Month: November 2009

What are these bumps in my beard?!

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photo: emedicine.com

Q: Help! What are these bumps in my beard?! 

A: Pseudofolliculitis barbae (“razor bumps” or “shave bumps”) is a fairly common problem, affecting 50-80% of African-American men and around 3% of Caucasian men who shave their facial hair. The cheeks and neck are the most common areas affected. The bumps can be itchy, painful, or just plain unsightly and scratching them can lead to bacterial infection and scarring.

Many people confuse this condition with acne but this is not the case. Pseudofolliculitis barbae typically occurs when curly facial hairs are shaved off (which makes them sharper and shorter) and then curl back in and pierce the skin, causing an inflammatory reaction.

Stopping shaving and allowing the hairs to grow out usually fixes the problem. For acutely inflamed bumps, it is best to stop shaving for at least one month – you can use an electric trimmer to keep the hairs short, but should let them get no shorter than ¼ inch. You can also relieve the inflammation by applying a warm compress for 10 minutes, 3 times a day and applying hydrocortisone cream (1%) afterwards. 

For men who are unwilling or unable to grow a beard, some tips to minimize symptoms when shaving include:

  • Allow hairs to grow to at least ¼ inch
  • Rinse face and apply warm water compress for a few minutes
  • Use a generous amount of a lubricating shave cream or gel (i.e. Easy Shave) and allow to sit for 5-10 minutes to soften hairs before shaving
  • Use only a very sharp razor and shave in the same direction as hair growth
  • After shaving, rinse face with water and apply cold water compress
  • Look for any embedded hairs and try to dislodge (don’t pluck!) with a sterile needle or tweezers

There are also topical medications that can be used to treat more severe symptoms. Tretinoin (Retin-A), Benzoyl Peroxide and Clindamycin have all been shown to reduce symptoms. The only definitive cure for pseudofolliculitis barbae is permanent removal of the hair follicle or laser hair removal. These can be expensive and painful solutions so may not be for everybody.

If your shaving bumps persist after trying some of the steps listed above, see your doctor to talk about treatment options.  The physicians at Student Health Services are always happy to help.

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

Muhammad Khan, MD (Ohio State Student Health Services)

 

Can concussions cause long term problems or even kill you?

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photo: insidesocal.com

Q: I’ve been hearing a lot about football players getting concussions lately. Is it true that concussions can cause lasting effects and even kill you?

Short A: Yep

Long A: “Concussion” is a traumatic brain injury which causes a temporary loss of neurologic function with or without loss of consciousness. These are common in contact sports like football and hockey, but also occur in soccer, skiing, baseball, and rugby. Signs and symptoms of concussion include: 

  • Confusion
  • Amnesia and disorientation
  • Visual disturbance
  • Dizziness and balance problems
  • Mood changes
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Fatigue
  • Headache

Some symptoms-headache and amnesia-occur within minutes of the injury and may continue for some time after. Other symptoms-anxiety, depression, confusion, sleep disturbance, even seizures-might not show up until days or weeks after the injury. You should be examined by a doctor if you sustain a head injury which results in a loss of consciousness and/or experience any of the above symptoms.

Most people with a single, mild concussion will recover fully without noticeable side effects. However, one concussion makes it easier to get a second, even with a less forceful injury. This is why doctors usually make your favorite star athletes sit out a few weeks after a head injury. The brain needs time to heal before it is put at risk. “Second impact syndrome,” a potentially fatal swelling of the brain, can occur if a second injury occurs too soon after the first.

It’s clear that severe traumatic brain injury can cause permanent neurologic deficits. Surprisingly, it appears that multiple small concussions can cause cumulative neurologic and cognitive deficits as well. There is an association with multiple “knock outs” and Alzheimer’s disease in boxers.

General treatments for concussion include rest and over-the-counter pain medication. Drink lots of water and abstain from alcohol. You should not return to contact sports until you are completely recovered, which is at least a week for a mild concussion. More severe concussions might mean sitting out a season, or even changing sports.

Of course, the best treatment is prevention. Wear a helmet. Protect your head. 

Adam Brandeberry, Med IV (Ohio State College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

How do I know if I have appendicitis?

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photo: about.com

Q: What is appendicitis? How do I know if I have it?

A: Appendicitis is a condition in which the appendix, a small finger-like tube that is attached to the colon, becomes infected. It is a relatively common disease that affects one in fifteen people. It is mostly seen in people aged 10-30.  We don’t really know what the appendix does, but we do know that people without an appendix lead perfectly normal lives and are not affected by its absence.

Appendicitis can manifest in many ways, but classically presents as pain around the belly button which increases and eventually shifts to the right lower side.  The pain can also be accompanied by fever, nausea, vomiting, or loss of appetite.  People with appendicitis classically have sharp abdominal pain that increases with movement or jarring. Another classic sign is “rebound tenderness”, which is sharp pain that occurs when compression is released quickly from the tender area. In other words, you tell your doctor where it hurts and she presses hard, releases, and winces when you scream.

Appendicitis can be caused by a blockage that allows bacteria to grow in the tubular structure.  It can also occur after a gastrointestinal infection, which causes the appendix to become inflamed. Sometimes appendicitis occurs spontaneously and a cause is never identified.

Sometimes, if left too long, the appendix swells up like a balloon and explodes, spilling the infectious goo into the entire abdominal cavity (bacterial peritonitis).  Sometimes an abdominal abscess forms.  In any event, the treatment for appendicitis is surgery: Get it out. Antibiotics are necessary for peritonitis or an abscess.

Fortunately, almost everybody recovers uneventfully from the surgery within a few weeks with a small scar and a good story. Because of the serious complications of appendicitis, it is important for anyone experiencing severe pain for more than a few hours, especially with a fever, nausea, and/or vomiting to be seen by a physician.

Adam Brandeberry, Med IV (Ohio State College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

Surviving the Holidays without packing on the pounds!

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supplementalscience.wordpress.com

Q: How can I survive the holiday season without packing on the pounds? 

A: We’ve all been there.  You go home for Thanksgiving with the best intentions of not overdoing it, then out come the cookies, cakes, cocktails (whatever your weakness may be) and you blow your diet every time. And it’s not just the overabundance of yummy food that does it; add the stress of traveling, being back home, dealing with family and suddenly we find ourselves stuffed like a Thanksgiving turkey!

The days between Thanksgiving and New Years can be dangerous for the most strong-willed of us.  Here are a few strategies to prevent packing on the holiday pounds and heading off those New Years resolutions:

  • Have a light snack before going to dinner.  Fresh fruit, skim milk, a small salad – any of these will fill you up just enough to stop you from overloading your plate when you sit down to a big holiday dinner. If you starve yourself beforehand, you’ll eat much more food when dinnertime finally comes.
  • Watch your portion sizes.  Don’t load up your plate with huge portions; it is well known that people eat more than they intend to when confronted with large portions. A couple of good rules of thumb: one serving of meat is about the size of your palm or a deck of cards.  A serving of potatoes is about the size of a racquet ball.  A whole turkey is not one portion.  Neither is one pie.
  • Try not to go back for seconds.  Eat slowly and savor what you have on your plate so you can avoid that overfull feeling at the end of the meal.
  • Drink plenty of water.  This will also keep you feeling fuller and make you less likely to overeat.
  • Watch your alcohol intake.  This is a tough time of year for overdoing it with the booze as well – meeting up with old friends, eggnog at holiday parties, the stress of being around family.  Don’t forget that alcohol is loaded with calories and can pack an especially big punch when combined with heavy holiday meals.
  • Don’t forget to exercise.  Even if it means dragging yourself out in the cold for a walk around the old neighborhood, don’t let being home throw you off of your workout schedule.

If you’re doing the cooking this holiday season, there are many strategies to cut down the calories. Here are just a few:

  • Try cooking with skim milk or low fat yogurt instead of whole milk or half & half – chances are nobody will notice the difference.
  • Cut out half the fat in baked goods and replace it with applesauce or smashed banana – they will stay moist and lose much of the fat.
  • Put out fresh fruit & veggies instead of the cheese platter – you’ll cut out a ton of salt and fat.

For more tips, check out the CDC, Mayo Clinic and WebMD 

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

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

You wanna stick what!? Where!?

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photo: tbdhu.com

Q:  I want to get tested for STI’s, but my buddy told me that you’ll jam a huge swab up my penis!  Is that true!? 

A:  Fear not, my friend!  Thanks to the wonders of modern technology, life is much better these days.  The worst we’ll do to you now is make you pee in a cup.

STI (sexually transmitted infection) testing for men at the Student Health Center consists of three things:

  • A physical exam to look for infections such as genital warts (HPV), Herpes Simplex and Molluscum Contagiosum
  • A blood test to check for HIV (the virus that causes AIDS) and Syphilis
  • A urine test to check for Gonorrhea (GC) and Chlamydia (CT)

It’s that last part that you – and thousands of other guys – are worried about.  We used to check for Gonorrhea and Chlamydia by inserting a cotton swab into your urethra and twirling it around 5-10 times.  While you’ll get no sympathy from the ladies, who will rightfully tell you that they have to put up with a lot worse every year at their annual exam, no one would blame you for wanting to avoid this penile Roto-Rooter treatment.

Hence, the urine test.  It’s slightly more sensitive for picking up Chlamydia (97.9% vs. 95.9% for the swab) and slightly less sensitive for picking up Gonorrhea (98.5% vs. 99.1% for the swab) but as you can see, both tests are very good and these differences are not statistically significant.

The urine GC/CT test is obviously much easier on you, BUT there are some important stipulations you have to follow in order to produce accurate results.

You should not urinate for at least one hour before we collect the urine sample.  Peeing flushes the Chlamydia and Gonorrhea out of the urethra and we want the concentration of those little guys to be as high as possible.  However, the test is based on DNA amplification so even a minute amount will be detected. 

We usually get the results back in 72 hours, but many tests come back sooner.  We used to send them to the Mayo Clinic, but now they’re done at OSU East so the turn-around time is a lot quicker. 

In the last month we’ve had 48 men come in for testing and 1 tested positive for Chlamydia.  This should tell you two important things: a lot of other guys are being responsible and getting tested, and these infections are floating around on campus. 

If you’re sexually active, do the right thing for yourself and your partners – come in and get checked out!  With no more swabs to fear, you’ve got no more excuses!

David Gray, Lead Laboratory Technologist (Ohio State Student Health Services)

Does the HPV vaccine interfere with birth control medication?

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photo: timeinc.net

Q: Does the HPV vaccine counteract with birth control medication?

A: If you’re asking if the HPV vaccine makes your birth control less effective at preventing pregnancy, the answer is no. 

If you’re asking if there are any special risks of receiving the HPV vaccine while taking birth control, the answer is: highly unlikely, although this is a matter of some debate in the medical community at the moment.

More than 26 million doses of the HPV vaccine have been given in the United States so far.  In a recent report, the most common side effects were: pain at the injection site, headache, fever and fainting (which is why your doctor has you wait in the office for 15-20 minutes after a shot). These are common side effects with any vaccination.

There have been a lot of frightening reports in the news media that the vaccine can cause blood clots, but there is currently no evidence that the vaccine in combination birth control is unsafe.

According to a recent review in the Journal of the American Medical Association, out of 23 million doses given so far, there were 56 reports of blood clots, 31 of which had sufficient information for clinical review.  Of the 31 people who had a blood clot, 90% had a condition that put them at increased risk for blood clots before they ever received the vaccine: birth control use, family history of blood clots, smoking, being overweight or inactive.  Hormonal birth control itself is a well known risk factor for blood clot formation, so there is really no way to know whether receiving the vaccine had anything to do with those people developing blood clots.  What we do know is that the HPV vaccine provides protection against the viruses that cause 70% of cervical cancers worldwide.

The CDC and FDA are continuing to monitor the safety data as more people receive the vaccine.  If you have questions or concerns you can always schedule an appointment with one of the providers at Student Health Women’s Services.

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

Ryo Choi-Pearson, MD (Ohio State Student Health Services)

Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009 Aug 19;302(7):795-6., 

The “Magic Pill” and the Common Cold

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photo: ehow.com

Lest you think I’m against alternative medicine (see previous post) I’m not. I am wholeheartedly for any effective, safe treatment. Evidence about alternative therapies can be hard to find, sadly. Nevertheless, I made a list of stuff I’ve been asked about for treating colds over the last two weeks. I thought I’d lay out the fact and fiction about these popular treatments.

First, some standard, boring doctor disclaimers:

  1. Alternative products are food to the Food and Drug Administration and aren’t tested like drugs.
  2. As food, there is no standardized product. Is a burger from White Castle the same as McDonald’s? Wendy’s? No. When you test Echinacea, are all products the same? Purpurea or Pallida? In what dose? Is Nature Made’s product the same as Kroger’s? Nobody knows.
  3. Over 200 viruses cause the common cold. What works against rhinovirus might not against adenoviruses. This makes testing (pharmacologic or otherwise) very tricky.

Vitamin C:

Prevention: Not helpful, even in high doses.

Cure: Mixed. In high doses some studies (not all) suggest that the length of the cold might be shortened by a day or so. 

Zinc:

Prevention: Not helpful.

Cure: Don’t use the nasal spray. It might destroy your sense of smell forever. If you can stand the metallic, astringent taste of zinc lozenges, you’ll need to start using them within 24-48 hours of your symptoms and use one every 2-3 hours to possibly decrease a little the severity and duration of your already short, self-limited illness.

Echinacea:

Prevention: CONSISTENTLY proven to be useless.

Cure: Perhaps a 10-30% decrease in severity of symptoms.  However, there are plenty of studies which show no benefit whatsoever. Furthermore, Echinacea is related to ragweed. If you suffer from hay fever in the fall you should avoid Echinacea altogether.

Garlic:

Prevention: One very small study demonstrated one less cold a season.

Cure: No evidence.

Ginseng, American and Asian

Prevention: Mixed. There are a couple of trials demonstrating a decrease in the number of respiratory infections in a season, but not enough good evidence yet to recommend it. Ginseng interacts with a lot of commonly used drugs for diabetes, pain, mental health and blood clots, making safety potentially an issue.

Cure: No evidence.

Probiotics:

Prevention: In little kids, there are small studies demonstrating a moderate decrease in the number of respiratory infections. No good data on adults.

Cure: No data.

Things that DON’T work:

Airborne, Vitamin E, Oscillococcinum, goldenseal, bee propolis, boneset, wild indigo, peppermint, chamomile, meadowsweet, or linden flowers.

Lest you cry in your deadly nightshade, there is some hopeful news on the horizon. Andrographis, “Indian Echinacea” shows some promise in prevention and treatment. There’s not enough data yet on safety to recommend it. Given how much I hate being snotty, though, I will follow this closely. Maybe I’ll find a clinical trial and can offer my nose up to science. In the meantime I’m going to wash my hands, a proven way of preventing infection.

Victoria Rentel, MD (Ohio State University Student Health Services)

Prescribers Letter Vol 9 #29: Natural Medicines and the Clinical Management of Colds and Flu

Free walk-in HIV testing available tonight!

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photo: scrapetv.com

There will be free, anonymous walk-in HIV testing tonight in Derby Hall from 5-8pm for any Ohio State student who would like to be tested.  This event is sponsored by the Student Wellness Center and they will be using the rapid oral swab test so no needles and you’ll get your results right away!

In addition, Ohio State students have planned many exciting events for World AIDS Day and we strongly encourage you to check them out!  

Keep the Promise with Cleve Jones – Monday, 30 November at 7pm (doors open at 6:30pm), Room 100 Independence Hall.  The event is free and tickets are not needed.

Sexual wellness presentation – Tuesday, 1 December, 6:30-7:30pm, room 180 Hagerty Hall. Free.

Honors and Scholars Fireside Chat – Panel of infected and affected individuals.  Wednesday, 2 December, 5:30-7pm, Kuhn’s Honors and Scholars House.  Free.

Walk in HIV antibody testing – Thursday, 3 December, 3-7pm, Frank W. Hale Center.  Free.

Can my fatigue really be caused by depression?

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photo: www.scottcounseling.com

Q: Someone told me that depression could make me feel tired. Is that possible?

A: Absolutely. But let me just start out by saying that there are many medical conditions that can cause a person to feel tired all the time and even mimic the other symptoms of depression, so it is extremely important to see your health care provider if you are experiencing fatigue or other signs of depression.

Depression is one of the most common psychiatric conditions that doctors encounter, showing up in at least 20% of women and 12% of men during their lifetimes!  Fatigue or loss of energy is so common in depression that it is actually included in the diagnostic criteria. Other symptoms used to diagnose depression include:

  • loss of interest or pleasure in previously enjoyed activities
  • significant weight loss or gain
  • trouble sleeping or sleeping too much
  • feelings of worthlessness or guilt
  • inability to concentrate or focus
  • recurrent thoughts of death or suicide

If you are having any of these symptoms, there are many resources available to you on campus!

The providers at Student Health Services manage many patients with anxiety and depression from a medical standpoint. While the exact cause of depression is not yet known, there are many medications that act on neurotransmitters in the brain that are effective in treating it. These medications typically take a few weeks to become effective in alleviating symptoms.

Counseling & Consultation Service (CCS) has social workers, counselors, psychologists and psychiatrists to manage depression from a psychotherapy as well as a medical standpoint.  All enrolled students are eligible for 10 free counseling sessions per academic year.  If you have the Comprehensive Student Health Insurance Plan (SHIP), you may be eligible for additional counseling sessions with a $15 co-pay per session.  If you do not have SHIP and need additional counseling, CCS will assist you in finding services in Columbus.

Counseling is extremely important because it has been shown that medical therapy in combination with psychotherapy is much more effective in treating depression symptoms than either of these treatments alone.

Again, be sure to see a health care provider if you are experiencing fatigue or other signs of depression.

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

Muhammad Khan, MD (Ohio State University Student Health Services)

New support fund for OSU students who have experienced sexual violence

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A Sexual Violence Assistance Fund has been created by the Office of Student Life in partnership with Undergraduate Student Government (USG).  It provides financial assistance for students who have experienced sexual assault, intimate partner abuse and/or stalking.

Current Ohio State students can apply for up to $500 to assist with expenses such as replacement items, uncovered and documented medical expenses, emergency housing and other associated costs.

This fund was created through the initiative of USG and the student group Women and Allies Rising in Resistance (WARR), in partnership with the Office of Student Life. For more information and to learn how to apply, contact the Student Wellness Center’s Sexual Violence and Education Support team by going to their website or calling 614-292-4527

Nancy Radcliffe, (Ohio State University Student Wellness Center)