Year: 2009

News You Can’t Use – Killer Coconuts and Falling Squirrels

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This squirrel could've saved a life!

This is the first in what we hope are many installments of BuckMD’s latest online offering – News You Can’t Use!  We will scour the medical literature to bring you the latest (or completely out of date) medical news that has very little relevance to your life but is interesting, funny, weird and hopefully all of the above.  Today’s topic – killer cocunuts!

In 1984, scientists discovered that falling coconuts in the Pacific Islands accounted for 2.5% of admissions to the hospital in Papua, New Guinea. Said coconuts can weigh up to 10 pounds unhusked and can fall from a perch of up to 115 feet. Four cases of head injury secondary to deadly falling coconuts were described in an article in the Journal of Trauma (1984 Nov;24(11):990-1) including two instant fatalities. Recall from your physics class that momentum is conserved. These researchers have confirmed one of life’s inexorable truths – it is very bad for the momentum of a flying nut to be conserved in your head. 

Thankfully, closer to home here at The Ohio State University falling coconuts aren’t much of a threat.  Falling squirrels, however, are a fairly common event.  We at Student Health Services have managed more than our share of “Rodentia Gravitas” cases, and thankfully they rarely involve anything more serious than a few scratches on the arms and face.  While the injured students often report that they “did not see the squirrel coming,” they quickly get into the habit of searching the skies for signs of falling rodents.

Victoria Rentel, MD (Ohio State Student Health Services)

Are we all drug addicts?

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As I grabbed the Dispatch off my front porch yesterday, I was greeted by an interesting headline.  Pfizer, the world’s largest pharmaceutical company, was fined $2.3 billion because of “unlawful prescription-drug promotions.”  Apparently, the corporate giant encouraged its employees to shower doctors with financial perks and other incentives to get them to prescribe their medications for “off-label” indications.  Many medicines are used to treat conditions for which they were not specifically approved by the FDA, but it is illegal for drug companies to market them as such. 

The idea that what medicine we’re prescribed can be determined by something other than pure medical science – especially when that other something looks an awful lot like corporate greed – is infuriating and scary.  But what really struck me about this story is what was behind it… literally.  The entire back page of the front section of the paper was covered with a color advertisement taken out by a local grocery chain who – for a limited time! – is offering FREE 14-day supplies of antibiotics because they “Care About Your Health.”

Free prescriptions!?  How does a store make money by giving away antibiotics?  I’m no marketing guru, but I believe the term is “loss leader”: if you come in for the free antibiotics, the theory goes, you’ll also pick up some laundry detergent or beer or kitty litter and they’ll make a tidy profit.  So why aren’t they giving away free milk, or Oreos (besides the obvious safety concerns over the stampede that would surely ensue)? 

Maybe it’s because you can’t buy antibiotics without a prescription so they don’t have to worry about losing too much money.  Or maybe it’s because the psychological associations we make with medicines are more powerful than the ones we make with Oreos (albeit not by much): on some level we’re all worried that we won’t be able to afford health care when we need it nowadays so the idea of getting vital medication for free really strikes a nerve. 

You could argue that getting people to choose one pharmacy over another isn’t quite the same as promoting the use of a medication in a way it wasn’t intended, but you could also argue that it isn’t all that different either.  Maybe you’re going on vacation next week and you’re already in your doctor’s office for a check-up and hey, it’s free, so you ask for a script “just in case.”  Or you’re prone to urinary tract infections and money is tight this month so you want to get some antibiotics now while they’re free.  Or your doctor tells you that you have a cold and you don’t really need an antibiotic but gives you a script for one to fill now in case it doesn’t get better by next week.  In a real sense, these are all “off label” uses of antibiotics that occur all the time and that can have a negative impact on your health and the health of the community.

My point is this: the grocery store is doing exactly what Pfizer got in trouble for – using financial incentives to influence the behavior of health care consumers in a way that is more about profit than good medicine.  The only difference (besides a few billion bucks, give or take) is that the people getting the perks are the prescribe-ees (i.e. us) as opposed to the prescribers.  Whether that’s a good thing or not is up to you to decide, but either way, a big part of being an educated health care consumer is recognizing that when it comes to your health, there are often forces at work that you may not even be aware of.

John A. Vaughn, MD (OSU SHS)

WOMAN + WOMAN SEX ? SAFE SEX

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Many women enter college knowing if they are straight or lesbians, while others may be questioning and enjoy the chance to explore and experiment. Young lesbian, bisexual, and questioning women often assume that sexual activity between two women holds no risk of disease or STI’s. However, there are risks that need to be considered, depending on what you do.

ORAL – Oral-genital sex can put one at risk of Chlamydia, Syphilis, Gonorrhea, HPV, Herpes, and in some cases HIV. Dental dams or cut open condoms can be used as a protective barrier during oral sex. Even household plastic wrap can work, but use a couple layers. (BTW, for the guys reading this, plastic wrap is not recommended for penile sex.  Get a condom.)

ANAL – Oral-anal sex can put the “giver” at risk of Hepatitis A and intestinal parasites, along with the STI’s just mentioned. Latex or plastic barriers are a good idea here, too, along with cleaning the area before you start.

FINGERS AND TOYS – Penetrative sex can include the use of fingers or sex toys, and when used on both the vagina and the anus, can result in bacteria passing from anus to vagina, which can cause a vaginal infection.  This can also spread STI’s . So, wear latex gloves, and cover up your toys with latex gloves or condoms and change to fresh ones when moving from the anus to the vagina, or when sharing between partners.

So have fun, but don’t assume that lesbian sex is equal to safer sex. Take some precautions!

Alison Sauers, BA

Roger Miller, MD for BuckMD

 

Will shaving my head make me bald?

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Britney recovered - and so will you!

Q: I lost a bet with some friends and now I have to shave my head. Is it true that it can cause a bald spot?

A: There are lots of rumors surrounding shaving your head. I’ve heard the permanent baldness rumor, as well as the rumor that shaved hair grows back thicker and darker. One look at Britney can tell you that these rumors are both false!

For those of you that need further proof, let’s take a look at the anatomy of hair. Hair grows from the follicle, which resides in the deep dermis. This means that hair must grow several millimeters through the dermis and epidermis to get to the outside of the skin. When you shave, you lop off the hair at the skin surface, leaving several millimeters of hair growing through the dermis. The hair follicle doesn’t even know that the hair has been cut.

Some other hair removal methods can cause hair thinning or baldness. There is some evidence that repetitive plucking or waxing of hair can cause damage to the follicle, which could cause hair loss. In addition, a medical procedure called electrolysis – in which the hair follicle is actually zapped with a small electrical current – can destroy the hair follicle, resulting in permanent baldness. Shaving, however, will not turn you into Mr. Clean for the rest of your life.

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

National FLU PSA finalists

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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

 

 

 

Posted in flu

What are good options for birth control?

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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)

Get Some Sleep!

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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? 

  • Going to bed and waking up about the same time every day – even on weekends.
  • A relaxing sleep routine that doesn’t involve television, the computer, the phone, or your Ipod.
  • Avoiding alcohol, tobacco and caffeine for a few hours before bedtime.
  • Keeping your room as quiet as you can (duh).
  • Avoiding naps. If you must nap, try to limit it to 30 minutes or so.
  • Exercise, but not right before bed.

Speaking of naps, I might just feel one coming on…

Victoria Rentel MD (OSU SHS) 

  1. 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

  2. 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

How can I avoid the “freshman 15”?

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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)

This snoring is killing me!

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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)

 

Emergency Contraception

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Plan B One-Step

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