A Sound you NEVER want to hear


Take a listen to this.  Pretty awful, huh? 

That is a sound that we’re unfortunately starting to hear more and more after decades of sweet silence.  That, my friends, is Whooping Cough. 

The hallmark of Whooping Cough, or Pertussis, are those horrible bouts of coughing followed by quick, painful gasps of breath that make a “whoop” sound.  It’s extremely contagious and can last for a long time – it used to be known as the “100 Day Cough.”  

Whooping Cough may have a cute name, but it is a very serious and highly contagious illness.  Prior to the development of the pertussis vaccine, one in 200 children died of whooping cough – more than any other childhood disease.  At its peak in the 1920’s and 30’s, over 250,000 people caught Pertussis and about 9,000 of them died.  Thanks to the introduction of the vaccine in the 1940’s, the number of cases dropped by more than 99%; by 1976, there were only 1,010 cases reported.

The vaccine did have some problems.  It used a “whole cell” formula and caused reactions ranging from mild swelling and redness at the site of the injection to life threatening problems like seizures and permanent neurological damage.  Because of these problems many people were afraid to get the vaccine, and even though manufacturers have since developed an effective and much safer acellular version, this fear persists today.  Unfortunately, the combination of some people not getting vaccinated and the normal waning of immunity that occurs in those people who did have lead to a widespread resurgence of the illness.

So far this year (as of June 15th), there have been 910 confirmed cases – including 5 infant deaths – in California alone.  (Babies are especially vulnerable to whooping cough because of their small airways and because the immunizations they receive haven’t had time to kick in yet.)  Here in Franklin County, local health officials have issued a public health alert because as of July 12th, we’ve had 135 confirmed cases – compared to only 76 cases at the same time last year.  Ohio is now requiring a booster immunization that contains Pertussis (as well as diphtheria and tetanus) for kids entering 7th grade.  

Even though you’re way past seventh grade at this point, you should be sure to get a Pertussis booster if you haven’t had one recently.  Not only will you decrease your own chances of coughing for 100 days, but you’ll keep the whole community – especially those babies – safer and healthier by limiting the spread of this terrible disease.

If you have any questions about the Pertussis vaccine (called a “Tdap”), or would like to make an appointment to get one, contact the Preventive Medicine Coordinator at Student Health Services.  

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

Does HPV Really Cause Skin Cancer?


Q:  I heard a story on WCMH/Channel 4 recently that HPV causes skin cancer. Is this true? 

Short A:  Maybe.  We don’t really know.

Long A:  We know that there is a cause and effect relationship between certain strains of the Human Papilloma Virus (HPV) and cervical and anal cancers.  A recent study published in the British Medical Journal suggests there might also be an association between HPV and squamous cell carcinomas (SCC) of the skin.  Scientists measured HPV levels in patients who didn’t have SCC and compared them to those who did.  They found that patients had a 44% chance of having SCC if they had 2 or 3 strains of HPV; a 51% chance if they had 4 to 8 strains; and a 71% chance if they had more than 8 strains. 

But while those numbers look scary, they say nothing about whether HPV causes SCC or not.  They imply that there is a correlation between the two conditions, but correlation does not equal causation.  HPV and SCC occur together in a lot of people, but maybe having SCC makes some people more susceptible to getting HPV rather than the other way around?  You could just as easily say, “The more people you see on the oval carrying umbrellas, the more likely it is to be raining.”  But that doesn’t prove that the umbrellas caused the rain.

Here’s another good example of scary numbers, this time from the World Health Organization:

“The use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma”.

So if you’ve ever used a tanning bed, you have a 75% chance of getting melanoma!?  No.  That number is the relative risk.  The absolute risk of getting melanoma from tanning beds is actually very small: less than 0.003% of people who tan frequently get melanoma, compared to less than 0.002% of people who don’t.  While that rate is 75% higher, we’re still talking about a very small number – less than 3 out of 1000.  There’s a great article explaining all of this stuff over at the Association of Health Care Journalists website.

I’m NOT saying tanning beds are safe.  Melanoma is bad and even though it doesn’t happen that often, anything that increases your risk of it even a tiny bit should be avoided.  You should wear sunscreen and condoms as often as possible (well, you know, when appropriate… and maybe not at the same time… you know what I mean).  My point is that numbers can say very different things depending on how you look at them, and people will often exploit that fact to sell you stuff from milk to medicines, and not always with your best interests at heart. 

Being an informed and knowledgeable health care consumer is as important to your health as sunscreen and condoms.  So lather up, cover up and always read the fine print.  You’ll be glad you did. 

Victoria Rentel, MD
Student Health Services
The Ohio State University

Can Chiropractors really help my neck and back pain? Are they safe?


BuckMD Readers – We received a couple comments on this earlier post. Take a look, and add your own comments!

 I don’t know a lot about chiropractors.  I’ve never worked with any, didn’t learn much about them in my medical training, and don’t refer a lot of patients to them since a lot of insurances don’t cover chiropractic treatment.   

But a lot of people swear by them.  And I have a few medical colleagues who recommend them for certain patients.  And our very own medical center has a Center for Integrative Medicine that provides chiropractic treatment (you can see their take on what a chiropractor does here).

There’s obviously something to it, so I have scoured the medical literature to provide you with the most objective information I can find.  Here goes…

Do people suffering from chronic neck or back pain benefit from chiropractic treatment?

Spinal manipulation has been shown to be mildly beneficial in the treatment of uncomplicated low back pain.  Uncomplicated means that there is nothing more serious going on, like severe arthritis, pinched nerves or slipped discs.     

There’s just not enough good information about whether or not spinal manipulation is beneficial in the treatment of neck pain.  Some studies showed it might be; others showed it was only helpful if used in conjunction with exercise, and others showed no benefit. 

There is no evidence that spinal manipulation is beneficial in the treatment of headaches.

Is the cure temporary or permanent?

That’s hard to say.  Most problems that cause back or neck pain are chronic and recurrent so the treatments don’t “cure” the condition but rather relieve the symptoms of an acute flare-up.  If the symptoms come back, it’s not necessarily that the treatment didn’t do what it was supposed to.

Are there any adverse effects of chiropractic treatment?

Minor complaints are fairly common after spinal manipulation, occurring in a third to a little over half of patients.  They include headache, fatigue, and pain at the site of manipulation.  Some people report dizziness and nausea, but these are less common.

Serious adverse effects from spinal manipulation (slipped disc, stroke or torn blood vessels in the spinal column) are pretty rare.  Since the cervical spine (i.e. neck) is so much more mobile than the lumbar spine, it may be at higher risk for these problems.  Because of this – and because spinal manipulation doesn’t have any proven benefit in treating neck pain – you should probably avoid seeing chiropractors for neck pain. 

If you’re having back or neck pain, come in and see us at Student Health.  We have a full-service Physical Therapy and Sports Medicine Department right here in the building and we will be happy to discuss all of your treatment options with you after we figure out what the problem is.

John A. Vaughn, MD (OSU SHS)

Maybe the Eyes really are the Window to the Soul

Jon Radwan 2000

Depression is a common condition – about 10% of adults are diagnosed with a depressive illness at some point in their lives – and a tough one to treat.  The problem is that the symptoms are based on subjective feelings, so a lot of people think that it’s not a “real” medical problem.  I can measure your blood sugar and tell you if you have diabetes; I can measure your cholesterol and tell you if you’re at risk of having a heart attack; but how do I measure any of the following?

  • mood changes
  • withdrawal from friends
  • decreased interest in work, school, or other activities previously enjoyed
  • feeling worthless, irritable, hopeless, or tired
  • loss of concentration, sleep or appetite
  • Loss of interest in sex
  • Thoughts about dying or suicide attempts

Who doesn’t feel one or more of those things every now and then?  Is everyone depressed?  Can some people just not handle it?  Besides someone telling you that these feelings are a problem, is there any way to know that how they feel is any different or worse than how you feel?

Well someday it might be as easy as looking them in the eye…

Researchers at the University of Freiburg in Germany found that depressed people weren’t able to see the contrast between black and white as well as non-depressed people by measuring the electrical activity in their retinas.  They used a device called an electroretinogram – basically, they did a tiny little EKG on their eyes. 

Now it’s way too early to tell if this technology will actually provide a meaningful way to diagnose and monitor depression – we’re not going to have any kind of Star Trek retina scanner depress-o-meter at the student health center any time soon.  But if your roommate keeps telling you that “everything just looks blah around here,” it wouldn’t be a bad idea to ask how things are going. 

Roger Miller, MD
Student Health Services
The Ohio State University

Shake Your Groove Thing


Recent item of interest in The Gray Lady to anyone who spends most of their day sitting in chairs and staring at computers.  I’m talking to you, engineering and liberal arts students, artists, bench scientists, graduate students en masse; anybody writing papers, sitting in class, studying for tests, counting beans, watching a lot of TV or playing a lot of video games.

Turns out if your buns are being warmed by a chair for the majority of your day – at school, work, home, on planes, trains or automobiles-your heart is probably suffering.   Even if you exercise regularly.

Animal models suggest that as you withdraw the regular isometric contractions and active muscle activity from walking, bending, lifting, etc. on a daily basis, muscle cells experience deleterious microscopic changes like those associated with Type 2 Diabetes as well as insulin resistance and elevated levels of free fatty acids in the blood. 

Research has shown that males who are sedentary for 23 hours a week (that’s only a little more than 3 hours a day!) have a much greater chance of dying of heart disease (67%) than males who are sedentary less than 11 hours a week.   What is striking about this is that the risk is greater in the more sedentary group even when they exercised regularly.  So all those hours of studying, prepping, working, researching and vegging out in front of the boob tube can take their toll on your muscles even if you hit the gym afterwards.  And remember, your heart is the most important muscle you got.

I’m not suggesting you stop heading over to the RPAC to hit the elliptical machine and weight room – just make sure you’re moving around the rest of the day too.  Use the restroom on another floor; take the stairs instead of the elevator; walk out of your way at lunch; do a few push-ups or crunches in your cubicle if you can; deliver a message on foot, in person with a smiling face, rather than a bland email.  

And then go hit the gym.

Victoria Rentel, MD
Student Health Services
The Ohio State University

If A-Rod played the violin, would anyone care?

photo: Mark Heayn

photo: wikimedia commons

Yesterday, Alex Rodriguez of the New York Yankees became the youngest Major League Baseball player to hit 600 home runs.  Like so many recent feats in baseball this one comes with the ‘asterisk’ of steroid abuse, which got me thinking about the nature of performance enhancing drugs. 

I’ve never taken care of any professional baseball players, but I have treated more than few musicians for performance anxiety, which manifests itself as a physiologic tremor.  We all have a baseline tremor in our hands of about 10-12 Hz.  Normally, it’s not apparent but many things can make the shakiness very noticeable: caffeine, nicotine, certain drugs, muscle fatigue and – most commonly – excitement, fear or stress. 

For most of us, those shaky hands are just a mild annoyance.  But for a violinist auditioning for a job with a major orchestra – or a spot in the music performance program – it can have an enormous impact on her life.  Luckily there are cheap and relatively safe medications that can blunt those tremors and allow such people to perform to their maximum potential in those situations where their nervous system doesn’t.

In the minds of many sports fans, A-Rod’s use of performance enhancing drugs makes him a big, fat cheater.  So am I helping my patients cheat?

Is a cellist taking a beta-blocker to keep from shaking uncontrollably during a concert the same thing as a pro baseball player juicing up with roids?  It seems unfair to say that treating a medical condition is cheating; after all, you wouldn’t tell a diabetic shortstop that he couldn’t take his insulin before a game or a pitcher with poor vision that he can’t wear his glasses. 

But one could argue that dealing with the pressure of being in front of an audience is an integral part of performing, and that using a chemical substance to enhance your ability to do so is cheating.  After all, a lot of weekend duffers can sink a 12-foot putt on the practice green, but there’s only one Tiger Woods.

So what do you think?  Is taking a medication for an anxiety-induced tremor simply a matter of leveling of the playing field for someone with a medical deficit; or is it giving an unfair edge to someone who can’t handle the heat?

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