If A-Rod played the violin, would anyone care?

photo: Mark Heayn

photo: wikimedia commons

Yesterday, Alex Rodriguez of the New York Yankees became the youngest Major League Baseball player to hit 600 home runs.  Like so many recent feats in baseball this one comes with the ‘asterisk’ of steroid abuse, which got me thinking about the nature of performance enhancing drugs. 

I’ve never taken care of any professional baseball players, but I have treated more than few musicians for performance anxiety, which manifests itself as a physiologic tremor.  We all have a baseline tremor in our hands of about 10-12 Hz.  Normally, it’s not apparent but many things can make the shakiness very noticeable: caffeine, nicotine, certain drugs, muscle fatigue and – most commonly – excitement, fear or stress. 

For most of us, those shaky hands are just a mild annoyance.  But for a violinist auditioning for a job with a major orchestra – or a spot in the music performance program – it can have an enormous impact on her life.  Luckily there are cheap and relatively safe medications that can blunt those tremors and allow such people to perform to their maximum potential in those situations where their nervous system doesn’t.

In the minds of many sports fans, A-Rod’s use of performance enhancing drugs makes him a big, fat cheater.  So am I helping my patients cheat?

Is a cellist taking a beta-blocker to keep from shaking uncontrollably during a concert the same thing as a pro baseball player juicing up with roids?  It seems unfair to say that treating a medical condition is cheating; after all, you wouldn’t tell a diabetic shortstop that he couldn’t take his insulin before a game or a pitcher with poor vision that he can’t wear his glasses. 

But one could argue that dealing with the pressure of being in front of an audience is an integral part of performing, and that using a chemical substance to enhance your ability to do so is cheating.  After all, a lot of weekend duffers can sink a 12-foot putt on the practice green, but there’s only one Tiger Woods.

So what do you think?  Is taking a medication for an anxiety-induced tremor simply a matter of leveling of the playing field for someone with a medical deficit; or is it giving an unfair edge to someone who can’t handle the heat?

John A. Vaughn, MD
Student Health Services
The Ohio State University

How can I cut back on caffeine without the withdrawal?

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Q: I’m trying to cut down on coffee as a New Year’s resolution but I get an intense headache on days when I don’t have it.  Is this caffeine withdrawal? How can I make it go away?

A: Congrats on trying to kick the caffeine habit!  You’re doing the right thing.  Caffeine can cause sleep problems, nervousness, irritability, fast heart beat, headaches, tremors, and anxiety (not to mention a light wallet – those daily Grande low-fat lattes get really expensive!)

It definitely sounds like you’re dealing with caffeine withdrawal, which can involve all of the following symptoms:

  • Headache, which is the most common symptom
  • Fatigue or drowsiness
  • Bad mood, irritability, or depression
  • Difficulty concentrating
  • Nausea, vomiting, or muscle pains

Withdrawal symptoms typically hit you within a day of quitting and can last up to a week.  The more coffee you’ve been drinking the worse the withdrawal will probably be, but it can happen even if you’ve only been consuming as little as 100 mg of caffeine per day.  To give you an idea of how easy it is to reach that level, here are the caffeine contents of some common drinks:

8 ounce cup of coffee

135mg

Starbucks coffee, short

250mg

Starbucks coffee, grande   

550mg!!

8 ounce cup of tea (leaf/bag/green)

35mg

12 ounce can of Coke/diet Coke

46mg

12 ounce can of Mountain Dew

54mg

8.3 ounces of Red Bull

80mg

16 ounce can of Rockstar

160mg

16 ounce can of Monster    

160mg

What can you do to make it go away?  Um… drink some coffee.  Consuming caffeine can make withdrawal symptoms go away within an hour.  Of course, the down side is that you’re back to being a coffee junkie. Cutting back gradually can help: try drinking one less cup or one smaller size per day.  Another method could be to mix decaf with regular coffee so that you cut down on caffeine content without cutting back on volume.

And watch out for chocolate or any food/gum/drink that promises an energy or concentration boost – they’re loaded with caffeine.  You even have to be careful of some over-the-counter pain medications.  The reason ExcedrinTM is so good at getting rid of “migraines” so quickly is that its main ingredient is caffeine, and the headache is really caused by caffeine withdrawal.  Stick with Acetaminophen or Ibuprofen if necessary.

Good luck with your resolution!  Here’s to a decaffeinated 2010!

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

 

Is there anything that will help me quit smoking?

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Q: I saw your post last week and I think I’m ready to quit smoking.  What now?

A: Congratulations, that’s great news! But before we pop the champagne, you should know that the days ahead are going to be tough, and most people make several attempts before they actually kick the habit for good. So don’t be too discouraged if it takes a few tries to make it stick!

The great news is that there are a TON of resources out there to help you quit smoking.

One of my favorite programs is 1-800-QUIT-NOW (1-800-784-8669). You can call this free hotline and speak to a professional smoking cessation counselor. They can help you get over your fears about quitting, help you set your quit date, teach you coping strategies for cravings, etc. The really great thing about this service is that they can often help you get access to nicotine replacement therapy if you are qualified, whether or not you have insurance. Plus, people who use “quit lines” have been found to be more successful in their attempts to quit!

If you’re not into the idea of calling a quit line, this government website is another great resource. It offers tips for quitting, a savings calculator, a cravings journal and much more!  The CDC website also offers a list of resources to help you quit. 

Closer to home, the staff of Student Health Services is also here to help. In addition to advice and encouragement, we can offer several prescription medication options to help you quit.  All medications have side effects, so be sure to discuss them fully with your health care provider before taking them.  The main options are:

Varenicline (Chantix) works by blocking the effect of nicotine on your brain, so if you relapse and light up, that cigarette won’t give you the same pleasurable effect it used to.  It also helps to reduce withdrawal symptoms.  Varenicline is not covered by insurance and it ain’t cheap (about $120/month), but it does seem to be very effective. 

Buproprion (Wellbutrin) is a commonly prescribed antidepressant that has been found to decrease tobacco cravings and withdrawal symptoms.  Buproprion is much cheaper than Varenicline (it’s on many $4 prescription plans and is usually covered by health insurance) but doesn’t seem to be quite as effective. 

There are also a number of nicotine replacement products on the market these days. You can get anything from patches to gum to lozenges to inhalers. These are typically priced so that a month of treatment costs the same as a month of cigarettes (at about a pack per day). So really, while it seems pricey up front, in the long run you’ll be saving money.  Even though you can buy them without a prescription, it’s always a good idea to talk to your health care provider before starting one of these products.

Good luck!  Please post a comment and let us know how you’re doing!  Who knows, your experiences may help someone else kick the habit!

Angela Walker, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

Reasons to quit smoking that you might actually care about

photo: nytimes.com

Q: Yeah, yeah, yeah… smoking might give me lung cancer when I’m like 80.  So why should I worry about it now when I can just quit when I’m old?

A: Sure, lung cancer is one of the main reasons to quit, but we know you college (and graduate) students are invincible and don’t really care about little things like mortality, so here are a few other good reasons to quit smoking that might hit a little closer to home:

Tooth Loss

  • It is well known among dentists that smoking dramatically increases your chances of “edentulism” (i.e having no teeth). Smoking causes gum disease and plaque build-up which lead to tooth decay and loss. One study showed that the risk of tooth loss in smokers is more than 4 times that of non-smokers! Think you look cool holding that cigarette? Just think how much cooler you’ll look with dentures. The good news is that the risk of tooth loss decreases with smoking cessation.

Wrinkles

  • Smoking is one of the leading causes of premature skin aging. (One of the identical twins in the photo at the right smokes and has been in the sun more than the other – can you tell which one it is?) Tobacco leads to degradation of the collagen and elastic fibers that keep skin looking smooth and young, leading to premature wrinkles, especially around the mouth and eyes. The mechanisms for this are thought to be similar to the damaging effects of ultraviolet radiation on the skin – so stop tanning too while you’re at it!

Cervical cancer

  • Ladies, did you know that if you have been infected with certain types of Human Papillomavirus (HPV), smoking increases your risk of developing cervical cancer compared to nonsmokers? Researchers are still looking into why this is, but they have actually detected nicotine in the cervical mucous of smokers!  And cervical cancer isn’t one of those things you only have to worry about in the distant future; it is increasingly affecting women in their 20s and 30s. The risk gets higher the longer you smoke, so the sooner you quit the better.

Birth defects

  • It is amazing that in this day and age we still need to tell people to quit smoking before they become pregnant, but unfortunately we still see it all the time. Smoking increases a woman’s risk of premature delivery, still birth, low infant birth weight, and sudden infant death syndrome (SIDS). Since roughly 50% of pregnancies are unplanned, the time to quit is now!

Limb amputation

  • Smoking is one of the major risk factors for peripheral arterial disease (loss of blood flow to the extremities which can lead to tissue damage and amputation). Ok, maybe this is another one of those long term problems you don’t want to think about while you’re young and indestructible, but it’s out there and it affects many people as they get older.

Poverty

  • We know that financial concerns are far and away the biggest stressors for students: tuition, rent, books, fees, not having enough time to study for your classes because you have to work so many hours to pay for them. A pack of cigarettes costs around $5, so a pack-a-day habit costs you $1825 a year! Think about that. How many months of rent or credit hours would that buy? How many student loans could you pay off (or not take out in the first place)? Even if you’re just a casual smoker who only buys a pack on the weekend when you go out drinking, that’s $250 in a year. That would buy you an iTouch!

The thought of becoming a poor, wrinkly, stressed out, toothless, cancer-ridden amputee still not enough reasons to quit?  Check out the CDC’s website for more useful information on the risks of smoking and resources for quitting.  We’ll follow up with another post listing some local resources for quitting soon.

Angela Walker, Med IV (Ohio State College of Medicine)

John A. Vaughn, M.D (Ohio State Student Health Services)

Is it OK to share ADD medicine?

Don't end up like this guy!

ADD medicine

Q:  Is it OK to give my friend one of my ADD pills to help him study for a test?

A:  Before we answer that question, let me ask you another one.  Would you sell that pill to a stranger for $50?  I’m guessing – hoping – your answer is an emphatic “NO.”  Well, from a legal point of view, these two questions are identical.

Most ADD medications (such as Concerta, Ritalin, Adderall, Focalin, Metadate, Methylin, and Daytrana) are Schedule II controlled substances because of their serious side effects and potential for addiction.  They are monitored very closely by doctors, pharmacists, and the Drug Enforcement Agency (DEA).  We’re not lawyers here at Student Health, but we do know that… 

It is a violation of Section 2925.03 of the Ohio Revised Code (Ohio law) to sell another person a controlled substance.  The important thing to remember here is that the legal definition of “sell” includes “delivery, barter, exchange, transfer, or gift…”  

So even if you are just trying to help out your friend – and getting nothing in exchange for it – you are breaking the law.  And we’re not talking about a speeding ticket here.  You are committing a 4th degree felony, which is punishable by 6-18 months in prison and/or a $5,000 fine.  And assuming you are anywhere on or near campus, the felony gets bumped up to 3rd degree and you’re looking at 1-5 years in prison and/or a $10,000 fine.  Not to mention the fact that you could lose your financial aid and/or get kicked out of school.  

Now granted, the odds of someone busting into your dorm room and catching you in the act are very slim.  And unless you really don’t get along with your roommates or neighbors, odds are no one is going to turn you in.  But forget about the legal stuff for a minute.

  1. These medications are addictive and there’s a real chance your friend could get hooked on this stuff.  You don’t want to risk sending someone down that dark road.
  2. While these medications have a calming effect on people with ADD, they are actually central nervous system stimulants so in addition to things like headache, insomnia, anorexia, agitation, anxiety, tremors, vertigo, depression, and nervousness, they can cause life-threatening problems like heart attacks, increased heart rate, increased blood pressure, and heart arrhythmias.  Doctors evaluate people for these conditions prior to starting these medications and monitor them closely while they’re taking them.  Without knowing your friend’s health history, you could literally be putting his life at risk – and no test is worth that much. 

Managing your health is a serious responsibility and that’s especially true if you have ADD.  If you’re taking one of these medications, the best thing to do is keep it to yourself – if no one knows you have the pills, they won’t be able to ask you for one.  And if you have a friend who is taking these medicines, don’t pressure them into giving you one.  It’s more likely to hurt you than help you, and it’ll just put everyone at risk for serious trouble. 

If you have any questions about these or other medications you may be taking, the staff of Student Health Services pharmacy is always available to help!

Jason Goodman, PharmD, RPh (OSU SHS)

Is 5-Hour Energy Safe? Does It Work?

5-Hour Energy

Better than this?

Q: I drank 2 bottles of 5-hour Energy and got warm, red in the face and jittery.  Is this stuff safe?  Does it work? 

A:  5-Hour Energy, the little bottle that has sprouted like dandelions across grocery store counters everywhere, promises an immediate energy boost that lasts for hours but without the “crash” associated with other energy drinks.  Its main ingredients are B Vitamins and an “energy blend” consisting of citicoline, tyrosine, phenylalanine, taurine, malic acid, glucuronolactone and caffeine.   

We put caffeine in bold letters because while all that other stuff has that really cool “medical yet natural” sound to it, the only thing in 5-Hour Energy (or Monster or Red Bull or RockStar or any other “energy” product) that has been proven to improve mental alertness is caffeine.  

The B Vitamins in a can of 5-Hour Energy (and their percentage of Recommended Daily Allowance) include: Vitamin B3 (150%), Vitamin B6 (2000%) and Vitamin B12 (8333%).  All of these vitamins are important for your metabolism and while not having enough can hurt you, it’s never been proven that having extra will help you – or increase your energy.  And while unlikely to be dangerous, an excess of Vitamin B3 (Niacin) can produce that uncomfortable flushing sensation that you experienced.   In addition, consuming 200mg or more of Vitamin B6 (about 5 bottles) could impair the normal functioning of your nerves and muscles.  

In terms of the “crash” that 5-Hour Energy supposedly avoids, we can only assume that they are referring to the fact that it contains no sugar.   Some people – especially those with insulin resistance like diabetics – do feel a “crash” sensation when their blood sugar level goes up and then down after consuming a large amount of sugar, so this may be a theoretical benefit compared to energy drinks with sugar in them.  But again, it’s never been actually tested so we don’t really know.   

Like almost all “energy” products, 5-Hour Energy is ultimately just a glorified caffeine delivery system.  And like all drugs, caffeine has side effects: jitteriness, increased heart rate, increased blood pressure and insomnia.  If you decide to try 5-hour Energy, the best we can say is never drink more than two bottles and don’t mix it with any other caffeine containing products.  If you need some quick energy for a late night of studying or driving, it probably won’t hurt you any more than a cup of coffee will.

Adam Brandeberry, Med IV (OSU COM)

John Vaughn, MD (OSU SHS)

 

Will my buddy make me fail a drug test?

Q: While I was at ComFest a few weeks ago I was around a lot of people who were smoking pot. I have a urine drug test coming up and I’m wondering if I might test positive.

A: The urine marijuana test detects a chemical called tetrahydrocannabinol (THC), which is the active drug in marijuana. THC is stored in body fat and excreted in the urine. For someone who smokes a single marijuana cigarette, THC metabolites are detectable for several days. For chronic marijuana smokers, the level of THC builds up in the body fat over time and is excreted for weeks after the last time they used the drug.  Urine drug tests are set with a high threshold to eliminate false positives (people that test positive but do not use the drug).

Traces of marijuana may be detectable in the urine for a day or two in someone who was around marijuana smoke, but if you didn’t personally smoke it, you likely have nothing to worry about.  Smelling marijuana smoke at an outside event is very unlikely to result in a positive test, but it’s probably a good idea to avoid enclosed areas where people are smoking, like cars and closed rooms.