Medical Mythbusters – Poison Ivy!

poison ivy

rashes caused by poison ivy

Now that we are in the dog days of summer, an old friend is rearing it’s ugly, leafy head.  Yes, it’s poison ivy season, my friends, and while most of us think we know all there is to know about this itch-inducing plant, there are some medical myths lurking around it that need to be busted!

First, the facts:  Poison ivy, poison oak, and poison sumac plants are all coated with a colorless oil called urushiol.  Urushiol is a very sticky, colorless substance present in the leaves, stems, fruit, and roots of the plant. After contact with urushiol, about half of us will develop intense itching, swelling, and skin redness. Then, we will develop fluid-filled blisters that are often arranged in a line or streak.  (See photos)  The symptoms are usually most severe within 1 to 14 days after exposure to the plant, but can occur up to 21 days after exposure if someone had never been exposed to urushiol before.

Technically speaking, poison ivy usually resolves within 1-3 weeks without treatment, but without something to control the itching they will be the longest 3 weeks of your life.  Cool wet compresses can be placed on the affected areas for 15 to 30 minutes at a time.  A group of medications called antihistamines are very good at reducing the itching: diphenydramine (Benadryl) is good for night time because it makes you sleepy and loratadine (Claritin) and cetirizine (Zyrtec) are good for daytime because they don’t.  Oatmeal baths, calamine lotion and hydrocortisone cream are also sometimes helpful, but the best way to knock out the rash and itching is to see your primary health care provider to get a prescription steroid treatment.  Sometimes you can get by with just a shot, but that often does’t last long enough (1-2 days) so you can take a course of pills over a couple of weeks.

Now, on to the myth…

TRUE OR FALSE: Poison Ivy is contagious

FALSE!! 

Poison ivy is not contagious and can not be passed from person to person.  Only contact with urushiol will cause someone else to get poison ivy – the fluid that leaks from blisters does not contain the oil and can not cause symptoms.  Once you’ve washed the urushiol off of your skin (and clothes and fingernails and gardening tools and pets…) you can not spread poison ivy to someone else or yourself.  The rash sometimes appears to be “spreading” from one part of the body to another, but this is because blisters develop at different rates in different parts of the body – any real spreading that went on happened before you realized you had the urushiol on your skin.  This explains why poison ivy has such an unfortunate predilection for our privates.  Please believe me – if you’ve been weeding in the yard, or camping in the woods, make sure you wash your hands before you go to the bathroom as well as after…

John Vaughn, MD – Student Life Student Health Services

Updated by Maribeth Mulholland, MD – Student Life Student Health Services

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) can definitely be a frustrating diagnosis as a college student as late night pizza and ice cream binges can exacerbate symptoms. IBS is a common disorder affecting 5% to 15% of the general population. Unfortunately, the list of foods to enjoy and those to avoid may be different for each person. There are some general rules that those with IBS should follow. These standard recommendations include establishing regular eating times, eating smaller frequent meals, and drinking enough fluids. Foods that should (generally) be avoided for those with IBS include banana, coffee, corn, eggs, milk, peas, potatoes and wheat. Caffeine and alcohol are known IBS triggers. Recent studies of low FODMAP diets have shown promising preliminary data in decreasing IBS symptoms. It is also recommended that you make sure to consume enough fiber (25-38Gg/day) though your diet or through fiber supplementation. You can also purchase probiotics over the counter that can aid in reducing IBS symptoms. In conclusion, IBS is a very common disorder that can be difficult to manage as a college student. If you have questions about how to better manage your IBS or think you have IBS, please call the Wilce Student Health Center to schedule an appointment with one of our providers today.

Megan Lottes, C.N.P.

Medical Marijuana and Student Life Student Health Services

So marijuana is now legal in the state of Ohio….what does that mean for me as a student here at The Ohio State University?

Can I get marijuana prescribed by a provider at the Student Life Student Health Center (SLSHS)?

I haven’t heard of anyone who has been prescribed medical marijuana yet.

As of September 8, state licensure, registration, and certification are required for Ohio’s Medical Marijuana Control Program. Ohio law requires the Ohio Medical Marijuana Control Program to be fully operational by this date.

 

Can I get a prescription from any doctor?

“The federal government prohibits doctors from being able to prescribe marijuana. Instead, patients must have a recommendation from a certified physician. Physicians interested in recommending the use of medical marijuana for patients must apply for a certificate to recommend from the State Medical Board of Ohio.” The Ohio Medical Marijuana Control Program

Many students will not qualify by age alone, as one must be at least 21 years old.

Physicians at the Wilce Student Health Center will not be certified. They will not be prescribing medical marijuana. That being said, it is very important that patients always disclose all supplements or other medications they are prescribed when seeking medical care. Be sure to let your SLSHS provider know if you are taking medical marijuana (or using recreational marijuana).

 

What kind of medical problems can be treated with marijuana?

The State of Ohio Medical Board has a defined list of medical diagnoses that qualify for treatment with medical marijuana.

The most common use is for pain control, especially nerve pain. Medical marijuana can also be helpful with certain types of nausea, muscle spasticity (as with multiple sclerosis and Parkinson’s disease), and glaucoma.

There are some initial studies that indicate marijuana may have a place in treating post traumatic stress disorder.

 

Keep in mind…

Marijuana is still illegal per federal law. The Federal Drug Free Schools and Community Act of 1989 prohibits the use of drugs (including marijuana) on campus if the school is receiving any federal funds.

We are in need of more medical research in the benefits and side effects/complications of marijuana use.

Just like with alcohol, one should not drive while using marijuana (medical or recreational).

The smoke from marijuana has toxic chemicals just like tobacco smoking.

In a student population already struggling with anxiety, depression and attention deficit disorders, the use of marijuana is likely to compound the issues. There is also increased risk of psychosis and impairments in learning, perception and judgement.

Kathryn McKee, M.D.

What’s in your work out supplements?

It’s the start of 2018, which means the “new year, new me” resolutions are picking up some good momentum by now. Hitting the gym more often is definitely one of my resolutions, and if our resolutions are on the same page, then this post can be of some help to you!

Work out supplements… we see them advertised all over our social media pages, and if you are walking into your local GNC, or Vitamin Shoppe the selection can be intimidating. What I’ve learned so far is that there are supplements that you take as a pre-workout, and supplements that do just as they are named, supplement.

Pre-workout Supplements:

What’s the scoop? Boosting your performance is all part of the plan. Growing bigger muscles, having quicker gains, and hoping for an easy solution is something we all strive for. Most of us understand that easy isn’t necessarily so, and may not entirely be the correct way in doing something. Unlike medications, workout supplements are not as strictly regulated by The Food and Drug Administration (FDA), which means dangerous ingredients may be incorporated without the knowledge of consumers. Some of the ingredients may actually have detrimental effects, and potentially cause death.

1, 3- dimethylamine, methylhexanamine or geranium extract—also known as DMAA is an ingredient that has been found illegally in some dietary supplements, where manufacturers mask the component as a “natural” stimulant. In 2013, a case report was published in the Clinical Journal of Sport Medicine, highlighting an incident where a 21- year old male suffered from cardiac arrest after ingesting a workout supplement containing DMAA. Structurally, DMAA is similarly related to amphetamine, methamphetamine, and MDMA. DMAA does not produce any type of stimulant similar to the mentioned substances, but if you are set to take a urine drug test for a new job, or professional program at The Ohio State University… heads up, you may fail.

Good news, DMAA has been banned by the FDA after the unfortunate incident that occurred in 2013, however, there are still some supplements through online purchase that may have the ingredient incorporated within the product, and I would recommend reading the back of the nutrition label before purchasing any type of supplement. The discontinued substance that contained DMAA was specifically the pre-workout supplement marketed as Jack3d made by USPLabs.

Regular Supplements:

First off, let me drink some protein.” Protein supplements are frequently consumed by athletes, as well as those who work out recreationally. There is much debate on the theory of amount of protein per day a person should intake and the timing of supplementation, and if you have any questions towards these matters PubMed.gov is a good source for you to do some more research about the topic.

Protein powders come in three common forms, those being—whey, soy and casein. A study by Kanda, A. et al in 2016, looked at the co-ingestion of all three substances and their effects on muscle protein synthesis after exercise in rats. The results of the study demonstrated a difference in peak time according to the type of protein ingestion, the authors concluded that whey protein was quicker to initiate the process compared to casein and soy.

Branched chained amino acids (BCAAs) especially leucine have been shown to increase muscle synthesis after exercise. Leucine is another component to keep an eye out for. Kanda, A et al. also noted that leucine displays a specific saturation point. The threshold described was around 43 mg of leucine, which means anything above this dose resulted in no further increase in the muscles anabolic response.

This is just the tip of the iceberg when it comes to the types of supplements that are available commercially, the big take away from this blog is to get you use to looking at the nutrition label located on the back of the products up for purchase. Speaking to your healthcare providers about any of your concerns is a good thing to do, especially if some of the components of your supplements seem a bit off.

 

Justin Corpus

PharmD Candidate 2018

References:

  1. Kanda, A. et al. Effects of whey, caseinate, or milk protein ingestion on muscle protein synthesis after exercise. Nutrients. 2016 Jun; 8(6): 339.
  2. Lioudmila, K et al. Cardiac arrest in a 21-year old man after ingestion of 1,3 dmaa—containing workout supplement. Clin J Sport Med. 2015 Jan; 25 (1): 23-25

Sick as a dog? Keep the cold/flu at bay!

Taking an antibiotic for the cold or flu? What is the point?

Antibiotics are medications that are used to treat infections caused by bacteria. The common cold and flu are viral infections, and asking your prescriber for an antibiotic to treat these conditions is something we do not encourage you to do.

When is it ok for you vs not okay to take antibiotics?

Common Cause: Virus Common Cause: Bacteria
Sore throat, sinusitis

Vomiting and diarrhea

Runny nose, cough, head cold

Kidney infection

Skin infection

Meningitis

Pneumonia

Antibiotics rarely needed Antibiotics needed

 

If you were to take antibiotics when they are not needed this may create antibiotic resistance, which can occur when bacteria are exposed to antibiotics and can learn to resist them. How can you avoid antibiotic resistance?

  1. If you have been prescribed an antibiotic COMPLETE the course of medication by taking all of the dispensed pills
  2. DO NOT skip doses of antibiotics if prescribed
  3. DO NOT save pills for later

Don’t want to get sick this winter … then take these precautions and you can limit your exposure to feeling ill.

  1. Wash your hands!
    1. Your hands are a good environment for cold viruses, and these viruses can stay on your skin for up to 2 hours.
  2. Try and avoid close contact to those who are ill!
  3. Sneeze or cough into the pit of your elbow, to avoid virus from spreading onto your hands!

If you unfortunately catch the common cold or flu, then symptomatic treatment until the virus passes is the best option. If symptoms do not resolve after a week, or worsen, we would encourage you to schedule an appointment with our providers at Student Life Student Health Services, or visit your primary care physician.

 

Symptoms Treatment
Sore throat Acetaminophen or Ibuprofen

Honey and lemon, or anesthetic lozenges

Dry cough (lack of mucus)

Wet cough (production of mucus)

Dry cough—dextromethorphan

Wet cough—guaifenesin

Fever, pain, joint or muscle ache Acetaminophen or ibuprofen
Runny nose, or congestion Nasal sprays—oxymetazoline (do not use more than 3 days, ask your pharmacist if symptoms persist)

Oral Decongestants—pseudophedrine or phenylephrine

 

Justin Corpus

PharmD Candidate 2018

 

References:

  1. Marjama, K. Treating the common cold. Pharmacy Times (2017). 83 (12): 95-96.
  2. Allan, M., Arrol, B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ (2014); 186 (3): 190-199.
  3. Schroeder, M., Brooks, B., Brooks, A. The complex relationship between virulence and antibiotic resistance. Genes (2017). 8 (1): 39-62

My BuckMD data protected by BuckeyePass – Effective Wednesday, January 3

Cybercriminals’ top priority is a real-life payout. For Ohio State student systems, that means criminals may target your personal health information (PHI). If criminals get your user name and crack your password, they may be able to view your PHI and share information about you that you would prefer not to have shared.

If you have more than one step to log in – more than just your user name and password – your risk is reduced significantly. That’s why we’re adding a multifactor authentication tool called BuckeyePass (link is external) as an extra layer of security for student systems. Extra security protects your personal information stored in My BuckMD.

How does BuckeyePass affect me?

  • BuckeyePass (link is external) will be added to My BuckMD on Wednesday, January 3.
  • BuckeyePass (link is external) requires not only a password and username, but also a second method of authentication that you control. We recommend that you sign up as soon as possible and enroll multiple devices so you have a backup in case your primary device is stolen, broken or unavailable for any reason.

What do I need to do?

The first step is to enroll in BuckeyePass (link is external).  We have found the tool to be reliable and easy to use. We’ve posted a video (link is external) so you can see what the process looks like and how it works.

 

Information above summarized from:  https://odee.osu.edu/news/2017/11/01/students-should-sign-buckeyepass-november-5

Prior Authorization

One of the most frustrating experiences as a patient is arriving at the pharmacy to pick up your medication and being told that a prior authorization is required. If you have never experienced this before the process can be especially confusing and aggravating. Unless you decide to pay cash for your medication or your doctor decides to change your therapy it can also involve a significant delay before you can actually get your medication.

Prior authorization is a process where the insurance provider wants more information from the doctor before they will pay for a medication. This process typically starts at the pharmacy when the staff there try to bill an insurance plan for a drug. The insurance will then send the pharmacy a rejection notifying them that a prior authorization needs to be completed. At this point the pharmacy will contact the doctor to let them know they must complete a prior authorization if they want the insurance company to cover the cost of the prescribed drug. The doctor must then answer some questions about the use of the prescribed medication and send those answers to the insurance provider. Finally, the insurance provider must review the doctor’s response and decide if they will pay for the medication or not. Thankfully this process is quicker than it used to be as many of these interactions are automated or electronic. Typically this process can take anywhere from a day to a week to complete, although times may vary. If a patient stays on their medication for an extended time it is likely that the prior authorization will need to be completed again at some point. Many plans require prior authorizations annually while some require them more often.

The main reason insurance plans institute prior authorization is cost savings. Plans want to review the use of high cost medications and make sure they are being utilized appropriately. A common way they do this is called step-therapy. Step therapy means that the insurance provider will require a trial of one or more lower cost medications before they will pay for a high cost drug. Many insurance providers require prior authorization for brand name drugs if a generic is available. Insurance plans often prefer a certain drug within a medication class due to cost and require providers to complete a prior authorization if they write a prescription for a different drug in the same class.

Prior authorization can be frustrating for both patients and healthcare workers. Despite that the practice isn’t going away anytime soon. If you want to be more informed about which drugs will require prior authorization on your health insurance you can request a copy of your insurance formulary which will show you which drugs your insurance plan prefers. Drugs on this list will be less likely to require a prior authorization.

Michael Kowalczyk

PharmD candidate 2018

Prescription Refills

Are you on a daily medication or learning to handle your own prescriptions for the first time? Do you have a prescription that you need to continue taking but you are out of refills?

In most cases, if you are out of refills it means that your provider felt at the time of writing your prescription that a follow-up visit was indicated in this period of time. We generally write most on-going prescriptions with the number of refills that fits the standard of care for following that health condition. Sometimes there are lab tests or physical findings that need to be checked periodically.

You don’t have time to come in for an appointment right now?

Ideally you would be able to make the time to come in for a visit so that we can provide the best possible care. However, we too were students once and understand your crazy schedules, so you can either message your provider through MyBuckMD or call the health center to leave a message with your provider asking for an extension until you can make it in for an appointment.

How to avoid running out of medications?

Plan ahead! If you notice that your medication is running low, take a look at the bottle for any refills. If you see no refills remaining, make an appointment with the prescribing provider as soon as you can.

Don’t see an appointment on-line that fits your schedule?

All available appointments do not show up for on-line scheduling. So if you are having trouble finding an appointment with your provider, please call our appointments line at 614-292-4321. Our appointments associates will be happy to help you find the next available appointment that fits your schedule.

Ryan Hanson, M.D.

My Journey into Mindfulness Based Stress Reduction

I was browsing the internet when a statement caught my eye and it stated “Do you want to
relieve stress related symptoms, promote a sense of well being and peace of mind”? I was
intrigued and thought I would love to relieve stress and also learn ways to help my patients too.
I clicked on the link and was taken to a course description titled “Mindfulness-Based Stress
Reduction program (MSBR) that was being offered for 8 weeks over the summer.

I signed up for the program without really knowing what the course was going to be about.
The first night of class I was in a room with 15 other participants who were of different ages,
backgrounds and occupations with our instructor Kevin who was a licensed social worker. We
were given the book “ Full Catastrophe Living” by Jon Kabat-Zinn along with a workbook and a
CD. He had us imagine that we had a rock in our hand and walked up to a well and dropped it
in and then he went around the room and asked us what that symbolized to us. I remember
that I had said that it symbolized throwing away the stressful feelings and discomfort. He also
asked us not to set a goal or expectations for the course.

The program focused on attitudinal qualities that would relieve stress including: non-judging,
patience, beginner’s mind, trust, non-striving and acceptance. Non-judging is being an
impartial witness to our own experience and not having a reaction to the experience. Patience
is allowing letting things unfold in good time and make a connection to the present. Beginner’s
mind is not allowing our beliefs and thinking from seeing things as they really are. Trust is to
listen and trust our own being through meditation. Non-striving is about trying less and
through meditation we are non-doing. Acceptance is seeing things as they are in the present
and not trying to force things to the way we want them to be which causes more stress and
prevents positive change.

We had daily meditations on our CD that guided us through body scan which focused our mind
on each body part starting with the head and then ending at our toes or sitting or laying
meditations or meditative yoga. We had a log in our workbook to document our feelings and
reactions to different situations that may have given us distress or pleasure. We had a retreat
day after our sixth week in which we did not speak during that time. Our instructor gave us
directions during the day and guided us through different types of mediation. We ate our lunch
mindfully and took our time tasting and chewing our food more times than we would normally
and did not pick up the fork before we swallowed our bite. I was a little anxious as well as
some of the other participants of not talking or using our phones for a whole day and staying
focus on the present, but it actually was easier than I thought and at the end of the day I felt a
sense of peace.

This type of course is not for everyone, but it is evidenced based and taught internationally.
The course has taught me a way of being. It is not a philosophy, it is a be practiced by being
mindful and carrying out the meditation practices daily. It takes commitment and is to be
practiced daily in order for it to be available when needed.

At the end of the eight weeks, I am better at being more mindful and at mediation, but it is a
work in progress. After the eight week course I had learned that my initial response to the first
question of dropping the rock into the well throwing away stress thoughts and feelings was not
mindfulness, it is about learning to live with all the thoughts or feelings good and bad and
acknowledging them and not reacting to them. “ Life is not the way it’s supposed to be. It is
the way it is. And how we relate with this truth is what makes all the difference. “. Virginia Satir

Submitted by Edith Chang, M.D.

Medication Disposal Day – Don’t rush to flush!

The Student Health Services Pharmacy will be holding our 6th annual DEA-approved Medication Disposal Day Thursday, October 26th, from 9:00 a.m. to 2:00 p.m. 

All students, staff, and faculty are invited to bring unused or expired medicines to be disposed of in a safe, legal, and environmentally-friendly way.  This service is entirely free of charge and is completely anonymous.  No questions asked!  We will take any expired, damaged or unused medications (even if they are a controlled substance like narcotic pain medication or ADD medication).

Please note: Do not remove medication labels before drop-off.  Syringes, needles, and thermometers will not be accepted.

Our goal is to address a vital public safety and public health issue by removing potentially dangerous prescription drugs from your backpacks and medicine cabinets.

  • Since 2007, more Ohians have died from unintentional drug overdosing than motor vehicle accidents.
  • More than 7 million Americans currently abuse prescription drugs, according to the 2009 Substance Abuse and Mental Health Administration’s National Survey on Drug Use and Health.
  • Each day, approximately 2,500 teens use prescription drugs for the first time to get high, according to the Partnership for a Drug Free America.
  • Studies show that a majority of abused prescription drugs are obtained from family and friends, including the home medicine cabinet.

These expired medicines can be as bad for our environment as they are for our health.  Measurable quantities of some common medications are showing up in lakes, reservoirs, and municipal water supplies, thought to be due in large part to improper flushing of medications down sinks and toilets.

So make the right choice and join us for our 5th Annual Medication Disposal Day!  It’s a great way to keep yourself healthy and our campus safe!

This event is jointly sponsored by Student Health Services (Office of Student Life), Department of Public Safety, and Generation Rx.

Candace Haugtvedt, RPh, PhD
Student Health Services
The Ohio State University