Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) can definitely be a frustrating diagnosis as a college student as late night pizza and ice cream binges can exacerbate symptoms. IBS is a common disorder affecting 5% to 15% of the general population. Unfortunately, the list of foods to enjoy and those to avoid may be different for each person. There are some general rules that those with IBS should follow. These standard recommendations include establishing regular eating times, eating smaller frequent meals, and drinking enough fluids. Foods that should (generally) be avoided for those with IBS include banana, coffee, corn, eggs, milk, peas, potatoes and wheat. Caffeine and alcohol are known IBS triggers. Recent studies of low FODMAP diets have shown promising preliminary data in decreasing IBS symptoms. It is also recommended that you make sure to consume enough fiber (25-38Gg/day) though your diet or through fiber supplementation. You can also purchase probiotics over the counter that can aid in reducing IBS symptoms. In conclusion, IBS is a very common disorder that can be difficult to manage as a college student. If you have questions about how to better manage your IBS or think you have IBS, please call the Wilce Student Health Center to schedule an appointment with one of our providers today.

Megan Lottes, C.N.P.

Medical Marijuana and Student Life Student Health Services

So marijuana is now legal in the state of Ohio….what does that mean for me as a student here at The Ohio State University?

Can I get marijuana prescribed by a provider at the Student Life Student Health Center (SLSHS)?

I haven’t heard of anyone who has been prescribed medical marijuana yet.

As of September 8, state licensure, registration, and certification are required for Ohio’s Medical Marijuana Control Program. Ohio law requires the Ohio Medical Marijuana Control Program to be fully operational by this date.

 

Can I get a prescription from any doctor?

“The federal government prohibits doctors from being able to prescribe marijuana. Instead, patients must have a recommendation from a certified physician. Physicians interested in recommending the use of medical marijuana for patients must apply for a certificate to recommend from the State Medical Board of Ohio.” The Ohio Medical Marijuana Control Program

Many students will not qualify by age alone, as one must be at least 21 years old.

Physicians at the Wilce Student Health Center will not be certified. They will not be prescribing medical marijuana. That being said, it is very important that patients always disclose all supplements or other medications they are prescribed when seeking medical care. Be sure to let your SLSHS provider know if you are taking medical marijuana (or using recreational marijuana).

 

What kind of medical problems can be treated with marijuana?

The State of Ohio Medical Board has a defined list of medical diagnoses that qualify for treatment with medical marijuana.

The most common use is for pain control, especially nerve pain. Medical marijuana can also be helpful with certain types of nausea, muscle spasticity (as with multiple sclerosis and Parkinson’s disease), and glaucoma.

There are some initial studies that indicate marijuana may have a place in treating post traumatic stress disorder.

 

Keep in mind…

Marijuana is still illegal per federal law. The Federal Drug Free Schools and Community Act of 1989 prohibits the use of drugs (including marijuana) on campus if the school is receiving any federal funds.

We are in need of more medical research in the benefits and side effects/complications of marijuana use.

Just like with alcohol, one should not drive while using marijuana (medical or recreational).

The smoke from marijuana has toxic chemicals just like tobacco smoking.

In a student population already struggling with anxiety, depression and attention deficit disorders, the use of marijuana is likely to compound the issues. There is also increased risk of psychosis and impairments in learning, perception and judgement.

Kathryn McKee, M.D.

What’s in your work out supplements?

It’s the start of 2018, which means the “new year, new me” resolutions are picking up some good momentum by now. Hitting the gym more often is definitely one of my resolutions, and if our resolutions are on the same page, then this post can be of some help to you!

Work out supplements… we see them advertised all over our social media pages, and if you are walking into your local GNC, or Vitamin Shoppe the selection can be intimidating. What I’ve learned so far is that there are supplements that you take as a pre-workout, and supplements that do just as they are named, supplement.

Pre-workout Supplements:

What’s the scoop? Boosting your performance is all part of the plan. Growing bigger muscles, having quicker gains, and hoping for an easy solution is something we all strive for. Most of us understand that easy isn’t necessarily so, and may not entirely be the correct way in doing something. Unlike medications, workout supplements are not as strictly regulated by The Food and Drug Administration (FDA), which means dangerous ingredients may be incorporated without the knowledge of consumers. Some of the ingredients may actually have detrimental effects, and potentially cause death.

1, 3- dimethylamine, methylhexanamine or geranium extract—also known as DMAA is an ingredient that has been found illegally in some dietary supplements, where manufacturers mask the component as a “natural” stimulant. In 2013, a case report was published in the Clinical Journal of Sport Medicine, highlighting an incident where a 21- year old male suffered from cardiac arrest after ingesting a workout supplement containing DMAA. Structurally, DMAA is similarly related to amphetamine, methamphetamine, and MDMA. DMAA does not produce any type of stimulant similar to the mentioned substances, but if you are set to take a urine drug test for a new job, or professional program at The Ohio State University… heads up, you may fail.

Good news, DMAA has been banned by the FDA after the unfortunate incident that occurred in 2013, however, there are still some supplements through online purchase that may have the ingredient incorporated within the product, and I would recommend reading the back of the nutrition label before purchasing any type of supplement. The discontinued substance that contained DMAA was specifically the pre-workout supplement marketed as Jack3d made by USPLabs.

Regular Supplements:

First off, let me drink some protein.” Protein supplements are frequently consumed by athletes, as well as those who work out recreationally. There is much debate on the theory of amount of protein per day a person should intake and the timing of supplementation, and if you have any questions towards these matters PubMed.gov is a good source for you to do some more research about the topic.

Protein powders come in three common forms, those being—whey, soy and casein. A study by Kanda, A. et al in 2016, looked at the co-ingestion of all three substances and their effects on muscle protein synthesis after exercise in rats. The results of the study demonstrated a difference in peak time according to the type of protein ingestion, the authors concluded that whey protein was quicker to initiate the process compared to casein and soy.

Branched chained amino acids (BCAAs) especially leucine have been shown to increase muscle synthesis after exercise. Leucine is another component to keep an eye out for. Kanda, A et al. also noted that leucine displays a specific saturation point. The threshold described was around 43 mg of leucine, which means anything above this dose resulted in no further increase in the muscles anabolic response.

This is just the tip of the iceberg when it comes to the types of supplements that are available commercially, the big take away from this blog is to get you use to looking at the nutrition label located on the back of the products up for purchase. Speaking to your healthcare providers about any of your concerns is a good thing to do, especially if some of the components of your supplements seem a bit off.

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Kanda, A. et al. Effects of whey, caseinate, or milk protein ingestion on muscle protein synthesis after exercise. Nutrients. 2016 Jun; 8(6): 339.
  2. Lioudmila, K et al. Cardiac arrest in a 21-year old man after ingestion of 1,3 dmaa—containing workout supplement. Clin J Sport Med. 2015 Jan; 25 (1): 23-25

Can I drink this beer while on medication?

NFL playoffs and the OSU Spring Semester are in full swing, and this may mean an increase in alcohol consumption during the months to come. There are many drugs that interact with alcohol to some extent. These interactions can either metabolize medications and decrease the medications effectiveness, or can have the opposite additive effect and increase the risk of toxicity.

Here is a limited chart of studied alcohol-drug interactions and the risk/warnings of combining the two, be sure to ask your pharmacist about any drug-drug interactions before taking your medication:

Common OTC/Prescribed Medications Clinical Effects Recommendations
Pain Medications:
Acetaminophen (can be found in multiple OTC/prescribed drugs) Acute alcohol use in large amounts can increase risk of liver toxicity Do not consume >3 alcoholic drinks/day while taking this medication
Aspirin (Excedrin), ibuprofen (Motrin) and naproxen (Aleve) Increased risk of gastrointestinal bleeding Do not consume >3 alcoholic drinks/day while taking this medication
Codeine, hydrocodone + acetaminophen (Norco, Lortab, Lorcet, Vicodin), oxycodone + acetaminophen (Percocet, Endocet) and tramadol (Ultram) Co-ingestion may lead to respiratory failure, increased dizziness, sedation and can potentially be fatal Avoid alcohol consumption while on these medications
Antidepressants/Seizure medications:
Amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil); and bupropion (Wellbutrin/Zyban); phenytoin, perampanel (Fycompa) Increased risk of sedation, dizziness, fainting; may also increase risk of seizures; may cause psychiatric effects Minimize or avoid alcohol use, speak to your doctor/pharmacist about alternatives
Diabetic medications:
Glyburide (Diabeta), metformin (Glucophage) and insulin therapies May cause vomiting, nausea, headache, muscle or stomach pain and visual disturbance. Unpredictable effects while on insulin may occur Avoid heavy alcohol consumption (>3 drinks/day)
Antihistamines:
Diphenhydramine (Benadryl, ZZZquil) and doxylamine (Sleep Aids) Increased risk of sedation and dizziness Advise against alcohol consumption, speak to your doctor/pharmacist about alternatives
Antihypertensives:
Amlodipine (Norvasc), nicardipine (Cardene), nifedipine (Procardia), atenolol (Tenormin), and metoprolol (Lopressor, Toprol XL) Increased risk of dizziness and fainting

 

Advise against heavy alcohol consumption (>3 drinks/day)
Antimicrobials:
Doxycycline (Vibramycin), ketoconazole, metronidazole (Flagyl), and isoniazid May decrease effectiveness of medication, as well as increase risk of vomiting, nausea, stomach pain. Isoniazid and alcohol may cause liver damage Advise to avoid alcohol on all antimicrobial agents ask your pharmacist about interactions with your medications

 

Next time someone hands you an alcoholic drink and you are taking medication, ask yourself… is it worth the risk?

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Alcohol and Drug Interactions. Pharmacist’s Letter/Prescriber’s Letter. December 2015.

Sick as a dog? Keep the cold/flu at bay!

Taking an antibiotic for the cold or flu? What is the point?

Antibiotics are medications that are used to treat infections caused by bacteria. The common cold and flu are viral infections, and asking your prescriber for an antibiotic to treat these conditions is something we do not encourage you to do.

When is it ok for you vs not okay to take antibiotics?

Common Cause: Virus Common Cause: Bacteria
Sore throat, sinusitis

Vomiting and diarrhea

Runny nose, cough, head cold

Kidney infection

Skin infection

Meningitis

Pneumonia

Antibiotics rarely needed Antibiotics needed

 

If you were to take antibiotics when they are not needed this may create antibiotic resistance, which can occur when bacteria are exposed to antibiotics and can learn to resist them. How can you avoid antibiotic resistance?

  1. If you have been prescribed an antibiotic COMPLETE the course of medication by taking all of the dispensed pills
  2. DO NOT skip doses of antibiotics if prescribed
  3. DO NOT save pills for later

Don’t want to get sick this winter … then take these precautions and you can limit your exposure to feeling ill.

  1. Wash your hands!
    1. Your hands are a good environment for cold viruses, and these viruses can stay on your skin for up to 2 hours.
  2. Try and avoid close contact to those who are ill!
  3. Sneeze or cough into the pit of your elbow, to avoid virus from spreading onto your hands!

If you unfortunately catch the common cold or flu, then symptomatic treatment until the virus passes is the best option. If symptoms do not resolve after a week, or worsen, we would encourage you to schedule an appointment with our providers at Student Life Student Health Services, or visit your primary care physician.

 

Symptoms Treatment
Sore throat Acetaminophen or Ibuprofen

Honey and lemon, or anesthetic lozenges

Dry cough (lack of mucus)

Wet cough (production of mucus)

Dry cough—dextromethorphan

Wet cough—guaifenesin

Fever, pain, joint or muscle ache Acetaminophen or ibuprofen
Runny nose, or congestion Nasal sprays—oxymetazoline (do not use more than 3 days, ask your pharmacist if symptoms persist)

Oral Decongestants—pseudophedrine or phenylephrine

 

Justin Corpus

PharmD Candidate 2018

 

References:

  1. Marjama, K. Treating the common cold. Pharmacy Times (2017). 83 (12): 95-96.
  2. Allan, M., Arrol, B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ (2014); 186 (3): 190-199.
  3. Schroeder, M., Brooks, B., Brooks, A. The complex relationship between virulence and antibiotic resistance. Genes (2017). 8 (1): 39-62

New Year’s Resolutions

At the beginning of a new year, many of us resolve to take better care of ourselves.  This often includes a desire to eat more healthfully.  How to accomplish that can be confusing.  There are numerous “experts” and guidelines.  They sometimes conflict and often do not seem to be practical or helpful.

The types of foods we consume can have a huge effect on how we feel and think.  Sugar intake has markedly increased over the past few decades.  This correlates with a significant rise in obesity, diabetes, heart disease, hypertension, and other health problems.

It appears highly likely that reducing sugar intake can have a big effect not only on how we feel and look now, but also reduce our chances for numerous chronic diseases in the future.

This does not mean that you have to “diet” or be hungry.  I would encourage you to eat when you are hungry and include a diverse range of foods such as unprocessed meat, fish, chicken, nuts, vegetables, and fruits.

However, try to avoid sugar and foods that cause a rapid elevation of blood sugar levels.  Examples of foods to avoid include the following:

  • Processed grains such as breads and cereals
  • Foods and condiments containing sugar
  • Sweets (e.g. candy, soda)
  • Potatoes

Eating healthfully can be a challenge.  However, it can make a big difference.  Please make an appointment at the Student Life Student Health Center (614-292-4321) if you would like more information.

Submitted by Matthew Peters, M.D.

My BuckMD data protected by BuckeyePass – Effective Wednesday, January 3

Cybercriminals’ top priority is a real-life payout. For Ohio State student systems, that means criminals may target your personal health information (PHI). If criminals get your user name and crack your password, they may be able to view your PHI and share information about you that you would prefer not to have shared.

If you have more than one step to log in – more than just your user name and password – your risk is reduced significantly. That’s why we’re adding a multifactor authentication tool called BuckeyePass (link is external) as an extra layer of security for student systems. Extra security protects your personal information stored in My BuckMD.

How does BuckeyePass affect me?

  • BuckeyePass (link is external) will be added to My BuckMD on Wednesday, January 3.
  • BuckeyePass (link is external) requires not only a password and username, but also a second method of authentication that you control. We recommend that you sign up as soon as possible and enroll multiple devices so you have a backup in case your primary device is stolen, broken or unavailable for any reason.

What do I need to do?

The first step is to enroll in BuckeyePass (link is external).  We have found the tool to be reliable and easy to use. We’ve posted a video (link is external) so you can see what the process looks like and how it works.

 

Information above summarized from:  https://odee.osu.edu/news/2017/11/01/students-should-sign-buckeyepass-november-5

Prior Authorization

One of the most frustrating experiences as a patient is arriving at the pharmacy to pick up your medication and being told that a prior authorization is required. If you have never experienced this before the process can be especially confusing and aggravating. Unless you decide to pay cash for your medication or your doctor decides to change your therapy it can also involve a significant delay before you can actually get your medication.

Prior authorization is a process where the insurance provider wants more information from the doctor before they will pay for a medication. This process typically starts at the pharmacy when the staff there try to bill an insurance plan for a drug. The insurance will then send the pharmacy a rejection notifying them that a prior authorization needs to be completed. At this point the pharmacy will contact the doctor to let them know they must complete a prior authorization if they want the insurance company to cover the cost of the prescribed drug. The doctor must then answer some questions about the use of the prescribed medication and send those answers to the insurance provider. Finally, the insurance provider must review the doctor’s response and decide if they will pay for the medication or not. Thankfully this process is quicker than it used to be as many of these interactions are automated or electronic. Typically this process can take anywhere from a day to a week to complete, although times may vary. If a patient stays on their medication for an extended time it is likely that the prior authorization will need to be completed again at some point. Many plans require prior authorizations annually while some require them more often.

The main reason insurance plans institute prior authorization is cost savings. Plans want to review the use of high cost medications and make sure they are being utilized appropriately. A common way they do this is called step-therapy. Step therapy means that the insurance provider will require a trial of one or more lower cost medications before they will pay for a high cost drug. Many insurance providers require prior authorization for brand name drugs if a generic is available. Insurance plans often prefer a certain drug within a medication class due to cost and require providers to complete a prior authorization if they write a prescription for a different drug in the same class.

Prior authorization can be frustrating for both patients and healthcare workers. Despite that the practice isn’t going away anytime soon. If you want to be more informed about which drugs will require prior authorization on your health insurance you can request a copy of your insurance formulary which will show you which drugs your insurance plan prefers. Drugs on this list will be less likely to require a prior authorization.

Michael Kowalczyk

PharmD candidate 2018

Meningitis B

It seems like every year there are several outbreaks of meningococcal infections on college campuses across the country. This disease is caused by a bacterium called n. meningitides which can infect both the brain and the blood. Although meningococcal infections are rare even with treatment this infection can be deadly in 10-15% of patients. Those who survive can experience permanent disabilities like amputation, hearing loss, brain damage, kidney damage, and scarring from skin grafts. As a student at The Ohio State University you are required to be vaccinated for meningitis before you can live in university housing. This vaccine covers meningitis type A,C,Y, and W-135. It does not cover meningitis B which causes nearly half of meningitis cases in patients aged 17-22. There are currently two vaccines on the market for meningitis B, Trumenba and Bexsero. Both vaccines are approved in the United States for patients aged 10-25 for the prevention of meningococcal type B infection. Although the medication is approved for 10-25 the Advisory Committee on Immunization Practices and the CDC give these recommendations.

These vaccines are recommended for patients ten years and older who:

  • Are at risk due to a type b outbreak
  • Have a damaged or removed spleen
  • Have an immune system condition known as “persistent complement component deficiency.”
  • Are taking eculziumab (Soliris)
  • Routinely work with N. meningitides.

There is an additional recommendation that the vaccine may be given to anyone aged 16-23 with a preferred age of vaccination being 16-18. This allows patients and their healthcare providers to determine if they want the vaccine.

Both vaccines require multiple doses. Bexsero is a two dose series with the doses being administered at least one month apart. Trumenba can be a two or three dose series depending on your risk level for meningococcal B infection.

 

Michael Kowalczyk

PharmD candidate 2018

Prescription Refills

Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?

In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.

You don’t have time to come in for an appointment right now?

Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.

How to avoid running out of medications?

Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.

Don’t see an appointment on-line that fits your schedule?

All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.

Ryan Hanson, M.D.