Month: December 2009

Why am I only allowed to ask you about one problem during my visit?

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photo: getty images

Q: When I called to make an appointment, the nurse told me I could only ask you about one problem at my visit.  What’s up with that?

A: OK… Here’s the deal.  For every appointment I must:

  • Review your history. If I’ve never seen you before, this means complete past medical history, surgical history, medications, drug allergies, family history, smoking, etc.
  • Review why you’re here today, including your current symptoms, when they started, what you’ve done for them, what makes them better or worse, how they’ve changed since they started, etc.
  • Perform a physical examination
  • Order any necessary diagnostic testing (labs, x-rays, etc.)
  • Use my amazing medical superpowers to figure out what is going on; explain to you what my plan is to remedy it; and answer any questions you might have
  • Order prescriptions
  • Type every single word into our occasionally truculent electronic health record and assign a diagnostic code that tells your insurance company why you were here. Then I assign another code for the level of service provided, which (theoretically) determines how much SHS will be paid for providing those services.
  • Clean my room for the next patient.

For all of that, I have 20 minutes. 20 minutes!  For many routine situations – a sore throat, a simple urinary tract infection – that’s actually pretty doable.  And if your other question is as simple as, “While I’m here, can I get a refill on my allergy medication?” then fine, no sweat. 

But if you say, “I also want to ask you about this chest pain I’ve had for a while… or my stomach has been killing me for 2 weeks… or I get dizzy every time I work out” then the 20-minute time limit becomes impossible. These symptoms could be anything from simple stress to a life-threatening condition and it takes me a lot of time to figure it out. 

Which isn’t to say that I don’t want to figure it out. I do! But the clock is ticking, and there are other sick students waiting to be seen. If you tell our schedulers exactly why you need an appointment, they’ll do their best to help you, either by scheduling extra time or by working with you to figure out what the most pressing issue is today.  At Student Health Services we really do want to help, but we walk a tightrope. We are happy to see you for whatever you need, but there are thousands of you and only a few of us and only so many hours in the day.

John A. Vaughn, MD (OSU SHS)

What are the negative side effects from moderate alcohol usage?

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Q: What are the negative side effects from moderate alcohol usage?

(Editor’s note: this is the very first question submitted to our new BuckMD question/comment box in the lobby of the Student Health Services pharmacy!  Jotting questions down on scraps of paper isn’t exactly high tech, but we figured knowing that you’ll be completely anonymous might make it easier to ask some things that you always wanted to know but were afraid to ask.  Please swing by the SHS pharmacy and put the comment box to good use!  Now on to your question…)

A: First let’s define moderate alcohol use.  No more than 1 drink per day for women and no more than 2 drinks per day for men.  A “drink” is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Drinking in moderation is typically low-risk unless you are:

  • under 21 years of age
  • pregnant or considering pregnancy
  • unable to limit drinking to low levels
  • planning to drive, operate machinery, or take part in other activities that require attention, skill, or coordination
  • taking medication that interacts with alcohol (for example, Tylenol)
  • alcohol dependent or recovering from alcoholism
  • being treated for a medical condition which is worsened by alcohol use, like diabetes

Negative side effects from alcohol use tend to occur more with heavy or binge drinking, which is defined as 5 or more drinks on a single occasion for men or 4 or more drinks for women.  Examples of negative effects from binge drinking include:

  • unintentional injuries (car crashes, falls, burns, drowning… jumping into mirror lake)
  • intentional injuries (firearm injuries, sexual assault, domestic violence)
  • alcohol poisoning
  • sexually transmitted infections
  • unintended pregnancy
  • Giving birth to children with Fetal Alcohol Spectrum Disorders
  • high blood pressure, stroke, and other cardiovascular diseases
  • liver disease
  • neurological damage
  • sexual dysfunction

For more information you can check out the CDC and NIH websites, or stop in and talk to us at the Student Wellness Center. 

Amanda Blake, MPH (OSU Student Wellness Center)

John A. Vaughn, MD (OSU SHS)

Medical Mythbusters – Poisonous Poinsettas!

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poinsettapictures.com

True or False: Poinsettias are poisonous to kids and pets.

FALSE!!

This is one of those holiday myths that just refuses to die. It supposedly began back in 1919 when a 2-year-old boy was found dead after eating a poinsettia leaf – it was just assumed that the plant had killed him. However, since that time, many studies have shown that kids (and pets) that are exposed to poinsettia plants do just fine.

The sap of the plant is mildly irritating but according to POISINDEX (the resource used by Poison Control Centers) a 50-pound kiddo would have to eat about 500 leaves to have any toxic effects.  And while I myself have never dined on a poinsettia salad, the leaves are reportedly not very tasty, so it’s highly unlikely that kids or even hyperactive pets would be willing to eat that many! The most common side effects that have been reported from poinsettia ingestions are upset stomach and vomiting, and some people with serious latex allergies have had a skin reaction after touching the leaves.

If you or any of your relatives happen to nibble on a poinsettia (or any other plant for that matter) and you are concerned, you can always call your Poison Control Center at 1-800-222-1222 to speak with an expert.  But in the mean time, go ahead and get decorating for the holidays – with your crazy Uncle Louie coming over to celebrate with his famous High Octane Egg Nog, the plants are the least of your worries!   

Angela Walker, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

Does the birth control patch have cardiovascular side effects?

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Q: Does the birth control patch have cardiovascular side effects like abnormal or fast heart rates?

A: Not really – or at least no more than oral contraceptive pills.  The patch does deliver more estrogen than oral contraceptive pills, so you tend to get more side effects like breast tenderness and nausea with the patch.  These tend to go away after a few months.

Reasons not to use the patch are the same as those for other forms of birth control that contain the hormones estrogen and progestin: history of blood clots, a tumor that responds to estrogen (like some forms of breast cancer) and liver disease (like hepatitis or cirrhosis).  And obviously, women who have a history of sensitive skin or skin diseases like eczema or psoriasis would probably want to avoid using the patch as well.

Research has shown that the most common side effects of the patch (other than unscheduled bleeding) are:

  • Breast symptoms (22%)
  • Headache (21%
  • Application site reactions (17%)
  • Nausea (17%)
  • Upper respiratory tract infection (10%)
  • Painful periods (10%)

Fewer than 2% of the women in these studies felt that these side effects were bad enough to stop using the patch[1].

The Women’s Services clinical staff at Student Health Services can help you manage all forms of birth control, including the patch.  You can make an appointment to discuss your birth control questions with them any time!

John A. Vaughn, MD (OSU SHS)

[1] UpToDate Online 17.3

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)

Eating Right – What You Need to Know

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Demanding schedules and lack of access to certain foods are the biggest barriers to a healthy lifestyle for students.  If you’re ready to start making changes, be sure you are prepared with the facts.  Here are some tips to get you started: 

  • Plan to have three meals each day.  Knowing what you will be eating will help prevent grabbing something less healthy at the last minute.  
  • Do not skip meals.  Eating less may seem like a good strategy to lose weight, but it does not work.  Your body requires a certain amount of nutrients and energy and skipping meals will lessen your chances of getting them.  It has also been shown that individuals who consume one large meal, or take in most of their calories in the evening have more difficulty managing their weight.
  • Do not be afraid to enjoy healthy snacks.  Not only can snacks provide you nutrients and energy, they also are important in curbing that ravenous hunger you may have before meal time.  Store healthy snacks in your bag or car.
  • Location, Location, Location.  Chose one place to consume your foods.  Eating while studying, working, watching TV, or using the computer tends to drive us to eat larger portions and choose less nutritious and higher calorie foods.
  • Know when you have had enough to eat.  The sensation of feeling “full” is delayed, and we often overeat by the time we get the signal from our brain to stop.  To prevent this, slow down your eating.
  • Balance your meals with appropriate portions.  One simple method to achieve this is to have ½ your plate vegetables, ¼ your plate grains, ¼ your plate lean protein.
  • Start your meal off with nutrient dense, low calorie foods.  Examples are a piece of fruit, vegetables, and salads with salad dressings on the side.  Then move on to your main course or side dishes.
  • Whenever possible choose fruits, vegetables, beans, peas, and whole grains.  Choosing these higher fiber foods may be beneficial in regulating blood sugar, lowering cholesterol, and controlling appetite.
  • Avoid drinking calories.  With the exception of milk, calories from beverages are not needed.  Avoid regular sodas, specialty coffees, smoothies, juices, sports drinks, and “energy” drinks.  Good alternatives are diet sodas, unsweetened beverages, or lower calorie sports drinks.
  • If you chose to drink alcohol, do so in moderation.  A typical alcoholic beverage can be very dense in calories.  To burn off the calories in one 12-ounce can of a standard light beer, a 150-pound person would have to bike 10 miles per hour for 25 minutes.

The Nutrition Therapy department at the Wilce Student Health Center is here to help.  If you are not seeing your desired weight-loss results; if you are frustrated or confused about healthy food choices; or if you feel you don’t know the correct portion sizes for food servings, make an appointment to see one of our Registered Dieticians.

Greg Avellana RD, LD, CDE (OSU SHS)

Depo Provera: A primer

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about.com

Q: Does Depo-Provera lead to permanent infertility? 

Short A: Nope.

Long A:  Depo Provera (“Depo,” “the Shot”) is one of a family of progesterone-only contraceptive products. It is an injectable product-a shot. It is a really effective and convenient way to prevent pregnancy; you only have to think about it 4 times a year and in clinical studies, less than 1% of women get pregnant on it.  (In real life, about 5% get pregnant – probably because in real-life some women didn’t get their shot on time.)

There are a couple of downsides to Depo Provera. It is, as noted, a shot. Ouch. It can be expensive if your insurance doesn’t cover contraception. (On the other hand, a baby is a whole lot more expensive!) Like most hormonal contraceptive products (say that three times fast), some women will feel a little bit pregnant-bloated, queasy, weight changes, headachy-on Depo, especially at first. Some women gain up to 5-10 pounds on Depo, although most gain only 3-5 pounds. (While 3-5 pounds ain’t nothin’ it’s still a whole lot less than a baby!)  It can interfere with bone mineralization, making osteoporosis and fractures slightly more likely down the road.

There are some big upsides, though, too. Periods often stop, although for the first few weeks/months of use there can be some irregular spotting. (Are all you men out there going, yuck, gross, icky?)  The incidence of pelvic inflammatory disease, endometrial hyperplasia, endometrial cancer, and endometriosis pain are all decreased.  And there are also specific medical conditions which benefit from Depo-Provera:

  • Because the metabolism of Depo Provera doesn’t change with anti-seizure medicine, it’s a good choice for women with seizure disorders.
  • Women with sickle cell disease appear to have fewer pain crises while on depo. 
  • Peri-menopausal vasomotor symptoms (the dreaded “hot flashes“) tend to be better compared to birth control that has estrogen in it.    

Depo Provera does not appear to increase the risk of liver, breast, or ovarian cancers. It probably does not affect blood pressure or coagulation, making it sometimes an okay choice for women who have had high blood pressure, heart disease, or a history of blood clots. It unfortunately does not protect women from sexually transmitted infections so you still need to get a condom on your partner.

So to finally answer your question, Depo Provera does not permanently impair your ability to get pregnant. It can, though, take a few months off the medication (sometimes up to 18) to become pregnant.

And by the way, if you are pregnant and accidentally get the shot, there is no evidence to suggest that any harm will come to the baby as a result of the medicine.

Victoria Rentel, MD (OSU SHS)

Gettin’ a little dirty may actually be good for you

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photo: nymag.com

Bing Images

Science has done it again. Dirty pigs are healthier pigs. It has been proven. Don’t ask how, because it involved a lot of fetal pigs (which makes my undergraduate pig dissecting PTSD flare up), poop and blood.  But it also involved a lot of wallowing and I am ALL about science that proves that wallowing is good for you.

Sure, the title – Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces – scintillating as it is, might not immediately strike you as a defense of all that is good about being dirty. But pull up a chair and consider the dirty details.

Gut immunologists took baby pigs and sent them outside, inside or into a kind of antibiotic-laced biologic bubble. The guts of the outdoor, mud-wallowing pigs were full of healthier bacteria than the indoor pig guts. Not only was there more of the good stuff in outdoor beasts, there was also less harmful bacteria in the chute. Most cool and interesting, though, is that the bacterial composition of the piggies’ guts influenced the expression of immunologic genes: pristine, white-glove pork expressed more inflammatory genes and other icky inflammatory stuff.

I know what you’re thinking. Pigs aren’t human, Dr. Rentel. True. Based on this study I’m not going to build a heated pigsty with a giant HDTV for me and my kids in the backyard. There is, however, a growing, stinking, microbial-filled gooey heap of evidence that human interaction with bacteria is good. Why does the prevalence of autoimmune diseases and allergies keep going up? This study gives some very direct, powerful evidence as to how the cascade of autoimmune badness gets started. Okay, yes, in pigs, but pigs are a whole lot like us.

As my favorite infectious disease specialist in the whole wide world (Dr. George Gianakopoulos) used to say, “Nature abhors a vacuum. Kill the good bacteria and welcome in the bad.”  I’m not saying you should order dirt for take-out tonight.  But skipping the whole-body antimicrobial gel bath every day might not be a bad idea. 

Victoria Rentel, MD (Ohio State Student Health Services)

BMC Biology 2009, 7:79

Reasons to quit smoking that you might actually care about

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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)

Feeling SAD? Lighten up at CCS!

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photo: ehow.com

Sleeping More… low energy… hibernating… feeling down or blue… finding it harder to Study… craving carbs…         

Sound familiar? If so, you may be dealing with the Winter Blues or Seasonal Affective Disorder (SAD).  Both are caused by gray skies and low sunlight, which is as much a part of winter at Ohio State as bowl games and Uggs.  So unless you plan to transfer to USC or Florida before next quarter, read on to see what you can do to stay healthy. 

Winter Blues affect 10-30% of the population – regardless of race, gender or culture – and can negatively impact your grades, job, athletic performance or your social life.  There are a lot of useful things you can do to manage the Winter Blues:

  • Increase your exposure to daylight, even on cloudy days
  • Stress reduction
  • Eat and sleep well
  • Exercise, especially outside
  • Avoid alcohol, which is a depressant
  • Socialize
  • Don’t waste your money on tanning beds

If these measures don’t work, or if you are experiencing more severe changes in your mood, appetite, sleep, concentration or energy levels, you may have Seasonal Affective Disorder (SAD). 

SAD is a more serious form of depression characterized by a feeling of hopelessness or helplessness and even suicidal feelings.  As with any depression, suicide is a serious risk. SAD affects 5-10% of the population in all races or cultures and may run in families. If you are having signs and symptoms of SAD, you need to get help – and luckily you can find it right here on campus!

In addition to counseling and stress management strategies, SAD is usually treated with antidepressant medication and/or bright light therapy with a 10,000-lux light box.  All of these therapies are available at Counseling and Consultation Service.

Since light boxes can cause side effects like hypomania (episodes of abnormally elevated, unrestrained or irritable mood), CCS requires you to be evaluated and followed by one of our psychiatrists during therapy.  Once we know that the treatment is effective and safe, many students purchase their own light box to avoid the hassle of having to come to the Younkin Success Center every morning.   

Light boxes typically run in the neighborhood of $250-$300.  The bulbs last 2-3 years with normal use and can be replaced for $40 or so.  While that’s a lot of money up front, compared to the cost of medications it can actually be a bargain in the long run.  Some insurance plans even cover the box with a written prescription, so the out-of-pocket cost may even be less. 

If you do decide to purchase your own light box, be sure to watch out for advertisements touting “full spectrum” light boxes.  That sounds really cool, but it isn’t actually relevant and those boxes are less than the recommended 10,000 lux strength.  They may work, but they’ll require a lot more time to be effective which usually ends up being counterproductive.

We never want anyone at Ohio State to “Go Blue” (man, it hurt us to even type those words…)  If you start to feel that way, be sure to contact Student Health or CCS – we are here to help!

Denise Deschenes, M.D.  Richard A. Mitsak, M.D. (Ohio State Counseling and Consultation Service)

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