Medical Mythbusters – Green Snot!

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True or False: My snot is green so I need an antibiotic, right?


This is one of the most tenacious, and frustrating, medical myths out there: that clear snot indicates a viral infection that will clear on its own while green snot automatically means a bacterial infection that requires an antibiotic for treatment. 

This is simply not true! Coming down with a sinus infection is very common this time of year. You may know the symptoms: headache, stuffy nose, nasal discharge, facial pain and pressure, fever, cough and ear pressure. The vast majority of cases are caused by viruses and resolve on their own within 10 days.  The only time antibiotics are recommended is when the infection lasts for more than 10 days, or worsens over 5-7 days.

Many people come to the doctor expecting antibiotics for minor viral infections but keep in mind that not only do antibiotics do nothing against viruses, they are not always benign either. They can have side effects such as upset stomach and diarrhea. More importantly, overuse can lead to resistance, so that if heaven forbid you come down with a serious infection that does require antibiotics in the future, they may not work as well and the infection will be more difficult to treat.

As for the myth of the green snot, microbiologists believe the color comes from enzymes released by your white blood cells (myelo-peroxidases and other oxidases) to break down bacteria and other organisms. These enzymes contain iron, which gives off a greenish color. Also, the longer the mucus stagnates in your sinuses, the more likely it is to look green when it comes out. So when your sinuses are clogged up during a sinus infection, it is more likely to stagnate and appear green, just as your early morning snot will be more green just from sitting in your nose all night. The only kind of snot that deserves antibiotics is purulent (think pus) mucus coming from your nose or throat.

Remember, most of these infections clear on their own with a little TLC. Over the counter products such as pseudoephedrine (“Sudafed”) or my personal favorite, the neti pot are usually effective at alleviating the symptoms while the infection runs its course.   

If your sinus infection has been going on for more than 10 days, or it’s been getting worse over the past week, be sure to contact Student Health Services to be evaluated.

Angela Walker, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)


Winter, Spring, Summer, Fall: Ice Cream Headache Survives them All

From the British Medical Journal Archives (courtesy of NCBI ROFL) an ice cream study which answers the question humans have been asking themselves through the ages: Do ice cream-evoked headaches (ICE-H) happen in the winter like they do in the summer?

Forget cancer! Thank God there are scientists to study these critical issues. Fellow ice cream eaters, the answer is yes, you can get an ice cream headache in the winter, at least if you’re a Canadian middle-schooler.

This important contribution to the world of science was determined by randomizing 145 middle-schoolers in Canada during the winter to one of two groups, after obtaining informed consent regarding the risks and benefits of eating ice cream quickly.  One group was instructed to eat their ice cream slowly; the other to consume their 100cc portion in less than 5 seconds. Almost unheard of in randomized trials, there were no refusals to participate and no participants were lost to follow-up.

The findings? About a quarter of the speedy ice cream eaters reported ice cream-evoked headache, compared to about 13% of the pokey eaters. Of those afflicted with this dreaded ice cream complication, a little over half suffered more than 10 seconds, although all returned to normal eventually. Although researchers reported a lifetime prevalence of ICE-H in their study group of about 80%, nobody reported that they would be avoiding ice cream in the future.

Why is it that I am never recruited for studies like this? Who at The Ohio State University is willing to go further with this critical work and do the translational research necessary to determine if the ICE-H has the same prevalence with ice cream sandwiches, popsicles, and sherbet? Gelato? Jeni’s vs. Graeters? Let me be the first to volunteer myself for the sake of the advancement of knowledge.

Read this important contribution to the scientific literature @:

BMJ 2002;325:1445-1446 ( 21 December )

Victoria Rentel, MD (OSU SHS)

Should I always see the same provider at Student Health?

Q: Why do the appointments people always try to get me to see the same provider?

A: While familiarity might breed contempt in family and friends, it breeds better care from your doctor.   

To do my job well, I have a bunch of balls to keep in the air. First, there’s sorting out whatever brought you in for an appointment.  You tell me this, I ask about that. I listen to this, poke that, move another thing, gathering as much objective information as I can to figure out what is wrong and how sick you are. This is usually the most straightforward part of an appointment. 

I also have to cover historical information. Your past medical issues, your family history, medication history, tobacco use, surgeries, etc. The first time I see you this can take a while.

I’m also trying to figure out you. This is hard work, as I have a limited amount of time at any one appointment. Who are you? Where do you live? Who do you live with? Where do you come from? What has your experience with healthcare been? Are you formal or casual? Big words or a minimalist? Native English speaker?  Nervous? Relaxed? Suspicious? Assertive? Informed and interactive? Taciturn or frightened? The more I know about who you are, what you bring to the table, and how you think, the better I’m able to tailor an effective treatment plan and sell it.

Now, this might not all seem relevant for a sore throat or an ankle sprain – and it might not always be.  But I can’t become a “you” expert in one appointment; I pick up clues over many visits. Sure, your visit today for a runny nose might be easy, but I used the time to dig into how stressed out you are about your research, which helps me in a month when your hair is falling out or you can’t sleep. Once I really get to know you after that first information-intensive appointment, little nuggets of useful, often vital contextual information fall like raindrops in a thunderstorm.

Care with the same provider is usually more efficient. It saves both of us time if you don’t have to answer the same 8 billion questions about medication reactions, chronic health problems, etc.  I can really dig into the problem at hand, whether it is a cough that just won’t go away or diabetes that you and I have been beating into submission over years. 

Of course, I’m not here all the time. I, like you, am a mere mortal and have been known to get sick and take vacations. For self-limited problems-ankle sprains, the occasional cold, rashes-it’s okay to see somebody else in a pinch.  Occasionally it’s even helpful to have a fresh set of eyes look and think about complicated problem.  But in general, even though any other health care provider can open your chart and meet the “virtual” you, it won’t compare to how well I know the real thing. 

Victoria Rentel, MD (OSU SHS)

The L.A.N.C.E. of Testicular Cancer, Part 2

In part 1 of this post, I introduced the L (lethal) A (all men) N (numbers) C (curable) E (early self-detection) of testicular cancer, inspired by the cancer survival story of cyclist Lance Armstrong.  Now, I want to elaborate further on the topic of early detection.

All males between the ages of 15-35 years are encouraged to do testicular self-examination at least once a month, ideally while taking a warm shower so that the scrotal skin is relaxed.  The exam is easy:  feel around the testicles for a firm lump the size of a pea or marble that wasn’t there before.   If you find one, you should visit your health care provider as soon as possible; a testicular tumor can double in size every 10-30 days and the longer it goes untreated, the greater the potential for metastasis.   

Most testicular tumors are painless, at least initially, but sometimes there is tenderness or a sensation of heaviness in the testicle.  Sometimes there is just some vague change in the texture or size of the testicle.  Other benign conditions – such as varicocele, hydrocele, epididymal cyst, seminoma, or epididymitis – may also cause many of these findings, but diagnosing should be left to the healthcare provider.  When the physical exam is concerning or unclear, the next step is usually ultrasound imaging of the scrotum, which is a fast and painless procedure.

Another benefit of periodic testicular self-examination is that the man is more likely to note other problems with his penis or scrotum, such as genital warts, which might then be treated prior to transmission to another person.

Millions of people are now wearing yellow bracelets from the Lance Armstrong Foundation to recognize those who have been affected by cancer.  We encourage you to let L.A.N.C.E. remind you of the 5 key facts about testicular cancer, and let each sighting of a yellow bracelet remind you to take charge of your own health and routinely check your testicles (or those of the man you care for).

James R. Jacobs, M.D., Ph.D., FACEP

Director, The Ohio State University Student Health Services

See Your Immune System In Action!

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Nerd alert! I apologize for yet another fabulously awesome (to a dork) visual of the human body in action, or at least part of the human body in action.

Behold… The mighty neutrophil chasing a Staph aureus straight outta Dodge!

This video has been around for a while. Shout out to Orac @ Respectful Insolence for posting it this week despite its relative old age in our brave new world of instant internet access.  It’s short and sweet. Give it a click:

I’m gonna get you Sucka’!

Next time you read about some horrible staph infection, think about this happening in your body all the time, because it is. We’re covered from head to toe with Staph aureus and our immune system and the creepy little bug duke it out all day and all night. (Getting itchy?) We have evolved a complex system of protection, only part of which involves white blood cells such as the stalwart neutrophil in this movie. Fortunately, thanks to those white blood cells, other more helpful bacteria, sebum, complicated acid-base balance,  good sanitation, quality nutrition, good hygiene, and blah blah blah, the bacteria lose 99.9% of the time. Crazy little cooties keep coming back for more! Even when we give up some ground, most of the time we can beat the bugs back with antibiotics and the few other tricks we have up our Staph-covered sleeves.

Victoria Rentel, MD

Reference: Crawling Neutrophil Chasing a Bacterium, Thomas P. Stossel (Brigham and Women’s Hospital and Harvard Medical School), June 22, 1999

The L.A.N.C.E. of Testicular Cancer – Part 1

The dramatic story of cyclist Lance Armstrong’s cancer survival has raised public awareness of testicular cancer and has made it easier to discuss.  Seizing this opportunity, I want to highlight 5 facts about testicular cancer that everyone must know – the L.A.N.C.E. of testicular cancer.

Lethal.  Most testicular tumors are malignant, meaning that they have a tendency to metastasize (spread) to other parts of the body, like the lymph nodes, lung, and brain.  It is invasion of these other organs, rather than damage to the testicle itself, that leads to serious illness or death.

All men.  Testicular cancer occurs most commonly in Caucasians, but all men are at risk.  The cause of testicular cancer is not known, but there are well-established risk factors:

  • History of an undescended testicle. Even with corrective surgery, an undescended testicle is 3-5 times more likely to become cancerous than a properly descended testicle.
  • A testicle that has not developed properly because of previous trauma, torsion, or mumps infection
  • Family history of a brother who has had testicular cancer.

Numbers.  Testicular cancer is the single most common type of malignant tumor occurring in men ages 15-35.  The incidence of testicular cancer has been increasing in many countries, including the United States.  The American Cancer Society estimates that approximately 8,400 new cases of testicular cancer are diagnosed in the United States each year. 

Curable.  Among all forms of malignancy, testicular cancer is one of the most curable.  If it is diagnosed in an early stage (e.g., while the tumor is still localized to the testicle) the cure rate is nearly 100%.  Even when it is widely metastatic prior to detection, the cure rate with aggressive treatment is greater than 80%.  At a minimum, treatment of testicular cancer requires surgical removal of the cancerous testicle.  Abhorrent as this might seem, it does not typically have any long-term effect on fertility or sexual function, as long as the remaining testicle is normal.  When metastases are present, treatment requires chemotherapy and sometimes radiation therapy or additional surgery.

Early self-detection is critical.  Most testicular tumors are discovered by the man himself, through intentional or inadvertent testicular self-exam, and sometimes even by an intimate partner.  The reality is that testicular cancer discovered during a routine medical examination, or after symptoms have developed, is likely to be much further advanced than one discovered by the man himself.  

If you are worried that you may have an undescended testicle, of if you notice any change in the size or shape of your testicle,  be sure to seek medical consultation as soon as possible.  Next week, we will discuss testicular self-examination.

James R. Jacobs, M.D., Ph.D., FACEP

Director, The Ohio State University Student Health Services


Last chances for free and confidential STI testing through Student Wellness and Columbus Public Health!

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The Student Wellness Center and the Columbus Public Health Department will offer walk-in STI testing two more times this quarter:

On Tuesday, February 16th from 4-7pm: free, walk-in HIV rapid testing using the oral swab specimen will be available.  ONLY RAPID HIV TESTING WILL BE AVAILABLE ON THIS DATE.

On Thursday, 18 February from 4-7pm: In addition to the free, walk-in HIV rapid testing (oral swab) offered by Student Wellness, Columbus Public Health will offer free and confidential testing for Chlamydia and Gonorrhea (urine sample) and syphilis (blood draw).

Both events will be held at Hillel (46 E. 16th Avenue).  Click on the map at right for a larger view.

If you have any questions, please feel free to contact the Student Wellness Center at 614-292-4527 (2-4527 from a campus phone).

If you are unable to attend these sessions, confidential and comprehensive STI screening is always available by appointment at the Student Health Center.  The Comprehensive Student Health Insurance Plan pays for STI screening once a year.  If you have another insurance plan, you can check with them for coverage.  Call 614-292-4321 to make an appointment.

John A. Vaughn, MD

Is breakfast really the most important meal of the day?

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Q: Is breakfast really the most important meal of the day?

“Rather go to bed supperless, than run in debt for a Breakfast.”
Benjamin Franklin (1706-1790) Poor Richard’s Almanac

A: It’s hard to say which meal is the most important; a well balanced diet should always be a priority. There are a whole bunch of reasons to skip your Wheaties: lack of time, lack of hunger, or even the desire to lose weight.  

Investigators keep trying to pinpoint what it is specifically about breakfast (versus other meals) that makes it all that, but nutritional studies are tricky. There are a lot of confounding variables. Tabulating actual calories ingested and their nutritional content is fraught with the perils of self-reporting. Nevertheless, there is a wealth of data supporting an association between breakfast and better grades, more daily exercise, and less absenteeism. Separating causation from association here, though, is difficult. Are people who eat breakfast healthier in general because they tend to take better care of themselves, or does the act of eating breakfast actually makes them healthier?  

Breakfast and weight loss is a little clearer. There is a popular belief that skipping breakfast can help you lose weight. In fact, skipping this first meal appears to work against you and sadly can lead to weight gain. In particular, a healthy breakfast of fruit and grains tends to keep hunger at bay throughout the day, making you less likely to eat quick but tasty snacks, often nutritionally lacking but calorie-filled. Fasting also increases your insulin response to snacky food challenges, making you more likely to store nutrients as fat.

Skipping that bowl of oatmeal isn’t just risky for your figure.  There’s some good evidence, especially in school children, that school performance is better with a full belly. Kids who receive breakfast at school miss less days of class, get better grades, and subjectively report better attention and task completion. This is an interesting finding because school breakfast experiments are able to control for some of those confounding variables that make nutritional studies hard to interpret: the meal is the same for everybody; they measure objective data (rates of absence, grades) as opposed to just subjective symptoms; and in some studies, the meals were free so there was no bias for or against kids who weren’t getting breakfast at home.

Do your body and your brain a favor. Feed them a bowl of cereal and piece of fruit before you head out in the morning.

Adam Brandeberry, Med IV (OSU COM), Victoria Rentel, MD (OSU SHS)


Get Prepared for Life After College!

From Classmates to Colleagues: Come gain the knowledge that will help you get a job!

University Career Services Committee, the Student Wellness Center, Office for Disability Services, and The Alumni Association are sponsoring a free event for anyone who wants to prepare for a job or internship.

You will have the opportunity to meet with recent alumni, wellness professionals, and career experts to assist you with life after college transitions, particularly in light of the changing economy. You can attend workshops that address managing finances, coping with life after college challenges, marketing your college experience, finding alternatives to 9-5 work, and learning how to network. Additionally, a resource room will be available for you to get free resume critiques, access to helpful career handouts, and meet representatives from a few organizations in the community.

WHEN: Monday, February 22, 2010 from 4:30PM-8:00PM

WHERE: 3rd Floor RPAC Meeting Rooms

FOR MORE INFO: website and Facebook page and attached flier (click on link at right to open)

There is limited seating for the workshops so please plan to arrive early!

Business Casual Dress Recommended!