop from hurting yourself or someone else.

Call your doctor or nurse call line now or seek immediate medical care if:

• You hear voices.
• You feel much more depressed.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

• You are having problems with your depression medicine.
• You are not getting better as expected.

Colitis is the medical term for swelling (inflammation) of the intestine. It can be caused by different things, such as an infection or loss of blood flow in the intestine. Other causes are problems like Crohn’s disease or ulcerative colitis.

Symptoms may include fever, diarrhea that may be bloody, or belly pain. Sometimes symptoms go away without treatment. But you may need treatment or more tests, such as blood tests or a stool test. Or you may need imaging tests like a CT scan or a colonoscopy. In some cases, the doctor may want to test a sample of tissue from the intestine. This test is called a biopsy.

The doctor has checked you carefully, but problems can develop later. If you notice any problems or new symptoms, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Rest until you feel better.
• Your doctor may recommend that you eat bland foods. These include rice, dry toast or crackers, bananas, and applesauce.
• To prevent dehydration, drink plenty of fluids. Choose water and other caffeine-free clear liquids until you feel better. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having a problem with your medicine. You will get more details on the specific medicines your doctor prescribes.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• Your stools are maroon or very bloody.

Call your doctor or nurse call line now or seek immediate medical care if:

• You have new or worse belly pain.
• You have a fever.
• You are vomiting.
• You cannot pass stools or gas.
• You have new or more blood in your stools.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

• You do not get better as expected.
• You have new or worse symptoms.
• You are losing weight.

An undescended testicle (or “testis”) is when it fails to drop into the normal place in the scrotum. Your child’s health care provider can find this during a routine exam. This issue is found in about 3 or 4 out of  100 newborns (and up to 21 out of 100 premature newborns). Luckily, about half of these testicles will drop on their own during the first 3 months of life. But testicles won’t drop on their own after 3 months of age. Thus, about 1 or 2 out of 100 boys with undescended testicles will need treatment.

It’s important not to confuse undescended testicles with “retractile” testicles. After 6 months of age, a male child has a reflex that temporarily pulls the testicles up to protect them when he’s cold or frightened. These testicles are in the scrotum at other times and don’t need treatment. Only testicles that are truly undescended need treatment. A pediatric urologist can tell the difference with a physical exam.

The testicles need to be 2 to 3 degrees cooler than normal body temperature to make sperm. The scrotum is many degrees cooler than body temperature, and so is the ideal place for the testicle. Testicles that don’t drop into the scrotum won’t work normally. The longer the testicles are too warm, the lower chances are that the sperm in that testicle will mature normally. This can be a cause of infertility, especially when both testicles are affected.

Undescended testicles are also linked to a higher risk of:

• Testicular cancer in adulthood (though the risk is still less than 1 in 100)
• Testicular torsion (twisting of the chord that brings blood to the scrotum)
• Developing a hernia near the groin

Causes

In most children with this health issue, it’s not known why the testicles fail to drop. It may be because the testicles aren’t normal to start with. In other cases, there’s a mechanical problem. The testicles drop but miss the scrotum, ending up next to the scrotum instead. These are called “ectopic testicles.” Or it may be that the baby’s hormones can’t stimulate the testicles normally. No studies have shown that the problem is caused by something the mother did or ate during pregnancy.

Sometimes the testicles drop but don’t attach in the scrotum. Then, when the boy grows, it becomes clear that the testicles aren’t attached. About 1 of every 5 cases of undescended testicles are found once the boy is no longer a baby. For this reason, all boys should have the location of their testicles checked during each annual physical exam.

Diagnosis

A testicle that can’t be felt in a physical exam is called “nonpalpable.” Nonpalpable testicles may be in the abdomen (undescended), absent, or very small (“atrophic”). It’s important to find out whether there is a testicle that hasn’t dropped. An undescended testicle left inside the abdomen could form a tumor later in life. Such a tumor might not be noticed until it becomes quite large or causes symptoms. Unfortunately, there’s no test, such as an ultrasound, that can definitively show whether a testicle is there. Surgery is the only way to find out for sure.

Pediatric urologists are experts in both open and laparoscopic surgery. Laparoscopy is surgery done through thin tubes put into your child’s body through a small cut. The surgeon uses a special camera to see inside your child’s body. The surgeon will find one of 3 situations:

1. Blind-ending testicular blood vessels – proving there’s no testicle
2. Vessels leaving the abdomen – proving there’s no testicle in the abdomen
3. A testicle in the abdomen. If a testicle is found, it’s brought down into the scrotum or removed, based on its condition.

Treatment

The testicle won’t drop after 3 months of age, so the only treatment choice is surgery. Surgery is recommended after 6 months of age. The timing takes into account when the child is able to handle anesthesia and the surgery. Drugs or hormone treatment aren’t useful.

This surgery is called an orchiopexy. The child is put under (general anesthesia) for this surgery. Almost always the child can go home the same day and is back to normal within 1 to 2 days. A cut about 1 inch long is made in the groin area (most often it can hardly be seen later). The testicles is freed from all nearby tissues so that it moves easily into the scrotum. Then it is stitched into place. If there’s a hernia, it’s fixed at the same time. In some cases, the testicle is too high for this simple surgery. If this is the case, more complex methods (and sometimes even 2 surgeries) are needed. Overall, the success rate with surgery is 98 out of 100.

After Treatment

After treatment, the testicle often grows to normal size in the scrotum. In some cases, the testicle wasn’t normal to start with, and never grows the right way. In other cases, sperm never grow, even though the testicle size is normal. In most cases, after treatment for 1 undescended testicle, fertility becomes normal and the chances of fathering a child in the future are high. When the child becomes a teen, he should have routine physical exams and do monthly testicular self-exams. Routine physicals will look for signs of testicular cancer, which remains a slight risk.

Frequently Asked Questions

Is an undescended testicle always found in babies?

No. About 1 of every 5 cases of undescended testicles are found after the boy is no longer a baby. The testicles of these boys appeared to have dropped normally as babies. If an undescended testicle appears later it is called an “ascending testicle.” This happens because the testicle doesn’t “fix” itself in the scrotum, and is noticed as the child grows. Often these boys are known to have a retractile testicle before they are diagnosed with an ascending testicle. These testicles need surgery to move them into the scrotum. Sperm won’t mature if the testicle stays undescended. For these reasons, boys should have their genitals checked during their yearly physical exam.

Trichomonas vaginal infection is often called “trich.” It is caused by a parasite that is passed during sex. This makes trich a sexually transmitted infection (STI). Both men and women can get trich, but it is more common in women.

Most people who have trich don’t have any symptoms at first. If symptoms do occur, they may take weeks or months to develop.

Symptoms in women can include:

• Thin discharge from the vagina that may smell bad and be clear, white, gray, green, or yellow in color
• Itching, burning, redness, or soreness in or around the vagina
• Pain in the lower belly
• Frequent urination or pain and burning during urination
• Pain during sex

Symptoms in men are not very common. Men may have trich and pass it to women during sex without knowing they were ever infected.

Trich is most often treated with antibiotics. Without treatment, trich can increase the risk of more serious health problems such as:

• Pelvic inflammatory disease (PID)
• Preterm delivery (giving birth to a baby early if you’re pregnant)
• HIV and certain other STIs

Home care

• Take the antibiotics you’re prescribed exactly as directed. Finish  all of the medicine, even if your symptoms go away.
• Don’t drink alcohol until you’re done with your treatment.
• Tell any partners you have sex with that you have trich. They will need to be tested for trich and possibly treated as well.
• Don’t have sex until 7 to 10 days after you and any partners you have sex with are confirmed to have been treated.

Prevention

The only way to prevent getting trich or any other STI is to not have sex. If you choose to have sex, then take steps to lower your health risks:

• Use condoms when having sex.
• Limit the number of partners you have sex with.
• Get tested regularly for STIs. Ask any partner you have sex with to do the same.
• Don’t have sex with anyone who has symptoms that may be due to an STI.

Follow-up care

Follow up with your healthcare provider, or as advised. Testing will likely be done to ensure that the infection has cleared.

When to get medical advice

Call your healthcare provider right away if:

• You have a fever of 100.4ºF (38ºC) or higher, or as directed by your provider.
• Your symptoms get worse, or they don’t go away even after completing your treatment.
• You have new pain in the lower belly or pelvic region.
• You have side effects that bother you or a reaction to the medicine you’re taking.
• You or any partners you have sex with have new symptoms, such as a rash, joint pain, or sores.

Any object placed inside the vagina is called a vaginal foreign body. This includes tampons, birth control devices, and sex toys. In some cases, objects not designed for the vagina may be placed inside.

If an object is left inside the vagina too long or becomes stuck, it can cause symptoms. It can also lead to infection and damage nearby tissues.

Symptoms can include abnormal or bad-smelling discharge. Bleeding, redness, swelling, or rash may also occur. Some women may feel pain or pressure in or around the vagina.

Treatment includes removing the object. Once the object is removed, symptoms should go away. If the object caused an infection, antibiotics may be given.

Home care

• If you’re prescribed any medicines, take them as directed.
• Don’t douche unless advised to by your provider.
• Wait until all symptoms are gone before having sex.
• Check with your provider before using tampons. If it’s OK, remember to remove each tampon you use after 6 to 8 hours or sooner.
• If you have new symptoms or any questions or concerns, contact your healthcare provider.

Follow-up care

Follow up with your healthcare provider, or as advised.

When to get medical advice

Call your healthcare provider right away if any of these occur:

• Your symptoms don’t improve or they get worse.
• You develop pain in the belly or groin, especially if it gets worse with walking.
• You have burning or pain when urinating.
• You have a fever of 100.4ºF (38ºC) or higher, or as directed by your provider.

Call 911

Call 911 or get medical care right away if you:

• Feel weak, dizzy, or faint.

Bacterial vaginosis (BV) is an infection in the vagina.

It may cause vaginitis, which is irritation and inflammation of the vagina.

DISCHARGE INSTRUCTIONS:

Medicines:

• Antibiotics: These are given to kill the bacteria that cause BV. They may be given as a pill or a cream to put in your vagina. Take or use as directed.
• Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Prevent bacterial vaginosis:

• Keep your vaginal area clean and dry: Wear underwear and pantyhose with a cotton crotch. Wipe from front to back after you urinate or have a bowel movement. After bathing, rinse soap from your vaginal area to decrease your risk for irritation.
• Do not use products that cause irritation: Always use unscented tampons or sanitary pads. Do not use feminine sprays, powders, or scented tampons because they may cause irritation and increase your risk of BV. Detergents and fabric softeners may also cause irritation.
• Do not douche: This can cause an imbalance in healthy vaginal bacteria.
• Use latex condoms: This helps prevent another infection and keeps your partner from getting the infection.

Contact your healthcare provider if:

• Your symptoms come back or do not improve with treatment.
• You have vaginal bleeding that is not your monthly period.
• You have questions or concerns about your condition or care.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Unlike typical angina – which is often triggered by exertion or emotional stress – Prinzmetal’s angina almost always occurs when a person is at rest, usually between midnight and early morning. These attacks can be very painful.

Prinzmetal angina may also be referred to as:

• Variant angina
• Prinzmetal’s variant angina
• Angina inversa

Prinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.

Causes of Variant (Prinzmetal) Angina: The pain from variant angina is caused by a spasm in the coronary arteries (which supply blood to the heart muscle).

The coronary arteries can spasm as a result of:

• Exposure to cold weather
• Stress
• Medicines that tighten or narrow blood vessels
• Smoking
• Cocaine use

Symptoms of Variant (Prinzmetal) Angina:

The pain or discomfort:

• Usually occurs while resting and during the night or early morning hours
• Are usually severe
• Can be relieved by taking medication

Treatment of Variant Angina (Prinzmetal) Angina

Medicines can help control the spasms. Drugs such as calcium antagonists and nitrates are the mainstays of treatment.

The spasms tend to come in cycles – appearing for a time, then going away. After six to 12 months of treatment, doctors may gradually reduce the medication.

Prinzmetal’s angina is a chronic condition that will need to be followed by your healthcare provider even though the prognosis is generally good.

When your child vomits (throws up), it’s normal to be concerned or worried. But vomiting is usually not due to a major health problem. Vomiting is most often caused by viral infection or food poisoning. It usually lasts only a day or two. The biggest concern when your child is vomiting is dehydration (too little fluid in the body). This sheet tells you what you can do to help your child feel better and stay hydrated.

How is vomiting treated at home?

• Stomach rest. Keep your child from eating or drinking for 30 to 60 minutes after vomiting. This gives your child’s stomach a chance to recover.
• Replacing fluids. Dehydration can be a problem when your child is vomiting. Start replacing fluids after your child has not vomited for 30 to 60 minutes. To do this: 
  • Wait until your child feels well enough to ask for a drink. Don’t force your child to drink if he or she still feels unwell. And don’t wake your child to drink if he or she is sleeping.
  • Start by giving your child very small amounts (1/2 oz or less) of fluid every 5 to 10 minutes. Use a teaspoon instead of a glass to give fluids.
  • Use water or another clear, noncarbonated liquid. Breast milk may be given if your child is breastfeeding.
  • If your child vomits the fluid, wait at least another 30 minutes. Then start again with a very small amount of fluid every 5 to 10 minutes.
  • If your child is having trouble swallowing liquids, offer frozen juice bars (without pieces of fruit) or ice chips.
  • Oral rehydration solution may be used if your child is dehydrated from repeated vomiting. You can buy rehydration solution at your local grocery store or pharmacy. Stay away from sports drinks. They have too much sugar.
• Solid food.  If your child is hungry and asking for food, try giving small amounts of a bland food. This includes crackers, dry cereal, rice, or noodles. Avoid giving your child greasy, fatty, or spicy foods for a few days as your child recovers.
• Medicines. If your child has a fever, ask your healthcare provider if you can give an over-the-counter medicine, such as acetaminophen. These medicines may also be available in suppository form if your child is still vomiting. Talk with your pharmacist to learn more. Don’t give your child aspirin to relieve a fever. Using aspirin to treat a fever in children could cause a serious condition called Reye syndrome. Also, ibuprofen is not approved for infants under 6 months of age.

When to call your child’s healthcare provider

Call your child’s healthcare provider right away if your otherwise healthy child has any of the following:

• Fever (see Fever and children, below)
• Vomiting several times an hour for several hours
• Bloody vomit
• Greenish vomit (contains bile)
• Stomach pain
• Uncontrolled retching (without producing vomit)
• Vomiting after taking prescription medicine
• Very forceful vomiting (projectile vomiting)
• Bloody diarrhea

Symptoms of dehydration

• Listless or lethargic behavior
• No urine for 6 to 8 hours or very dark urine
• Child refuses fluids for 6 to 8 hours
• Dry mouth or sunken eyes

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

• Ask your child’s healthcare provider how you should take the temperature.
• Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
• Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

• Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
• Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

• Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
• Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

Acute nausea and vomiting start suddenly, worsen quickly, and last a short time.

DISCHARGE INSTRUCTIONS:

Return to the emergency department if:

• You see blood in your vomit or your bowel movements.
• You have sudden, severe pain in your chest and upper abdomen after hard vomiting or retching.
• You have swelling in your neck and chest.
• You are dizzy, cold, and thirsty and your eyes and mouth are dry.
• You are urinating very little or not at all.
• You have muscle weakness, leg cramps, and trouble breathing.
• Your heart is beating much faster than normal.
• You continue to vomit for more than 48 hours.

Contact your healthcare provider if:

• You have frequent dry heaves (vomiting but nothing comes out).
• Your nausea and vomiting does not get better or go away after you use medicine.
• You have questions or concerns about your condition or treatment.

Medicines:

You may need any of the following:

• Medicines may be given to calm your stomach and stop your vomiting. You may also need medicines to help you feel more relaxed or to stop nausea and vomiting caused by motion sickness.
• Gastrointestinal stimulants are used to help empty your stomach and bowels. This may help decrease nausea and vomiting.
• Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Prevent or manage acute nausea and vomiting:

• Do not drink alcohol. Alcohol may upset or irritate your stomach. Too much alcohol can also cause acute nausea and vomiting.
• Control stress. Headaches due to stress may cause nausea and vomiting. Find ways to relax and manage your stress. Get more rest and sleep.
• Drink more liquids as directed. Vomiting can lead to dehydration. It is important to drink more liquids to help replace lost body fluids. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you. Your provider may recommend that you drink an oral rehydration solution (ORS). ORS contains water, salts, and sugar that are needed to replace the lost body fluids. Ask what kind of ORS to use, how much to drink, and where to get it.
• Eat smaller meals, more often. Eat small amounts of food every 2 to 3 hours, even if you are not hungry. Food in your stomach may decrease your nausea.
• Talk to your healthcare provider before you take over-the-counter (OTC) medicines. These medicines can cause serious problems if you use certain other medicines, or you have a medical condition. You may have problems if you use too much or use them for longer than the label says. Follow directions on the label carefully.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your follow-up visits.

© Copyright IBM Corporation 2020 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

What to Know When Taking Warfarin

Warfarin is a medicine that controls how your blood clots. It’s used to help prevent blood clots that may cause serious health problems. You may be taking warfarin to reduce your risk for stroke or heart attack. Or you may be taking it to stop a blood clot passing to your lung. But warfarin can also increase your risk of bleeding. This can be dangerous. Because of this, you’ll need to take important steps when you’re on warfarin.

Before you start warfarin

Before starting warfarin, tell your healthcare provider if you have ever had any of these:

• Stomach ulcer
• Vomiting of blood, or red or black stools
• Any heart or blood vessel disease
• A blood disorder
• A stroke or transient ischemic attack (TIA)
• Kidney or liver disease
• Lupus or other collagen-vascular disease

Also tell your healthcare provider if you:

• Are pregnant or breastfeeding
• Are younger than 18 years old
• Had a recent dental procedure or surgery
• Have an upcoming dental procedure or surgery
• Had a spinal puncture, recent spinal anesthesia or spinal surgery

Many medicines cause problems if you take them while you’re on warfarin. Tell your healthcare provider about every medicine you take. It may be dangerous for you to take some medicines and supplements, such as:

• Medicines that thin your blood, such as aspirin, clopidogrel, ticagrelor, or prasugrel
• Antibiotics
• Heart medicines
• Cimetidine
• Ibuprofen
• Naproxen, ketoprofen, or other arthritis medicines
• Medicines for depression, cancer, HIV, diabetes, seizures, gout, high cholesterol, or thyroid
• Vitamins that have vitamin K
• Herbal products like ginkgo, Q10, garlic, or St. John’s wort

This list may not include all medicines and supplements that can affect how your medicine works. Talk with your healthcare provider and pharmacist. Your healthcare provider may change or tell you to stop taking some of these before you take warfarin.

Taking your warfarin as directed

You’ll need to take the medicine exactly as directed by your doctor. Make sure to:

• Take it at the same time each day.
• Take it with a full glass of water. You can take it with or without food.
• Use a pillbox to help keep track of your doses.
• If you miss a dose, call your healthcare provider right away to find out how much to take.
• Never take a double dose. If you take too much, it can cause bleeding on the outside and inside of your body.

Keeping certain foods steady in your diet

Some foods can affect how warfarin works.

Many foods contain vitamin K. Vitamin K is a substance that helps your blood clot. So eating foods that contain vitamin K can affect the way warfarin works. You don’t need to avoid foods that have vitamin K. But you do need to keep the amount of them you eat steady — about the same day to day. Foods that have vitamin K include:

• Asparagus
• Avocado
• Broccoli
• Cabbage
• Kale
• Spinach
• Some other leafy green vegetables
• Oils such as soybean, canola, and olive

Other foods and drinks can affect the way your blood clots. You’ll also need to keep the amounts of these steady in your diet. These include:

• Cranberries and cranberry juice
• Fish oil supplements
• Garlic, ginger, licorice, and turmeric
• Herbs used in herbal teas or supplements
• Alcohol

If you change your diet for any reason, such as because of illness or to lose weight, tell your healthcare provider.

Preventing injury

Once you’re on warfarin, you’ll need to be extra careful. Because it makes you bleed more, you’ll need to protect yourself from breaks in the skin. To do this:

• Don’t go barefoot. Always wear shoes.
• Don’t trim corns or calluses yourself.
• Use an electric razor instead of a manual one.
• Use a soft-bristled toothbrush and waxed dental floss.

You’ll also need to avoid any activities that may cause injury. If you fall or are injured, call your healthcare provider right away. You could be bleeding inside your body and not know it. Make sure to get medical attention right away if you have:

• A serious fall
• A blow to the head
• Any other kind of injury

Getting your blood tested

You’ll need to have your blood tested on a regular schedule. Your healthcare provider will tell you how often you need to have your blood tested. This is to make sure you’re taking the right amount of warfarin. Too much can cause excess bleeding, which can be very serious. Too little may not prevent blood clots from harming you.

The blood tests check your international normalized ratio (INR) and prothrombin time (PT). These show how quickly your blood clots. Together the test is called PT/INR.

You may need to visit a hospital or clinic to have your blood tested. Or, a nurse may come to your home and test your blood. In some cases, you may be able to test your blood at home with a small machine. Talk with your healthcare provider to find out what’s best for you. Do not miss any appointments to get your blood tested. If you have a blood test outside of your healthcare provider’s office, make sure to call him or her as soon as you get your test results.

After the blood test, your healthcare provider may tell you to change your dose of warfarin. Take the medicine exactly as directed. Don’t stop taking it unless your healthcare provider tells you to.

Important tips

While on warfarin:

• Make sure you report any new medicines started by any of your providers to the team that manages your warfarin. You may need to be monitored more often after starting a new medicine, changing the dose or stopping a medicine you have been on.
• Don’t stop taking the medicine without talking with your provider. If you have an upcoming surgery or procedure your surgeon and your healthcare provider will give you specific instructions on how to change your dose to prevent excessive bleeding for your procedure or surgery.
• Tell all of your healthcare providers that you take warfarin. This includes your dentist, chiropractor, nurses, physical therapist, and home health nurse.
• Wear a medical alert bracelet or carry an ID card in your wallet that says you take warfarin.
• Keep all appointments for your blood tests.
• Talk with your healthcare provider before taking any new medicine. This includes any over-the-counter medicines. It also includes supplements, herbs, or vitamins.
• Tell the healthcare provider who manages your warfarin if you change your contact information

Call 911

Warfarin increases your risk of bleeding. Call 911 and your healthcare provider right away before you take your next dose of warfarin if you have any of these problems:

• Bleeding that doesn’t stop in 10 minutes
• Coughing up blood
• Vomiting blood or what looks like coffee grounds
• Nausea, bloating, or diarrhea
• Dark red or brown urine
• Red or black tarry stools
• Dizziness, headache, weakness, or fatigue
• Chest pain or trouble breathing
• A serious fall or a blow to the head
• Signs or symptoms of a stroke (facial drooping, difficulty speaking, weakness on one side of the body)
• Signs of an allergic reaction such as swelling of the mouth, lips, throat, tongue, or face; rash, hoarseness, trouble breathing or speaking
• Severe pain, loss of sensation, color change to the skin, and temperature change to a part of the skin or an extremity such as the arm or leg. This may indicate a rare but serious side effect of warfarin where the skin and tissue does not get blood flow.

When to call your healthcare provider

Other urgent or important signs and symptoms that you want to call your provider about include:

• Swelling or pain after an injury
• Swelling or pain at an injection site
• Bleeding gums after brushing your teeth
• A fever or an illness that gets worse
• Bleeding hemorrhoids
• A heavier-than-normal period or bleeding between periods
• Red or black-and-blue marks (bruises) on the skin that get larger