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Patient Resource Manual

Disaster Preparednessfor Persons with Chronic Disease

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TABLE OF CONTENTS

PREFACE

WHY PREPARE? ...........................................4

WHAT YOU NEED TO DO ...........................5 1.GetInformed............................................................................. 5 2.MakeaPlan................................................................................ 9 3.AssembleaDisasterSuppliesKit..................................... 10 4.MaintainYourPlan...............................................................13

IF DISASTER STRIKES ...............................14

ADDITIONAL RESOURCES .......................15 1.SourcesForEmergencyPreparednessInformation...15 2.CommunityEmergency/DisasterResourceForm..... 16 3.PersonalMedicalInformationForm............................... 17 4.EmergencyContactCards.................................................. 19 5.PetsandDisasters...................................................................20 6.TransferTrauma...................................................................... 21 7.StressReactions.......................................................................22 8.MedicalItemsNeeded..........................................................22 9.Dietary........................................................................................24

DISEASE SPECIFIC INFORMATION ..........26 1.Asthma,ChronicObstructivePulmonary Disease(COPD)andOtherLungDiseases....................26 2.Cancer........................................................................................ 31 3.DementiaandMemoryLoss..............................................34 4.Diabetes......................................................................................39 5.HeartDisease,HighBloodPressureandStroke..........43 6.KidneyDisease/Dialysis.......................................................50 7.Osteoporosis,ArthritisandBoneDiseases...................65 8.Parkinson’sDisease,Alzheimer’sDisease andOtherNeurologicalDisorders...................................70

PREFACEThismanualwaspreparedbyUniversityofLouisvilleHospitalwithagrantfromtheKentuckyDepartmentforPublicHealth.

Itisintendedforindividualswithchronicdisease,aswellasfamilymembersandcaretakersofthoseindividuals,topreparefordisasters.

ThispublicationwassupportedbyacooperativeagreementwiththeCDC.ItscontentsaresolelytheresponsibilityoftheauthorsanddonotnecessarilyrepresenttheofficialviewsoftheCDC.

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Disasterplanningisessentialforeveryone.Thisisespeciallytrueforthemorethan90millionAmericansthatcurrentlylivewithchronicdiseases.Youmaybeabletoeasilymanageyourconditionnow,butduringadisaster,manyservicesyourelyonmaynotbeavailable.Yourconditionandalackoftheseservicesmakeyouveryvulnerableinadisaster.Ithasbeenfoundthatlackofaccesstoroutinehealthcareisaleadingcauseofdeathafterdisasters.Properdisasterplanningcanhelptolimityourvulnerability.

Therearemanythingstoconsiderwhenplanningforadisaster.Wherewillyou,yourfamily,yourfriendsorpersonalcareattendantsbewhenanemergencyordisasterstrikes?You,andthoseyoucareabout,couldbeanywhere–athome,work,schoolorintransit.Howwillyoufindeachother?Willyouknowyourlovedoneswillbesafe?Emergenciesanddisasterscanstrikequicklyandwithoutwarning.Theycanforceyoutoleaveyourneighborhoodorconfineyoutoyourhome.

Ifutilities(water,gas,electricityortelephones)werenotavailable,whatwouldyoudo?Localofficialsandreliefworkerswillbeonthesceneafteradisaster,buttheycannotreacheveryonerightaway.Youareinthebestpositiontoplanforyourownsafety.Why?Becauseyouarebestabletoknowyourabilitiesandpossibleneedsduringandafteranemergencyordisastersituation.Youcancopewithdisasterbypreparinginadvancewithyourfamilyandcareattendants.Knowingwhattodoisyourbestprotectionandyourresponsibility.

Theinformationinthismanualistohelpyouplanandpreparefordisastersituations.Agreatdealoftheinformationisgeneral,innature,andcanbeusefultoanyoneplanningfordisasterpreparedness.Thereisalsospecificinformationtohelpyouovercomethechallengesthatyourchronicdiseasepresentswhenpreparingfordisasters.Rememberthatstresscanaggravateanychroniccondition.Preparingnowcanhelptoreducestressshouldadisasteroccur.

WHY PREPARE?

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WHAT YOU NEED TO DO

�. Get InformedInorderforindividualstobeproperlyinformedaboutdisasterpreparednesstheyneedtogatherinformationfrommultiplesources.Thisisaccomplishedbycompletinganassessmentinthefollowingthreeareas:

•Personal •Household •Community

Personal AssessmentIndividualsshouldcompleteapersonalassessmentinordertoidentifytheirneedsduringandafteradisaster.Apersonalassessmentisespeciallyimportantforthosewithchronicdiseasebecauseoftheirincreasedvulnerabilityduringadisaster.

Twomainscenariostoconsiderare: •StayingIn •GettingOut

Staying In–whatindividualsneedtoconsideriftheyhavetoremainintheirhomesduringorfollowingadisaster.

DailyLiving:Itemsforpersonalcaresuchasbathing,groominganddressing;adaptivefeedingdevicessuchasspecialutensils

Lossofutilitiessuchaswaterorelectricity(Note:Most utility companies requireindividuals who are dependent upon electrically run medical equipment to registerwith them before a disaster occurs)

Mobility:Dealingwithdebrisinoraroundthehome;usingmobilityaidssuchasmotorizedormanualwheelchairs,walkers,canes,etc.

AdditionalSupplies:Obtaininggroceries,medicationsandmedicalsuppliesafterthedisasterkithasbeenexhausted

GettingHelp:Notifyingthepersonalsupportnetwork(thisconceptwillbediscussedingreaterdetaillaterinthismanual)

Getting Out–whatindividualsneedtoconsideriftheyhavetoleavetheirhomesduringorfollowingadisaster.

DailyLiving:Whatpersonalcareitemstotakealongsuchasbathing,groominganddressing;adaptivefeedingdevicessuchasspecialutensils

Mobility:Lossoftheabilitytousemobilityaids,suchasdamagetoramps;usingalternativeexitstogetout;lossordamagetotransportation,suchascarsorspeciallyequippedvehicles;seekingalternateformsoftransportationsuchaspublictransportationorambulanceservices

AdditionalSupplies:Obtaininggroceries,medicationsandmedicalsuppliesafterthedisasterkithasbeenexhausted

GettingHelp:Notifyingpersonalsupportnetworkoflocationandpossibleneeds;assistancewithevacuation(friends,family,firstandcommunityresponders)

SeekingShelter:Itispreferabletostaywithfamily,friendsoreveninahotel.

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Apublicsheltershouldbealastresort.Individualswithchronicdiseasemaynotbeabletoreceivecareataregularshelter.Somecommunitieshavespecialneedssheltersavailableforthosewithchronicdisease.Thesesheltersoftenrequireadvancedregistration.

Evenaspecialneedssheltermaynothavethecorrectmedicalsupplies.Individualsareencouragedtobringtheitemstheirconditionrequires.

Mostsheltersdonotallowpets,onlylicensedserviceanimals.Itisimportanttoidentifypetfriendlysheltersorboardingfacilitiesaheadoftime.

Household AssessmentTheActionChecklistisatoolthatcanbeusedtodeterminethegeneraldisasterpreparednessofahousehold.

Action Checklist: Items to Do Before a Disaster

Considerations for People with Disabilities Individualswithdisabilitiesorotherspecialneedsoftenhaveuniqueneedsthatrequiremoredetailedplanningintheeventofadisaster.Considerthefollowingactionsasyouprepare:

qLearnwhattodoincaseofpoweroutagesandpersonalinjuries.Knowhow toconnectandstartaback-uppowersupplyforessentialmedicalitems.

qConsidergettingamedicalalertsystem.Itwillallowyoutocallforhelpifyou cannotgettoaphoneinanemergency.Mostalertsystemsrequireaworking phoneline,sohaveaback-upplansuchasacellphoneorpager.

qIfyouuseanelectricwheelchairorscooter,haveamanualwheelchairforbackup.

qTeachthosewhomayneedtoassistyouinanemergencyhowtooperatenecessary items.Also,labelitemsandattachlaminatedinstructionsforeachitem’suse.

qStoreback-upitems(mobility,medical,etc.)atyourneighbor’shome,school oryourworkplace.

qArrangeformorethanonepersonfromyourpersonalsupportnetworktocheck onyouinanemergency,sothereisatleastoneback-upiftheprimaryperson yourelyonisunavailable.

qIfyouuseapersonalcareattendantfromanagency,checktoseeiftheagency hasspecialprovisionsforemergencies.Forexample,dotheyprovideservicesat anotherlocationshouldanevacuationbeordered?

qIfyouliveinanapartment,askthemanagementtoidentifyandmarkaccessible exitsandaccesstoallareasdesignatedforemergencyshelterorsaferooms.

qHaveacellphonewithanextrafully-chargedbattery.Ifyouareunabletogetoutofa building,youcanletsomeoneknowwhereyouareandguidethemtoyou.Keepthe numbersyoumayneedtocallwithyouifthe9-1-1emergencynumberisoverloaded.

qLearnaboutdevicesandothertechnologyavailable(PDAs,textradio,pagers,etc.) toassistyouinreceivingemergencyinstructionsandwarningsfromlocalofficials.

qBepreparedtoprovideclear,specificandconciseinstructionstorescuepersonnel. Practicegivingtheseinstructions(verbally,pre-printedphrases,wordboard,etc.) clearlyandquickly.

qPrepareyourpersonalsupportnetworktoassistyouwithanticipatedreactions andemotionsassociatedwithdisasterandtraumaticevents,suchasconfusion, agitation,fear,panicandanxiety.

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qYoudonothavetobetheonlyoneprepared.Encourageotherstobepreparedand considervolunteeringorworkingwithlocalauthoritiesondisabilityandother specialneedspreparednessefforts.

Utilities: qKnowhowandwhentoturnoffwater,gasandelectricityatthemainswitches orvalvesandsharethisinformationwithyourfamilyandcaregivers.

qKeepanytoolsyouwilluseneargasandwatershutoffvalves.

qTurnofftheutilitiesonlyifyoususpectdamagedlines,aleakoriflocalofficialsinstruct youtodoso.(Note:Gasshut-offprocedure–Aspartofthelearningprocess,donot actuallyturnoffthegas.Onlyaqualifiedprofessionalcanturnonthegasbackon.It mighttakeseveralweeksforaprofessionaltorespond.Inthemeantime,youwillrequire alternatesourcestoheatyourhome,makehotwaterandcook).

Fire Extinguisher: qBesureeveryoneknowshowtouseyourfireextinguishers(ABCtype)andwheretheyarelocated.

Smoke Alarms: qInstallsmokealarmsoneachlevelofyourhome,especiallynearthebedrooms.

qFollowlocalcodesandmanufacturer’sinstructionsaboutinstallationrequirements.

qInstallacarbonmonoxidealarminyourhome.

Insurance Coverage: qCheckifyouhaveadequateinsurancecoverage.Homeownersinsurancedoes notcoverflooddamage.Italsomaynotprovidefullcoverageforotherhazards.

qTalkwithyourinsuranceagentandmakesureyouhaveadequatecoverageto protectyourfamilyagainstfinancialloss.

First Aid/CPR & AED (Automated External Defibrillation):qTakeafirstaidandaCPR/AEDclass.RedCrosscoursescanaccommodate peoplewithdisabilities.Discussyourneedswhenregisteringfortheclasses.

Inventory Home Possessions:qMakearecordofyourpossessionstoassistwithclaimreimbursementincase oflossordamage.

qStorethisinformationinasafedepositboxorothersecure(flood/firesafe) locationtoensuretherecordssurviveadisaster.

qIncludephotographsorvideooftheinteriorandexteriorofyourhomeaswell ascars,boatsandrecreationalvehicles.

qHavephotosofdurablemedicalitemsandbesuretomakearecordofthe makeandmodelnumbersforeachitem.

qObtainprofessionalappraisalsofjewelry,collectibles,artworkorotheritemsthat maybedifficulttoevaluate.

qMakecopiesofreceiptsandcanceledchecksshowingthecostforvaluableitems.

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Vital Records and Documents:Thefollowingimportantdocumentsshouldbekeptinasafedepositboxorothersafelocation:

qBirthandmarriagecertificates qDeedsqSocialSecuritycards qFinancialrecordsqPassports qInsurancerecordsqWills qImmunizationrecords

Reduce Home Hazards: Inadisaster,ordinaryitemsinthehomecancauseinjuryanddamage.Takethesestepstoreduceyourrisk:

qKeeptheshut-offswitchforoxygenitemsnearyourbedorchair,soyou cangettoitquicklyifthereisafire.

qHaveaprofessionalrepairdefectiveelectricalwiringandleakygasconnections.

qPlacelarge,heavyobjectsonlowershelves,andhangpicturesandmirrors awayfrombeds.

qUsestrapsorotherrestraintstosecuretallcabinets,bookshelves,largeappliances (especiallywaterheater,furnace,andrefrigerator),mirrors,shelves,largepicture framesandlightfixturestowallstuds.

qRepaircracksinceilingsandfoundations.

qStoreweedkillers,pesticidesandflammableproductsawayfromheatsources.

qPlaceoilyragsorwasteincoveredmetalcansanddisposeofthemaccording tolocalregulations.

qHaveaprofessionalcleanandrepairchimneys,fluepipes,connectorsandgasvents.

Community AssessmentContactyourlocalemergencymanagementofficeorAmericanRedCrossChaptertogatherinformationyouwillneedtocreateaplan.

•CommunityHazards: ºAskaboutthespecifichazardsthatthreatenyourcommunity(e.g.,floods, tornados,earthquakes).

ºAskaboutyourriskfromthosehazards.

•CommunityDisasterPlans: ºLearnaboutcommunityresponseplans,evacuationplansand designatedemergencyshelters.

ºAskifyourcommunityhasashelterthatcanmeetyourspecialneeds. Ifso,findoutifyouneedtoregisterwithyourcommunity.Remember, mostpublicsheltersarenotsetuptocareforthosewithspecialneeds.

ºAskabouttheemergencyplansandproceduresthatexistinplaces youandyourfamilyspendtime,suchasplacesofemployment,schools andchildcarecenters.

ºIfyoudonotownavehicleordon’tdrive,findoutinadvancewhatyour community’splansareforevacuatingthosewithoutprivatetransportation.

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•CommunityWarningSystems: ºFindouthowlocalauthoritieswillwarnyouofadisaster.

ºHowwilltheyprovideinformationtoyouduringandafteradisaster?

ºLearnaboutNationalOceanicandAtmosphericAdministration(NOAA) WeatherRadioanditsalertingabilities.

•AssistancePrograms: ºAskaboutspecialassistanceprogramsavailableintheeventofanemergency. Manycommunitiesaskpeoplewithadisabilitytoregister,usuallywiththe localfire,policeoremergencymanagementoffice.Thisissoneededhelp canbeprovidedquicklyinanemergency.

ºLetyourpersonalcareattendantknowyouhaveregistered,andwithwhom.

ºIfyouareelectric-dependent,besuretoregisterwithyourlocalutilitycompany.

2. Make a PlanAdisastercandisruptyourprimaryemergencyplan.Itisimportantforyoutodevelopaback-upplantoensureyoursafety.

Create a Personal Support Network • Meet with Your Family/Personal Care Attendants/Building Manager: ºReviewtheinformationyougatheredaboutcommunityhazardsandemergencyplans.

• Choose an “Out-of-Town” Contact: ºAskanout-of-townfriendorrelativetobeyourcontact.Followingadisaster, familymembersshouldcallthispersonandtellthemwheretheyare.Everyone mustknowthecontact’sphonenumbers.Itisofteneasiertomakealongdistance callthanalocalcallfromadisasterarea.

• Decide Where to Meet: ºIfyouseparatefromhouseholdmembersinanemergency,haveaspecificmeetingspot.

ºChooseaplacerightoutsideyourhomeincaseofasuddenemergency,suchasafire.

ºChoosealocationoutsideyourneighborhoodincaseyoucannotreturnhome.

• Complete a Communication Plan: ºYourplanshouldincludecontactinformationforfamilymembers,members ofyoursupportnetwork,caregivers,workandschool.

ºYourplanshouldalsoincludeinformationforyourout-of-towncontact,meeting locations,emergencyservicesandtheNationalPoisonControlCenter(1-800-222-1222).

ºTeachyourchildrenhowtocalltheemergencyphonenumbersandwhenit isappropriatetodoso.

ºBesureeachfamilymemberhasacopyofyourcommunicationplanandpostitnear yourtelephoneforuseinanemergency.

• Escape Routes and Safe Places.Inafireorotheremergency,youmayneedtoleave atamoment’snotice. ºBereadytogetoutfast.Besureeveryoneinyourfamilyknowsthebestescape routesoutofyourhome.

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ºTheyalsoshouldknowwherethesafeplacesareinyourhomeforeachtype ofdisaster.Forexample,ifatornadoapproachesgotothebasementorthe lowestfloorofyourhomeoraninteriorroomorclosetwithnowindows.

ºUseablanksheetofpapertodrawthefloorplansofyourhome.Showthelocationof: •Doors •First-aidkits •Windows •Utilityshut-offpoints •Stairways •Fireextinguisher •Largefurniture •Importantpointsoutsidesuchasgarages,patios, •Disastersupplieskit stairways,elevators,drivewaysandporches •Smokealarms •Collapsibleladders

ºIndicateatleasttwoescaperoutesfromeachroom.

ºMarkaplaceoutsideofthehomewherehouseholdmembersand/oryour personalcareattendantshouldmeetincaseoffire.

ºIfyouorsomeoneinyourhouseholdusesawheelchair,makeexitsfrom yourhomewheelchair-accessible.

ºPracticeemergencyevacuationdrillsatleasttwiceayear.Alsopractice whenyouupdateyourescapeplan.

ºBesuretoincludefamilyand/oryourpersonalcareattendantinthedrills.

• Plan for Your Pets: ºTakeyourpetswithyouifyouleave.Forhealthreasons,emergencypublic sheltersdonotallowpets(otherthanserviceanimals).

ºPreparealistoffamily,friends,boardingfacilities,veterinariansand “pet-friendly”hotelsthatcouldshelteryourpetsinanemergency.

• Prepare for Different Hazards: ºIncludeinyourplanhowtoprepareforeachhazardthatcouldaffectyour localcommunityandhowtoprotectyourself.Forinstance,mostpeopleshelter inabasementwhenthereisatornadowarning,butmostbasementsarenot wheelchair-accessible.

ºDetermineinadvancewhatyouralternativeshelterwillbeandhowyou willgetthere.Otherhazards,suchasahomefire,willrequireyoutoleave.

ºMakesurebothprimaryandsecondaryexitsareaccessible.Beabletolocatethemby touchorfeel(sincelightsmaybeoutandthick,blacksmokemaymakeitveryhardtosee).

�. Assemble a Disaster Supplies KitSomeemergenciesmayrequireyoutoleaveatamoment’snotice.Othersmayrequireyoutoremainathome.Eitherwayyouprobablywillnothavetheopportunitytoshoporsearchforthesuppliesyouandyourfamilywillneed.Everyhouseholdshouldassembleadisastersupplieskitandkeepitup-to-date.

Adisastersupplieskitisacollectionofbasicitemsafamilywouldprobablyneedtostaysafeandbemorecomfortableduringandafteradisaster.Disastersupplieskititemsshouldbestoredinaportablecontainer(s)ascloseaspossibletotheexitdoor.Reviewthecontentsofyourkitatleastonceperyearorasyourfamily’sneedschange.Also,considerhavingemergencysuppliesineachvehicleandatyourplaceofemployment.Individualsshouldpreparetobeontheirownfor72-96hours.

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Basic disaster suppliesThefollowingitemsshouldbeincludedinyourbasicdisastersupplieskit:

• Three-daysupplyofnonperishablefoodandmanualcanopener.Seethedisease specificDietaryNeedssectionsformoreinformationbasedonyourchroniccondition

• Three-daysupplyofwater(onegallonofwaterperpersonperday).Your conditionmayrequiremorewater.Askyourphysicianaboutyourneeds.

• Portable,battery-poweredradioortelevisionandextrabatteries

• Flashlightandextrabatteries

• Firstaidkitandmanual

• Sanitationandhygieneitems(handsanitizer,moisttowelettesandtoiletpaper)

• Matchesinwaterproofcontainer

• Whistle

• Extraclothingandblankets

• Kitchenaccessoriesandcookingutensils

• Photocopiesofidentification,creditcardsandotherimportantpapers (e.g.,SocialSecuritycard,insurancepolicies,financialinformation)

• Cashandcoins

• Specialneedsitems(eyeglasses,contactlenssolution,hearingaidbatteries,etc.)

• Itemsforinfants,tools,petsupplies,amapofthelocalareaandotheritems tomeetyouruniquefamilyneeds

Thinkaboutyourclothingandbeddingneeds.Besuretoincludeonesetofthefollowingforeachperson:

• Changeofclothing

• Sturdyshoes

• Sleepingbagorwarmblanket

• Extraitemsforcoldweather(jackets,gloves,scarves,boots,etc.)

• Extraitemsforwarmweather(sunscreen,widebrimmedhat,bugspray,etc.)

Suppliesforyourvehicleinclude:

• Flashlight,extrabatteriesandmaps

• Firstaidkitandmanual

• Whitedistressflag

• Tirerepairkit,booster/jumpercables,pumpandflares

• Bottledwaterandnon-perishablefoodssuchasgranolabars

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Medical items/needsTheitemslistedheremayapplytomanydifferentchronicdiseases.Additionalinformationcanbefoundinthemedicalitems/needssectionsandwillhelpyouwithyourspecificneeds.

• WearamedicalIDbracelettoquicklyalertresponderstoyourconditionandallergies.

• Two-weeksupplyofallmedicationsandmedicalsuppliesandcopiesofallprescriptions incasemedicationsarelostordamaged

• Necessarymedicalequipment(e.g.oxygen,wheelchair,walker,monitors)

• Alistofimportanthealth--relatedinformation,toinclude:

ºCopyofhealthinsurancecard(s)

ºModel/serialnumberofanymedicaldevicesandcompanycontactinformation incasetheyarelostordamaged

ºSummaryofyourmedicalhistory(SeeAdditionalResources: PersonalMedicalInformationFormforasampleform)

•Listofpastandcurrentconditionsordiagnoses

•Listcurrentmedications,amountstaken,purposetaken,timestaken andanyotherspecialinformation(e.g.,takewithmeals)

•Listallergiestomedicine,foodandmaterials

•Immunizationrecord

•Namesandphonenumbersofyourhealthcareproviders

•Listofphysiciancontactinformationoutsideofareaincaseofevacuation

•Placecopiesofmedicalhistorywithyourotherimportantdocuments.

Dietary needs • Whengatheringfooditemsforyourdisastersupplieskit,keepinmindany dietaryrestrictionsyoumayhave(e.g.,lowsodium)foodsthatmaybedifficult toeatandfoodsthatyoudonottoleratewell.

• Trytopackfoodsthatyouenjoyandwilleat.Thiscanmakeadisastersituation moretolerable.Asthefoodsupplynearsitsexpirationdate,youcaneatthefood withoutwastingitthenrestockwithnewitems.

• Keepgeneralhealthguidelinesinmindwhengatheringnon-perishablefoods foryourkit.Itmaybetemptingorconvenienttoloadupyourkitwithchips, cookiesandotherkindsof“junk”foodsincetheyareusuallynonperishable. Maintainingahealthydietcanhelpyoufeelbetterandprovideadditional strengthtocopewiththesituationandfightoffillness.

Diseasespecificdietaryinformationcanbefoundinthedietarysection.

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�. Maintain Your Plan

Quiz:Reviewyourplaneverysixmonthsandquizyourfamilyaboutwhattodoinanemergency.

Drill:Conductfireandemergencyevacuationdrillsonaregularbasiswithyourfamily.

Restock:Checkfoodsuppliesforexpirationdatesanddiscardorreplacestoredwaterandfoodeverysixmonths.Ifyouhavestoredextramedicalsupplies,makesuretheyhavenotexpiredorareunusable.

Test:Readtheindicatoronyourfireextinguisher(s)andfollowthemanufacturer’sinstructionstorecharge.Testyoursmokealarmsmonthlyandchangethebatteriesatleasttwiceayear.Replacealarmsevery10years.

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IF DISASTER STRIKESIf you are instructed to take shelter immediately, do so at once!

If you are instructed to evacuate:Shouldyouneedtoevacuate,yourfirstoptionandplanshouldalwaysbetostaywithfamilyorfriends.Theycanhaveroomforyou,yourpetsandhelpyoubemostcomfortableinastressfulsituation.Emergencypublicshelterswillbeavailableandcanprovidemealsandasafeplacetostaywhileyouarethere.However,theydonotprovidepersonalhealthcare.Ifyourequirethecareofapersonalattendantandchoosetogotoashelter,bringtheattendantwithyou.

•Listentotheradioortelevisionforthelocationofemergencyshelters. Notethosethataccommodatepeoplewithspecialneeds.

•Shutoffwater,gasandelectricityifinstructedtodoso.

•Wearappropriateclothingandsturdyshoes.

•Takeyourdisastersupplieskit.

•Lockyourhome.

•Usetravelroutesspecifiedbylocalauthoritiesanddonotuseshortcuts becausecertainareasmaybeimpassableordangerous.

•Confirmuponarrivalatanemergencyshelterthatitcanmeetyourspecialcareneeds.

•Informmembersofyoursupportnetworkandout-of-towncontactofyourlocation andstatus.

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ADDITIONAL RESOURCES

�. Sources For Emergency Preparedness InformationStateKentucky Office of Homeland Securityhttp://homelandsecurity.ky.gov/

Kentucky Division of Emergency Managementhttp://kyem.ky.gov/

Kentucky Emergency Management Associationhttp://www.kyema.org/

Kentucky Cabinet for Health and Family Services Public Health Preparednesshttp://chfs.ky.gov/dph/epi/preparedness/KentuckyDisasterResponsePlans.htm

Kentucky Outreach and Information Network (KOIN)http://www.chfs.ky.gov/dph/epi/preparedness/KOIN.htm

Kentucky Community Crisis Response Boardhttp://kccrb.ky.gov/

FederalCDC Emergency Preparednesshttp://emergency.cdc.gov/

Disaster Researchhttp://www.disaster-research.us/special_needs1.htm

FEMA Disaster Preparedness Guidehttp://www.fema.gov/areyouready/

Red Cross Disaster Preparedness http://www.redcross.org/services/disaster/0,1082,0_9_,00.html

Sources for Medical EmblemsMedicAlert Foundation http://www.medicalert.org1-800-ID-ALERT(1-800-646-4777)

Yourlocalpharmacy

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2. Community Emergency/Disaster Resource FormCompletethisformasyouarepreparingyouremergencyplan.Itcanbeaquickreferenceifyouhaveaquestionorareupdatingyourplan.

Sources for Medical Emblems

Contact person or office Location Phone/Email/Web site

Emergency Preparedness Planner/Office

Contact person or office Location Phone/Email/Web site

Red Cross

Contact person or office Location Phone/Email/Web site

Public Health Department

Contact person or office Location Phone/Email/Web site

Emergency Shelters (Includespecialneedssheltersandnoteaccordingly)

Contact person or office Location Phone/Email/Web site

Other Resources (e.g.FireandPoliceDepartments,SeniorCenter,FoodBank,UtilityCompanies,etc.)

Contact person or office Location Phone/Email/Web site

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�. Personal Medical Information FormCompletethisformandupdateitregularlysoyoualwayshaveyourmedicalinformationreadytotakewithyouinadisaster.

Name: DOB:

Address:

City: State: Zip:

Home Phone: Mobile Phone:

Emergency Contacts Physician Information

Name: Primary Care Provider

Name:Address:

Address:

Phone:

Relationship: Phone:

Name: Specialty Care Provider

Name:Address:

Specialty:

Phone: Address:

Relationship:

Next of Kin: Phone:

Power of Attorney: Specialty Care Provider

Name:

Current Diagnoses

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Specialty:

Address:

2.

�. Phone:

�. Specialty Care Provider

Name:�.

�. Specialty:

�. Address:

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�. Phone:

�0.Allergies (List food, environmentaland medication allergies):Pharmacy Information

Name:

Phone:

Name:

Phone:

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Medication Information: It is important to not only know the name anddosage of the medication, but also why you take it and what can happen it you stop.

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20.

Please copy this sheet if more medications need to be listed.

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�. Emergency Contact Information CardsMakesureyourfamilyhasaplanincaseofanemergency.Filloutthesecardsandgiveonetoeachmemberofyourfamilytomakesuretheyknowwhotocallandwheretomeetincaseofanemergency.

Emergency Contact Information Emergency Contact Information

Contact Name: Contact Name:

Phone: Phone:

Out-of-Town Contact Name: Out-of-Town Contact Name:

Phone: Phone:

Neighborhood Meeting Place: Neighborhood Meeting Place:

Phone: Phone:

Additional Important Contacts & Info Additional Important Contacts & Info

Emergency Contact Information Emergency Contact Information

Contact Name: Contact Name:

Phone: Phone:

Out-of-Town Contact Name: Out-of-Town Contact Name:

Phone: Phone:

Neighborhood Meeting Place: Neighborhood Meeting Place:

Phone: Phone:

Additional Important Contacts & Info Additional Important Contacts & Info

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�. Pets and DisastersIfyouareevacuating,remember,ifitisnotsafeforyou,itisnotsafeforyourpets.Whilepreparingyourfamily’sdisastersupplieskit,includeitemsyourpetsmayneed.ListedbelowarerecommendationsfromtheAmericanSocietyforthePreventionofCrueltytoAnimals(ASPCA):

•Food:Keepatleastathree-daysupplyoffoodinanairtight,waterproofcontainer.

•Water:Storeatleastathree-daysupplyofwaterspecificallyforyourpets inadditiontowateryouneedforyourselfandyourfamily.

•Medicines and medical records:Keepanextrasupplyofmedicines yourpettakesonaregularbasisinawaterproofcontainer.

•First aid kit:Talktoyourveterinarianaboutwhatismostappropriate foryourpet’semergencymedicalneeds.Mostkitsshouldinclude:

ºCottonbandagerolls ºLatexgloves ºBandagetape ºIsopropylalcohol ºScissors ºSalinesolution ºAntibioticointment ºPetfirstaidreferencebook ºFleaandtickprevention

•Collar with ID tag, harness or leash:

ºYourpetshouldwearacollarwithitsrabiestagandidentificationatalltimes.

ºIncludeabackupleash,collarandIDtaginyourpet’semergencysupplykit.

ºPlacecopiesofyourpet’sregistrationinformation,adoptionpapers,vaccination documentsandmedicalrecordsinacleanplasticbagorwaterproofcontainer andaddthemtoyourkit.

ºConsidertalkingwithyourveterinarianaboutpermanentidentification suchasmicrochippingandenrollingyourpetinarecoverydatabase.

•Crate or other pet carrier:

ºThecarriershouldbelargeenoughforyourpettostand,turnaroundandliedownin.

•Sanitation:

ºPetlitterandlitterbox,ifappropriate;newspapers,papertowels andplastictrashbags

ºHouseholdchlorinebleach(canbeusedasadisinfectant,dilutenine partswatertoonepartbleach)

•A picture of you and your pet together:

ºApictureofyouandyourpettogetherwillhelpyoudocumentownershipand allowotherstoassistyouinidentifyingyourpet,ifyoubecomeseparated

ºIncludedetailedinformationaboutspecies,breed,age,sex,colorand distinguishingcharacteristics

•Familiar items:

ºPutfavoritetoys,treatsorbeddinginyourkit.Familiaritemscanhelp reducestressforyourpet.

• Sheltering pets:

ºOtherthanserviceanimals,animalsarenotallowedinpublicshelters.Prepare alistoffamily,friends,boardingfacilities,veterinariansand“pet-friendly” hotelsthatcouldshelteryourpetsinanemergency.

20 2�

•Emergency contact information:

ºGathercontactinformationforemergencyanimaltreatment.

ºMakealistofcontactinformationandaddressesofareaanimalcontrolagencies includingtheHumaneSocietyorASPCAandemergencyveterinaryhospitals.

ºKeeponecopyofthesephonenumberswithyouandoneinyourpet’s emergencysupplykit.

�. Transfer TraumaDefinition:Transfertraumaisdefinedasthenegativeimpactofsuddenrelocationusuallyfollowingabrupt,unplannedmovesofthefrailelderly.Thisconditionmayoccurwhetherinashelter,hotelorstayingwithfriendsorrelatives.

Signs and Symptoms:

•Confusion

•Aggression

•ObsessiveBehaviors

•Depression

•Seriousillnessthatcouldleadtodeath

Behavioral Symptoms:

•Asksfrequently,‘Whattimeisit?”

•Distrustful-afraidsomeonewillstealtheirbelongings

•Crying

•Refusaltoeat,batheorchangeclothes

•Jumblingfacts

•Maybecomecombative

•Increasedincontinence

How to Minimize the Effects of Transfer Trauma:

•Learnallyoucanaboutthenatureofthedisaster.

•Developandupdateyourdisasterplan.

•Designatewhowillberesponsiblefortransportation ofallfamilymembers.

•Haveafamilymeetingandsharetheplanwitheveryone.

•Includephysical,personalandemotionalsecurityissuesintheplan.

•Bringacalendartoprovideavisualpictureofdayandlengthofstay.

•Establishachainofcommandandacommonmeetingplace.

•Makearrangementsforpets.

•Gathermedicalsupplies.

•Takesmallvaluablesandfamiliarobjects.

•Assignaconstantcompaniontotheelderly.

•Writedownwhereandwithwhomeachpersonisgoingandhave onepersontocontact.

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�. Stress ReactionsItisnormaltofeelanxiousandupsetwhenyouareinvolvedinadisasterorcrisissituation.Individualswithachronicdiseasemayfeelthesymptomsmoreintenselythanotherindividualswhodonothavetoplanformedicalcare.Thefollowingsignsandsymptomsareverycommonincrisissituations.Youmayexperiencejustoneorseveralatatime.Donotbetooalarmed;thesesymptomsarenormal.If,however,theylastlongerthantwotofourweeksandareaffectingyourhealth,pleasetalktoamemberofyourhealthcareteam(doctor,nurse,socialworker,etc.).

Common Symptoms of Stress •Anxiety •Sleeplessness

•CryingSpells •PanicAttacks

•Irritability •AppetiteLoss

•MemoryProblems •DifficultyMakingDecisions

•Nightmares •InabilitytoConcentrate

•Anger •FeelingOverwhelmed

Remember,inmostcases,youarereactingnormallytoanabnormalsituation.Somethingsyoucandoforyourselfandyourfamily,duringthistime,include:

•Recognizeyourownfeelings

•Talktoothers;itwillhelprelieveyourstress

•Accepthelpfromothers

•Getenoughrest

•Getasmuchphysicalactivityaspossible

�. Medical Items/NeedsMedical items/needsItisimportantthatyoutakeallmedicationsasprescribedanddonotinterruptorstopanytreatmentswithoutyourdoctor’sapproval.Doingsomayresultinareturnofyoursymptomsandprogressionofyourdisease.Adisasteroremergencysituationmaymakeitdifficulttocontinuewithyourtreatmentregime.Thatiswhyitissoimportanttoplanahead.Inadditiontothoseitemspreviouslylistedinthismanual,thefollowingmaybehelpfultohaveavailableinadisastersituation: •Ifyouusesupplementaloxygen:

ºHaveanextraportablecylinderofoxygenavailable.

ºTrytoestimatethetimeittakestouseanoxygencylinder.Thiswillhelpin determininghowlongyoursupplywilllast.Remember,stressfulsituationsmay causeyoutobreathemorequickly,causingyouroxygensupplytorundownfaster.

ºContactyouroxygenproviderandaskhowmuchoxygenisrequiredinyour homesothatoxygenflowisuninterrupted,evenduringapoweroutageorsnow emergency.Thislengthoftimeisdependentonanumberoffactors,including howeasyitistogettoyourhomewithsnoworiceontheground.

ºIfyouliveinaruralorremoteareawherefrequentorlong-lastingpoweroutages occur,youshouldconsiderpurchasingandinstallingagenerator.

ºHaveaplantoobtainadditionaloxygenshouldyoursupplyrunout.

ºPackextranasalcannulassotheycanbechangedparticularlyiftheprongs becomesoiledoruncomfortable.Inmanyplacestheyarefreefromyoursuppliers.

•Storeallofyoursuppliesandpartsforyournebulizerorothermedicalequipment inaplasticcontainerorstoragebagnexttoyourequipment.Itcanbegatheredup quicklyincaseyouhavetoevacuateyourhome.

22 2�

•Packanyitemsneededtoproperlycleanandsanitizeyourequipment.

•Includeamaskorotherequipmenttominimizeyourcontactwithirritants. Disasterscanstirupavarietyofirritants(smoke,pollen,mold,fumes,etc.).

•Youmaybeextrasensitivetotemperatureextremes(coldorhotweather). Packthefollowingitemsinyourkittohelpwiththis:

ºColdweather—acoat,sweaters,shawlsorblankets,socks,glovesanda scarforcold-weathermask(Makesurethecoatiswarm,butlight-weight enoughthatitwon’tmakeyouoverheat.)

•Coldweathercanmakearthritisandcertaincirculationproblemsworse. Packdisposableheatpackstowarmupstiffhands.

ºHot/humidweather:Asmallbattery-operatedormanualfanmayhelptokeepyoucool.

•Putonshoesandtakecomfortableslipperswithyou.

•Ifyouareonspecialtreatmentssuchaschemotherapyorradiationyoushould havecopiesofyourchemotherapyorradiationtreatmentplansinadditionto anymedicationsyouaretaking.

•Ifyouhavetoleaveyourareaandareundergoingchemotherapyorradiationtreatment, consultyourphysicianoraskyourtreatmentfacilityhowtoplanforanalternative treatmentlocationifneeded.Contactthealternativetreatmentfacilitytofindoutwhere theyarelocatedandhowitwouldworkifyouneededtoseethemduringadisaster.

•Yourconditionand/ortreatmentmaymakeyoumoresusceptibletoaninfection. Packplentyofhandsanitizer,disinfectantwipes,etc.Also,makesureyouonlydrink waterandeatfoodthatyouknowissafe.

•Somecancertreatmentsandcertainbloodpressuremedicationsandfluidpillscan makeyouverysensitivetothesun.Besuretopacksunscreen,awide-brimmedhat, anumbrellaorotheritemsthatcanshieldyoufromthesunifneeded.

•Yourconditionandtreatmentcancauseyoutobecomeeasilyfatigued.Takeseveral napsorrestbreaksduringtheday,ratherthanonelongrest.Planyourdaytoinclude restbreaks.Takeshortwalksorgetregularexercise,ifpossible.Somepeoplefindthis helpstolessentheirfatigueandraisetheirspirits.

•Sideeffectsfromcertaintreatments(e.g.,vomiting,diarrhea)mayrequireadditional medicationincludingover-the-countermedications.Remembertoconsultyour physicianaboutwhatyoucantakeandincludetheseinyourkit.

•Yourconditionmayalsorequiremorewaterthanthegallonadayperperson recommendation.Ifyouhavebeenadvisedtodrinkmorefluids,havemoreavailable.

•CommunicationDevices

ºIfyoudorequireacommunicationdevice,itmaybehelpfultohave preprogrammedstatementsorpreprintedcardsalertingrescuepersonnel ofyourconditionandpossibleneeds.

ºIfyoudonotrequireacommunicationdevice,preprintedcardslistingyour conditionandpossibleneedsmaystillbehelpful.Youmaybeunabletospeak quicklyandemergencysituationsmaymakeitdifficultforyoutoclearly communicatewithresponders.

•Storeneededmobilityaids(canes,crutches,legbraces,walkers,wheelchairs)closetoyou inaconvenientlocation.Ifpossible,keepextrasinseverallocationsthroughoutyourhouse.

•Ifyoufalleasily,considergettinghipprotectors.Inadisastersituation,youmay beforcedtogetarounddebrisorwalkaroundinanunfamiliarplace.Hipprotectors canhelppreventafractureifyoushouldfall.

2� 2�

•Avoidheavyliftingorcarrying.Placedisastersuppliesinacartwithwheelsthat canbepushedorpulled.

•Aportablescalemaybenecessaryifyouhavebeentoldtomonitordailyweights forheartfailure.

•Ifyouuseawheelchair:

ºKeepapatchkitorextrainnertubesinyourkit.

ºManualwheelchair:Keepapairofheavyglovesincaseyouhavetowheelover glassorothersharpdebris.

ºMotorizedwheelchair:Incaseofapoweroutage,keepanextrabatteryandhave aplantorechargeyourchair.Forexample,purchaseaconverterthatplugsinto yourvehicle’scigarettelighter.

ºConsiderhavingalightweightmanualwheelchairasaback-up

ºTherewillbetimeswhenyoumayhavetoleaveyourwheelchairinorderto evacuatesafely.Ifyoucannotusestairs,familiarizeyourselfandyourpersonal carenetworkwithliftingandcarryingtechniquesthatworkforyou.Also,be preparedtogivetheseinstructionstorescueworkers.

ºWhenpreparingyourexitplan,makesuremorethanoneexitiswheelchairaccessible.

•Haveyourmedicationanddosingscheduleprintedoutclearly.

•Ifpossible,informanyrespondersornewcaregiversaboutanypatternofups anddownsthatarepartofyourusualfunctioningdueto“on-off”fluctuations.

�. DietaryDietary needs •Whengatheringfooditemsforyourdisastersupplieskit,keepinmindthe nonperishablefoodsinyourdisastersupplieskitshouldbeaswell-balanced aspossiblewithfoodsprovidingprotein,carbohydrates,andfats;remembering topackfoodsthatarefoundinanoverallhealthydiet.

•Keepinmindanydietaryrestrictionsyoumayhave.Forexample,foodshigh insodiumcancausefluidretentionwhichmaymakeyourfeetswellandaffectyour breathing.Mostcannedfoodscontainalotofsodium.Curedorsmokedmeats(jerky orbeefsticks)alsocontainveryhighlevelsofsalt.Ifyouareonasodiumrestricteddiet, lookfornonperishablefoodsthatarelowinsodium.

•Packnonperishablefoodsthatyouareabletoprepareandeat.Forexample,your conditionmaymakeitdifficulttouseamanualcanopener,sochoosefooditems suchasgranolabarsorcanswithpop-tops.

•Makesurethefoodsyouchoosedonotinteractorinterferewiththeeffectiveness ofyourmedications

•Ifyouuseanyspecialdevicestohelpyouprepareoreatfood,remembertoinclude theminyouremergencysupplieskit.Thesecanincludeeasytogripforks,spoons, andknives,non-skidplatesandbowls,aswellascupsandmugswithlidsandstraws.

•Someofthesesuggestionsmaybedifficulttofollowduringadisastersituation. Perishablefoodssuchasmilk,cheeseandeggsmaybehardtocomebyandare unlikelytobestoredinadisastersupplieskit.Highproteinfoodscanbefoundin nonperishableforms.Forexample,powderedmilk,cannedmeatsandproteinbars canallbeused.Otherexamplesaregranola,proteinorothermealreplacementbars thathavetearopenpackages.

2� 2�

•Checktomakesurefooditemsdonotcontainanyallergensthatcanaffectyourbreathing.

•Eatingseveralsmallmealsthroughoutthedaymakesdigestioneasieronthe bodyanduseslessenergy!

•Avoidorlimitfoodsthatcauseheartburnorgas,becausebloatingmakesbreathing moredifficult.

•Maintaingoodfluidintake.Drinkplentyoffluids(atleastonegallonofwatereach day)unlessyouhavebeentoldbyyourphysiciantolimityourfluids.Thiswillprevent dehydration,especiallyifyouhavediabetesorareoncertainmedications.Italsohelps thinsecretions,makingiteasiertocoughupmucusifyouhavelungdisease.

•Ifyouhavecancer,yourdoctorordieticianmaymakerecommendationsthat aredifferentfromyourregulardiet.Youmaybetoldtoeatmorecalories.You mayalsobetoldtoincreaseyourproteinbyeatingmoreeggs,cheeseandmilk. Youmayevenbetoldtoeatlessofcertainhigh-fiberfoodsbecausetheycan aggravateproblemssuchasdiarrheaorasoremouth.

•Sideeffectsfromcancertreatmentoftenaffecteating.Itisimportanttoknowwhat theeffectsaresothatyoucanstocktheappropriatefoodsinyourdisastersupplies kit.Also,sideeffectssuchasvomitinganddiarrheamaycausedehydration.Pack extrawaterandanyover-the-countermedicationsyourdoctorhassuggestedtotreat thesesymptomsinyourkit.Workwithyourphysicianoryourdietitiantolearnabout thefoodsitemsyoushouldincludeinyourdisastersupplieskit.Yournutritionneeds andthefoodsyoutoleratewellmaychangeasyougothroughtreatment.

•Yourphysicianordietitianmayalsorecommendthatyoutakenutritionalsupplements (vitaminsand/orliquidsupplements)basedonyourindividualneeds.Rememberto includetheseinyourdisastersupplieskit.

•Iftakinginenoughcaloriesandswallowinghasbecomedifficult,youmayneedto packliquidnutritiondrinks,athickenerforfluidsorevenfeedingtubesupplements.

•Ifyouareadiabetic,besuretopickfruitcannedinjuice,notsyrup.

•Pleaseconsultyourphysicianformoreinformationoranyquestionsaboutplanning foradisasteranddietaryrestrictions.

2� 2�

DISEASE SPECIFIC INFORMATION

�. Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Other Lung Diseases

AsthmaAsthmaisalungdiseasethatcausesyoutohavedifficultybreathing.Morethan20millionAmericanssufferfromasthma.Peoplewithasthmamayhaveairwaysthatareinflamed.Thismeansthattheyswellandproducelargeamountsofthickmucus.Theyarealsooverlysensitivetocertainthingslikedust,cigarettesmokeorevenexercise,whicharecalledtriggers.Thissensitivitycausesthemusclesthatsurroundtheairwaystotightenup.Thecombinationofairwayinflammationandmuscletighteningnarrowstheairwaysandmakesitdifficultforairtomovethrough.Thisiswhathappenstoaperson’slungsduringanasthmaattack.

What are the Symptoms of Asthma?

Mostpeoplewithasthmaonlyhavedifficultybreathingeverysooften.Whenitdoeshappen,itisknownasanasthmaflare-uporanasthmaattack.Apersonhavinganasthmaattackmaycough,wheeze(makeawhistlingsoundwhilebreathing),beshortofbreathandfeelanintensetightnessinthechest.Manypeoplesayitfeelsextremelyhardtogetairinandoutoftheirlungs,liketheyarebreathingthroughasmallstraw.Anasthmaattackcanlastforseveralhoursorlongerifapersondoesn’tuseasthmamedication.Afterwards,thepersonusuallyfeelsbetter.

What Causes Asthma?

Theexactcauseofasthmaisnotknown,butitisbelievedtobeacombinationofenvironmentalandgeneticfactors.Itisn’tcontagious.Asthmasymptomscanbetriggeredbymanythings.Whatcausessymptomsinonepersonmightnotbotheranotheratall.Thefollowingaresomeofthecommontriggers:

•Allergens

•Airborneirritantsandpollutants

•Exercise

•Weather

•Respiratorytractinfections

Thereareotherthingsthatcantriggersymptoms,evenlaughing,crying,andyellingcansometimescausetheairwaystotighteninsensitivelungs,triggeringanasthmaattack.

How do Doctors Diagnose Asthma?

Indiagnosingasthma,thedoctorwillstudyyourmedicalhistoryandalsoperformaphysicalexam.Yourdoctormayperformsometestsincludingspirometryandpeakflowmetertests.Thesetestsmeasurehowwellyourlungsareperforming.Yourdoctormayalsorecommendallergyteststoseeifallergiesarecausingyoursymptomsorspecialexerciseteststoseewhetheryourasthmasymptomsmaybebroughtonbyphysicalactivity.

How is Asthma Treated?

There’snocureforasthma,buttheconditioncanusuallybemanagedandflare-upscanbeprevented.Asthmaistreatedintwoways:byavoidingpotentialtriggersandwithmedication.Avoidingtriggersthatmakeasthmasymptomsworseisimportant.Theycan’talwaysbeavoided(likecatchingacold),butyoucancontrolyourexposuretosometriggers,suchaspetdander,forexample.

2� 2�

Eachpersonwithasthmaistreateddifferentlybecauseeachpersonhasadifferentseveritylevelandadifferentsetoftriggers.Thereareavarietyoftreatmentmedicationsdoctorscanchoosefrom.Mostasthmamedicationsareinhaled(whichmeansthatapersontakesthemedicationbybreathingitintothelungs),butasthmamedicationscanalsotaketheformofpillsorliquids.Theyfallintotwocategories:

•Rescue medications-aretakenasneededandactquicklytohaltasthma symptomsoncetheystart.

•Controller medications-preventsymptomsfromoccurringinthefirstplace.

Manypeoplewithasthmaneedtotakemedicationeverydaytocontroltheconditionoverall.Controllermedications(alsocalled“preventive”or“maintenance”medications)workdifferentlyfromrescuemedications.Theytreattheproblemofairwayinflammationinsteadofthesymptoms(coughing,wheezing,etc.)thatitcauses.Controllermedicationsareslowactingandcantakedaysorevenweekstobeginworking.Althoughyoumaynotnoticethemworkinginthesamewayasrescuemedications,regularuseofcontrollermedicationsshouldlessenyourneedfortherescuemedications.Doctorsalsoprescribecontrollermedicationsasawaytominimizeanypermanentlungchangesthatmaybeassociatedwithhavingasthma.

Thebestwaytocontrolasthmaisprevention.Althoughmedicationscanplayanessentialroleinpreventingflare-ups,environmentalcontrolisalsoveryimportant.Herearesomethingsyoucandotohelppreventcomingintocontactwiththeallergensorirritantsthatcauseyourasthmaflare-ups:

•Keepyourenvironmentclearofpotentialallergens.

•Payattentiontotheweatherandtakeprecautionswhenyouknowweather orairpollutionconditionsmayaffectyou.Youmayneedtostayindoorsor limityourexercisetoindooractivities.

•Don’tsmoke(orifyou’reasmoker,quit).Smokingisabadhabit,especially forsomeonewhohasasthma.

•Exercise,butbecareful.Ifyou’repronetoexercise-inducedasthmaattacks, talktoyourdoctorabouthowtomanageyoursymptoms.

Preventingasthmasymptomsmaybedifficulttododuringanemergencysituation.Adisastercanstirupavarietyofirritantsintotheair.Takeprecautionsbyattemptingtoavoidareas(outdoorsorindoors)wheretherearehighlevelsofirritants.Wearingadustmaskmayalsohelptocutdownonexposure.Itisalsoimportantthatprescribedmedicationsbecontinued.Interruptingorstoppingmedicationscancauseanincreaseinairwayinflammation,leadingtocoughing,wheezing,shortnessofbreath,chesttightnessandmorefrequentasthmaattacks.Overuseoffastactingorreliefmedicationscanalsocausethemtolosetheireffectiveness.

Chronic Obstructive Pulmonary Disease (COPD)Chronicobstructivepulmonarydisease(COPD)isanumbrellatermforchronicbronchitis,emphysemaandarangeofotherlungdisorders.Thesedisordersarecharacterizedbyobstructionofairflowthatinterfereswithnormalbreathing.InCOPD,theairwaysthatcarryairinandoutofyourlungsbecomepartiallyblocked,makingitdifficulttogetairinandout.COPDisamajorcauseofdeathandillnessthroughouttheworldandisthefourthleadingcauseofdeathintheU.S.

2� 2�

What are the Symptoms of COPD?

ThesymptomsofCOPDincludeacoughthatdoesnotgoaway,coughingupsputum(mucus),shortnessofbreath(especiallywithexercise),wheezingorawhistlingsoundwhenyoubreathe,tightnessinthechestandfatigue(tiredness).Thesesymptomsoftenstartyearsbeforetheflowofairinandoutofthelungsisreduced.NoteveryonewhohasacoughandsputumwilldevelopCOPDlaterinlife.

What Causes COPD?

COPDusuallydevelopsslowlyovertime.Symptomsmaydevelopwhenanindividualisbreathinginfumes,dustsandotherirritantsthatdamagethelungsandairwaysoveralongperiodoftime.Smokingtobacco(cigarettes,cigarsandpipes)isthemostcommoncauseofCOPD.MostpeoplewithCOPDaresmokersorhavebeensmokersinthepast.

Individualswhohaveworkedmanyyearsaroundcertainkindsofchemicalsandbreathedinthefumes,workedinadustyareaorhavehadheavyexposuretoairpollutionmayalsodevelopCOPD.Inrarecases,COPDiscausedbyagene-relateddisordercalledalpha1antitrypsindeficiency.Peoplewiththealpha1antitrypsinproteinintheirbloodmayexperiencelungdamageandCOPD.Ifpeoplewiththisconditionsmoke,thediseaseprogressesmorerapidly.Ifyousmoke,themostimportantthingyoucandotopreventmorelungdamageistostopsmoking.Itisalsoimportanttostayawayfrompeoplewhosmokeandplaceswhereyouknowtherewillbesmokers.

How do Doctors Diagnose COPD?

YourdoctorwilldiagnoseCOPDbyexaminingyou,listeningtoyourlungs,askingyouquestionsaboutyourmedicalhistoryandwhatlungirritantsyoumayhavebeenaroundforlongperiodsoftime.Yourdoctormayalsouseaspirometermeasurehowmuchairyourlungscanholdandhowfastyoucanblowairoutofyourlungs.Basedonthistest,yourdoctorcandetermineifyouhaveCOPDandhowsevereitis.YourdoctormayalsoorderachestX-rayandanarterialbloodgastest.Thebloodtestshowstheoxygenlevelinthebloodtoseeifoxygentreatmentisneeded.

How is COPD Treated?

ThereisnocureforCOPD.Damagetoyourairwaysandlungscannotbereversed,buttherearethingsyoucandotofeelbetter.COPDsymptomscanbemanagedanddamagetothelungscanbeslowed.Themostimportantthingyoucandotoslowtheprogressofthediseaseistoquitsmoking.Yourdoctormayrecommendtreatmentstorelieveyoursymptomsandtherearethingsyoucandotolivebetterwiththedisease.ThegoalsofCOPDtreatmentareto:

•relievesymptomswithnoorminimalsideeffectsoftreatment

•slowtheprogressofthedisease

•improvetheabilitytostayactiveandexercise

•preventanycomplicationsfromthedisease

•improvehealthoverall

Treatmentforeachpersonisdifferentandisbasedonwhethersymptomsaremild,moderateorsevere.Thereareavarietyoftreatmentsthatcanhelpreducesymptomsandmanagecomplications,including:

•Bronchodilators-medicationsthatworkbyrelaxingthemusclesaroundyourairways, openingthemandmakingiteasiertobreathe.Theycanlasteither4-6hoursor12hours, dependingonthetype.Mostareinhaleddirectlyintothelungswiththeuseofaninhaler.

2� 2�

• Inhaled steroids-usedforsomepeoplewithmoderateorsevereCOPD toreducetheinflammationorswellingintheairways.

•Vaccines-itisrecommendedthatyougetapneumococcalvaccinetoprevent pneumoniaandanannualflushottoavoidanybreathingcomplications.

•Pulmonary or lung rehabilitation (rehab)-helpsyoustayactivedespiteyour COPD.Itincludesexercisetraining,nutritionadviceandeducationaboutmanaging thedisease.Acustompulmonaryrehabprogramismanagedbyamultidisciplinary team(doctors,nurses,respiratorytherapists,exercisespecialists,dietitians).

•Oxygen therapy-forsevereCOPDandlowlevelsofoxygenintheblood.Usingextra oxygencanhelpyouperformtasksoractivitieswithlessshortnessofbreath,protect theheartandotherorgansfromdamage,improvethequalityanddurationofyoursleep, improveyouralertnessduringthedayandhelpyoulivelonger.

•Surgery-isusuallydoneforpatientswhohaveseveresymptoms,havenotimproved withmedicationsandhaveahardtimebreathingmostofthetime.Therearetwotypes ofsurgeryforCOPD:abullectomy,whichremovesalargeairsacthatmaycompressa goodlung,oralungtransplant.

ThegoalofCOPDtreatmentistopreventorminimizetheprogressionofthedisease.Duringadisasteroremergencysituationitmaybedifficulttofollowalltreatmentrecommendations.Stoppingtreatmentsmayincreasethefrequencyorseverityofbreathingdifficulties.Youmayalsobecomeoverlytiredandeventuallyrequirehospitalization.Youshouldalsocallyourdoctorifyouhavesuddenchesttightness,morecoughing,achangeinyoursputumorfever.Thiscouldsignalalunginfection.Itisimportantthatalltreatmentrecommendationsbefollowedtothebestofyourabilityinordertomaintainlungfunction,preventfurtherlungdamageandmaintainyourqualityoflife.

Chronic BronchitisChronicbronchitisisaninflammationofthemainairwaysinthelungsthatcontinuesforalongperiodoftimeorkeepscomingback.Cigarettesmokingisthemaincauseofchronicbronchitis.Themoreapersonsmokes,themorelikelythepersonwilldevelopseverebronchitis.Secondhandsmokemayalsocausechronicbronchitis.Airpollution,infectionandallergiesmakechronicbronchitisworse.

Symptomsincludeacoughthatproducesmucus(sputum),whichmaybebloodstreaked;shortnessofbreathaggravatedbyexertionormildactivity;frequentrespiratoryinfectionsthatworsensymptoms;wheezing;fatigue;ankle,footandlegswellingthataffectsbothsides;andheadaches.

Chronicbronchitisisoneformofchronicobstructivepulmonary(lung)disease.Chronicbronchitis,emphysema,andasthmaasagrouparealeadingcauseofdeathintheU.S.

EmphysemaEmphysemaisalungdiseasethatinvolvesdamagetotheairsacs(alveoli)inthelungs.Theairsacsareunabletocompletelydeflate,andarethereforeunabletofillwithfreshairtoensureadequateoxygensupplytothebody.

Cigarettesmokingisthemostcommoncauseofemphysema.Tobaccosmokeandotherpollutantsarethoughttocausethereleaseofchemicalsfromwithinthelungsthatdamagethewallsoftheairsacs.Thisdamagebecomesworseovertime,affectingtheexchangeofoxygenandcarbondioxideinthelungs.

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Symptomsofemphysemaincludeshortnessofbreath;chroniccoughwithorwithoutsputumproduction;wheezinganddecreasedabilityabilitytoexercise.Additionalsymptomsthatmaybeassociatedwiththisdiseaseinclude:anxiety;unintentionalweightloss;ankle,feet,andlegswelling;andfatigue.

Smokingcessationisthemostimportantandeffectivetreatment.Quittingsmokingcanstoptheprogressionoflungdamageonceithasstarted.Medicationsusedtoimprovebreathingincludebronchodilators(hand-heldinhalerornebulizer),diureticsandcorticosteroids.Antibioticsmaybeprescribedwhenrespiratoryinfectionsoccur.Influenza(flu)vaccinesandPneumovax(pneumoniavaccine)arerecommendedforpeoplewithemphysema.

Sources for Additional Asthma,COPD and Other Lung Diseases Information

American Lung Associationwww.lungusa.org1-800-LUNG-USA(1-800-586-4872)

Asthma and Allergy Foundation of Americawww.aafa.org1-800-7-ASTHMA(1-800-727-8462)

National Heart Lung and Blood InstituteCOPD-http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.htmlAsthma-http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html

Kentucky Cabinet for Health and Family ServicesCOPD-http://chfs.ky.gov/dms/hi/COPD.htmAsthma-http://chfs.ky.gov/dms/hi/Asthma.htm

Free Tobacco Cessation Assistance1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov

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2. Cancer

Cancerisanumbrellatermformorethan100life-threateningdiseasescharacterizedbytheuncontrolled,abnormalgrowthofmalignant(cancerous)cells.Normally,cellsgrowanddivideuntiltheyeventuallydie.Cancercellscontinuetogrowanddivide.Theresultingmassortumorcaninvadeanddestroysurroundingnormaltissues.

What are the Symptoms of Cancer?

Therearemanydifferenttypesofcancer.Asaresult,therearemanydifferentsymptoms.Thereareafewcommonsymptomsincluding:

•Unintentionalweightloss •Swellingorlumpsincertainparts (10ormorepounds) ofthebody(e.g.,abdomenorneck)

•Extremeexhaustion •Problemswithwalkingorbalance

•Headaches •Moreinfections

•Blurredvision •Unusualbleeding

•Nausea

What Causes Cancer?

Scientistsandresearchersdonotreallyknowwhatcausescancer,butthereissomeunderstandingofwhypeoplegetcancer.Peoplegetcancerbasedontheirgeneticsandcertainenvironmentalorbehavioraltriggers.Forexample,ifacloserelativehadlungorskincancer,youmaybemorelikelytoinheritthetendencytogetlungorskincancer.Ifyouareexposedtoenvironmentalorbehavioraltriggerssuchassmokingcigarettesorexcessivesunexposure,youmaybemorelikelytogetlungorskincancer.Thecombinationofgeneticsandenvironmentalandbehavioraltriggersdeterminethelikelihoodthatyouwillgetcancer.

How do Doctors Diagnose Cancer?

Ifcancerissuspected,yourdoctorwillorderseveraltests.Thesemayincludebloodtests,x-raysoranMRI.Abiopsy,whichinvolvestheremovalofasmalltissuesampletoexamineitforcancercells,mayalsobeperformed.

How do Doctors Treat Cancer?

Therearethreecommonmethodsfortreatingcancer:surgery,chemotherapyandradiation.Cancertreatmentplansaretailoredtoeachpatientbecausecancerisdifferentineachpatient.Apersonwithcancermayundergoanyoneofthesetreatmentsoracombinationofthem:

•Surgeryremovescanceroustissue.Asurgeonremovesthecanceroustissuealongwith asmallamountofthehealthytissuesurroundingittomakesurethatallthecancer isremovedandhasnotspread.

•Chemotherapyisthetreatmentofcancerusingmedicationtodestroymalignant (cancerous)cells.Sideeffectsincludenausea,fatigue,hairlossorothersideeffects. Chemotherapymaydestroysomehealthycellsintheprocessofremovingofthe malignantcells.Thesehealthycellswilleventuallystarttogrowagainandthe sideeffectsshoulddisappear.

•Radiation or radiotherapyiswhenhighlevelsofradiationareusedtokillcancercells ortoshrinktumors.Itisusuallypainless,buttherearesideeffectsincludingfatigue,

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nausea,vomitingordiarrhea.Sometimes,theareaofskinthathasbeenirradiated becomesinflamed.Mostofthesesideeffectsaretemporary.

Aninterruptioninchemotherapyorradiationtreatmentcanresultinaspreadofthecanceroramorerapidprogressionofthedisease.Itcanalsoincreaseanypainthattheindividualwassufferingduetothecancer.Itisimportantthatyourtreatmentscontinueasscheduledeveninadisaster.

Side Effects to Certain Cancer Treatments

Cancer Treatment How it Can Affect Eating What Sometimes Happens: Side Effects

Surgery Increases the need for good nutrition.May slow digestion. May lessen the ability of the mouth, throat and stomach to work properly. Adequate nutritionhelps wound-healing and recovery.

Before surgery, a high-protein, high-calorie diet may be prescribed if a patient is underweight or weak. After surgery, some patients may not be able to eat normally at first. They may receive nutrients through a needle in their arm or through a tube in their nose or stomach.

Radiation Therapy

As it damages cancer cells, it also may affect healthy cells and healthy parts of the body.

Treatment of head, neck,chest or breast may cause: • Dry mouth • Sore mouth • Sore throat • Difficulty swallowing (dysphagia) • Change in taste of food • Dental problems • Increased phlegm • Nausea and vomiting • Diarrhea • Cramps, bloating

Chemotherapy As it destroys cancer cells, it also may affect the digestive system and the desire or ability to eat.

• Nausea and vomiting • Loss of appetite • Diarrhea • Constipation • Sore mouth or throat • Weight gain or loss • Change in taste of food

Biological Therapy Immunotherapy

As it stimulates your immune system to fight cancer cells, it can affect the desire or ability to eat.

• Nausea and vomiting • Diarrhea • Sore mouth • Severe weight loss • Dry mouth • Change in taste of food • Muscle aches, fatigue, fever

Hormonal Therapy

Some types can increase appetite and change how the body handles fluids.

• Changes in appetite • Fluid retention

Chart source: National Cancer Institute www.cancer.gov

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Sources for Additional Cancer InformationAmerican Cancer Societyhttp://www.cancer.org1-800-ACS-2345TTY:1-866-228-4327

National Cancer Institutehttp://www.cancer.gov1-800-4-CANCER(1-800-422-6237)TTY:1-800-332-8615

Kentucky Cancer Programhttp://louisville.edu/org/kycancerprogram

Cancer Carehttp://www.cancercare.org1-800-813-HOPE(1-800-813-4673)

National Coalition for Cancer Survivorshiphttp://www.canceradvocacy.org1-888-650-9127

Free Tobacco Cessation Assistance1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov

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�. Dementia and Memory Loss

Dementiaisaconditionofdecliningmentalabilities,especiallymemory.Anindividualwithdementiawillhaveproblemsdoingthingsheorsheusedtobeabletodo,likekeepthecheckbook,driveacarsafelyorplanameal.Theindividualwilloftenhaveproblemsfindingtherightwordsandmaybecomeconfusedwhengiventoomanythingstodoatonce.Dementiamayalsocausechangeinpersonality,makingonebecomeaggressive,paranoidordepressed.

Itmaytakelongertorememberthingsortofindtherightwordtosayaspeoplegetolder,butthisisnotdementia.Dementiacausesmentalchangesthatkeeppeoplefromdoingthethingstheyusedtodo.Agingalonedoesnotinterferewiththeabilitytofunction.

What are the Symptoms of Dementia?

Dementiacausesmanyproblemsforthepersonwhohasitandfortheperson’sfamily.Manyoftheproblemsarecausedbymemoryloss.Somecommonsignsofdementiaarelistedbelow.Noteveryonewhohasdementiawillhaveallofthesesigns.

•Recent memory loss-Peoplewithdementiaoftenforgetthings,buttheynever rememberthem.Theymightaskyouthesamequestionoverandover,eachtime forgettingthatyou’vealreadygiventhemtheanswer.Theywon’tevenremember thattheyalreadyaskedthequestion.

•Difficulty performing familiar tasks-Peoplewhohavedementiamightcook amealbutforgettoserveit.Theymightevenforgetthattheycookedit.

•Problems with language-Peoplewhohavedementiamayforgetsimplewords orusethewrongwords.Thismakesithardtounderstandwhattheywant.

•Time and place disorientation-Peoplewhohavedementiamaygetlostontheirown street.Theymayforgethowtheygottoacertainplaceandhowtogetbackhome.

•Poor judgment-Peoplewhohavedementiacanforgetsimplethings,likeforgetting toputonacoatbeforegoingoutincoldweather.

•Problems with abstract thinking-Peoplewhohavedementiamayforgetwhat numbersareandwhathastobedonewiththem.

•Misplacing things-Peoplewhohavedementiamayputthingsinthewrongplaces andcan’tfindthemlater.

•Changes in mood-Peoplewithdementiamayhavefastmoodswings,goingfrom calmtotearstoangerinafewminutes.

•Personality changes-Peoplewhohavedementiamayhavedrasticchanges inpersonality.Theymightbecomeirritable,suspiciousorfearful.

•Loss of initiative-Peoplewhohavedementiamaybecomepassive.Theymight notwanttogoplacesorseeotherpeople.

What Causes Dementia?

Therearemanycausesofdementia,includingstrokes,lowvitaminB12levels,thyroidconditions,depression,AIDSandotherinfections.Medicationsandsomeillnessescancauseconfusion(delirium)inolderpeoplethatmaylooklikedementia.Dementiaisalsocausedbythedestructionofbraincells.Aheadinjury,astroke,abraintumororAlzheimer’sdiseasecandamagebraincells.

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How do Doctors Diagnose Dementia?

Ifdementiaissuspected,thedoctorwillperformamedicalexam,orderbloodworkandrunsomememorytests.Othertests,includingaCTscanorMRIscanofthebrain,mayalsobedone.

How is Dementia Treated?

Somecasesofdementiaarecausedbymedicalconditionsthatcanbetreated,fullyorpartlyrestoringmentalfunction.Whendementiacannotbereversed,thegoaloftreatmentistomakelifeaseasyaspossibleforthepersonandthecaregivers.

Ifthecauseofdementiacanbereversed,thedoctorwillprescribetreatment.Forexample,thepersonmighttakevitaminsforadeficiencyoffolicacid,vitaminB12,orthiamine;takemedicinestotreataninfection,suchasencephalitis,thatiscausingchangesinmentalstate;orstoporchangemedicationsthatarecausingmemorylossorconfusion.

Ifthecauseofdementiacannotbetreated,thedoctorwillworkwiththepersonandcaregiverstodevelopaplantomakelifeeasierandmorecomfortable.Careplansmayincludetipstohelpthepersonbeindependentandmanagedailylifeaslongaspossible.Educationofthefamilyandothercaregiversiscriticaltosuccessfullycaringforapersonwithdementia.

Tips for Managing a Person with Dementia in a DisasterPeoplewithdementiaareespeciallyvulnerabletochaosandemotionaltrauma.Theyhavealimitedabilitytounderstandwhatishappening,andtheymayforgetwhattheyhavebeentoldaboutthedisaster.Planningaheadnowcanhelptoreducetraumaandeaseagitationshouldanemergencyordisastersituationoccur.Inadditiontothoselistedpreviouslyinthismanual,otheritemsthatmaybehelpfultohaveinadisastersituation,include:

Additional Items to Include in Your Kit

•Changeofclothing—makesuretheseitemsarecomfortabletowearandareeasy togetonoroff.

•Sleepingbagorwarmblanket—olderindividualscannottoleratethecoldas wellasyoungerpeople.Considerpackingextrablankets.Also,afamiliarblanket maybeacomfortitemtoanindividualwithdementia.

•Extraidentificationitemssuchasclothingtags,walletcardsorIDjewelry (bracelets,necklace,dogtags,etc.)

•Arecentphotoofyourlovedoneincasehe/shewandersawayinthecommotion

•Activitiestokeeptheindividualoccupied(e.g.,books,crosswordpuzzles, newspapers,playingcards)

•Additionalhealthcareinformation:

ºCopiesofanylegaldocumentssuchasyourpowerofattorney

ºMakesureothercareattendantsthathelpyoualsohavecopiesofyourloved one’sdementiamedicalhistory,physicianinformationandfamilycontacts.

During an Evacuation

Bealerttopotentialreactionsthatmayresultfromchangesinroutine,travelingornewenvironments.

•Whenappropriate,informothers(hotelorshelterstaff,familymembers,airlineattendants) thatyourlovedonehasdementiaandmaynotunderstandwhatishappening.

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•Donotleavethepersonalone.Itonlytakesafewminutestowanderawayandgetlost.

•Don’taskastrangertowatchtheperson.Apersonwhodoesn’tunderstanddementia anditseffects,andwhodoesn’tknowyouortheperson,won’tunderstandhowtoreact inadifficultsituation.

•Changesinroutine,travelingandnewenvironmentscancause:

ºAgitation

ºWandering

ºIncreaseinbehavioralsymptoms,includinghallucinations,delusionsandsleepdisturbance

ºDoyourbesttoremaincalm.Thepersonwithdementiawillrespondtothe emotionaltoneyouset.

Tips for Preventing Agitation

•Trytospendextratimewiththepersontohelphimorheradjusttothenewenvironment.

•Trytomaintaindailyroutinesasmuchaspossible.

•Reassuretheperson.Holdhandsorputyourarmonhisorhershoulderandassure themthingswillbefine.

•Findoutletsforanxiousenergy.Takeawalktogetherorengagethepersoninsimpletasks.

•Redirecttheperson’sattentionifheorshebecomesupset.

•Limitnewsmediaexposuretothedisaster.

•Movethepersontoasaferorquieterplace,ifpossible.Limitstimulation.

•Makesurethepersontakesmedicationsasscheduled.

•Trytoscheduleregularmealsandmaintainaregularsleepschedule.

•Avoidelaborateordetailedexplanations.Provideinformationusingconcreteterms. Followbriefexplanationswithreassurance.

•Bepreparedtoprovideadditionalassistancewithallactivitiesofdailyliving.

•Payattentiontocuesthatthepersonmaybeoverwhelmed(fidgeting,pacing).

•Remindthepersonthatheorsheisintherightplace.

•Providecomfortitems,suchas:

ºApilloworfamiliarstuffedanimalthatcanbehugged

ºLotionorotheritemsthatcanhelpsoothetheindividual

Helpful Hints During an Episode of Agitation

•Approachthepersonfromthefrontandusehisorhername.

•Usecalm,positivestatementsandapatient,low-pitchedvoice.Reassure.

•Respondtotheemotionsbeingexpressedratherthanthecontentofthewords.For example,say,“You’refrightenedandwanttogohome.It’sokay.I’mrightherewithyou.”

•Don’targuewiththepersonortrytocorrecthim.Instead,affirmhisorherexperience, reassureandtrytodivertattention.Forexample,say,“Thenoiseinthisshelteris frightening.Let’sseeifwecanfindaquieterspot.Let’slookatyourphotobooktogether.”

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Wandering Behavior

•Identifythemostlikelytimesofdaythatwanderingmayoccur,andplan activitiesatthattime.

•Provideopportunitiesforactivitiesandexercise,suchasfoldingtowels, listeningtomusicanddancing.

•Whennightwanderingisaproblem,makesurethepersonhasrestrictedfluids twohoursbeforebedtimeandhasgonetothebathroomjustbeforebed.Limit daytimenaps,ifpossible.

•Monitorreactiontomedications.Consultaphysician,ifnecessary.

•Utilizecommunicationfocusedonexplorationandvalidation(notcorrecting) whentheindividualsaysthatheorshewanttoleavetogohomeortowork.

•Ifwanderingisinprogress,usedistractiontore-directtheindividual’sfocus.

•ConsiderenrollingyourlovedoneintheAlzheimer’sAssociation’sSafeReturn®

program[moreinformationinnextsection].Anindividualwithdementiamay nothavethisparticulardisease,butwanderingbehaviormaybeasymptomof hisorherdementia.Thisprogramcanhelpinlocatinganindividual.

Take Care of Yourself

•Takecareofyourselfbyfindingagoodlistenertohearyourthoughts andfeelingsabouttheevent.

•Findmomentstobreathe,meditateandreflect.

•Ensurepropernutritionandhydration.

Alzheimer’s Association Safe Return®

TheAlzheimer’sAssociationSafeReturn®programassistsinthesafereturnofindividualswithAlzheimer’sdiseaseorarelateddementiawhowanderandbecomelost.SafeReturnisanationwideidentificationandsupportprogramworkingatthecommunitylevel.Assistanceisavailable24hoursadaywheneverapersonislostorfound.OnecallimmediatelyactivatesthecommunitysupportnetworktohelpreunitealostpersonwithAlzheimer’sdiseasewithhisorhercaregivers.Whenanindividualismissing,SafeReturnfaxestheenrolledperson’sinformationandphototolocallawenforcement.Whenapersonisfound,acitizenorlawofficialcallsthe800-numberandSafeReturnnotifieslistedcontacts.ThelocalAlzheimer’sAssociationchapterprovidessupporttothefamilyduringtheincident.

Safe Return® Benefits

•TheAlzheimer’sAssociation24-hourtoll-freeemergencyincidentline

•AregistrationlineavailableMondaythroughFridaybetween7a.m.and11:30p.m.(CST)

•Personalizedidentificationproducts

•FivestepsforaSafeReturn®magnetcard,whichprovidesusefultipswhensomeoneismissing

•Enrollmentinanationalinformationandphotodatabasethatincludesemergency contactinformationtohelpreunitealostpersonwithhisorhercaregivers

•TheAlzheimer’sAssociation24/7Helpline,whichisavailabledayandnight, everyday,forinformationandcareconsultation

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•YourAlzheimer’sAssociationlocalchapter,whichprovidesinformation, referralandotherservices

•Educationandtrainingonwanderingbehaviorforfamilies,caregivers andemergencyresponders

Forsafetyandpeaceofmind,enrollinSafeReturntoday.Contactustodaybycallingtoll-freeat1.888.572.8566oronlineathttp://www.alz.org/safereturn.

TheAlzheimer’sAssociation,theworldleaderinAlzheimerresearch,careandsupport,isdedicatedtofindingpreventionmethods,treatmentsandaneventualcureforAlzheimer’s.

24/7Helpline800-272-3900TDDAccess312-335-8882Websitehttp://www.alz.orge-mailinfo@alz.org

©2006Alzheimer’sAssociation.Allrightsreserved.©10/27/97PF/226/RAlzheimer’sAssociationSafeReturn®ThisisanofficialpublicationoftheAlzheimer’sAssociationbutmaybedistributedbyunaffiliatedorganizationsandindividuals.SuchdistributiondoesnotconstituteanendorsementofthesepartiesortheiractivitiesbytheAlzheimer’sAssociation.

Sources for Additional Dementia and Memory Loss Information

National Institute for Neurological Disorders and Strokehttp://www.ninds.nih.gov/disorders/dementias/dementia.htm

Alzheimer’s Association http://www.alz.orgTel:1.800.272.3900

Alzheimer’s Association Safe Returnhttp://www.alz.org/safereturnTel:888.572.8566

National Institute on Aging Alzheimer’s Disease Education and Referral (ADEAR)http://www.alzheimers.nia.nih.govTel:1.800.438.4380

Family Caregiver Alliance http://www.caregiver.orgTel:1.800.445.8106

Children of Aging Parentshttp://www.caps4caregivers.orgTel:800.227.7294

Eldercare Locatorhttp://www.eldercare.govTel:800.677.1116

Well Spouse Associationhttp://www.wellspouse.orgTel:800.838.0879

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�. Diabetes

Ifyouhavediabetes,yourbodycannotmakeorproperlyuseinsulin.Insulinisahormonethathelpscontrolthesugar,orglucose,inyourblood.Glucoseisthemainsourceoffuelforyourbody.Whenyouhavediabetes,thelevelsofbloodglucosearetoohigh.Thereare20.8millionchildrenandadultsintheU.S.,or7percentofthepopulation,whohavediabetes.Whileanestimated14.6millionhavebeendiagnosed,6.2millionpeople(ornearlyone-third)areunawarethattheyhavethedisease.

What are the Symptoms of Diabetes?

Diabetesisoftencalleda“silent”diseasebecausemanypeoplehavenosignsorsymptomsbeforetheyarediagnosed.Symptomscanalsobesomildthatyoumightnotnoticethem.Morethan5millionpeopleintheU.S.havetype2diabetesanddonotknowit.Thesignsofdiabetesare:

•Beingverythirsty •Havingsoresthathealslowly •Urinatingoften •Havingdry,itchyskin •Feelingveryhungryortired •Havingblurryeyesight •Losingweightwithouttrying •Losingthefeelinginyourfeetorhaving tinglinginyourfeet

What Causes Diabetes?

Diabetespreventsthebodyfromproperlyconvertingfoodsintotheenergyneededfordailyactivity.Whenyoueat,yourbodychangesmostofthefoodintoaformofsugarcalledglucose.Glucosetravelsthroughthebloodstreamto“fuel,”yourcells.Forglucosetogetintocells,thehormoneinsulinmustbepresent.Ifyourbodydoesnotmakeenoughinsulinoriftheinsulindoesn’tworkthewayitshould,glucosecan’tgetintoyourcells.Itremainsinyourblood,whilethecellsarestarvedofenergy.Thelevelofglucoseinyourbloodthengetstoohigh,causingdiabetes.Overtime,highlevelsofglucoseintheblooddamagenervesandbloodvessels.Thiscanleadtocomplicationssuchasheartdiseaseandstroke,kidneydisease,blindness,nervedamage,guminfectionsandlowerlimbamputation.

•Type �diabetesisanautoimmunedisease.Theimmunesystemattacksthe insulin-producingcellsinthepancreasanddestroysthem.Thepancreasthen produceslittleornoinsulin.

•Type 2diabetes,themostcommonform,usuallybeginswhenthecellsdonotuse insulinproperly(calledinsulinresistance).Astheneedforinsulingoesup,the pancreasgraduallylosesitsabilitytoproduceasmuchasneeded.Insulinproduction tendstodecreaseinpeoplewithType2diabetesafterseveralyears.

Diabetesriskfactorsinclude:

•Beingoverweightorobese

•Havingafirst-degreerelative(aparent,brotherorsister)withdiabetes

•BeingAfricanAmerican,AmericanIndianorAlaskanNative,AsianAmerican orPacificIslanderorHispanicAmerican/Latino

•Havinggestationaldiabetes,orgivingbirthtoatleastonebabyweighingmore than9pounds

•Havingbloodpressureof140/90orhigher,orhavingbeentoldthatyouhave highbloodpressureorontherapyforhighbloodpressure

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•Havingabnormalcholesterollevels(HDLlevelof35orlower,oratriglyceridelevel of250orhigher)

•Beinginactiveorexercisingfewerthanthreetimesaweek

•WomenwithPolycysticOvarianSyndrome(PCOS)

•Conditionsassociatedwithinsulinresistance(severeobesityandacanthosisnigricans)

•Historyofcardiovasculardisease

How do Doctors Diagnose Diabetes?

Doctorsusethefollowingteststodiagnosediabetes:

•Fasting plasma glucose (FPG test)-measuresyourbloodglucoseafteryouhave goneatleast8hourswithouteating.

•Oral glucose tolerance test (OGTT)-measuresyourbloodglucoseafteryouhave goneatleast8hourswithouteatingand2hoursafteryoudrinkasweetbeverage.

•Random plasma glucose test–measuresbloodglucosewithoutregardtowhen youateyourlastmeal.

How is Diabetes Treated?

Diabetescannotbecured,butitcanbecontrolled.Strictcontrolofbloodglucose,orbloodsugar,aswellasbloodpressureandcholesterolisthebestdefenseagainsttheseriouscomplicationsofdiabetes.Peoplewithtype1diabetescontroltheirbloodsugarwithinsulininjectionsandfrequentself-monitoringofbloodglucose.Peoplewithtype2diabetesgenerallycontroltheirbloodsugarwithoralmedicationsand,insomecases,insulin.Sometimesapersonwithtype2diabetescancontrolbloodglucoselevelswithdietandexercisealone.Goodcontrolofbloodglucoserequires:

•Following a Meal Plan:Healthyeatingisveryimportant,helpingyoureachandstay atahealthyweight,keepingyourbloodglucoseinadesirablerangeandpreventing heartandbloodvesseldisease.

•Getting Regular Physical Activity:Exercisehelpskeepweightdown,helpsinsulin workbettertolowerbloodglucose,isgoodforyourheartandlungsandgivesyou moreenergy.Beforeyoubeginexercising,talkwithyourdoctor.

•Taking Your Diabetes Medicine Every Day

•Checking Your Blood Glucose as Recommended

•Monitoring Your Diabetes ABCs:Heartdiseaseandstrokearetheleadingcauses ofdeathforpeoplewithdiabetes.Ifyouhavediabetes,heartdiseaseismorelikely tostrikeyouandatanearlieragethansomeonewithoutdiabetes.Therefore,people withdiabetesneedtocontroltheirA1Corbloodglucoseaverage,theirBloodpressure, andtheirCholesterol--theABCsofdiabetes.

Propermonitoringofyourdiabetesisvital,especiallyinadisastersituation.Whileitmaybedifficulttomonitorglucoselevelsandtakemedications,failingtodothiscanleadtodiabeticcomplicationsincluding:

•Visionproblems–diabetesistheleadingcauseofblindnessintheU.S.

•Numbnessorpaininarms,legs,handsandfeet

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•Kidneydisease

•Increasedriskforheartdisease

•Poorwoundhealing

•Decreasedimmunesystemfunction

•Diabeticketoacidosis–thisisasevereandlifethreateningcomplication

Foot Care

Footcareisveryimportantforpeoplewithdiabetes.Highbloodglucoselevelsandareducedbloodsupplytothelimbscausenervedamagethatreducesfeelinginthefeet.Someonewithnervedamagemaynotfeelapebbleinsidehissockthatiscausingasore.Onemaynotfeelablistercausedbypoorlyfittingshoes.Footinjuriessuchasthesecancauseulcers,whichmayleadtoamputation.Peoplewithdiabetesshouldchecktheirfeeteverydayandwatchforanycuts,sores,redspots,swellingandinfectedtoenails.Thisisespeciallytrueinadisasterssituationwhenyouaremorelikelytobewalkingonoroverdebris.Sores,blisters,breaksintheskin,infectionsorbuildupofcallusesshouldbereportedrightawaytoapodiatristorafamilydoctor.

Skin Care

Skincareisveryimportanttoo.Becausepeoplewithdiabetesmayhavemoreinjuriesandinfections,theyshouldprotecttheirskinbykeepingitclean,usingskinsoftenerstotreatdrynessandtakingcareofminorcutsandbruises.Preventingcutsorscrapesmaybedifficultinadisastersituation.Besuretopackafirstaiditemsintoyourdisastersupplieskit.Ifawoundappearstobeinfectedornothealingproperly,seekmedicalattentionimmediately.

•Ifyouareadiabetic,makesureyouincludeyourglucosetestingsuppliesincluding yourglucosemeter,extrainsulin,glucagon,syringes,lancets,bloodteststrips,ketone teststripsandalcoholwipes.

•Insulinpumpusersshouldhavebasalrates,insulin-to-carbratiosandcorrectionfactors andanysuppliesassociatedwiththepump.

•Extrabatteriesforyourglucosemonitorand/insulinpump

•Ifanyofyourmedications(e.g.,insulinandcertainosteoporosisandarthritisinjections) requiresrefrigeration,makesureyourkitcontainsasmallinsulatedcooler.Haveiceready orpurchaseFRIOcoolingpacks.

•Inadisaster,itmaybedifficulttomonitoryourbloodsugarasoftenasyoushould. Trytodoyourbest.Payattentiontoanyunusualsymptomsyoumayexperienceand seekhelpimmediately.

•Trytopreventthefollowing:

ºDehydration–Rememberitcanbecausedbyhyperglycemia(highbloodsugar). Makesuretogetenoughfluidstomeetyourbody’sneeds.

ºHypoglycemia(lowbloodsugar)–Trytokeepsomethingwithsugaroremergency glucosetabswithyouatalltimes.

ºInfections(especiallyfootinfections)–Tryyourbesttoavoidwadingthrough contaminatedwaterorinjuringyourfeet.Inspectthemregularlyforcuts,sores orblisters.Seekmedicalcareimmediatelyifyounoticeanysignsofinfection (swelling,redness,and/ordischargefromawound).

ºHyperglycemia(highbloodsugar)–Makesureyoutakeyourmedicationsas prescribedbythedoctorandavoidfoodchoicesthatcanincreaseyourbloodsugar.

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Sources for Additional Diabetes InformationAmerican Diabetes Associationhttp://www.diabetes.org1-800-DIABETES(1-800-342-2383)

Kentucky Cabinet for Health and Family Serviceshttp://chfs.ky.gov/dph/ach/cd/diabetes.htm1-502-564-7996

Defeat Diabetes Foundation, Inc.http://www.defeatdiabetes.org

National Diabetes Information Clearing Househttp://diabetes.niddk.nih.gov1–800–860–8747

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�. Heart Disease, High Blood Pressure and Stroke

Heart Disease

Heartdiseasecanbedefinedasanyofanumberofdiseasesrelatedtotheheartandbloodvessels.Whengroupedtogether,thesediseasesaretheleadingcauseofdeathintheU.S.Today,morethan80millionAmericanshavesomeformofit.Thisdiseaseincludesavarietyofproblems,includingheartfailure,highbloodpressureandstroke.Someotherproblemsthatgoalongwithheartdiseaseare:

•Hardeningofthearteries,alsocalledarteriosclerosis,meansthearteriesbecome thickenedandarenolongerasflexible.

•Abuildupofcholesterolandfatthatmakestheirarteriesnarrowersolessblood canflowthroughiscalledatherosclerosis.Thosedepositsarecalledplaque.

•Apaininthechestthatmeanstheheartisn’tgettingenoughbloodiscalledangina.

•Whenabloodclotorotherblockagecutsbloodflowtoapartoftheheartitis calledaheart attack.

Heart Failure

Inheartfailure,theheartcannotpumpenoughbloodthroughthebodyoritcannotfillwithenoughbloodorpumpwithenoughforceorboth.Heartfailuredevelopsovertimeasthepumpingactionoftheheartgetsweaker.Itcanaffecttheright,theleft,orbothsidesoftheheart.Inmostcases,heartfailureaffectstheleftsideoftheheartwhenitcannotpumpenoughoxygen-richbloodtotherestofthebody.Whenheartfailureaffectstherightside,theheartcannotpumpenoughbloodtothelungs,whereitpicksupoxygen.

What are the Symptoms of Heart Failure?

Commonsymptomsofheartfailurearefatigue,shortnessofbreathandswelling.Thisisbecausetheheartcan’tpumpbloodinandoutoftheheartwellenoughtopreventbloodandfluidfrombackingup.Thefluidbackupcausesswellingintheankles,feet,legsandsometimesintheabdomen.Thisfluidbuildupcanleadtoweightgain,frequenturinationandachroniccough.Thecoughcanbeworseatnightandwhenlyingdown.

What Causes Heart Failure?

Heartfailureiscausedbyotherconditionsthatdamagetheheartmuscleincludingcoronaryarterydisease,heartattacksandheartdefects.Diabetesandhighbloodpressurecanalsocontributetoheartfailurerisk.

How is Heart Failure Diagnosed?

Manyofthesymptomsofheartdiseasearesimilartothoseofotherdiseases.Becauseofthis,thereisnosingletestthatcandetectheartdisease.Aphysicianwillmakeaheartfailurediagnosisaftertakingamedicalhistory,performingaphysicalexamandrunningsometests.Teststhataregiventodetermineheartfailureinclude:

•EKG or ECG (electrocardiogram)-measurestherateandregularityofyourheartbeat.

•Chest X-ray-willshowwhetheryourheartisenlargedoryourlungshavefluid inthem,bothsignsofheartdisease.

•BNP blood test-measuresthelevelofahormonecalledBNP(B-typenatriureticpeptide) thatisincreasedinpeoplewithheartfailure.

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Yourprimarycarephysicianmaysendyoutoacardiologist(adoctorwhospecializesinthediagnosisandtreatmentofheartdisease).He/shewillalsoperformaphysicalexamandmayordermoretests.Thereareseveralteststhatcanidentifythecauseofheartfailure.Thesetestsinclude:

•Echocardiogram-usessoundwavestocreateapictureoftheheartandshows howwelltheheartisfillingwithblood.

•Holter monitor-iswornfor24hours,providesacontinuousrecordingofheart rhythmduringnormalactivity.

•Exercise stress test-readsyourEKGandbloodpressurebefore,duringorafter exercisetoseehowyourheartrespondstoexercise.

How is Heart Failure Treated?

Heartfailurecannotbecured,buttreatingtheconditionsthatcauseditcanhelptomanagesymptoms.Treatmentincludeslifestylechangesandmedications.Treatmentforheartfailurewillhelpimprovesymptomsandstopthemfromgettingworse.Itisveryimportantthatyoufollowyourtreatmentplanbykeepingappointmentswithyourdoctor,takingmedicationsandmakinglifestylechanges.

Lifestylechangesthatyoumayneedtomakeincludelosingweight,quittingsmokingandlimitingtheamountofalcoholyoudrink.Youwillprobablyhavetofollowalow-saltdietaswell.Saltcancauseextrafluidtobuildupinyourbody,makingheartfailureworse.Yourdoctormayalsoaskyoutolimitthefluidsyoudrinkandtoweighyourselfeveryday.Ifyouhavesuddenweightgain,letyourdoctorknowrightaway.Thiscouldmeanextrafluidisbuildingup.Yourdoctormayprescribemedicationstoimproveyourheartfunctionandsymptomsincluding:

•Diuretics-reducefluidinyourlungsandswellinginyourfeetandankles.

•ACE inhibitors-lowerbloodpressureandreducestrainonyourheart.

•Angiotensin II Receptor Blockers (ARBS)-arenewerbloodpressuredrugsthatprotect yourbloodvesselsfromangiotensinII.Theymakethebloodvesselsrelaxandbecome widerandyourbloodpressuregoesdown.

•Beta blockers-slowyourheartrateandlowerbloodpressuretorelieve someoftheworkloadonyourheart.

•Digoxin-helpstheheartbeatstrongerandpumpmoreblood.

Thosewithheartfailureshouldtrytoavoidrespiratoryinfectionslikepneumoniaandtheflu.Itisrecommendedthatyougetapneumococcalvaccinetopreventpneumoniaandanannualflushottoavoidanybreathingcomplicationsfromtheflu.Yourdoctormayalsoorderextraoxygenifyouhavetroublebreathing.Theoxygencanbeusedinyourhomeorinthehospital.

Followingallofyourdoctor’srecommendationsduringadisastermaybedifficult.Itisimportantthattheybefollowedtothebestofyourabilities.Thisincludescontinuingtoweighyourselfdaily,takeallmedicationsonaconsistentscheduleandeatabalanceddiet.Failingtocontinueyourtreatmentscancauseallofyoursymptomstoreturnorgetworse.Fluidscanbuildupandcauseextrastrainonyourheart,lungsandevenyourkidneys.

High Blood Pressure

Bloodpressureistheforceofthebloodpushingagainstthewallsofthearteries.Bloodpressureisalwaysgivenastwonumbers,thesystolicanddiastolicpressures.Bothareimportant.Usuallytheyarewrittenoneaboveorbeforetheother--forexample,120/80mmHg.Thetopnumberisthesystolicandthebottomnumberisthediastolic.

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Ifyourbloodpressureis120/80,yousaythatitis“120over80.”Yourbloodpressurechangesthroughouttheday.Itislowestwhenyou’reasleepanditriseswhenyouawaken.Italsocanrisewhenyouareexcited,nervousoractive.Soitvariesthroughouttheday.

Asystolicbloodpressureof140mmHgorhigher,oradiastolicbloodpressureof90mmHgorhigher,isconsideredhighbloodpressureorhypertension.Hypertensionisthemedicaltermforhighbloodpressure.Highbloodpressurecurrentlyaffectsmorethan65millionAmericans.

What are the Symptoms of High Blood Pressure?

Highbloodpressureusuallyhasnosymptomsandisoftenreferredtoasthe“silentkiller”.Manytimes,peopleonlyfindouttheyhavehighbloodpressurewhentheyhavetroublewiththeirheart,brainorkidneys.Whenhighbloodpressureisnotdiagnosedandtreated,itcanleadtootherlife-threateningconditions,includingheartattack,strokeandkidneyfailure.Highbloodpressurecancause:

•Yourhearttoworktoohardandbecomelarger,whichcanleadtoheartfailure.

•Smallbulges(aneurysms)toforminyourbloodvessels.Commonlocationsfor aneurysmsaretheaorta,whichisthemainarteryfromtheheart;thearteriesin yourbrain,legs,andintestines;andthearteryleadingtoyourspleen.

•Bloodvesselsinyourkidneystonarrow,whichcancausekidneyfailure,and bloodvesselsinyoureyestoburstorbleed,whichmaycausevisionchanges andcanresultinblindness.

•Arteriesthroughoutyourbodyto“harden”faster,especiallythoseinyourheart, brain,kidneysandlegs.Thiscancauseaheartattack,strokeorkidneyfailure, orleadtoamputationofpartoftheleg.

What Causes High Blood Pressure?

Thereisnospecificcauseofhighbloodpressure,butthereareseveralriskfactorsthatcanmakeyoumorelikelytodevelopitincluding:

•Overweightorobese

•Amanovertheageof45orawomanovertheageof55

•Afamilyhistoryofhighbloodpressure

•Pre-hypertension,(120-139/80-89mmHg)

•Eatingtoomuchsalt

•Drinkingtoomuchalcohol

•Physicalinactivity

•Certainmedicines

•Long-lastingstress

How is High Blood Pressure Diagnosed?

Highbloodpressureisdiagnosedwhenyourdoctorchecksyourbloodpressureseveraltimesondifferentdays.Ifseveralofthereadingsare140/90mmHgorhigher(130/80mmHgorhigherifyouhavediabetesorchronickidneydisease)youhavehighbloodpressure.

How is High Blood Pressure Treated?

Normalbloodpressureislessthan120/80.Yourdoctorwilltellyouwhatyounormalrangeshouldbe.Severallifestylechangescanhelplowerbloodpressureincluding:

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•Eatinghealthyfoodsthatincludefruits,vegetablesandlow-fatmilkproducts

•Cuttingdownonsaltandsodiuminthediet

•Losingexcessweightandstayingatahealthyweight

•Beingphysicallyactivefor30minuteseachday

•Limitingalcoholintake

Lifestylechangesdon’talwayslowerbloodpressureenoughandyourdoctormayprescribemedications.Thereareavarietyofmedicationsthatyourdoctormayprescribeforyourhighbloodpressure.Somedrugslowerbloodpressurebyremovingextrafluidandsaltfromyourbody.Othersaffectbloodpressurebyslowingdowntheheartbeatorbyrelaxingandwideningbloodvessels.Often,yourdoctorwillprescribemorethanonemedication.Thetypesofmedicinesusedtotreathighbloodpressureinclude:

•Diuretics-“waterpills.”Theyworkbyhelpingyourkidneysflushexcesswater andsaltfromyourbody.Thisreducestheamountoffluidinyourbloodand yourbloodpressuregoesdown.

•Beta blockers-causeyourhearttobeatmoreslowlyandwithlessforce.Yourheart pumpslessbloodthroughthebloodvesselsandyourbloodpressuregoesdown.

•Angiotensin converting enzyme (ACE) inhibitors-keepyourbodyfrommakinga hormonecalledangiotensinII,whichnormallycausesbloodvesselstonarrow.ACE inhibitorspreventthisnarrowingsoyourbloodpressuregoesdown.

•Angiotensin II Receptor Blockers (ARBS)-arenewerbloodpressuredrugsthatprotect yourbloodvesselsfromangiotensinII.Theymakethebloodvesselsrelaxandbecome widerandyourbloodpressuregoesdown.

•Calcium channel blockers (CCBs)-keepcalciumfromenteringthemusclecellsofyourheart andbloodvessels.Thiscausesbloodvesselstorelaxandyourbloodpressuregoesdown.

•Alpha blockers-reducenerveimpulsesthattightenbloodvessels,allowingblood topassmoreeasilyandcausingbloodpressuretogodown.

•Alpha-beta blockers-reducenerveimpulsestobloodvesselsthesamewayalphablockersdo, buttheyalsoslowtheheartbeat,asbetablockersdo.Asaresult,bloodpressuregoesdown.

•Nervous system inhibitors-relaxbloodvesselsbycontrollingnerveimpulsesfromthe brain.Thiscausesbloodvesselstobecomewiderandbloodpressuretogodown.

•Vasodilators-openbloodvesselsbydirectlyrelaxingthemuscleinthevesselwalls, causingbloodpressuretogodown.

Stoppingtreatmentcanleadtoheadaches,anincreaseinbloodpressureandallofthepossiblecomplicationsduetohighbloodpressure(stroke,heartattack,heartfailure,kidneyfailure).Itisimportantthatyoutakeyourbloodpressuremedicationthesametimeeachday.Thismaybedifficulttodoinadisastersituation,buttryyourbesttokeeptoyourmedicationschedule.

Stroke

EachyearintheU.S.,therearemorethan700,000newstrokes.Strokeisthethirdleadingcauseofdeathinthecountry,afterheartdiseaseandcancer.Strokecausesmoreseriouslong-termdisabilitiesthananyotherdisease.Nearlythree-quartersofallstrokesoccurinpeopleovertheageof65.

Therearetwokindsofstroke.Themostcommonkindofstrokeiscalledischemicstroke.Itaccountsforapproximately80percentofallstrokes.Anischemicstrokeiscausedbyabloodclotthatblocksorplugsabloodvesselinthebrain.Theotherkindofstrokeiscalledhemorrhagicstroke.Ahemorrhagicstrokeiscausedbyabloodvesselthatbreaksandbleedsintothebrain.

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What are the Symptoms of Stroke?

Itisveryimportanttoknowthesignsandsymptomsofastroke.Seekingtreatmentimmediatelycanhelptolessencomplications.Ifyouobserveoneormoreofthefollowingsignsofastroke,don’twait.Calladoctoror911rightaway!

•Suddennumbnessorweaknessoftheface,arm,orleg,especiallyononesideofthebody

•Suddenconfusion,troublespeakingorunderstanding

•Suddentroubleseeinginoneorbotheyes

•Suddentroublewalking,dizziness,lossofbalanceorcoordination

•Suddensevereheadachewithnoknowncause

•Otherdangersignsthatmayoccurincludedoublevision,drowsiness,andnauseaorvomiting.

What Causes Stroke?

Therearedifferentcausesforthetwotypesofstrokes;ischemicandhemorrhagic.Ischemicstrokesarecausedby: •Theformationofaclotwithinabloodvesselofthebrainorneck,calledthrombosis

•Themovementofaclotfromanotherpartofthebody,suchasfromthehearttothe neckorbrain,calledanembolism

•Aseverenarrowingofanarteryinorleadingtothebrain,calledstenosis

Thecommoncauseofahemorrhagicstrokeisableedinganeurysm.Ananeurysmisaweakorthinspotonanarterywall.Overtime,theseweakspotsstretchorballoonoutduetohighbloodpressure.Thethinwallsoftheseballooninganeurysmscanruptureandspillbloodintothespacesurroundingbraincells.Arterywallscanalsobreakopenbecausetheybecomeencrusted,orcoveredwithfattydepositscalledplaque,eventuallylosetheirelasticityandbecomebrittle,thinandpronetocracking.Highbloodpressureincreasestheriskthatanarterywallwillgivewayandreleasebloodintothesurroundingbraintissue.

Whilefamilyhistoryofstrokeplaysaroleinyourrisk,therearemanyriskfactorsyoucancontrol:

•Getyourhighbloodpressureundercontrol.

•Ifyousmoke,quit.

•Ifyouhavediabetes,learnhowtoproperlymanageit.

•Ifyouareoverweight,startmaintainingahealthydietandexercisingregularly.

•Ifyouhavehighcholesterol,workwithyourdoctortolowerit.

How is Stroke Diagnosed?

Astrokeisdiagnosedwithavarietyofthingsincludingquestionsaboutwhenthesymptomsbeganandaneurologicalexam.Yourdoctormayalsoorderbloodtests,anelectrocardiogramandabrainscan(eitherCTorMRI).Thesescanscanhelpyourdoctordeterminewhatkindofstrokeitissothattreatmentcanbedecided.

How is Stroke Treated?

Withstroke,treatmentdependsonthestageofthedisease.Therearethreetreatmentstagesforstroke:prevention,therapyimmediatelyafterstrokeandrehabilitationafterstroke.Stroketherapiesincludemedications,surgeryandrehabilitation.

Medicationordrugtherapyisthemostcommontreatmentforstroke.Thrombolyticdrugsstopthestrokebydissolvingthebloodclotthatisblockingbloodflowtothebrainandare

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usedforischemicstrokes.Anothertypeofdrug,antithromboticsareusedtopreventstroke.Theymaybegiventosomeonewhoisathighriskofstroke,whichincludessomeonewhohasalreadyhadastroke.Antithromboticspreventtheformationofbloodclotsthatcanbecomestuckinanarteryofthebrainandcausestrokes.

Surgerycanbeusedtopreventstroke,totreatstrokeortorepairdamagetothebloodvesselsormalformationsinandaroundthebrain.

•Carotid endarterectomyisasurgicalprocedureinwhichadoctorremovesfatty deposits,orplaque,fromtheinsideofoneofthecarotidarteries.Theprocedure isperformedtopreventstroke.Thecarotidarteriesarelocatedintheneckand arethemainsuppliersofbloodtothebrain.

•EC/IC bypass surgeryisaprocedurethatrestoresbloodflowtoablood-deprived areaofbraintissue.Thesurgeonreroutesahealthyarteryinthescalptothearea ofbraintissueaffectedbyablockedartery.

•Asurgicalprocedurefortreatmentofbrainaneurysmsthatcancausehemorrhage, orbleeding,isatechniquecalledclipping.Clippinginvolvesclampingoffthe aneurysmfromthebloodvessel,whichreducesthechancethatitwillburstandbleed.

StrokeisthenumberonecauseofseriousadultdisabilityintheU.S.Thereareavarietyoftherapiesthatcanoftenhelpanindividualregainfunctioning:

•Physical therapyhelpsthestrokepatientrelearnsimplemotoractivitiessuchaswalkingsitting.

•Occupational therapyhelpspatientsrelearndailyactivitiesincludingeatinganddressing.

•Speech therapyhelpsstrokepatientsrelearnlanguageandspeakingskillsorlearn otherformsofcommunication.

•Talk Therapy,alongwiththerightmedication,helpspatientswiththepsychological problemssuchasdepression,anxiety,frustrationandangerthatarecommondisabilities inpeoplewhohavesufferedastroke.

Formanypeople,3-6monthsafterastrokeisakeytimeforrecovery.Ifyouareinthistime,itisimportantthattherapydoesnotgetinterruptedorstopped.Thismaybedifficulttodoinanemergencyordisastersituation.Ifyougotoaspecificplaceforyourrehab,arrangewithyourtherapistsanalternatelocationyoucangotoincaseofadisastersituation.Ifyoureceivetherapyathome,makearrangementswiththeagencytohavethemcometoyournewlocation(familyorfriend’shome).Ifyouhavetostayfarfromyourhome,youragencymaynotbeabletocometoyournewlocation.Askyouragencyhowfartheywilltravel.Iftheyareunabletogotoyouroutoftownlocation,askthemtoassistyouinarrangingrehabservicesinthatarea.

Early intervention in Stroke and Heart Disease

IfyoubegintosufferfromanysymptomsofstrokeorheartdiseaseSEEK MEDICAL ATTENTION IMMEDIATELY!!Oftenpeoplewaittoseeifsymptomswillgoawayontheirown.Theyoftenwanttorestforawhileorgetagoodnightsleepfirst.DO NOT WAIT.Avarietyoftreatmentoptionsareavailable,butphysicianscanonlyusethemifyouseekcare.Promptmedicaltreatmentnotonlyhelpstopreventcomplicationsfromstrokeandheartdisease,butmayalsoallowphysicianstousemedicationsandotherinterventionsinsteadofsurgery.Itmaybedifficulttoseekmedicalassistanceinadisastersituation,butpromptcareisnecessary.Ifyoubegintoexperienceanystrokeorheartrelatedsymptomstellyourfamily,friends,shelterworkers,oranyonethatcanhelpyougetthemedicalassistanceyouneed.

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Sources for Additional Heart Disease,High Blood Pressure and Stroke Information

American Heart Association http://www.americanheart.org1-800-AHA-USA-1(1-800-242-8721)

American Stroke Association http://www.strokeassociation.org1-888-4-STROKE(1-888-478-7653)

National Stroke Associationhttp://www.stroke.org1-800-STROKES(1-800-787-6537)

The National Women’s Health Information Center http://www.4women.gov/FAQ/heartdis.htm1-800-994-9662

Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/cardiovascular.htm1-502-564-7996

Free Tobacco Cessation Assistance 1-800-QUIT-NOW(1-800-784-8669)http://1800quitnow.cancer.gov

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�. Kidney Disease/Dialysis

Yourkidneysfilterwastefromyourblood.Thewastesfromyourbloodthatcomesfromthenormalbreakdownofactivetissuesandfromfoodyoueat.Ifyourkidneysdonotremovethesewastes,theybuildupinthebloodanddamageyourbody.Inaddition,yourkidneysalso:

•Regulateyourbodywaterandotherchemicalsinyourbloodsuchassodium, potassium,phosphorusandcalcium.

•Removedrugsandtoxinsintroducedintoyourbody.

•Releasehormonesintoyourbloodtohelpyourbody.

•Regulatebloodpressure.

•Makeredbloodcells.

•Promotestrongbones.

Kidneydiseaseresultsfromdamagetothenephrons,thetinystructuresinsideyourkidneysthatfilterblood.Usuallythedamageoccursverygraduallyoveryears.

What are the Symptoms of Kidney Disease?

Mostpeoplemaynothaveanyseveresymptomsuntiltheirkidneydiseaseisadvanced.However,youmaynoticethatyou:

•Feelmoretiredandhavelessenergy

•Havetroubleconcentrating

•Haveapoorappetite

•Havetroublesleeping

•Havemusclecrampingatnight

•Haveswollenfeetandankles

•Havepuffinessaroundyoureyes,especiallyinthemorning

•Havedry,itchyskin

•Needtourinatemoreoften,especiallyatnight

What Causes Kidney Disease?

Thetwomaincausesofchronickidneydiseasearediabetesandhighbloodpressure,whichareresponsibleforuptotwo-thirdsofthecases.

•Diabetes:Indiabetes,thebodydoesn’tuseglucose(sugar)verywell.Theglucose staysinyourbloodandactslikeapoison.Ifyouhavediabetes,youcanprevent kidneydiseasebycontrollingyourbloodsugarlevels.

•HighBloodPressure:Highbloodpressurecandamagethesmallbloodvesselsin yourkidneys.Whenthishappensyourkidneyscannotfilterwastesfromyourblood verywell.Ifyouhavehighbloodpressure(hypertension)besuretotakeanymedicines yourdoctorprescribes.

Somekidneydiseasesresultfromhereditaryfactorsandcanruninfamilies.Ifyourfamilyhasahistoryofanykindofkidneyproblems,youmaybeatriskforkidneydiseaseandshouldtalktoyourdoctor.

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How do Doctors Diagnose Kidney Disease?

Earlykidneydiseaseisasilentproblem,likehighbloodpressure,anddoesnothaveanysymptoms.Youmayhaveit,butnotknowit,becauseyoudon’tfeelsick.Todetectthediseasedoctorscandoverysimpleteststhatinclude:

•Measurethelevelofserumcreatinineinyourbloodtoestimateyourglomerular filtrationrate(GFR).

•Measurethelevelofproteininyoururine(increasedlevelsofproteinshowyour kidneysarenotworkingright).

•Checkingyourbloodpressure.

How is Kidney Disease Treated?

Kidneydiseaseoftencannotbecured.Ifyouareintheearlystagesofakidneydisease,youcantakecertainstepsthatmayhelptomakeyourkidneyslastlonger.Itisalsoimportanttoreduceyouriskfactorsforstrokeandheartattacksincekidneypatientsaresusceptibletotheseproblems.

Ifyouarediabetic,itisimportanttomonitoryourbloodsugarstokeepyourdiabetesundercontrol.Peoplewithreducedkidneyfunctionshouldhavetheirbloodpressurecontrolled,andanACEinhibitororanARBshouldbeoneoftheirmedications.Manypeoplewillrequiretwoormoretypesofmedicationtokeepthebloodpressurebelow130/80mmHg.AdiureticisanimportantadditiontotheACEinhibitororARB.

Completeandirreversiblekidneyfailureissometimescalledend-stagerenaldisease,orESRD.Ifyourkidneysstopworkingcompletely,yourbodyfillswithextrawaterandwasteproducts.Thisconditioniscalleduremia.Yourhandsorfeetmayswellandyouwillfeeltiredandweakbecauseyourbodyneedscleanbloodtofunctionproperly.Untreateduremiamayleadtoseizuresorcomaandwillultimatelyresultindeath.Ifyourkidneysstopworkingcompletely,youwillneedtoundergodialysisorkidneytransplantation.

Dialysis

Youneeddialysisifyourkidneysnolongerremoveenoughwastesandfluidfromyourbloodtokeepyouhealthy.Thisusuallyhappenswhenyouhaveonly10to15percentofyourkidneyfunctionleft.Youmayhavesymptomssuchasnausea,vomiting,swellingandfatigue.However,evenifyoudon’thavethesesymptomsyet,youcanstillhaveahighlevelofwastesinyourbloodthatmaybetoxictoyourbody.Yourdoctoristhebestpersontotellyouwhenyoushouldstartdialysis.

Therearetwomajorformsofdialysis:

•Inhemodialysis,yourbloodissentthroughamachinethatfiltersawaywasteproducts. Thecleanbloodisreturnedtoyourbody.Hemodialysisisusuallyperformedatadialysis centerthreetimesperweekfor3to4hours.

•Inperitonealdialysis,afluidisputintoyourabdomen.Thisfluid,calleddialysate, capturesthewasteproductsfromyourblood.Afterafewhours,thedialysatecontaining yourbody’swastesisdrainedaway.Then,afreshbagofdialysateisdrippedintothe abdomen.Patientscanperformperitonealdialysisthemselves.Patientsusingcontinuous ambulatoryperitonealdialysis(CAPD),themostcommonformofperitonealdialysis, changedialysatefourtimesaday.

Nomatterwhatstageofkidneydiseaseyouhave,itisimportantthattreatmentrecommendationsarefollowed,evenduringadisaster.Notfollowingtreatmentcanincreasetheriskfor

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complicationsincludingincreasedbloodpressureandassociatedcardiovascularproblems.Itcanalsodecreasekidneyfunctionleadingtoaneedfordialysisorakidneytransplant.

Medical & Dietary Information for Kidney Disease/Dialysis

Medical items/needs

Itisimportantthatyoutakeallmedicationsasprescribedanddonotinterruptorstopanytreatmentswithoutyourdoctor’sapproval.Doingsomayresultinareturnofyoursymptomsandprogressionofyourdisease.Adisasteroremergencysituationmaymakeitdifficulttocontinuewithyourtreatmentregime.Thatiswhyitissoimportanttoplanahead.Inadditiontothoselistedpreviouslyinthismanual,hereareadditionalitemsthatmaybehelpfultohaveinadisastersituation:

•WearamedicalIDbracelettoquicklyalertresponderstoyourconditionandallergies. Donotwearthebraceletonthesamesideasyourdialysisaccess.Itcouldblockblood flowifitispulledupthearm.

•HaveinstructionsforKayexalateadministration.

•Knowhowtocareforyouraccess.

•Haveacopyofyourdialysistreatmentplan(seeAdditionalResources: TreatmentInformationForm).

•Knowtheemergencypreparednessplanofyourdialysisunit.Knowhowtotake yourselfoffthemachineinanemergencyifthedialysisunitstaffareunableto. (Thedialysisunitstaffcaninstructyouonhowtodothis.)

•Makesureyourdialysisunitcaneasilycontactyouincaseofemergency.

•Hospitalsmaynotbeabletogiveyoumaintenancedialysistreatments.

•Havealternatedialysisunitsplannedincaseofdisasters.Note:Contactthealternate dialysisunitaheadoftime.Someunitsrequireadvancedregistrationfordisaster situationsbecausetheymaybeatcapacityortheymayhavedifferenthoursavailable.

•Haveasummaryofyourmedicalhistorythatincludesallofyourdialysisinformation (SeeAdditionalResources:DialysisPatientInformationForm)

If you are a home hemodialysis patient:

•Keepalistofdialysisunitsinyourareaathomeandatyourworkplace.

•Keepatwo-weekstockofdialysissuppliesatalltimes.Checkexpirationdates regularlyandreplacesupplieswhenneeded.

•Registerwithyourlocalwaterandpowercompaniesforpriorityrestorationofservice.

•Learntobecomfortabletakingyourselfoffthemachineinanemergency.

•Ifyoulosepowerwhiledialyzingduringtheemergency,followthedirections fordiscontinuingdialysisgiventoyoubyyourhometrainingstaff.

•Ifyouarenotabletocontinueyourtreatmentsathomeduringtheemergency, contactthehometrainingstaffsoalternatearrangementscanbemade.

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If you are on CAPD (continuous ambulatory peritoneal dialysis)or CCPD (continuous cycling peritoneal dialysis):

•Keepatwo-weekstockofperitonealdialysissupplies.

•Checkexpirationdatesregularlyandreplacesupplieswhenneeded. Ifyouuseanultravioletdevice,keepthebatterycharged.

•Includeinyouremergencymedicationpackafive-daysupplyoftheantibiotic thatyourdoctorordersforperitonitis.Ifadisasteroccurs,itmaybedifficultto maintainacleanenvironmentandyourriskofperitonitismaybehigher.

•Registerwithyourlocalwaterandpowercompaniesforpriorityrestorationofservice.

•IfyoudoCCPD,youshouldalsoknowhowtodoCAPDexchangesincaseyouare unabletousethecycler.

•IfyouareaCCPDpatientandyoulosepowerwhiledialyzing,followtheinstructionsgiven toyoubytheCCPDtrainingstafffordiscontinuingdialysisinanemergencysituation.

Dietary needs

Ifyouareunabletoreceiveyourscheduleddialysistreatmentduetoextremeweatheroranyotherdisaster,remembertofollowthesuggestedEmergencyDietinthisguidebookand/orchangeswhichyouhavediscussedwithyourdietitian.Besuretochoosethecorrectdietversionandgrocerylist.Includedaredietsandgrocerylistsforadults(diabeticandnon-diabetic)andoneforpediatricpatients.Thisdietisintendedtolimitthesodium,potassium,proteinandfluidloadonyourbodyintheeventthatyourtimebetweentreatmentsisextendedbeyondyourcontrol.Followingthisdietwilllessentheriskofhighbloodpressure,shortnessofbreathorincreasedpotassiumlevelsthatcouldcauseyourhearttostop.Youshouldfollowthisdietonlyfortheperiodoftimethatisnecessaryuntilyourdialysisservicescanberesumed.

Fluids: It is necessary to restrict fluids even more than before!

Takeyourphosphatebinderwiththefluidspecifiedinyourmealplan.Your2cupdailylimitallowsfor4ouncesor1/2cupoffluidinadditiontothe11/2cupsinyourmealplan.Cannedorbottledcarbonatedbeverageswillprovidemorecaloriesthanbottledwaterandoftenisabetterchoicefornon-diabetics.Chewgumtoquenchthirst.

Sodium:Avoidtablesaltandsaltsubstitutes–flavorfoodswithherbedseasoning,garlicpowderandlemonjuice.Oneeggoroneounceofmeat(cooked)thathasbeenstoredatasafetemperaturecanbesubstitutedfor1/4cupoflowsodiumcannedmeat.

Supplement Option:Ifpurchasingemergencyfoodsupplieskeepsfallingtothebottomofyour“todo”list,youmayconsiderpurchasingaconvenientspecializedliquidnutritionproducttodrinkinsteadoffollowingthesuggestedmealplan.Yourdietitiancanadviseyouofthecommerciallypreparedproductthatwillprovideloweramountsofprotein,sodium,potassiumandfluid.Thisoptionreducesconcernsforstorage,spaceandpreparation.Yourdietitiancanhelpyoutodeterminethecorrectamounttoconsumeandhowtoadjustyourotherfluidintake.

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Adult Renal Non-Diabetic Diet �-day Meal Plan for Emergencies

Thesamplemealplangivencontainsapproximately42gramsofprotein,1200mgssodium,1200mgspotassium,630mgsphosphorus,and1925caloriesperday.

Day �

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedchicken*

1tblspsugar 1tblspmargarine,oilormayonnaise*

2tblspmargarine,oilormayonnaise*

½cupdrainedpineapple ½cupgreenbeans ½cupdrainedpears

½cupcranberryjuiceordrinkfrompowderedmix

½cupcranberryjuiceordrinkfrompowderedmix

Morning Snack Afternoon Snack Evening Snack

10candies(seegrocerylist) 10marshmallows 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers

½cupapplesauce 2tblsphoneyorjelly

10candies 10candies

Day 2

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedturkey* 2ozunsaltedchicken*

1tblspsugar 1tblspmargarine,oilormayonnaise*

2tblspmargarine,oilormayonnaise*

½cupdrainedpeaches 4spearslowsodiumasparagus

½cupdrainedpineapple

½cupcranberryjuiceordrinkfrompowderedmix

½cupcranberryjuiceordrinkfrompowderedmix

Morning Snack Afternoon Snack Evening Snack

½cupapplesauce 10marshmallows 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers

10candies 10candies 2tblsphoneyorjelly

10candies

*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.

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Day �

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedturkey*

1tblspsugar 1tblspmargarine,oilormayonnaise*

2tblspmargarine,oilormayonnaise*

½cupdrainedpears 4spearslowsodiumcarrots ½cupdrainedcherries

½cupcranberryjuiceordrinkfrompowderedmix

½cupcranberryjuiceordrinkfrompowderedmix

Morning Snack Afternoon Snack Evening Snack

10marshmallows 10candies 5vanillawafersor5sugarwafersor3grahamcrackersquaresor6unsaltedcrackers

½cupapplesauce 2tblsphoneyorjelly

10candies(seegrocerylist) 10candies

*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.

Suggested Grocery List forEmergency Adult Renal Non-diabetic DietBread/cereal(Choose5-6servingsperday) WhiteBread DryCereal(sweetenedpreferred) VanillaWafers PuffedWheat GrahamCrackers PuffedRice UnsaltedCrackers(plain) CrispedRice

Fruits/juices(Choose2-4servingsperday) Cannedapplesauce,pears,peaches,cherries,orpineapple

Fish/meat(4oz.perday)Choosefrom: Cannedtuna,Chicken,Turkeyinwater

Frozenorshelfstablenon-dairycreamer(4ozperday)

Sweets Choosefrom:marshmallows,honey,sugar,jelly Assortedcandies(jellybeans,sourballs,mints,hardcandies)

Vegetables(1/2cup/day) Choosefromcanned:lowsodiumgreenbeans,asparagus,orcarrots

Fats(Choose6ormoreservingsperday) Margarine*Oil(oliveorvegetable) Mayonnaise(perishableafteropening)* *Individual mayonnaise or margarine packets are recommended to avoid spoilage

OtherBeverages(Limitto1/2cup/dayinadditiontomealplan) 1gallonofspringwater,gingeraleorlemon-limesoda Cranberryjuiceorpowderedjuicemix(Kool-Aid,Tang)

Other Herbalseasoning,garlicpowder,breathspray,chewinggum,freshorreconstitutedlemonjuice

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Adult Renal Diabetic Diet �-day Meal Plan for Emergencies

Thesamplemealplangivencontainsapproximately43gramsofprotein,1200mgssodium,1300mgspotassium,675mgsphosphorus,190gramscarbohydrate,and1700calories.Youcanadjustmenustofityourindividualtastewiththehelpofyourdietitian.Thesemealplansarestricterthanyournormalrenal-diabeticdiettokeeppoisonsfrombuildingupinyourblood.

Day �

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedchicken*

½cupdrainedpineapple(cannedinjuice)

1½tblspmargarine,oilormayonnaise*

1½tblspmargarine,oilormayonnaise*

½cuplowsodiumgreenbeans

½cupdrainedpeaches(cannedinjuice)

½cupcranberryjuice** ¼cupcranberryjuice**

Afternoon Snack Evening Snack

½cupapplesauce(sugarfree)

¼cupcranberryjuice**

5vanillawafersor3grahamcrackersor6unsaltedcrackers

1tspmargarineand1½tspjelly

Day 2

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedturkey* 2ozunsaltedchicken*

½cupdrainedpeaches(cannedinjuice)

1½tblspmargarine,oilormayonnaise*

1½tblspmargarine,oilormayonnaise*

4spearslowsodiumasparagus

½cupdrainedpears

½cupcranberryjuice** ¼cupcranberryjuice**

Afternoon Snack Evening Snack

½cupapplesauce(sugarfree)

¼cupcranberryjuice**

5vanillawafersor3grahamcrackersor6unsaltedcrackers

1tspmargarineand1½tspjelly

*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.**Low calorie cranberry juice

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Day �

Breakfast Lunch Dinner

½cupnon-dairycreamer 2sliceswhitebread 2sliceswhitebread

¾cupdrycereal 2ozunsaltedtunafish* 2ozunsaltedturkey*

½cupdrainedpeaches(cannedinjuice)

1½tblspmargarine,oilormayonnaise*

1½tblspmargarine,oilormayonnaise*

4spearslowsodiumcarrots ½cupdrainedcherries(cannedinjuice)

½cupcranberryjuice** ¼cupcranberryjuice**

Afternoon Snack Evening Snack

½cupapplesauce(sugarfree)

5vanillawafersor3grahamcrackersor6unsaltedcrackers

1tspmargarineand1½tspjelly

*If unable to keep food chilled in refrigerator, after opening, keep packed in cooler with ice or snow and discard at the end of the day.**Low calorie cranberry juice

Suggested Grocery List forEmergency Adult Renal Diabetic DietBread/cereal(Choose5servingsperday) WhiteBread DryCereal(sweetenedpreferred) VanillaWafers PuffedWheat GrahamCrackers PuffedRice UnsaltedCrackers(plain) CrispedRice

Fruits(Choose3servingsperdaycannedinownjuices) Applesauce,pears,peaches,pineapple,cherries

Fish/meat(Choose4ouncesperday) CannedTunainwater CannedChickeninwater CannedTurkeyinwater

Vegetables(1servingperday) Choosefromcanned:lowsodiumasparagus,greenbeansorcarrots

Frozenorshelfstablenon-dairycreamer(4ouncesperday)

Fats(10servingsperday) Margarine**Oil(oliveorvegetable) Mayonnaise(perishableafteropening)** **Individual mayonnaise or margarine packets are recommended to avoid spoilage

HighCaloricFoods(Choose3servingsperdayandifneeded1servingtoraisebloodsugar) Honey(1Tablespoon=1serving)Jelly(1Tablespoon=1serving) Sugar(4teaspoons=1serving)LowcalorieCranberryJuice(1/2cup) PoweredDrinkMix(1/2cup,mixed)CarbonatedBeverages(1/2cup)

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OtherBeverages(Limitto1/2cup/dayinadditiontomealplan) 1gallonofSpringWater Dietlemon-limecarbonatedbeverageorDietgingeraleOther(seasoningandfluidcontrolaids) Breathspray,freshorreconstitutedlemonjuice,herbalseasoning,garlicpowder, sugarlessgum,sugarfreehardcandies(asdesired)

Adult Diabetic Menu Pattern

Breakfast Lunch Dinner

1milksubstitute(½cup) 2starches 2starches

1starch 2meats 2meats

1fruit 4½fat 4½fat

1vegetable 1fruit

1highcalorie ½highcalorie

Afternoon Snack Evening Snack

1fruit 1starch

1fat

1highcalorie

Pediatric Renal Diet �-day Meal Plan for Emergencies

Servingsizesvaryaccordingtotheageofthechild.Asalways,foodconsistencyandchokinghazardsneedtobeconsideredonanindividualbasis.Forchildrenwhostilldrinkformula,themealplanshouldbeadjustedforthechildtodrinkformulainsteadoftheotherbeverageslisted.Formulashouldbepreparedonebottleatatimeasneeded.Adjusttheamountoffoodaccordingtotheageofthechild.Forchildrenwhoarestillonformula,giveformulainsteadofjuices.Youareencouragedtodiscussportionsizesaswellasfoodpreferencesandsubstitutionswithyourrenalnutritionist.Itisnecessarytolimitfluidsevenmorethanbefore.

Day �

Breakfast Lunch Dinner

non-dairycreamer whitebread whitebread

drycereal unsaltedcannedtuna* unsaltedchicken*

sugar lowsodiummayonnaiseormargarine

lowsodiummayonnaiseormargarine

cupdrainedpineapple lowsodiumcannedgreenbeans cannedpears

Kool-AidorTang cranberryjuice

Morning Snack Afternoon Snack Bedtime Snack

candy(seeSweetslist) applesauce grahamcracker

marshmallows jelly

candy(seeSweetslist)

* If unable to keep food chilled in refrigerator after opening, keep packed in cooler with ice or snow and discard at the end of the day.

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Pediatric Renal Diet

Day 2

Breakfast Lunch Dinner

non-dairycreamer unsaltedturkeysandwich* whitebread

CreamofWheat lowsodiummayonnaiseormargarine

unsaltedchicken*

sugar lowsodiumcannedcarrots lowsodiummayonnaiseormargarine

canneddrainedpeaches Kool-AidorTang cannedcherries

cranberryjuice

Morning Snack Afternoon Snack Bedtime Snack

sugarwafers unsaltedpretzels vanillawafers

gingerale candy(seeSweetslist) candy(seeSweetslist)

Day �

Breakfast Lunch Dinner

non-dairycreamer unsaltedturkeysandwich* unsaltedturkeysandwich*

drycereal lowsodiummayonnaiseormargarine

lowsodiummayonnaiseormargarine

sugar cannedpineapple lowsodiumcannedcorn

whitebread gingerale cranberryjuice

jelly unsaltedturkeysandwich*

Morning Snack Afternoon Snack Bedtime Snack

applesauce unsaltedpretzels canneddrainedpeaches

candy(seeSweetsList) Kool-AidorTang grahamcrackers

* If unable to keep food chilled in refrigerator after opening, keep packed in cooler with ice or snow and discard at the end of the day.

Suggested Grocery List forEmergency Pediatric Renal DietBread/cereal/starches Slicedwhitebread (Maysubstitutewhiterice,noodles,spaghetti, Drycereal(sweetenedpreferred) macaroni,orunsaltedcrackersforwhitebread) Puffedrice Sugarwafers(orsugarcookies) Crispedrice Vanillawafers (CreamofWheat,CreamofRice, Grahamcrackers andFarinacanbesubstituted) Unsaltedpretzels

Fruits/juices Canned(sweetenedorinsyrup)applesauce,pears,peaches,pineappleorcherries

Fish/meat/poultryCannedunsaltedtuna,chicken,turkey(preferablysmallcans)

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Frozenorshelfstableliquidnon-dairycreamer

Sweets Marshmallows,sugar,jelly,honey,hardcandy,gumdrops,jellybeans,sourballs,mints,etc.

Vegetables Cannedlowsodiumgreenbeans,carrots,corn(Cannedmushroomsorasparagus canbesubstitutedifpreferred)

Fats Lowsodiummayonnaiseandmargarine(preferablyindividualpackets orverysmalljarstoavoidspoilage)andoil

Otherbeverages Springwater,gingerale,lemonlimesoda(nocoladrinks),cranberryjuice, Kool-Aid(nograpeflavor),Tang

Other Herbalseasonings,garlicpowder,onionpowder,breathspray,chewinggum, freshorreconstitutedlemonjuice

Formula Powderedformula(prepareonebottleatatimeasneeded)

The dietary suggestions and menu plans are from, ESRD Network 4, Inc., Emergency Preparedness Resource for Dialysis Patients (2005). Please consult your physician and/or renal nutritionist before following any of the dietary suggestions in this guidebook.

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Dialysis Patient Information Form

Date / /

PatientName: DOB / /

Address:

City: State: Zip:

Phone: SocialSecurity# / /

Neighbor or Emergency Contact:

Name:

Relationshiptoyou:

Address:

City: State: Zip:

Phone:

MedicareNumber:

OtherInsurance:

PolicyNumber:

YourDialysisCenter:

Address:

City: State: Zip:

Phone:

HeadNurse:

Nephrologist: Phone:

UsualSourceofTransportation/Needs:

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Dialysis Treatment Information Form

Ifyouneedtogotoanotherfacilityorifyourtreatmentinformationisdestroyedorunavailable,thisinformationwillhelpyourcaregiversprovideyouwiththeappropriatetreatment.Yournurseordoctorcanhelpcompletethisform.Itshouldbeupdatedaschangesoccur.

DateCompleted:

PrimaryESRDDiagnosis:

Allergies:

Medications:

PertinentPastMedicalHistory:

TypeofTreatment: CenterHemodialysis CAPD

HomeHemodialysis CCPD

DialysisPrescription

Dialyzer: Dialysate:

HoursperRun: TimesperWeek:

DryWeight: AverageWeightGain:

Heparinization:

AccessSite: NeedleSize:

BloodFlowRate:

Re-Use:Yes No Lidocaine:Yes No

HBsAgStatus: BloodType:

SpecialNeeds/Problems:

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Peritoneal Dialysis Information: CAPD

System: NumberofExchanges:

FillVolume: EstimatedDryWeight:

Exchange InformationPercentage of Dextrose (based on weight increase):

1–2lbs.1.5% 3–5lbs.3.5%

2–3lbs.2.5% 3–5lbs.4.25%

LowCalcium3.5mEq/LDianeal:

Reg.Calcium3.5mEq/LDianeal:

DianealPD2Magnesium0.5:

Peritonitis

IspatienttrainedtodoIPantibiotics?Yes No

Doespatienthaveantibioticathome?Yes No

Nameofantibiotic:

Diabetic:Yes No Insulin:IP SQ

Specifyamountinsulinused:SQDose

EveningDose

Slidingscaleforinsulin(attachifavailable):

Usual dose of insulin per bag:

1.5% 3.5%

2.5% 4.25%

AdditionalInformation:

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Peritoneal Dialysis Information: CCPD

TypeofCycler:

NightTimeTotalLitersDelivered HoursofTherapy:

FillVolumeperCycle FillTime:

DwellTime: DrainTime:

DaytimeDwell:Yes No DaytimeVolume:

Exchange InformationPercentage of Dextrose (based on weight increase):

1–2lbs.1.5% 3–5lbs.3.5%

2–3lbs.2.5% 3–5lbs.4.25%

LowCalcium3.5mEq/LDianeal:

Reg.Calcium3.5mEq/LDianeal:

DianealPD2Magnesium0.5:

PeritonitisIspatienttrainedtodoIPantibiotics?Yes No

Doespatienthaveantibioticathome?Yes No

Nameofantibiotic:

Diabetic:Yes No Insulin:IP SQ

Specifyamountinsulinused:SQDose EveningDose

Slidingscaleforinsulin(attachifavailable):

Usualdoseofinsulinperbag:

1.5% 3.5%

2.5% 4.25%

AdditionalInformation:

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Sources for Additional Kidney Disease/Dialysis Information

National Kidney Foundation of Kentucky http://www.nkfk.org/1-800-737-5433

National Kidney Disease Education Programhttp://www.nkdep.nih.gov/patients1-866-4-KIDNEY(1-866-454-3639)

ESRD Network �/�0 (Illinois, Indiana, Ohio, & Kentucky)http://www.therenalnetwork.org317-257-8265

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�. Osteoporosis, Arthritis and Bone Diseases

OsteoporosisOsteoporosisisadiseasethatthinsandweakensthebonestothepointthattheybecomefragileandbreakeasily.IntheU.S.,10millionpeoplealreadyhaveosteoporosis.Millionsmorehavelowbonemass,orosteopenia,placingthematincreasedriskformoreseriousbonelossandsubsequentfractures.Osteoporosiscanstrikeatanyage,butitismostcommonamongolderpeople,especiallyolderwomen.Ofthe10millionAmericanswithosteoporosis,80percentarewomen.

What are the Symptoms of Osteoporosis?

Osteoporosisisoftencalled“silent”becausebonelossoccurswithoutsymptoms.Peoplemaynotknowthattheyhaveosteoporosisuntilasuddenstrain,bumporfallcausesabonetobreak.Womenandmenwithosteoporosismostoftenbreakbonesinthehip,spineandwrist.Butanyfractureinanolderpersoncouldbeawarningsignthattheboneisweakerthanoptimal.

Somepeoplemaybeunawarethattheyhavealreadyexperiencedoneormorespinefractures.Heightlossofoneinchormoremaybethefirstsignthatsomeonehasexperiencedspinefracturesduetoosteoporosis.Multiplespinefracturescancauseacurvedspine,stoopedposture,backpainandbackfatigue.Womenandmenwhohavehadafractureareathighriskofexperiencinganotherone.Afractureovertheageof45orseveralfracturesbeforethatagemaybeawarningsignthatapersonhasalreadydevelopedosteoporosis.

Itisimportanttopreventfallsamongindividualswithosteoporosisbecausetheirbonesbreakeasily.Fallscanbepreventedbyhavingthepersonbeginaregularexerciseprogram,reviewingmedications,checkingvisionandmakingtheenvironmentsafer.Environmentscanbemadesaferbyremovingclutterandthingsthatcanbeeasilytrippedover,providingappropriatelightingandmakingstairsandbathroomssaferbyinstallinggrabbarsandhandrails.

What Causes Osteoporosis?

Thefollowingfactorscanputyouatriskfordevelopingosteoporosis,buttherearealsostepsyoucantaketopreventit.

•Gender.Womenareathigherriskforosteoporosisthanmen.Theyhavesmaller bonesandlosebonemorerapidlythanmendobecauseofhormonechangesthat occuraftermenopause.

•Age.Becausebonesbecomethinnerwithage,theolderyouare,thegreateryour riskofosteoporosis.

•Ethnicity.CaucasianandAsianwomenareatthehighestriskforosteoporosis. African-AmericanandHispanicwomenarealsoatrisk,butlessso.

•Family History.Osteoporosistendstoruninfamilies.Ifafamilymember hasosteoporosisorbreaksabone,thereisagreaterchancethatyouwilltoo.

•History of Previous Fracture.Peoplewhohavehadafractureareathigh riskofhavinganother. •Diet.Gettingtoolittlecalciumoveryourlifetimecanincreaseyourriskfor osteoporosis.NotgettingenoughvitaminD--eitherfromyourdiet,supplements, orsunlight--canalsoincreaseyourriskforosteoporosis.VitaminDisimportant becauseithelpsthebodyabsorbcalcium.Anoveralldietadequateinprotein andothervitaminsandmineralsisalsoessentialforbonehealth.

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•Physical activity.Notexercisingandbeinginactiveorstayinginbedforlong periodscanincreaseyourriskofdevelopingosteoporosis.Likemuscles,bones becomestrongerwithexercise.

•Smoking.Smokersmayabsorblesscalciumfromtheirdiets.Inaddition, womenwhosmokehavelowerlevelsofestrogenintheirbodies.

•Medications.Somecommonlyusedmedicinescancauselossofbonemass. Theseincludeatypeofsteroidcalledglucocorticoids,whichareusedtocontrol diseasessuchasarthritisandasthma;someantiseizuredrugs;somemedicines thattreatendometriosis;andsomecancerdrugs.Usingtoomuchthyroidhormone foranunderactivethyroidcanalsobeaproblem.Talktoyourdoctoraboutthe medicationsyouaretakingandwhatyoucandotoprotectyourbones.

•Low body weight.Womenwhoarethinandsmall-bonedareatgreater riskforosteoporosis.

How do Doctor’s Diagnose Osteoporosis?

Peopleovertheageof45whohaveexperiencedafractureshouldtalktotheirdoctoraboutgettingevaluatedforosteoporosis.Thetestusedtodiagnoseosteoporosisiscalledabonedensitytest.Thistestisameasureofhowstrongordenseyourbonesareandcanhelpyourdoctorpredictyourriskforhavingafracture.

How is Osteoporosis Treated?

Althoughthereisnocureforosteoporosis,itcanbetreated.Thegoaloftreatmentistopreventfractures.Abalanceddietrichincalcium,adequatevitaminD,aregularexerciseprogramandfallpreventionareallimportantformaintainingbonehealth.

Severalmedicationsareavailableforthetreatmentofosteoporosis.Iftreatmentisstoppedoryourdoctor’srecommendationsregardingyourosteoporosisarenotfollowed,youruntheriskoffurtherlossofbonedensityandanincreasedriskoffractures.Foryoungerpeople,afracturemaysimplyinvolvewearingacastforafewweekswhileitheals.Inolderadults,fracturescausemoreconsequences:

•Itmaytake2-3monthsforpaintoresolve.

•Withhipfractures,asmanyas50%ofpatientsdonotregaintheirpre-fracture functionafter1year.

•About25%ofwomenwillspendsometimeinanursinghomeafterahipfracture.

•About10-20%ofhipfracturepatientswilldiewithin1yearofthefracture.

ArthritisArthritisliterallymeansjointinflammation,anditcanaffectjointsinanypartofthebody.Jointsareplacesinthebodywheretwobonesmeet.Manypeopleusethetermarthritistorefertorheumaticdiseases;however,thedifferentkindsofarthritiscomprisejustaportionoftherheumaticdiseases.Manyformsofarthritiscauseswelling,redness,heatandpain.

•Osteoarthritisisthemostcommonformofarthritisamongolderpeople. Osteoarthritisoccurswhencartilage,thetissuethatcushionstheendsofthe boneswithinthejoints,breaksdownandwearsaway.Insomecases,allofthe cartilagemaywearaway,leavingbonesthatrubupagainsteachother.

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Thediseaseaffectsbothmenandwomen.Beforeage45,osteoarthritisismore commoninmenthaninwomen.Afterage45,osteoarthritisismorecommonin women.Byage65,morethanhalfofthepopulationhasx-rayevidenceofosteoarthritis inatleastonejoint.Osteoarthritisaffectsonlyjoints,notinternalorgans.

•Rheumatoid arthritisnotonlyaffectsthejoints,butmayalsoattacktissue intheskin,lungs,eyesandbloodvessels.Peoplewithrheumatoidarthritis mayfeelsick,tiredandsometimesfeverish.Rheumatoidarthritisisclassified asanautoimmunedisease.Anautoimmunediseaseoccurswhentheimmune systemturnsagainstpartsofthebodyitisdesignedtoprotect.Rheumatoid arthritisgenerallyoccursinasymmetricalpattern.Thismeansthatifoneknee orhandisinvolved,theotheroneistoo.Itcanoccuratanyage,butusually beginsduringaperson’smostproductiveyears.Rheumatoidarthritisoccurs muchmorefrequentlyinwomenthaninmen.Abouttwotothreetimesas manywomenasmenhavethedisease.

What are the Symptoms of Arthritis?

Differenttypesofarthritishavedifferentsymptoms.Ingeneral,peoplewithmostformsofarthritishavepainandstiffnessintheirjoints.

Osteoarthritisusuallydevelopsslowlyandcanoccurinanyjoint,butoftenoccursinweightbearingjoints.Othersymptomsinclude:

•Jointsmayacheafterphysicalworkorexercise

•Mostoftenoccursinthehands,hips,knees,neckorlowback

•Jointpain,swellingandtenderness

•Stiffnessaftergettingoutofbed

•Acrunchingfeelingorsoundofbonerubbingonbone

Noteveryonewithosteoarthritisfeelspain,however.Infact,onlyathirdofpeoplewithx-rayevidenceofosteoarthritisreportpainorothersymptoms.

Rheumatoidarthritisischaracterizedbyinflammationofthejointlining.Thisinflammationcauseswarmth,redness,swellingandpainaroundthejoints.Apersonalsofeelssick,tiredandsometimesfeverish.Rheumatoidarthritisgenerallyoccursinasymmetricalpattern.Ifonekneeorhandisaffected,theotheroneisalsolikelytobeaffected.

What Causes Arthritis?

Thecausesofarthritisarenotfullyunderstood.Researcherssuspectthatosteoarthritisiscausedbyacombinationoffactorsinthebodyandtheenvironment.Thechanceofdevelopingosteoarthritisincreaseswithage.Osteoarthritisoftenresultsfromyearsofwearandtearonjoints.Thiswearandtearmostlyaffectsthecartilage,thetissuethatcushionstheendsofboneswithinthejoint.Osteoarthritisoccurswhenthecartilagebeginstofray,wearawayanddecay.Puttingtoomuchstressonajointthathasbeenpreviouslyinjured,improperalignmentofjoints,andexcessweightallmayleadtothedevelopmentofosteoarthritis.

Rheumatoidarthritisresultsfromtheinteractionofmanyfactorssuchasgenes,hormonesandtheenvironment.Researchsuggeststhataperson’sgeneticmakeupisanimportantpartofthepicture,butnotthewholestory.Someevidenceshowsthatinfectiousagents,suchasvirusesandbacteria,maytriggerrheumatoidarthritisinpeoplewithaninheritedtendencytodevelopthedisease.However,aspecificagentoragentsarenotyetknown.

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How do Doctors Diagnose Arthritis?

Tomakeadiagnosis,mostdoctorsuseacombinationofmethodsandtestsincludingacompletemedicalhistory,aphysicalexaminationx-raysandlaboratorytests.Rheumatoidarthritiscanbedifficulttodiagnoseinitsearlystagesforseveralreasons.First,thereisnosingletestforthedisease.Inaddition,symptomsdifferfrompersontopersonandcanbemoresevereinsomepeoplethaninothers.Also,symptomsofrheumatoidarthritiscanbesimilartothoseofothertypesofarthritisandjointconditions,anditmaytakesometimetoruleoutotherconditions.Finally,thefullrangeofsymptomsdevelopsovertime,andonlyafewsymptomsmaybepresentintheearlystages.

How is Arthritis Treated?

Althoughthereisnocureformostformsofarthritis,varioustherapiescanhelppatientsmanagesymptomsandimprovetheiroverallqualityoflife.

OsteoarthritisOsteoarthritistreatmentplansoftenincludewaystomanagepainandimprovefunction.Currenttreatmentsforosteoarthritiscanrelievesymptomssuchaspainanddisability,butrightnowtherearenotreatmentsthatcancureosteoarthritis.

•Exercise-candecreasepain,increaseflexibilityandhelpyoumaintainahealthy weight.Theamountandformofexercisewilldependonwhichjointsareinvolved, howstablethejointsare,whetherornotthejointisswollenandwhetherajoint replacementhasalreadybeendone.

•Heat or ice-youcanusewarmtowels,hotpacksorawarmbathorshower.In somecases,coldpackssuchasabagoficeorfrozenvegetableswrappedinatowel canrelievepainornumbthesorearea.Adoctororphysicaltherapistcanrecommend ifheatorcoldisthebesttreatment.Forosteoarthritisintheknee,wearinginsolesor cushionedshoesmayreducejointstress.

•Medications-doctorsusuallystartwithacetaminophenbecausethesideeffectsare minimal,thennon-steroidalanti-inflammatorydrugssuchasibuprofenandnaproxen maybeused.Corticosteroids,hyaluronicacidandtopicalcreamsarealsoused.

•Protection and support of joints-somepeopleusecanesandsplintstoprotect andtotakepressureoffthejoints.Splintsorbracesareusedtoprovideextrasupport forweakenedjoints.

•Surgery-helpsrelievethepainanddisabilityofosteoarthritis.Adoctormayperform surgerytosmoothout,fuse,orrepositionbonesortoreplacejoints.

Rheumatoid Arthritis

Treatmentsforrheumatoidarthritiscanhelprelieveyourpain,reduceswelling,slowdownorhelppreventjointdamage,increaseyourabilitytofunctionandimproveyoursenseofwell-being.Exercise,medication,andinsomecases,surgeryarecommontreatmentsforrheumatoidarthritis.Peoplewithrheumatoidarthritisneedagoodbalancebetweenrestandexercise;theyshouldrestmorewhenthediseaseisactiveandexercisemorewhenitisnot.

Anoverallnutritiousdietwiththerightamountofcalories,proteinandcalciumisimportant.Somepeopleneedtobecarefulaboutdrinkingalcoholicbeveragesbecauseofthemedicationstheytakeforrheumatoidarthritis.Reducingstressalsoisimportant.Doingrelaxationexercisesandtakingpartinsupportgroupsaretwowaystohelpreducestress.

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Mostpeoplewhohaverheumatoidarthritistakemedications.Somedrugsonlyprovidereliefforpain,othersreduceinflammation.Stillothers,calleddisease-modifyinganti-rheumaticdrugsorDMARDs,canoftenslowthecourseofthedisease.Steroids,whicharealsocalledcorticosteroids,areanothertypeofdrugusedtoreduceinflammationforpeoplewithrheumatoidarthritis.Earlytreatmentwithpowerfuldrugsanddrugcombinationsinsteadofsingledrugsmayhelppreventthediseasefromprogressingandgreatlyreducejointdamage.

Insomecases,adoctorwillrecommendsurgerytorestorefunctionorrelievepaininadamagedjoint.Surgerymayalsoimproveaperson’sabilitytoperformdailyactivities.Jointreplacementandtendonreconstructionaretwotypesofsurgeryavailabletopatientswithseverejointdamage.

Nomatterwhattypeofarthritisyouhave,thegoaloftreatmentistoreducepainandimprovedailyfunctioning.Itisimportantthattreatmentrecommendationsbefollowed.Thismaybedifficulttodoinadisastersituation,butfollowingyourtreatmentplancangoalongwayinmaintainingyourqualityoflife.

Sources for Additional Osteoporosis,Arthritis and Bone Disease InformationOsteoporosis

National Osteoporosis Foundation http://www.nof.org1-800-231-4222

Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/osteo.htm

National Women’s Health Information Center http://www.4women.gov/FAQ/osteopor.htm1-800-994-9962

ArthritisArthritis Foundation http://www.arthritis.org/arthritis-is.php1-800-283-7800

Arthritis Foundation Ohio River Valley Chapter http://ww2.arthritis.org/communities/chapters/Chapter.asp?Chapid=651-800-383-6843

Kentucky Cabinet for Health and Family Services http://chfs.ky.gov/dph/ach/cd/arthritis.htm

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�. Parkinson’s Disease, Alzheimer’s Disease and Other Neurological Disorders

Parkinson’s DiseaseParkinson’sdiseaseisamovementdisorderthatimpairsmotorskills,speechandotherfunctions.AsmanyasonemillionAmericanssufferfromParkinson’sdisease.Whileapproximately15percentofpeoplewithParkinson’sarediagnosedbeforetheageof50,incidenceincreaseswithage.

What are the Symptoms of Parkinson’s Disease?

ItisimportanttorealizethatnoteverypersonwithParkinson’sdevelopsallsignsorsymptomsofthedisease.Forexample,somepeopleexperiencetremorastheprimarysymptom,whileothersmaynothavetremorbutdohavebalanceproblems.Also,forsomepeoplethediseaseprogressesquickly,andinothersitdoesnot.ThefollowingaredescriptionsofthemostcommonprimarysymptomsofParkinson’sdisease:

•Slighttremorinthehandorfootononesideofthebody,orlesscommonly inthejaworface.

•Stiffnessorinflexibilityofthemusclesalsocalledrigidity.Rigiditycancause pain,crampingandadecreasedrangeofmotion.

•Slowingofmovementsisalsocalledbradykinesia.Peoplewhohavebradykinesia maywalkwithshort,shufflingsteps.

•Impaired balance and coordination:PeoplewithParkinson’sdiseaseoftenexperience instabilitywhenstandingorimpairedbalanceandcoordination.Peoplewithbalance problemsmayhavedifficultymakingturnsorabruptmovements.Theymaygothrough periodsof“freezing,”whichiswhenapersonfeelsstucktothegroundandfindsit difficulttostartwalking.

ThefollowingisalistofsecondarysymptomsofParkinson’sdisease:

•Speechchanges •Depression •Small,crampedhandwriting •Fearoranxiety •Lossoffacialexpressionor“masking” •Memorydifficultiesandslowedthinking •Difficultyswallowing •Sexualdysfunction •Drooling •Urinaryproblems •Pain •Fatigueandaching •Dementiaorconfusion •Lossofenergy •Sleepdisturbances •Compulsivebehavior •Constipation •Cramping •Skinproblems

What Causes Parkinson’s?

ThecauseofParkinson’sdiseaseisunknown.Itisknownthatitaffectscellscalledneuronsthatarelocatedinasmallareaatthebaseofthebraincalledthesubstantianigra.Theseneuronsnormallymakeachemicalcalleddopamine.Dopamineisoneofthechemicalsneededtohelpthebrainfunctionsmoothlyandcontrolmovementofthebody.Dopaminehelpsnerveimpulsestotransmitmessagestomuscles,resultinginwhatweknowasnormalbodymovement.

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Parkinson’sdiseaseresultswhenneuronsdieandlessdopamineismade.Whenthesupplyofdopamineisdecreasedbyapproximately50%-60%,symptomsofParkinson’sbegintostart.Overtime,asmoreneuronsarelostandthesupplyofdopamineislowerandlower,symptomsbecomemoresevere.ThecauseofthecelldeaththatleadstoParkinson’sdiseaseisunknown.

How do Doctors Diagnose Parkinson’s?

AnaccuratediagnosisofParkinson’sdiseasecanbedifficulttomake.Today,thereisnospecificdiagnostictestthatcanbeusedtoconfirmthedisease.However,anMRIscanorbloodtestscanbeusedtoruleoutotherdisordersthathavesomesymptomssimilartoParkinson’s.Diagnosisismadebyaphysicianbasedonaphysicalexaminationofthepatient,focusedonthebodymovementsymptomsthatareassociatedwithParkinson’s,alongwiththepatient’smedicalhistory.

How is Parkinson’s Treated?

Parkinson’sismainlytreatedwithmedications.Iftheydonotwork,sometimessurgeryhelpssomesymptoms.Thegoaloftreatmentistobalancethechemicalsdopamineandacetylcholinefoundinthebrain.Averycommonmedicationislevodopa,orL-dopa.Itisachemicalthebrainneedstomakedopamine.Itbreaksdownveryquicklyinthebrain,andpatientsoftentakeothermedicationstopreventthis.Othermedicationsaregiventhatactjustlikedopamineinthebrainandsomecounteractacetylcholine.Mostmedicationsusuallyworkwellatfirst.Overtime,dosesandcombinationsofmedicationsmayneedtobechangedforbestresults.

Parkinson’smedicationsdohavesideeffectsincludingnausea,depression,drymouthandblurredvision.Afterapatienthasbeentakingmedicationsforawhile,heorshemightstarttohavejerkymovementsinthefaceorarms.Thisiscalleddyskinesia.Themedicationscanalsomakeapersongofromhavinggoodmobilitytoalmostnomobility.Thisiscalled“on-offphenomena”

Physicalandoccupationaltherapycanhelpwithposture,walkingandfinemovements.Sometimeschangingmedicationcombinationsordosagesmakessymptomsbetter.Ifmedicationsdonothelp,surgerymaybeanoption.SurgeryforParkinson’seitherdestroysorstimulatespartsofthebrain.

Itisverydangeroustostoporchangemedicationswithoutdiscussingitwithyourdoctor.Interruptingtheprescribedtreatmentschedulecancauseaworseningofsymptoms,andpossiblynewones.Thesymptomscanleadtoadecreaseinfunctioning.Itmaybedifficulttokeeptoyourdosingscheduleduringadisaster,butitisimportanttodosoinordertomanageyoursymptomsandmaintainyourqualityoflife.

Alzheimer’s Disease Alzheimer’sdiseaseisatypeofdementia,whichcausesnervecellsinthebraintodie.Thediseaseaffectsmemory,thinking,personalityandbehavior.Scientiststhinkthatupto4.5millionpeopleintheU.S.sufferfromAlzheimer’sdisease.Thediseaseusuallybeginsafterage65andriskgoesupwithage.WhileyoungerpeoplealsomaygetAlzheimer’sdisease,itismuchlesscommon.About5percentofmenandwomenages65to74haveAlzheimer’sdisease,andnearlyhalfofthoseage85andoldermayhavethedisease.Itisimportanttonote,however,thatAlzheimer’sdiseaseisnotanormalpartofaging.

What are the Symptoms of Alzheimer’s?

Alzheimer’sdiseasebeginsslowly.Atfirst,theonlysymptommaybemildforgetfulness.PeopleintheearlystagesofAlzheimer’sdiseasemayhavetroublerememberingrecentevents,activities,orthenamesoffamiliarpeopleorthings.Simplemathproblemsmaybecomehardtosolve.Suchdifficultiesmaybeabother,butusuallytheyarenotseriousenoughtocausealarm.

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However,inthemiddlestages,forgetfulnessbeginstointerferewithdailyactivities.Peoplemayforgetthewayhomeorfindithardtocopewithdailylife.SuchsymptomsaremoreeasilynoticedandbecomeseriousenoughtocausepeoplewithAlzheimer’sdiseaseortheirfamilymemberstoseekmedicalhelp.

PeopleinthelaterstagesofAlzheimer’sdiseasemayforgethowtodobasictasks,likebrushingtheirteethorcombingtheirhair.Theycannolongerthinkclearly.Theybegintohaveproblemsspeaking,understanding,readingorwriting.Lateron,peoplewithAlzheimer’sdiseasemaybecomeanxious,agitatedoraggressiveorwanderawayfromhome.Eventually,patientsneedtotalcare.

What Causes Alzheimer’s?

ScientistsdonotyetfullyunderstandwhatcausesAlzheimer’sdisease,buttheyhavefoundbrainchangesinpeoplewiththedisease.Whatcausesthechangesisstillunknown.Thereprobablyisnotonesinglecause,butseveralfactorsthataffecteachpersondifferently.

•Age-themostimportantknownriskfactorforAlzheimer’sdisease.Thenumber ofpeoplewiththediseasedoublesevery5yearsbeyondage65.

•Family history-Scientistsbelievethatgeneticsmayplayaroleinthecausesof Alzheimer’sdisease.Forexample,early-onsetfamilialAlzheimer’sdisease,arare formofAlzheimer’sdiseasethatoccursbetweentheagesof30and60,isinherited.

•Other risk factors-likehighbloodpressure,highcholesterolandlowlevelsof thevitaminfolate–mayalsoincreasetheriskofAlzheimer’s.

Researchersarealsoinvestigatingthepossibilitythatphysical,mentalandsocialactivitiesmayprotectagainstAlzheimer’s.

How do Doctors Diagnose Alzheimer’s?

DoctorsuseseveraltoolstodiagnoseAlzheimer’sdisease:

•Acompletemedicalhistoryincludingquestionsaboutanydifficultiescarrying outdailyactivities

•Medicaltests,suchastestsofblood,urineorspinalfluid

•Teststomeasurememory,problemsolving,attention,countingandlanguage

•Brainscansthatallowthedoctortolookatapictureofthebraintoseeif anythingdoesnotlooknormal

Sometimes,thesetestresultshelpthedoctorfindotherpossiblecausesoftheperson’ssymptoms.Forexample,thyroidproblems,drugreactions,depression,braintumorsandbloodvesseldiseaseinthebraincancausesymptomssimilartothoseofAlzheimer’s.Someoftheseotherconditionscanbetreatedsuccessfully.

How is Alzheimer’s Treated?

ThereisnoknowncureforAlzheimer’s,buttherearetreatmentsthatcanpreventsomesymptomsfromgettingworseforalimitedtime.Forsomepeopleintheearlyandmiddlestagesofthedisease,therearedrugsthatmayhelppreventsomesymptomsfrombecomingworseforalimitedtime.Also,somemedicinesmayhelpcontrolbehavioralsymptomsofAlzheimer’sdiseasesuchassleeplessness,agitation,wandering,anxietyanddepression.Treatingthesesymptomsoftenmakespatientsmorecomfortableandmakestheircareeasierforcaregivers.

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FamilymembersandfriendscanassistpeopleintheearlystagesofAlzheimer’sincontinuingtheirdailyroutines,physicalactivities,andsocialcontacts.PeoplewithAlzheimer’sshouldbekeptup-to-dateaboutthedetailsoftheirlives,suchasthetimeofday,wheretheyliveandwhatishappeningathomeorintheworld.Memoryaidsmayhelpintheday-to-daylivingofpatientsintheearlierstagesofAlzheimer’s.Somefamiliesfindthatabigcalendar,alistofdailyplans,notesaboutsimplesafetymeasuresandwrittendirectionsdescribinghowtousecommonhouseholditemsareveryusefulaids.

Alzheimer’s Disease (additional information)

•Extraidentificationitemssuchasclothingtags,walletcardsorIDjewelry (bracelets,necklace,dogtags,etc.)

•ConsiderenrollingyourlovedoneintheAlzheimer’sSafeReturn®program.

•Arecentphotoofyourlovedoneincasehe/shewandersawayinthecommotion.

•Apillow,toyorsomethingelsetohug

•Lotionorotheritemsthatcanhelpsootheanagitatedindividual

•Makesureothercareattendantsthathelpyoualsohavecopiesofyourloved one’sdementiamedicalhistory,physicianinformation,andfamilycontacts.

•SeeSection3:DementiaandMemoryLossformoreinformationaboutcaring foralovedonewithdementiainadisastersituation.

Multiple Sclerosis (MS)MultipleSclerosis(MS)isadiseasethataffectsthebrainandspinalcord.Manydifferentareasofthebrainandspinalcordmaybeinvolved.Patchesoftheareasofthebrainandspinalcordaffectedbecomehardened(sclerosed)withscartissue.Anormalnervefiberissurroundedbyafattysubstancecalledmyelin,whichislikeinsulationprotectingelectricalwires.Myelinhelpsmessagestravelsmoothlyalongthenervefiber.Whenmyelinbreaksdown,scartissueformswhichpreventsmessagesfromflowingsmoothlyalongthenerve.Messagescanbecomecompletelyblockedandbodyfunctionssuchasspeaking,movingandseeingareaffected.

What are the Symptoms of MS?

Thesymptomsvarydependingontheareawherethescarpatchesoccur.Symptomsmayoccurinanycombination,andmaybemildtosevere,including:

•Poorbalance •Forgetfulnessorconfusion •Poorcoordination •Numbnessortinglyfeelings •Moodswings like“pinsandneedles” •Shakingofthehand(s) •Involuntary(uncontrolled) •Unusualfatigue rapidmovementsoftheeyes •Doubleorblurryvision •Weaknessofanarmorleg, •Slurredspeech whichmayleadtoparalysis •Musclecrampsorspasms orinabilitytomoveifthe •Difficultywalking diseaseissevere

What Causes MS?

ThecauseofMSisnotknown.TherearemanytheoriesincludingthatMSmaybeanauto-immunereaction.OnetheoryisthatMSmaybecausedbyavirusthatstaysinthebodyformonthsoryearsbeforesymptomsappear.AnothertheoryisthatMSmaybecausedbyacombinationofviralinfectionandimmunereaction.Thevirustakesoverbodycells.Theimmunesystemthenattacksthesecellsorthewallofthevirus.

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How is MS Diagnosed?

DiagnosingMSmaybeeasyinsomecasesanddifficultinothersbecauseearlysymptomscanbemildandgoawaywithouttreatment.Symptomsmaynotreappearforweeks,monthsoryears.MSmayhavethesamesymptomsasotherdiseasesandthereisnosingletestthatgivesadefinitediagnosis.TofindoutifapersonhasMS,thedoctorwillordercertaintests.However,thediagnosisofMSisalwaysmadebythehistoryandphysicalexam.

How is MS Treated?

ThereisnocureforMS.However,personswithMScanhaveasatisfactory,productivelifeevenwithlimitations.MSisnotafataldisease,butapersonwithMSmaybemorelikelytogetarespiratoryorurinarytractinfection.Iftheseinfectionsarenottreated,theycancausedeath.Youcaneasesymptomsby:

•Leadingahealthylifestyle

•Avoidingextremesofheatandcold

•Participatinginphysicaltherapywhichprovidesexerciseprogramsandmuscleretraining

•Takingmedicationsthatmayhelpcontrolsymptomsordecreasethefrequency,duration orintensityofattacks

ALS (Lou Gehrig’s Disease)Amyotrophiclateralsclerosis(ALS),oftenreferredtoas“LouGehrig’sdisease,”isaprogressiveneurodegenerativediseasethataffectsnervecellsinthebrainandthespinalcord.Motorneuronsreachfromthebraintothespinalcordandfromthespinalcordtothemusclesthroughoutthebody.TheprogressivedegenerationofthemotorneuronsinALSeventuallyleadtotheirdeath.Whenthemotorneuronsdie,theabilityofthebraintoinitiateandcontrolmusclemovementislost.Withvoluntarymuscleactionprogressivelyaffected,patientsinthelaterstagesofthediseasemaybecometotallyparalyzed.

What are the Symptoms of ALS?

AttheonsetofALSthesymptomsmaybesoslightthattheyarefrequentlyoverlooked.Withregardtotheappearanceofsymptomsandtheprogressionoftheillness,thecourseofthediseasemayincludethefollowing:

•muscleweaknessinoneormoreofthefollowing:hands,arms,legsorthemuscles ofspeech,swallowingorbreathing

•twitching(fasciculation)andcrampingofmuscles,especiallythoseinthehandsandfeet

•impairmentoftheuseofthearmsandlegs

•“thickspeech”anddifficultyinprojectingthevoice

•inmoreadvancedstages,shortnessofbreath,difficultyinbreathingandswallowing

What Causes ALS?

A-myo-trophiccomesfromtheGreeklanguage.“A”meansnoornegative.“Myo”referstomuscle,and“Trophic”meansnourishment–”Nomusclenourishment.”Whenamusclehasnonourishment,it“atrophies”orwastesaway.“Lateral”identifiestheareasinaperson’sspinalcordwhereportionsofthenervecellsthatsignalandcontrolthemusclesarelocated.Asthisareadegeneratesitleadstoscarringorhardening(“sclerosis”)intheregion.

Asmotorneuronsdegenerate,theycannolongersendimpulsestothemusclefibersthatnormallyresultinmusclemovement.EarlysymptomsofALSoftenincludeincreasingmuscleweakness,

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especiallyinvolvingthearmsandlegs,speech,swallowingorbreathing.Whenmusclesnolongerreceivethemessagesfromthemotorneuronsthattheyrequiretofunction,themusclesbegintoatrophy(becomesmaller).Limbsbegintolook“thinner”asmuscletissueatrophies.

How do Doctors Diagnose ALS?

ALSisaverydifficultdiseasetodiagnose.Todate,thereisnoonetestorproceduretoultimatelyestablishthediagnosisofALS.Itisthroughaclinicalexaminationandseriesofdiagnostictests,oftenrulingoutotherdiseasesthatmimicALS,thatadiagnosiscanbeestablished.Acomprehensivediagnosticworkupincludesmost,ifnotall,ofthefollowingprocedures:

•Electrodiagnostictestsincludingelectomyography(EMG)andnerveconductionvelocity(NCV)

•Bloodandurinestudiesincludinghighresolutionserumproteinelectrophoresis,thyroid andparathyroidhormonelevelsand24hoururinecollectionforheavymetals

•Spinaltap

•X-rays,includingmagneticresonanceimaging(MRI)

•Myelogramofcervicalspine

•Muscleand/ornervebiopsy

•Thoroughneurologicalexamination

How is ALS Treated?

WhilethereisnotacureortreatmenttodaythathaltsorreversesALS,therearetherapiesthatcanmanagethesymptomsofALSthathelppeoplemaintainasmuchindependenceaspossibleandprolongsurvival.ItisimportanttorememberthatALSisaquitevariabledisease;notwopeoplewillhavethesamejourneyorexperiences.TherearemedicallydocumentedcasesofpeopleinwhomALS‘burnsout,’stopsprogressingorprogressesataveryslowrate.Nomatterwhatyourindividualcourseorsituationmaybethereareresourcesthatcanhelp.

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Sources for Additional Parkinson’s Disease, Alzheimer’sDisease and Other Neurological Disorders Information

Parkinson’s DiseaseNational Parkinson’s Foundationhttp://www.parkinson.org1-800-327-4545

Parkinson’s disease Foundation http://www.pdf.org1-800-457-6676

Kentucky Parkinson’s Disease Information and Referral Center http://ukhealthcare.uky.edu/KNIapda_parkinsons.htm1-866-554-APDA(2732)

Multiple SclerosisNational MS Societyhttp://www.nationalmssociety.org1-800-344-4867

ALS (Lou Gehrig’s Disease)http://www.alsa.org/1-818-880-9007

Alzheimer’s DiseaseAlzheimer’s Association http://www.alz.org1-800-272-3900

Alzheimer’s Association Safe Returnhttp://www.alz.org/safereturn1-888-572-8566

National Institute on Aging Alzheimer’sDisease Education and Referral (ADEAR)http://www.alzheimers.nia.nih.gov1-800-438-4380

Family Caregiver Alliance http://www.caregiver.org1-800-445-8106

Children of Aging Parentshttp://www.caps4caregivers.org1-800-227-7294

Eldercare Locatorhttp://www.eldercare.gov1-800-677-1116

Well Spouse Associationhttp://www.wellspouse.org1-800-838-0879