In July, we talked about a contest being sponsored by the US Department of Health and Human Services, asking for submissions for a TV Public Service Announcement related to the H1N1 flu. Over 200 nationwide entries were submitted. Now, this is your chance to vote on the winner from the ten finalists selected. Take a look here. Vote on your choice, then stop back here, and tell us what you think of these entries!
Have a healthy return to campus!
Roger Miller, MD for BuckMD
Q: I’m currently on the pill. Are there other good options for birth control?
A: There are lots of birth control options out there, each with their own pros and cons. Here is a quick primer on all of them. Remember, this is a general discussion – you can always make an appointment with Student Health Women’s Services to determine which option is best for you.
Oral Contraceptive Pills (OCP’s, “the Pill”) – These work by preventing ovulation as well as thickening cervical mucus to prevent sperm penetration. There are so many different birth control pills on the market that it would be impossible to list them all here, but they all fall into 2 main categories: combination estrogen/progesterone pills and progesterone only pills.
The pill is easy to use and allows for spontaneity of sex – you don’t have to fish around your purse for one when the mood strikes. The failure rate is very low; with perfect use, only 1-2% of users become pregnant per year (although the failure rate is slightly higher in “real life”). The major down side with the pill is that they do not provide protection from STIs, and they can cause side effects such as nausea, bloating, weight gain and increased risk of blood clots, especially in smokers and women over 35. Also, for some people it’s hard to remember to take a pill at the same time every day.
Vaginal ring – Sold under the brand name NuvaRing, the vaginal ring releases the same hormones as one of the combination pills. The ring is typically left in for 3-4 weeks and then taken out for one week. The pros: it’s good for people who tend to forget to take their pills. The cons: it can cause the same side effects as the pill; you and/or your partner might feel it during sex; it could be expelled unintentionally; and there is the potential “ick” factor of having to insert and remove the ring yourself.
Injectable Contraceptives (“Depo,” “the shot”) – Depo-Provera is an injection that prevents pregnancy for 3 months. It works like other hormonal contraceptives by preventing ovulation and thickening cervical mucus. With Depo-Provera, you only have to remember to get a shot once every 3 months instead of taking a pill every day and it has one of the lowest failure rates: only 0.3% of people become pregnant in the first year if using it correctly. It can cause side effects such as irregular menstrual bleeding, weight gain and breast tenderness and some women may not return to regular ovulation for 6-18 months after discontinuing Depo-Provera, so if you’re thinking about getting pregnant in the near future, this might not be the method for you.
IUD – The IUD is one of the most widely used forms of birth control in the world, but for various reasons it’s gotten a bad rap here in the United States. The IUD is a small T-shaped device which contains either copper (Paragard) or a hormone (Mirena). It is inserted into the uterus by your health care provider, and prevents pregnancy by making the uterus a hostile environment for sperm (the exact mechanism isn’t entirely understood). The IUD is an effective, long term form of birth control; Paragard works for 10 yrs and Mirena for 5 yrs and the failure rate is less than 1%.
The downside to the IUD is that the initial cost is high (although it works out to be a good deal if you compare it to the cost of 10 years worth of pills or shots) and there is a slightly higher risk of pelvic inflammatory disease (PID) if a woman has an STI at the time of insertion. However, modern IUD’s are safe and effective and therefore can be used by most sexually active women who receive proper STI screening tests. The IUD can cause menstrual irregularities and an increased risk of spontaneous abortion in women who become pregnant with the IUD in place.
Male condom – The old standby! Condoms are cheap, plentiful, effective and easy to use. With perfect use they are 98% effective in preventing pregnancy (but again, in real life this is more like 85%). The biggest benefit of condoms is that for STI prevention, the male condom is still #1! The downside is that they can interfere with the spontaneity of sex, they can tear, people with latex sensitivity can’t use them, and some partners are reluctant to use them. Ladies, if your partner is unwilling to wear a condom for your protection, maybe it’s time to rethink whether you really want to be having sex with him!
Female condom – The female condom is a polyurethane sheath placed inside the vagina. It has the potential to protect against STIs, but not as well as the male condom. They do allow you to take protection into your own hands when your partner refuses to use a condom but the downside is that they are more expensive than male condoms, have a higher failure rate than male condoms (21% of users typically become pregnant within one year of use) and the polyurethane version can make some weird noises during sex.
The withdrawal method (“Coitus Interruptus”). While it doesn’t cost you a dime, the withdrawal method provides no protection against STI’s and has a failure rate of 15-25%! And it’s not just because guys tend to stay in when it’s time to get out – during sex, a sperm-containing fluid will often leak out of the penis before the man actually ejaculates and this can lead to pregnancy.
Rhythm method – This is where the couple plans sex around the woman’s cycle and abstains when she is most likely to be fertile. I like to quote my 7th grade Sex Ed teacher about this one: What do you call people who use the rhythm method? Parents!
Abstinence – The most effective birth control method ever invented – it’s totally free, has no side effects and has a guaranteed 100% success rate in preventing pregnancy and STI’s! When in doubt, this is always your best bet. But when the time is right, make sure you know about the other options!
Angela Walker, Med IV (OSU COM)
Ryo Choi-Pearson, MD (OSU SHS)
Students, the Journal of Adolescent Health has been watching you while you sleep… and they don’t like what they see.
Why? Well, according to the results of a National Sleep Foundation study published in June 20091, you have some serious problems. Researchers concluded that over 60% of you think your sleep quality stinks, and an ‘alarming’ number of you use medications (both prescription and over-the-counter) to help you fall asleep or stay awake. Not surprisingly, they found that emotional and academic stress was most predictive of sleep disturbance.
Why should you care? Well, skipping a little sleep now and then probably won’t kill you. If you’re operating heavy machinery or driving a car or flying a plane, well, you could be a danger to yourself. (Or to me… please sleep.) Chronic sleep deprivation is a major player in mood disorders, motor vehicle accidents, and occupational injuries.
The occasional use of a Tylenol PM probably will do you no harm, but consistent, regular use of any medication for sleep (or for wakefulness) can lead to problems. Some issues, like rebound insomnia, are pesky and inconvenient. Other issues, like drug dependency, are more serious. I’m not kidding! The vast majority of adolescents entering rehab programs in a 2005 University of Arizona study2 reported using psychoactive drugs to control sleep or combat fatigue.
Now for the boring, “Okay, Mom” part. What are some effective and healthy ways to improve your sleep that don’t involve taking a pill?
Speaking of naps, I might just feel one coming on…
Victoria Rentel MD (OSU SHS)
Sleep Patterns and Predictors of Disturbed Sleep in a Large Population of College Students
Hannah G. Lund, Brian D. Reider, Annie B. Whiting, J. Roxanne Prichard
Journal of Adolescent Health – 03 August 2009
Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness
Richard R. Bootzin, Sally J. Stevens
Clinical Psychology Review, Volume 25, Issue 5, Insomnia and Behavioral Sleep Medicine, July 2005
Q: Am I really going to gain 15 pounds during my freshman year!?
A: Ah, the infamous “freshman 15” – every college student’s nightmare, right? 15 pounds is a little bit of an exaggeration, but there actually is some truth to that urban legend.
A recent study showed that while the average weight gain during the first semester (obviously, the study wasn’t done here) of college is only about 3.3 pounds, about 1 in 4 freshmen actually gain around 5% of their initial body weight – about 10 pounds!
So why does this happen? Moving away from home and adjusting to college life is a very stressful transition. And just when all of this stress hits you, you’re thrown into a world where you’re surrounded by fast food restaurants, late night study sessions and parties. So you don’t have time (or a kitchen) to cook for yourself; you don’t have your parents making you eat your vegetables; you’re stressed out from adjusting to college life; you’re sleep deprived because of late nights and early classes; and you have 24-hour instant access to tasty, high-calorie snacks. It’s practically impossible to not gain weight in this situation!
So how can you prevent it? Try to stick to healthier choices in the dining halls; even a salad can pack a big punch if it’s topped with high fat toppings and dressing. Load up on whole grains, fruits, vegetables, and low fat dairy instead of burgers and fries. Watch your portion sizes and skip the seconds. Keeps late night snacking to a minimum; that pizza might sound good when you’re pulling an all-nighter but it can really pack on the pounds. And don’t forget that alcohol has calories! Even a light beer can have 100-125 calories so a couple of big weekends can do a lot of damage.
Make sure you’re getting 7-8 hours of sleep a night – yes, even during finals week – and don’t forget to exercise. Not only will a good workout relieve stress, it will keep off the weight as well. Remember, the RPAC is your friend, but only if you make it past the coffee shop and into the exercise area. You’re already paying the recreational fee so you might as well use it!
Now is the time to start healthy habits that will last a lifetime!
Angela Walker, Med IV (OSU COM)
John A. Vaughn, MD (OSU SHS)
Q: My boyfriend won’t stop snoring. It is really interfering with our relationship. How can I get him to stop?
A: Snoring is produced by vibration of the soft tissues of the upper airway during sleep. The muscles of our upper airway relax when we sleep, so when we inhale, the same amount of air has to travel through a smaller, ‘floppier’ passageway – hence the honk. Habitual snoring is common, occurring in almost 50% of guys and 25% of gals. Anything that can cause congestion in the nose or throat can make it worse; that’s why you notice it more when you have allergies or a cold. Snoring is generally harmless, besides being really annoying for bed partners or roommates.
However, there is a potentially harmful condition associated with snoring: obstructive sleep apnea (OSA). This occurs when the airway collapses completely. Now instead of just snoring, the person actually stops breathing! Eventually, the low oxygen levels sets off an internal alarm and the person will awaken with even louder snores and a sensation of choking, gasping, or smothering. This cycle will repeat itself over and over during the night and often the person never wakes up fully enough to know what’s going on; they’ll just notice that they are always tired despite getting a full night’s sleep, or have headaches in the morning. OSA is more common in people who are overweight and/or have short, thick necks. If you have any of the above symptoms, or your sleep partner tells you that you have episodes of not breathing during sleep, you should see your primary health care provider for evaluation. If left untreated, OSA can put you at serious risk for heart and lung problems in the future.
Here are a few things that can be done to improve snoring:
*Weight loss – People who snore that are overweight tend to snore less when they lose weight through diet and exercise. This is also the mainstay of treatment for OSA.
Avoiding tobacco and alcohol – Smoking and drinking alcohol (especially close to bedtime) are both associated with an increased risk of snoring. We’re not exactly sure how smoking makes snoring worse, but drinking alcohol 3-4 hours before sleep tends to relax the soft palate even more.
Sleeping on your side – People who sleep on their back are more likely to snore. Sleeping on your side will improve snoring, but changing sleeping position is very difficult. One method that may work involves fixing a tennis ball to the back of a snug shirt so that it is uncomfortable to sleep on the back.
Decongestants – the nasal passage is the smallest part of the upper airway, so for people who have nasal congestion from allergies or colds, pills or nasal sprays that reduce nasal congestion can help snoring. These don’t help as much if the problem is due to soft palate relaxation.
External nasal dilators – those little plastic strips that you stick on the bridge of your nose can also help snoring. Again, these are more helpful if nasal congestion is the major problem.
Adam Brandeberry, Med IV (OSUCOM)
John A. Vaughn, MD (OSU SHS)
Last month, the US Food and Drug Administration approved a simpler emergency contraceptive (EC) for purchase in pharmacies. Plan BTM has been available for several years and consisted of two pills that were taken 12 hours apart. The new version, Plan B One-StepTM is just one tablet, and is equally effective. Women over age 17 can buy either version at a pharmacy without a prescription.
Another version, PrevenTM, is available only by prescription.
All EC pills should be used within 72 hours of unprotected vaginal intercourse, and the sooner the better. These medicines are not recommended for use as a routine contraceptive, as they are less effective than other methods. EC medicines work by either preventing release of an egg from the woman’s ovary, preventing the egg and sperm from getting together, or preventing the fertilized egg from attaching to the wall of the uterus.
EC’s do not protect against sexually transmitted infections, and do not terminate pregnancies that are already attached (implanted in the uterus). If you have questions about EC, see your health-care provider or ask a pharmacist. As always, make sure you read the package warnings and instructions carefully for all your medicines. Our Student Health pharmacy staff can assist you.
Emergency contraception is frequently needed in situations that can make a woman (or couple) very anxious. Having this medicine available upon request in most pharmacies makes it much more convenient for use within the proper time limit. But even though you can get the medicine without seeing your health-care provider you should not hesitate to contact them if you need help dealing with your fears or other concerns.
Roger Miller, MD for BuckMD
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.
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)
True or False: Mosquitoes find some people more ‘tasty’ than others.
A: True!
Female mosquitoes need our blood to develop fertile eggs. When they bite us, they deposit a tiny bit of saliva into our skin. This saliva contains proteins that cause an allergic reaction. Individuals have different levels of reaction to these proteins; that’s why some people don’t seem all that bothered by the bites and others – like me – itch like crazy.
Researchers have discovered that mosquitoes actually do find some people tastier than others. They haven’t yet discovered exactly what attracts them, but they do know that it involves genetics, chemicals on our skin, and carbon dioxide. About 1 in 10 of us has just the right combination of those ingredients to whet the little buggers’ appetites!
So how do we keep them away?
There are a few ways you can protect yourself. Wearing long sleeves and pants definitely help, but I know that can be very appealing on a warm, humid summer night. Fortunately there are many useful mosquito repellants on the market such as DEET, picaridin (Cutter Advanced), and metofluthrin (DeckMate). Some people swear by natural oils such as citronella, eucalyptus, cedar, peppermint, lemongrass, and geranium. People used to believe that Avon Skin-So-Soft repels mosquitoes, but turns out it only keeps them at bay for about 10 minutes.
So what can you do once you’re bitten?
Topical steroids such as hydrocortisone cream (generic, Cort-Aid) can help with the inflammation and itching. Calamine lotion or baking soda paste (3 teaspoons baking soda and 1 teaspoon water) applied several times a day may also help. For more extreme itching, an over-the-counter antihistamine pill such as diphenhydramine (generic, Benadryl) or loratadine (generic, Claritin) is often very helpful. Diphenhydramine can make you very drowsy, so it’s useful at bedtime when the itching is keeping you awake. Loratadine is non-drowsy so is better for daytime use.
Angela Walker, Med IV (OSU COM)
John A. Vaughn, MD (OSU SHS)
The US Centers for Disease Control and Prevention (CDC) has posted information specifically related to the health of college students, as colleges nationwide prepared to welcome you all back this fall. Take a look at their information at http://www.cdc.gov/Features/CollegeHealth/
Good Health!
Roger Miller, MD for BuckMD
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)