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

To celebrate the last day of Movember, we’re re-running a two-part post about a men’s health issue that is especially important to male college and graduate/professional students.

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

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

To celebrate the last day of Movember, we’re re-running a two-part post about a men’s health issue that is especially important to male college and graduate/professional students.

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


Freaked out about cold sore giving girlfriend genital herpes

I just learned about the potential of oral HSV-1 to spread to the genital region, and I feel a little freaked out and worried about my girlfriend of 3 years.  I don’t believe I’ve ever kissed her or performed oral sex anywhere near the time of a cold sore break out, as they are rather infrequent for me (once every 1-2 years), but I have performed oral sex on her several times without protection.  On top of that, she has never had an outbreak of HSV-1 anywhere as far as I know, but what are the chances that I have given it to her, either orally and/or genitally?

More generally, why is genital HSV-1 on the rise? I read that it’s because more college-aged people are performing oral sex these days, so the incidence is increasing. But does this mean that it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1? Last, when they say that HSV-1 can spread to the genitals, what sort of probability are they talking about? 

Please give me some more information to help put my mind to rest.

As we covered in a recent post, the old way of thinking about Herpes Simplex Virus – that type 1 (HSV-1) only causes cold sores on the lips while HSV-2 only infects the genitals – isn’t really applicable anymore.  While HSV-1 does prefer to live above the belt and HSV-2 below, both can infect the mouth or genitals.  So unfortunately, you’re right to be a little freaked out.  But let’s go through your questions to hopefully put you at ease.

Why is genital HSV-1 on the rise? Has it has always carried the potential to spread to the genitals, or is this a mutation or a new strand of HSV-1?

Genital HSV-1 is on the rise.  In fact, among sexually active adults, new genital HSV-1 infections are as common as new oral HSV-1 infections[1].  This is especially true for college aged people.  A study done at the University of Wisconsin in 2003 showed that the proportion of newly diagnosed genital herpes infections resulting from HSV-1 increased from 31% in 1993 to 78% in 2001 in college students[2].  A 2011 study involving college students showed that this trend continues; HSV-1 accounted for 78% of female and 85% of male genital herpes infections[3].

This is not because of any new strand of Super Herpes, but because of changing beliefs in what constitutes “safe” sex.  College students report having vaginal intercourse and oral sex at about the same frequency, but the problem is that because they assume oral sex is safer, they are much less likely to use a condom.  While it certainly eliminates the risk of pregnancy, oral sex doesn’t eliminate the risk of transmitting sexually transmitted infections and in fact, increases the risk of transmitting HSV-1 because it is spread by direct contact.  So HSV-1 has always had the ability to spread to the genitals, it’s just getting more of an opportunity nowadays. 

When they say that HSV-1 can spread to the genitals, what sort of probability are they talking about?  What are the chances that you have passed HSV-1 on to your girlfriend, either orally or genitally?

Unfortunately, it’s really impossible to say.  The closest thing to an answer that I could find came from a 2006 study that showed that transmission of HSV-2 can occur pretty quickly in new sexual relationships[4]. In 199 people who acquired HSV-2 genital infection after beginning a new relationship, the median length of the relationship was 3.5 months and the median number of sex acts before transmission was 40.  But the most important finding is that it took a lot longer for participants whose partners told them up front that they had genital herpes to acquire the infection compared with participants whose partners didn’t – 270 days vs. 60 days.  So even though it’s kind of an awkward conversation to have at the beginning of a new relationship, talk to your partner about this stuff – it’s the best way to keep you both as safe as possible.

If you have any questions about HSV or any other sexually transmitted infections, make an appointment to see us at the Student Health Center.  We can answer your questions, take a look at what’s worrying you and perform any necessary lab testing.

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

[1] Langenberg AG et al. A prospective study of new infections with herpes simplex virus type 1 and type 2. N Engl J Med. 1999;341(19):1432.

[2] Roberts CM, Pfister JR, Spear SJ. Increasing proportion of herpes simplex virus type 1 as a cause of genital herpes infection in college students. Sex Transm Dis. 2003;30(10):797.

[3] Horowitz , et al. Herpes simplex virus infection in a university health population: clinical manifestations, epidemiology, and implications. J Am Coll Health. 2011;59(2):69.

[4] Wald A et al. Knowledge of partners’ genital herpes protects against herpes simplex virus type 2 acquisition. J Infect Dis. 2006;194(1):42.

Dumb Ways to Die!

In honor of last night’s exercise in… not smart behavior at Mirror Lake, and in the spirit of wishing you all a healthy and happy Thanksgiving, BuckMD brings you the following PSA.  It’s totally worth 3 minutes of your life:


Alison Sauers
Student Health Services
The Ohio State University

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

Can I get the flu shot if I’m sick? What if I have a fever?

Flu shots available in the pharmacy.

We’re quickly heading into the heart of flu season here, Buckeyes – in fact we’ve already seen a couple of cases – so it’s time to talk flu vaccine. 

There are a few valid reasons to not get a flu vaccine:

  • You’ve had a severe allergic reaction to eggs in the past
  • You’ve had a bad reaction to a flu vaccine in the past
  • You’ve had something called Guillain-Barré Syndrome (GBS) after receiving influenza vaccine in the past. 

These are pretty rare conditions, but being sick this time of year sure isn’t and we get asked all the time whether or not someone can get a flu shot if they’re sick.  Or even worse – people just assume they can’t and we never see them!  So let’s set the record straight.

If you’re sick with a cold or other mild illness (respiratory or otherwise) and you don’t have a fever, you can absolutely get your flu vaccine.  If you have a fever (temp over 99.5ish), the general consensus has always been that you should hold off on getting the flu vaccine until it breaks.  Why?  Two reasons:

  1. If you spike a fever right after getting the vaccine, we won’t know if you’re having a bad reaction to the vaccine (see above) or if it’s just your illness.  We don’t want to confuse the matter and cause you to not get the vaccine in the future.
  2. The vaccine might not be as effective.  If your immune system is all fired up fighting an infection, your white blood cells might get confused and attack the vaccine along with whatever ails you, leading to a weaker response to the vaccine.

As you can see, neither of these issues is a safety concern – getting a flu shot while you have a fever isn’t going to hurt you.  Because of this, and because influenza can be deadly even in healthy teenagers, many health care providers are starting to think it might be better to give the flu vaccine to someone with a fever and risk them having a slightly weaker response than to send them away and risk them not coming back for the vaccine at all. 

When in doubt, just ask us.  You can come into our pharmacy to get your flu shot between 8:30am – 4:00pm, Monday through Friday – no appointment necessary!  Just go to the first floor registration desk at the Wilce Student Health Center.  We’ll collect your payment; you’ll turn around and walk about 12 steps to the pharmacy where one of our highly skilled and dedicated pharmacists will administer the immunization.  We’ll ask you to stick around for 10 minutes to ensure you do not have a bad reaction.

So come in and see us for your flu vaccine!  To save yourself time, you can even download the 3 forms you’ll need to fill out here and bring them in with you.  See how easy it is?

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


Benefits of Being Tobacco-Free

wikimedia commons

Now that Ohio State is considering a tobacco-free campus initative, perhaps we should learn if smoking bans lead to measurable positive health results.  A recent study looked at health benefits after a smoking ban was put in place in restaurants and workplaces in a community in Minnesota. 

They found:

  • A 33% decrease in heart attacks (myocardial infarctions)
  • A 17% decrease in sudden cardiac death

This study also measured other possible risk factors for heart problems, so that it avoided overestimating the benefit. 

The docs conducting the study concluded:

  • “Exposure to second-hand smoke should be considered a modifiable risk factor for MI”
  • “All people should avoid second-hand smoke exposure as much as possible, and those with coronary heart disease should have no exposure to second-hand smoke.”

If you are interested in advice about smoking and reducing your risk for heart disease, come visit a provider at Student Health Services.  We are happy for assist you.  Until then, squash that butt!

 Good Health!

 Roger Miller, MD (OSU Student Health Services)

Everything you need to know about fish oil supplements

Ever since researchers discovered that Greenland Eskimos had really low rates of heart disease because of all of the fish they ate, fish oil has been a hot topic.  And once supplement manufacturers realized they could bottle and sell it, fish oil really took off. 

So let’s dish about fish – here’s everything you need to know about fish oil supplements.      

What conditions does fish oil really help?

It’s been proven that the Omega-3 fatty acids in fish oil – eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid – prevent heart disease, improve cholesterol by reducing triglyceride levels, and prevent heart attacks, stroke, and death in people who already have heart disease. 

While Dr. Google will tell you that fish oil will cure rheumatoid arthritis, high blood pressure, depression, bipolar disorder, menstrual pain, and certain kidney problems, there isn’t a lot of good evidence to back that up at this point.

Is taking a fish oil supplement the same as eating fish?

Obviously, the best way to consume fish oil is to eat oily fish.  The American Heart Association (AHA) recommends at least two servings per week for cardiovascular health.  A serving is 3 ounces (the size of a deck of cards, or ¾ of a cup).  So if you can afford, prepare and stomach salmon a couple times per week, you can skip the fish oil capsules.

How much fish oil supplement should you take?

A good target intake is between 250 and 500 mg per day of EPA + DHA.  You could get that in a daily 1 gram fish oil supplement, which contains between 200 and 800 mg of EPA + DHA, depending on the formulation and manufacturer.   

Do fish oil capsules have side effects?

The most common side effects are nausea, heartburn, a fishy aftertaste, and burping.  Taking them with food or refrigerating them helps a lot, but some brands can’t be refrigerated so be sure to check with your pharmacist.  In general, fish oil capsules have an “expiration date” of about 90 days after opening a new bottle.  Capsules with a very strong or spoiled smell should be thrown away.

Can you get mercury poisoning from taking fish oil supplements?

There’s been a lot of concern lately about mercury contamination in the world’s fish supply.  In general, this is more of a concern for pregnant women and young children, but it’s always a good idea to pay attention to what you’re eating.  Fish known to be low in mercury include shrimp, canned light tuna (not albacore), salmon, pollock, and catfish. 

Fish oil capsules are generally low in mercury and other pollutants.  But to be safe, only buy products with the “USP Verified Mark” on the label; these have been tested and found to contain acceptable levels of mercury.    

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University