Month: April 2013

What is covered as part of a routine physical?

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Let's Get (a) Physical!

Last week we talked about what tests and examinations are involved in a “routine physical” for most college, graduate and professional students.  Now we’re going to talk about some special situations in which a physical might entail something different.  

It’s important to note that health insurance companies vary as to what preventive medicine services they will pay for.  Most base their coverage on the recommendations of several expert groups who have studied the relative value of various screening tests, immunizations, and health counseling.  These groups include the CDC (Centers for Disease Control and Prevention), the USPSTF (U.S. Preventive Services Task Force), the American Cancer Society, the ACOG (American College of Obstetrics and Gynecology), the ACIP (Advisory Committee on Immunization Practices – part of the CDC) and others.

Fortunately, students between the ages of 18-45 who are in good health don’t require many preventive measures.  Those that are generally recommended (and covered by insurance) are:

  • Annual flu (influenza) shots
  • A tetanus booster every 10 years (the shot actually prevents diphtheria and pertussis as well)
  • The HPV vaccine (Gardasil)- a series of three shots that prevent Human Papilloma Virus infection
  • Counseling about quitting tobacco use
  • Counseling about healthy alcohol intake
  • Counseling about physical activity
  • Counseling about weight
  • Screening for the STD’s chlamydia, gonorrhea, HIV, and syphilis

Other screening tests may be recommended (and covered) in certain situations.  These include:

1. Cholesterol screening IF:

  • you are over age 35 (men) or over age 45 (women) OR
  • you are obese OR
  • you have a biologic brother, sister, mother, or father who has a history of Sudden Cardiac Death or cardiovascular disease (like a heart attack or heart surgery)

2. Updates on other immunizations if you have not received all the recommended shots as a child

3. For women, an annual pelvic exam, which usually includes a PAP smear and screening for STD’s

What about an actual physical examination?  Believe it or not, doing a head-to-toe complete physical isn’t recommended by most of the groups above because it’s never been shown to be an effective way to screen for hidden health problems.  SOME insurance companies do cover these physical exams, but the specifics of what is included may vary based on your age.  For example, hearing and vision screening is often included for children and older adults, but not for young adults.  When in doubt, check with your insurance company.

If you have any questions about your health or what exams, tests and immunizations you need, you should make an appointment to see us at the Student Health Center – we’re always glad to help. 

And check back next week, when we finish our series on physicals by discussing the different kinds of physical exams you may come to see us for.

Mary Jane Elam, MD
Student Health Services
The Ohio State University

Have you been asked the Five P’s??? – April is STD Awareness Month

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GYT - Make your appointment!

Use protection

Let’s say you are going to Student Health or your private caregiver.  In most cases, they are going to ask you a few questions about your sexual health and sexual practices. These questions are very personal, but they are as important as the questions about other areas of physical and mental health. Your answers are kept in strict confidence. 

So, are you ready to talk about your five P’s?  The five “P”s stand for Partners, Practices, Protection from STDs, Past history of STDs, and Prevention of pregnancy.

Partners

  • Are you currently sexually active? (Are you having sex?)
  • In the past 12 months, how many sex partners have you had?
  • Are your sex partners men, women, or both?

Practices

  • What kind of sexual contact do you have or have you had?
  • Genital (penis in the vagina), Anal (penis in the anus), Oral (mouth on penis, vagina, or anus)?

Protection from STDs

  • Do you and your partner(s) use any protection against STDs? If not, why?  If so, what kind”
  • How often do you use this protection? If “sometimes,” in what situations or with whom do you use protection?
  • Are there other forms of protection that you would like to discuss today?

Past history of STD’s

  • Have you ever been diagnosed with an STD?
  • Have you had any recurring symptoms or diagnoses?
  • Have you ever been tested for HIV, or other STDs? Would you like to be tested?
  • Has your current partner or any former partners ever been diagnosed or treated for an STD?

Prevention of pregnancy (Based on partners noted earlier, conception and contraception questions may be appropriate)

  • Are you currently trying to conceive or father a child?
  • Are you concerned about getting pregnant or getting your partner pregnant?
  • Are you using contraception or practicing any form of birth control?
  • Do you need any information on birth control?

Finally, before you move on to discuss other things with your caregiver, consider:

  • Are there other things about your sexual health and sexual practices that you should discuss to help ensure your good health?
  • Any other concerns or questions regarding sexual health in general?

Student Health Services can offer you expert advice, all the current diagnostic and treatment options, and vaccinations that can protect you long term.  Come see us, and GET YOURSELF TESTED! 

Roger Miller, MD (OSU Student Health)

Should I get a physical? And what is a physical anyway?

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Let's Get (a) Physical!

Students often wonder if they need to have a “physical” on a regular basis.  A physical is a preventive medicine visit, meaning that you are coming in to see your health care provider when you are NOT sick and don’t have any current problems.  It’s a visit designed to assess your risk for certain medical conditions and to come up with a strategy to continue your good health. 

For most college, grad and professional students (i.e. adults aged 18-35), the following physicals are usually recommended.  Why are these examinations recommended while others (like checking your cholesterol level) are not?  It’s because they screen for conditions that are likely to be affecting you, can be treated, and which would create a health problem for you if they were not detected and treated. 

For men who are sexually active, the recommendations are for an annual screening for Sexually Transmitted Diseases (STD’s) – specifically for chlamydia, gonorrhea, HIV, and syphilis.  This is done through a blood and urine sample taken in our lab, but the visit may also include an examination of the penis, scrotum, testes, inguinal (groin) area, and possibly a rectal exam.

For women who are sexually active, an annual pelvic and breast exam is recommended.  This usually includes screening for STD’s (as above), as well as a PAP smear (screening for cervical cancer and HPV), and a physical examination  of the vagina, cervix, uterus, ovaries, thyroid gland, and breasts.

Why don’t we include things like herpes, or HPV in men?  Because we don’t have a good test to screen for them.  Remember, we’re talking about physical exams when you have no problems.  If you’re having symptoms like a sore or bump, we have ways of checking for herpes or HPV, but if everything is perfectly fine below the belt, we don’t have a test that can tell if you have them.  

Check back next week for a discussion of other screening tests and preventive measures that may be recommended and – even more importantly – MAY be covered by your insurance.

Mary Jane Elam, MD
Student Health Services
The Ohio State University

Stressed?? CDC Tips for Coping

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Wilce Student Health Center

Overwhelmed?

With the shocking and traumatic events of this week, are you getting overwhelmed by the news coverage?  Perhaps you have family or friends directly impacted? 

The Centers for Disease Control and Prevention (CDC) has posted a number of symptoms to consider as possible danger signs, as well as tips on stress management 

Symptoms of Stress

  • Fear and anxiety about the future
  • Difficulty making decisions
  • Being numb to one’s feelings
  • Loss of interest in normal activities
  • Loss of appetite
  • Nightmares and recurring thoughts about the event
  • Increased use of alcohol and drugs
  • Sadness and other symptoms of depression
  • Crying
  • Sleep problems
  • Headaches, back pains, and stomach problems
  • Trouble concentrating

Tips for Self-Care

  • Avoid drugs and alcohol – in the long run they can create more problems instead of take stress  away.
  • Find support – talk to a partner, family member, friend, counselor, doctor, or clergyperson.
  • Connect socially – make sure that you are spending time with loved ones.
  • Take care of yourself – diet, exercise, sleep, normal routines
  • Give yourself a break if you feel stressed out
  • Stay active – helping a neighbor, volunteering in the community, even taking the dog on a long walk.

If you need additional help, come talk to a healthcare professional at Student Health Services, or contact our Student Life partners at Counseling and Consultation Services, the Student Wellness Center, or the Student Advocacy Center.

Take care,

 Roger Miller, MD (OSU Student Health)

Is there a place on campus to get tested for mental health disorders? Will my student insurance cover it?

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lauramuggli.com

Is there a place on campus to get tested for mental health disorders? Will my student insurance cover it?

Most of the time when people ask us about testing for mental health disorders, they’re talking about Attention Deficit Disorder, or ADD.  (It’s called ADHD if there is an element of Hyperactivity in addition to attention problems.)  And yes, there is a place to get tested on campus.

This type of testing is performed by a neuropsychologists and psychologists, and we are lucky to have some of them here at Ohio State.  You will need a referral from a primary health care provider in order to schedule an appointment for this testing, which we are happy to provide. 

We usually refer students to Dr. Robert Bornstein, Dr. Douglas Kramer, or Dr. Elizabeth Cook at The Ohio State University Wexner Medical Center.  Dr. Bornstein does the testing at the first appointment and it takes about 4 hours to complete.  Dr. Kramer and Dr. Cook will bring you in for a consultation first to determine what testing they want to do and then have you return for the testing itself.

Once the testing has been completed, the doctor will analyze the results and send a formal report back to you and the referring health care provider.  At that point, you would schedule a follow-up appointment with your referring provider to go over the results and determine the appropriate course of action.

OSU Aetna Student Health Insurance does cover ADD/ADHD testing. We can’t quote you an exact cost, but you can contact the Student Health Insurance office at 614-688-7979 to get more information about your benefits.

Whether or not you do formal neuropsychiatric testing, Counseling and Consultative Service offers individual and group counseling services for students with ADHD and The Office of Disability Services can assist students with ADHD in obtaining necessary accommodations for academic work.  However, it’s important to note that neither of these offices offers testing.

There are certainly other mental health issues besides ADD/ADHD that affect college and grad/professional students, but there aren’t specific tests to make or confirm the diagnosis.  These require a comprehensive evaluation by a health professional – sometimes multiple evaluations with multiple professionals – and luckily there are many resources here on campus (and beyond) that we connect you with if needed.

If you have any questions about the diagnosis and management of any mental health issues you are experiencing, you’re always welcome to call or make an appointment to speak with us about it.

Alison Sauers
Student Health Services
The Ohio State University

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

Travel Medicine In Focus

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cardiophile.com

Gorakhpur, India

Q:  I am going to (FILL IN YOUR DESTINATION HERE) and I don’t really think I need any shots to go there.  Should I still make a travel appointment at Wilce Student Health?

A: We see OSU students traveling to nearly every destination on the globe, and the risks do vary from country to country, no doubt.  However, there is more to a travel appointment than getting an exotic vaccine.  Our travel medicine providers will: 

·   Provide current health and security information about your destination(s)

·   Update your routine immunizations

·   Recommend tuberculosis (TB) testing when indicated

·   Prescribe travel medicines, including anti-malaria pills

·   Advise you on getting adequate supplies of your prescription medicines

·   Provide information on staying healthy while traveling, such as food and water safety, sun and insect protection, and more

·   Explain and recommend travel vaccines for diseases like typhoid and yellow fever

So, even if you are traveling to a destination with limited risk, you still might want to consider coming in for some advice and recommendations. 

Wilce Student Health is an Ohio Department of Health-approved vaccine site, and routinely stocks the most commonly used travel shots at reasonable prices.  We also issue official World Health Organization vaccine certificates to all travel patients. 

Happy Travels! 

Roger Miller, MD (OSU Student Health)

 

Breakthroughs in HIV research

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HIV - Public Health Image Library

At the March 2013 Conference on Retroviruses and Opportunistic Infections in Georgia, new research findings regarding long-term suppression of HIV virus in humans were discussed.  HIV is a retrovirus, meaning that it infects cells by inserting itself into the genetic code. 

Since 1996, highly aggressive antiretroviral therapy (HAART) has advanced to the point where HIV infection can be suppressed in patients, preventing the advancement of disease and reducing the risk for other associated infections.  However, these patients were not considered “cured”, since the virus levels would rise whenever the treatment was stopped. 

However, two recent breakthroughs may change our perspectives on an HIV cure. 

  • An infant in Mississippi born to an HIV infected mother was treated with a combination of HIV medicines from immediately after birth, but stopped the medicine.  However, when she was re-tested off medication, the virus was not detected. 
  • 14 adults in France who were treated with antiretrovirals shortly after exposure have been followed for several years off treatment, and all are maintaining extremely low virus levels. 

Both of these are considered “functional cures”, because the virus can still be found with special high sensitivity testing, but the virus levels stay low. This breakthrough only applies to a small subset of HIV patients, because it requires aggressive treatment in the period shortly after exposure.  However, any measure that gives sustained suppression of HIV without treatment is huge.

If you have questions or concerns about HIV exposure or infection, come see us at Student Health Services.  Our staff can help with the best advice and resources.

Good Health!

Roger Miller, MD (OSU Student Health Services)

Help! I saw blood on the toilet paper after I wiped – what should I do!?

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mayo foundation

Q: Help! I saw bright red blood on the toilet paper after I wiped.  What should I do!? 

Short A: Come in to see us so we can check it out.

Long A: Don’t panic. We see this all the time at Student Health and it’s rarely as scary as it looks.  You’re probably dealing with a hemorrhoid: a very common, and literal, pain in the butt. 

Hemorrhoids are abnormally swollen veins in the rectum or anus that bleed with minor pressure, such as that which occurs from bowel movements.  They can be painful or painless depending on their location, and are often associated with rectal pain and itching, a lump that you can feel and/or rectal bleeding. 

Risk factors for developing hemorrhoids include

  • Poor fiber intake
  • Prolonged sitting or standing
  • Being overweight
  • Pregnancy
  • Chronic constipation or diarrhea
  • Engaging in anal sex

When you come to the Student Health Center, we will ask you a lot of embarrassing questions and do an embarrassing examination to rule out other more serious causes of rectal bleeding such as infections, inflammatory bowel disease, anal fissures and even (rarely) colon cancer.  Since some hemorrhoids are located a few inches inside the rectal canal, we may have to use a small, lubricated, clear plastic tube called an anoscope to look on the inside.

The mainstay of hemorrhoid treatment (and prevention) is fiber, fiber, fiber.  Most of us don’t get enough fiber in our diet, which leads to constipation, which leads to straining to have a bowel movement, which leads to increased pressure in the rectal veins which… you get the idea.  Supplementing your diet with soluble fiber supplements (Metamucil or Benefiber) will work wonders for this problem.  Other things you can do include:

  • Avoid straining and prolonged sitting on the toilet
  • Lose weight if necessary
  • Drink 8 to 10 glasses of water per day
  • Exercise regularly
  • Gently clean the anal area with soft, moistened paper after each bowel movement and avoid the urge to scratch – as an old family doctor once told me: “Wipe, don’t polish!”

Again, while it can certainly be scary, rectal bleeding is rarely a sign of a life-threatening condition.  But if it happens to you, be sure to see your health care provider to make sure it isn’t, especially if the bleeding is dark brown or black, is heavy, you feel weak or light-headed, or the pain gets suddenly a lot worse.

 

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