Introduction
An underactive thyroid means your thyroid gland, located in the neck, does not produce enough hormones.
Common signs of an underactive thyroid are tiredness, weight gain and feeling depressed.
Medically known as hypothyroidism, an underactive thyroid is not usually serious. It is easily treated by taking hormone tablets to replace the hormones that your thyroid isn't making.
The thyroid produces a hormone called thyroxine, which controls how much energy your body uses. When the thyroid does not produce enough thyroxine, many of the body's functions slow down.
An underactive thyroid cannot be prevented. Most cases of underactive thyroid are caused either by your immune system attacking your thyroid or a damaged thyroid.
Find out more about the causes of underactive thyroid.
When to see Dr. B C Shah
See Dr. B C Shah and ask to be tested for an underactive thyroid if you have symptoms including:
Tiredness
Weight gain
Depression
Being sensitive to the cold
Dry skin and hair
Muscle aches
Symptoms of an underactive thyroid are often confused for something else, by patients and doctors. Symptoms also usually begin slowly and you may not notice them for several years. The only accurate way to find out if you have a thyroid problem is to get a blood test to measure your hormone levels.
Who can it affect?
Both men and women can have an underactive thyroid. However, it's more common in women.
One in 4,500 babies are born with an underactive thyroid (called congenital hypothyroidism).
Treatment
Underactive thyroid is usually not serious, and taking hormone-replacement tablets, called levothyroxine, will raise your thyroxine levels. You will usually need treatment for the rest of your life. However, with careful management, you should be able to lead a normal, healthy life.
If it is not treated, an underactive thyroid can lead to complications, including swelling of the thyroid (a condition called goitre), heart disease, mental health problems and infertility.
Symptoms of underactive thyroid
Many symptoms of an underactive thyroid (hypothyroidism) are the same as those for other conditions, so they can easily be confused for something else.
Symptoms usually begin slowly and you may not realise you have a medical problem for several years.
Common symptoms include:
Being sensitive to cold
Weight gain
Constipation
Depression
Tiredness
Slowness in body and mind
Muscle aches and weakness
Muscle cramps
Dry and scaly skin
Brittle hair and nails
Heavy or irregular periods
Elderly people with an underactive thyroid may develop memory problems and depression. Children may experience slower growth and development. Teenagers may start puberty earlier than normal.
If you have any of these symptoms, see Dr. B C Shah and ask to be tested for an underactive thyroid.
Find out more about getting tested for an underactive thyroid.
If underactive thyroid is not treated
It is unlikely that you would have many of the later symptoms of an underactive thyroid as the condition is often spotted before more serious symptoms appear.
Later symptoms of underactive thyroid include:
A low-pitched and hoarse voice
Dull facial expressions and a puffy-looking face
Thinned or partly missing eyebrows
A slow heart rate
Deafness
Anaemia
Causes of underactive thyroid
An underactive thyroid (hypothyroidism) happens when your thyroid gland doesn't produce enough of the hormone thyroxine, also called T4.
Most cases of underactive thyroid are due to either the immune system attacking the thyroid gland or a damaged thyroid.
Immune system
Most cases of underactive thyroid happen when the immune system, which normally fights infection, attacks the thyroid gland. Doctors describe this as an autoimmune reaction. This damages the thyroid, which means it is not able to make enough of the hormone thyroxine, and leads to the symptoms of an underactive thyroid.
Hashimoto's disease is the most common type of autoimmune reaction that causes an underactive thyroid.
It is not clear what causes Hashimoto’s disease, but the condition runs in families. It is also common in people with another disorder related to the immune system, such as type 1 diabetes and vitiligo.
Treatment for overactive thyroid
An underactive thyroid can also be a side effect of treatment for an overactive thyroid, a condition where the thyroid gland produces too much hormone.
Treatment for an overactive thyroid, medically known as hyperthyroidism, can involve medication, radiotherapy or surgery, all of which can cause your thyroid to become underactive.
Other rare causes
A lack of iodine in your diet may cause an underactive thyroid. This is because your body needs iodine to make thyroxine.
A viral infection or some drugs used to treat other conditions, such as depression and heart disorders, can cause the thyroid to stop working properly.
A baby may be born with an underactive thyroid if the gland does not develop properly in the womb. However, this is usually picked up during neonatal screening.
A problem with the pituitary gland could lead to an underactive thyroid. The pituitary gland is located at the base of the brain and regulates the thyroid. Therefore, damage to the pituitary may lead to an underactive thyroid.
Diagnosing underactive thyroid
If you have symptoms of an underactive thyroid(hypothyroidism), see Dr. B C Shah and ask for a blood test.
A blood test measuring your hormone levels is the only accurate way to find out if there is a problem.
The test, called a thyroid function test, looks at levels of thyroid-stimulating hormone (TSH) and thyroxine in the blood.
A high level of TSH and a low level of thyroxine hormone in the blood could mean you have an underactive thyroid.
If your test shows raised TSH but normal thyroxine, it means you may be at risk of developing an underactive thyroid in the future.
Referral
Dr. B C Shah may refer you to a specialist in hormone disorders, known as an endocrinologist, if you:
Are younger than 16
Are pregnant or trying to get pregnant
Have just given birth
Have another health condition, such as heart disease, which may complicate your medication
Are taking amiodarone or lithium medication
Treating underactive thyroid
An underactive thyroid (hypothyroidism) is usually treated by taking hormone-replacement tablets called levothyroxine.
Levothyroxine replaces the thyroxine hormone which your thyroid does not make enough of.
A blood test measuring your levels of thyroid-stimulating hormone (TSH) will establish how much levothyroxine you need.
If the test detects high levels of TSH, it means you have an underactive thyroid and your doctor may advise you to take levothyroxine.
You may start on a low dose of levothyroxine, which may be increased gradually depending on how your body responds.
You will initially have regular blood tests until the correct dose of levothyroxine is reached. This can take a little while to get right.
If your symptoms are mild
If testing detects high levels of TSH but you do not have any symptoms or they are very mild, you may not need any treatment.
Dr. B C Shah will usually monitor your hormone levels every few months and may start you on levothyroxine if you develop symptoms.
Some people start to feel better soon after beginning treatment, while others can take several months.
An underactive thyroid is a lifelong condition, so you will probably need to take levothyroxine for the rest of your life.
Levothyroxine does not usually have any side effects as the tablets simply replace a missing hormone.
Once you are taking the correct dose, you will usually have a blood test once a year to monitor your TSH levels.
Complications of underactive thyroid
Several complications can occur if you have an underactive thyroid that is not treated.
An underactive thyroid can be caused by a problem with the immune system, the body’s natural defence system, which can attack the body's own cells, including the thyroid.
This disorder may raise your risk of developing other immune conditions, although this is unusual.
These conditions include:
B12 deficiency
vitiligo (patches on the skin caused by pigment loss)
kidney failure
premature failure of the ovaries or early menopause
goitre
heart disease
Coma risk
In very rare cases, a severe underactive thyroid may lead to a life-threatening condition known as myxedema coma.
Warning signs include:
low body temperature
shallow breathing
low blood pressure
low blood sugar
unresponsiveness

- See more at: http://drbcshah.com/underactive-thyroid/#sthash.mrpuqdYL.dpuf

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What is alcohol withdrawal?

Alcohol withdrawal is physical symptoms and emotions you have if you drink heavily or frequently and suddenly stop drinking. You are most likely to have withdrawal problems 1 to 7 days after your last drink, or if you drink much less alcohol than you usually drink.
What is the cause?

If you abuse alcohol, you may have withdrawal if:
You decide to stop drinking.
You are in a place where you can't drink alcohol, such as at a hospital, treatment center, or jail.
What are the symptoms?

The effects of alcohol withdrawal vary greatly. Most people with mild to moderate alcohol dependence have one or more of these symptoms:
headache
dizziness
nausea and vomiting
shaking
sweating
restlessness
seizures
increased heart rate or blood pressure
trouble sleeping or concentrating
strong desire to drink to relieve the symptoms of withdrawal

Some people who are dependent on alcohol have a life-threatening condition called delirium tremens (DTs) when they stop drinking alcohol. This is a medical emergency. The symptoms may include:
confusion
hallucinations
agitation
seizures
memory problems
fever
very high heart rate and blood pressure.
How is it diagnosed?

Your healthcare provider will review your symptoms, examine you, and ask about your medical history and memory.

You may have one or more of these tests:
urine and blood tests to check for the level of alcohol and other drugs in your body
blood tests to find out how your liver and kidneys are working
X-rays to check for broken bones from a fall or other health problems.
How is it treated?

If you abuse or are dependent on alcohol, you must first admit that you have a problem. Some people know they have an alcohol problem but deny that they need help to stop drinking. When you can admit that you have problem and admit you need help, call your healthcare provider.

Many people who abuse or are dependent on alcohol have trouble admitting that they have a problem. Others may then have to confront those who abuse or are dependent on alcohol about the need for treatment.

Detoxification:
Detoxification is also known as "drying out." It means that you stop using alcohol completely. Detoxification can be done as an outpatient, or in a hospital or drug treatment facility. Which choice is best for you depends on how much and how long you have been drinking. It also depends on other medical problems that you may have.

Treatment for withdrawal symptoms may include:
anti-anxiety medicines
blood pressure medicine
anticonvulsants
vitamins
intravenous (IV) fluids.

Detoxification may take 3 to 4 days.

Long-Term Treatment:
After detoxification, treatment may include social, medical, and psychological therapies.
Social treatment involves family members and focuses on problems at home and at work.
To discourage you from drinking again, your healthcare provider may prescribe medicines. These medicines work best as one part of a full treatment program.
Disulfiram (Antabuse) will make you feel sick if you drink alcohol after you take the medicine. Knowing that you will have this reaction can discourage you from drinking.
Naltrexone (ReVia or Depade) or acamprosate (Campral) can help stop drinking by reducing the craving for alcohol.
Psychological therapy often involves:
Group therapy to understand alcohol dependence and why people drink.
Strategies to help people learn ways to limit the amount of alcohol they drink.
Cognitive behavior therapies are helpful for people trying to manage situations and triggers which may tempt them to abuse alcohol.

Self-help support groups such as Alcoholics Anonymous (AA) and Rational Recovery can be helpful. AA looks at alcohol abuse and dependence as a disease. RR looks at alcohol abuse and dependence as a choice. At local chapter meetings you can meet others and get support to help you avoid alcohol. Meetings are open to anyone who has a drinking problem and wants to become and stay sober. Al-Anon meetings can help support families of people who abuse alcohol.
How long will the effects last?

The severe shakes and hallucinations of delirium tremens (DTs) may last 1 to 5 days. Alcohol has long-lasting effects. It can take weeks or months before you feel more clear-headed, less depressed, less anxious, and have more energy. DTs can be fatal if not treated.
How can I take care of myself?

If you abuse or are dependent on alcohol, the most important thing you can do is to admit the problem and ask for help. If you decide to stop drinking alcohol or are in a situation in which you cannot drink (such as in a hospital), ask for medical help. You may not need hospital treatment for withdrawal symptoms, but you should be where someone can get help for you if you need it.

While you are being treated for withdrawal:
Define a treatment plan with your healthcare providers and follow it
Follow your provider's advice for treatment of any other medical problems.
Get support. Talk with family and friends. Consider joining a support group in your area.
Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Don't use alcohol or drugs. Exercise according to your healthcare provider's instructions.
Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.
What can be done to help prevent alcohol withdrawal?

If you are physically dependent on alcohol, you will have withdrawal symptoms when you quit drinking. Seek treatment so that you can withdraw safely and with much less discomfort

What is bipolar disorder?

Bipolar disorder is a brain disorder that causes extreme changes in mood, thinking, and behavior. There are usually two phases, a manic phase and a depressed phase. In the manic phase you feel highly energized and are very active. In the depressed phase you are very depressed. Most people with bipolar disorder have these severe mood swings many times during their lives. Some people have mostly manic phases. Others may have mostly depressed phases. Some people have a mix of manic and depressed symptoms. Bipolar disorder used to be called manic-depressive disorder.

Bipolar disorder may last a lifetime. Symptoms tend to get worse if not treated. Follow the treatment prescribed. Bipolar disorder can be managed even if it is not cured.
What is the cause?

About 1% of people develop bipolar disorder. It usually begins during the young adult years. About as many men as women get bipolar disorder.

The exact causes of the disorder are unclear. However, it does run in families. If you have relatives with bipolar disorder, you are more likely to have it.

Parts of the brain may not work normally during manic and depressive episodes. But exactly what triggers these switches is unclear.

If you are a woman, episodes may be more likely right before your monthly period or after the birth of a child.
What are the symptoms?

During a manic episode you may:
Have a very high sense of self-worth and a feeling of being "on top of the world."
Be very talkative and talk fast, maybe so fast that others have trouble following what you are saying.
Have racing thoughts and ideas to the point of being disorganized and muddled.
Have trouble concentrating and jump between different ideas.
Be very restless and hyperactive.
Have more feelings of anxiety and panic.
Go for days with little or no sleep and not feel tired.
Be very irritable and get into fights with others.
Have bursts of high interest in sex and sexual activity.
Be too active and act recklessly. For example, you might spend all your money, or take a sudden trip without planning.

If you have a very intense episode, you may also have symptoms like confusion, delusions (ideas that aren't true), or hallucinations (see or hear things that are not there).

A manic episode may be followed by a period of normal mood and behavior or a period of depression.

During a period of depression, you may:
Feel hopeless or just not care about anything.
Be irritable.
Have trouble falling asleep, wake up very early, or sleep too much.
Notice increases or decreases in your appetite and weight.
Notice a lower energy level, although you may sometimes feel overexcited.
Lose sexual desire and function.
Feel worthless and guilty.
Have trouble concentrating or remembering things.
Have unexplained physical symptoms.
Think often about death or suicide.

These symptoms may last for days or weeks. Rapid cycling patterns are defined by 4 or more mood disturbances (major depressive, mixed, manic, or hypomanic episodes) in a year.

You may also have what is called a mixed episode. A mixed episode is mania with depressed symptoms at the same time. In a mixed episode you may be overly active, withdraw from others, feel worthless, and cry often.
How is it diagnosed?

Your healthcare provider or mental health therapist will ask about your symptoms and any drug or alcohol use. You may have lab tests to rule out medical conditions such as thyroid gland problems.
How is it treated?

Medicines are the most effective treatment for bipolar disorder. If an episode is severe, you may need to spend some time in a hospital.

Medicines

Several types of mood stabilizing medicines can help treat bipolar disorder. Your healthcare provider will work with you to carefully select the best one for you.

Sometimes you may need other medicines. Your provider may prescribe an antidepressant, an antipsychotic, or an antianxiety medicine. However, it is possible that symptoms may become worse if you take antidepressants.

There are no nonprescription medicines for bipolar disorder.

Psychotherapy

Counseling and psychotherapy are usually very helpful. They help you learn how to maintain a positive lifestyle and attitude, which can reduce your episodes.

Natural Remedies and Alternative Treatments

Omega-3 fatty acids may help to reduce symptoms of depression. No herbal or natural remedies are effective in treating bipolar disorder.

Controlling stress, keeping to a regular sleep schedule, having friends or family to support you, and being more relaxed may help manage manic or depressive episodes.
How can I take care of myself?
Take your medicines every day , even if you are feeling well. Stopping your medicines when you feel well may bring about episodes.
Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, take walks. Try deep breathing exercises when you feel stressed.
Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs, because they can make your symptoms worse. Exercise according to your healthcare provider's instructions.
Check your medicines. Check with the healthcare provider treating you for bipolar disorder before you take other medicines to make sure there is no conflict with your bipolar medicines.
Get support. Talk with family and friends. Contact organizations such as the Depression and Bipolar Support Alliance (DBSA), the National Alliance for the Mentally Ill (NAMI), and the Mental Health America for information and support.
Watch yourself for the beginning signs of a manic or depressive episode. Ask others around you to also watch closely.
When should I seek help?

If you are showing the signs of either a manic or depressive episode, seek professional help quickly. Do not try to treat your illness by yourself. Professional treatment is necessary. If bipolar disorder is not treated, it tends to get worse. The mania and depression can be more severe and episodes happen more often. Most of the time, you will feel much better after a few weeks of treatment.

Get emergency care if you or a loved one has serious thoughts of suicide or harming others. Also get emergency help if manic behavior becomes so wild that it endangers you or others.

What is a migraine headache?

A migraine headache is a specific kind of headache that can last for hours to days. It can cause intense pain as well as other symptoms. For example, you may feel sick to your stomach or have changes in your vision just before or during the headache.
How does it occur?

The exact cause of migraines is not clear. Most experts think migraine attacks start with abnormal activity in the brain. They may be related to a problem with the blood flow in your brain, or they may happen with changes in brain chemicals. Migraine headaches often are triggered by specific things. Common migraine triggers include:
stress
tiredness
changes in the weather
certain foods, such as wine, cheese, or chocolate
MSG or food preservatives, such as nitrates
red wine
some medicines
bright lights.

Migraines tend to run in families. They affect women 3 times more often than men. They often happen right before or during a woman's menstrual period. Or they may happen when a woman is taking birth control pills or hormone replacement pills.
What are the symptoms?

Before a migraine starts, there is often a warning period when you don't feel well. Some people have vision changes before their head starts hurting. They lose part of their vision or see bright spots or zigzag patterns. These warning symptoms are called migraine aura. The vision changes of the aura usually go away as the headache begins.

Migraine symptoms may include:
throbbing or pounding headache
pain that gets worse with physical activity
extreme sensitivity to light, smells, and sounds
nausea
vomiting

The pain is usually more severe on one side of the head, but it can affect the whole head.

Sometimes a migraine can cause symptoms such as numbness or even weakness. However, these can also be symptoms of a stroke. If you have these other symptoms along with problems with your vision, do not assume a migraine is the cause. Call your healthcare provider right away.
How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. There are no lab tests or X-rays for diagnosing migraine headaches.

A careful history of your headaches is very helpful. Your healthcare provider may ask you to keep a headache diary in which you record the following:
date and time of each attack
how long the headache lasted
type of pain (for example, dull, sharp, throbbing, or a feeling of pressure)
location of pain
any symptoms before the headache began
foods and drinks you had before the headache began (This should include checking the ingredients in the product ingredient list of packaged foods you have eaten. Saving the labels of the foods or drinks might be a good way to record this information.)
use of cigarettes, caffeine, alcohol, or carbonated drinks before the headache began
time you went to bed and time you got up before the headache began
if you are a woman, the dates of your menstrual periods and use of birth control pills or other female hormones.

Depending on your headache symptoms and physical exam, your provider may recommend tests to check for other, more serious causes of your symptoms. For example, you may have a brain scan or magnetic resonance imaging (MRI).
How is it treated?

You may be able to stop mild migraine headaches by taking nonprescription pain-relief medicine when you start to have symptoms. Aspirin, acetaminophen, caffeine, ibuprofen, and naproxen have all been shown to be effective. You may find that any one of these medicines alone will treat your headache. Even just a caffeinated drink may help. However, some studies have shown combinations to be more effective and to work faster. Excedrin Migraine is an example of such a combination. It includes acetaminophen, aspirin, and caffeine. Other combination drugs, such as Midrin, are available for mild to moderate headaches with a prescription from your healthcare provider.

Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome. Aspirin, ibuprofen, and naproxen are nonsteroidal anti-inflammatory medicines (NSAIDs). NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take NSAIDs for more than 10 days for any reason.

Other medicines your healthcare provider may prescribe to help keep headaches from getting severe once they start are:
A group of drugs called triptans, which are available as tablets (including some that may be taken without water), a shot, and a nasal spray. Examples of triptans are naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
Ergot medicines such as dihydroergotamine (DHE) or ergotamine. These medicines are available in various forms, including pills you swallow or put under your tongue, nasal spray, rectal suppositories and shots.

It's best to take these medicines as soon as possible after a headache begins. This means you need to recognize the warning symptoms.

If you have frequent migraines (3 or more a month), you may need to take other medicine every day to prevent severe and frequent headaches. Examples of drugs your provider may prescribe for this purpose are:
antiseizure medicines (divalproex sodium/valproate, gabapentin, or topiramate)
antidepressants (tricyclics, such as amitriptyline, nortriptyline, or doxepin)
some beta blockers (such as atenolol, metoprolol, nadolol, nebivolol, propranolol, or timolol)
some calcium channel blockers (such as verapamil).

Women who have migraines triggered by their menstrual cycle may take preventive medicines for a few days around their period. Medicines that may be recommended are NSAIDs, triptans, and ergots. If these medicines do not work, hormone (estrogen) therapy may be helpful. Hormone therapy may also be helpful for women who have migraines during or after menopause. However, there is an increased risk of stroke for women with migraines who use birth control products (contraceptives) that contain estrogen.

You may need to take preventive medicine for several weeks before you know if it is helpful for you.

If you are planning to get pregnant, be sure to talk to your healthcare provider about whether the medicines you have been prescribed are safe during pregnancy. If they are not known to be safe, you will need a different treatment plan while you are trying to get pregnant and during pregnancy and breast-feeding.
How long will the effects last?

The headache may last from a few hours to a few days. You may tend to get migraines for the rest of your life. However, many people find that they have migraines less often as they get older.
How can I take care of myself?

When you have a migraine:
As soon as possible after the symptoms start, take the medicine recommended or prescribed by your healthcare provider.
If you can, rest in a quiet room until the symptoms are gone. The pain may go away with sleep.
Put a cool, moist washcloth on the painful side of your head. You might also try a heating pad set on the lowest setting.
Don't drive a car while you have the headache.

You can make your migraines easier to take care of. Learn to become aware of your early warning signs of headache. You will need to pay close attention to your body to be aware of these signs. When the warning signs appear, try going to a quieter place and doing relaxation exercises. This early care can make a big difference in how easily you can get over the migraine.

If your symptoms don't get better when you take medicine, make another appointment with your healthcare provider. It may take several visits to find the best way to control your headaches. Also, if you are having headaches more often, make a follow-up appointment with your provider to see if something has changed or you need more testing or preventive medicine.

Call your healthcare provider right away if:
Changes in your vision do not go away.
You have symptoms that are not usually part of your migraines, such as:
trouble talking or slurred speech
arm or leg weakness
You have other symptoms such as:
fever
stiff neck
repeated vomiting for several hours
numbness or tingling in your face, arms, or legs
You are pregnant and your headache is particularly bad or it seems different from your usual migraines, particularly in the last half of pregnancy. This is especially important if you have problems with your vision such as flashing lights, difficulty focusing or blurriness, any nausea or vomiting, or weakness in any part of your body. These may be signs of a pregnancy problem that needs immediate attention.
How can I help prevent migraine headaches?

Prevention is an important part of treatment. To help prevent migraine headaches:
You may need to take medicine prescribed by your healthcare provider.
You may need to avoid certain foods or activities suggested by your headache diary as possible triggers of headaches. Common food triggers are:
citrus fruit
chocolate
cheese and other preserved or aged foods containing tyramine, including leftovers held for more than 1 or 2 days at refrigerator temperature
sodium nitrate (found, for example, in food coloring, preservatives, processed meats and fish, hot dogs, and luncheon meats)
monosodium glutamate "MSG" (found, for example, in Chinese food, pepperoni, and many processed foods)
red wine and beer
the artificial sweetener aspartame
Ask your provider about avoiding medicines that may trigger headaches.
If you are taking birth control pills or other female hormones, ask your provider if you should stop taking them.
If you smoke, stop. If someone else in your household smokes, ask them to smoke outside. Cigarette smoke can make your symptoms worse.
Eat healthy meals at about the same time each day. Don't skip meals, especially breakfast.
Get regular rest and exercise.
Try to reduce stress. Relaxation exercises and biofeedback may help you manage stress.
Limit alcohol to no more than 1 drink a day for women and two drinks a day for men.

For more information, call or write:

American Council for Headache Education (ACHE)
Phone: 800-255-ACHE (255-2243)
Web site: http://www.achenet.org

National Headache Foundation
Phone: 800-843-2256
Web site: http://www.headaches.org
(includes more information about diet)

In this highly computerized world, more and more people of all ages are experiencing aches and pains that come from sitting at a computer for long periods of time. These aches and pains are felt in the neck, shoulder, upper and lower back, wrist and elbow joints. In some cases, the nerves to the hand become compressed, causing weakness and/or tingling in the fingers. These symptoms can occur in the onset of Repetitive Strain Injury (RSI), which may include damage to tendons, muscles, nerves and other soft tissues from repeated physical movements over time.
There are a number of factors that contribute to the onset of RSI, including:
• Posture – is the most critical component. Slouching at the keyboard puts your spine and limbs in positions that contribute to increased strain and tension, as well as increasing the risk of eye strain;
• Office set-up – a poorly designed workstation, or one that does not fit you well, can contribute to the onset of RSI (i.e. reaching for the mouse or keyboard too high or low, wrists extended during keyboarding);
• Worker technique – pounding the keyboard, using your wrists to move the mouse, or gripping the mouse tightly increases the demands on the hand and wrist and can trigger or aggravate symptoms of RSI; and
• Work Habits – sitting for extended periods of time without changing position is hard on your whole body and is a factor in developing RSI.
Don’t ignore the early warning signs, such as weakness of your grip, numbness, and discomfort or pain in the arms, hands, wrists or shoulders. Early diagnosis and treatment are vital to ensure recovery from the symptoms of RSI. For more information on RSI please contact physiotherapist in person.
We have created the following S.M.A.R.T. guidelines for computer user that you and your family can follow at home, at school and at work. S.M.A.R.T. is an acronym for Stretch, Move, Add it up, Reduce strain, Talk to a physiotherapist:
• Stretch – Include regular stretching into your work routine. Every 20 to 60 minutes, do three or four stretches – for hands, shoulders, neck and trunk. The key is to move your joints through their normal range of motion. Inquire about computer software that is set to interrupt work at chosen intervals with appropriate stretches, or set your onscreen timer to remind you to take “micro-breaks” as needed to momentarily change your arm position or to shift your weight.
• Move – Get up from your work station for a short stretch or walk around to promote blood flow to fatigued muscles every hour. No one has ever become more fit by sitting at a desk. Get regular daily exercise, away from the computer. It could be as simple as a walk around the office or getting off the elevator one floor early and taking the stairs. Move out of the pattern that the work is creating (i.e. stretch the opposite motion). Ensure you are not putting pressure on the carpal tunnel; slow key strokes to allow the median nerve to move off the tendons.
• Reduce strain – Make sure you are sitting correctly with your back supported:
• Adjust your chair, as below, to support your back and minimize awkward postures that can lead to muscle tension, fatigue and soreness. Avoid slouching;
• Sit with your buttocks right back in the chair and your feet flat on the floor, or on a footrest or phone book. Your knees should be bent at a 90-degree angle, at the same level or slightly above your hips. Keep your shoulders relaxed; arms close to your body or resting comfortably on the armrests, which should be positioned close to your sides; elbows bent at approximately 90 degrees; forearms parallel to the floor; and wrists straight, which may involve adjusting the angle of the keyboard;
• Keep your eyes level within range of the top third of the screen. Don’t squint to see the screen (check for glare or enlarge the font);
• Keep your work, keyboard and mouse centered in front of the monitor and close to you, to avoid arching your neck or twisting your body;
• Use a good quality mouse that requires minimal pressure to click, and be sure to position it on the same level and as close to the keyboard as possible. Keep your wrist straight and move the mouse with whole arm movements;
• Use ergonomic computer accessories, such as document holders to encourage neutral neck postures, and head sets to avoid awkward neck postures (often seen as holding the phone in the crook of the neck) while interfacing with the computer and telephone;
• A wrist pad on the keyboard allows you to rest your wrists on the pad and reduces stress on the wrist; and
• If you’re working on a computer all day at work, you may want to limit your computer-time at home. Choose activities for leisure and recreation that will not continue to stress the same muscles / tendons (i.e. if you’re keying on the computer all day, hanging out on the internet at night, or knitting / crocheting throughout the evening, this is not providing proper rest for the muscles and tendons that worked all day).
• Talk to a physiotherapist


DR. RAJESH PAL (PT)
MPT, BPT, MIAP, MDCPT
9811265450