How do I know if I have frostbite?

Q: I was out in the cold in tennis shoes for a long time. When I came inside my toes were blue and hurt really bad for a few hours. Did I get frostbite?

A: Frostbite occurs when tissue freezes.  The condition mainly affects the fingers, toes, ears, cheeks and nose, but any body part can freeze – even your eyeballs!  When exposed to prolonged cold temperatures, blood flow is decreased to the extremities and diverted to more vital organs, like your heart, lungs and brain.  Unfortunately, this leaves the vulnerable areas even more at risk.

There is a spectrum of severity in frostbite.  Superficial frostbite occurs when the areas of the skin close to the surface freeze. There is often a burning sensation, numbness, or tingling.  Affected tissue becomes cold and white, but maintains some of the elasticity of normal skin.  This type of frostbite can be serious, but is potentially reversible with no loss of tissue or function.

The deeper the freeze, the more serious the disease.  When there is more extensive damage the tissue becomes white and hard, sometimes with superficial blood blisters. Sensation in the tissue is either absent or profoundly decreased. There probably will be loss of tissue, and sometimes surgery is required.

Frostnip is a cold injury to the tissues that is different from frostbite.  In frostnip, superficial tissue becomes cooled, but is not cold enough to freeze.  Skin is usually pale and numb, but recovers fully with gradual warming.

People with frostbite should be seen by a physician as soon as possible.  The area involved should be elevated and gradually warmed.  No rubbing! Clapping, rubbing, or slapping those cold frozen fingers together is only going to cause more damage to already stressed tissue.

Of course, the best way to avoid frostbite is to listen to your mother (and Dr. Vicki) and wear your hat and gloves. Minimize your exposure during severe weather. Be extra careful if you’re sick, have diabetes, vascular disease, or you smoke. Be wary of cold weather and alcohol. Stay warm out there, Buckeyes!

Victoria Rentel, MD (OSU SHS)

Reviewed by Tina Comston, M.Ed.

Medical Mythbusters – Do you really lose 80% of your body heat from your head?

True or False:  80% of your body heat is lost from your head.


I love this one. My mother must have used it on me a million times growing up to get me to wear a hat, which I would not do since I grew up in the 70s and my Farrah Fawcett hair would have been ruined.

Where did this “80%” come from? Apparently from a weak US military study done in the 1950s that examined heat loss from Arctic volunteers dressed from neck to toe in survival gear. Duh, their uncovered heads lost more heat than the rest of their bodies. Were I to go outside in the bitter cold naked (as awful as that image is to contemplate) 100% of my body heat would be lost from my whole body. A slightly higher proportion of the heat might be lost from my head thanks to the greater blood supply to the head and face, but the head doesn’t have a lock on heat loss.  If you go outside in a pair of shorts you’re going to lose a lot of heat through your legs.

What my mom was worried about, of course, was the dreaded frostbite, of Jack Frost nipping at my nose. What exactly would put my nose (or ears or toes) at risk?

Environmental: Prolonged exposure, extreme cold, damp cold, high altitude. During severe cold, frostbite can develop in a matter of minutes. Everything that is exposed is at risk.  Feet and hands are affected most frequently, but ears, noses, cheeks, and even corneas are also at risk.  I challenge you to find a hat for your cornea.

Poor underlying health and/or altered mental status: Prior cold injury, alcohol use, tobacco use, malnutrition, diabetes, peripheral vascular disease, and severe mental health all limit the body’s ability to respond to any severe stress, including cold temperatures. Of note, prior cold injury can quadruple the risk of a subsequent cold injury.

Clothing: Inadequate clothing obviously increases exposure. But constrictive clothing that limits blood flow to the extremities, toes, etc. also increases risk of cold injury.

Being male: Whether this is because of some kind of genetic susceptibility or because males tend to spend more time outdoors isn’t clear.  African American males appear to be at special risk.  During both the Korean and Falkland Wars, there was a higher prevalence of frostbite in African American men than in other similarly attired races.

The bottom line? Mom was right, especially if you’re a male who likes to train for marathons during sleet storms at very high altitudes in super tight clothes while crazy drunk and smoking like a chimney.  So…

  • Minimize exposure, especially if it’s extremely cold and/or damp. Higher altitudes (like ski trips) warrant even more caution.
  • Wear sensible, warm, non-constrictive, layered clothing.
  • Stay dry.
  • If you’re going to be out in the cold, avoid drugs, alcohol, and tobacco.

Victoria Rentel MD (OSU SHS)

Medical Mythbusters – Poisonous Poinsettas!

True or False: Poinsettias are poisonous to kids and pets.


This is one of those holiday myths that just refuses to die. It supposedly began back in 1919 when a 2-year-old boy was found dead after eating a poinsettia leaf – it was just assumed that the plant had killed him. However, since that time, many studies have shown that kids (and pets) that are exposed to poinsettia plants do just fine.

The sap of the plant is mildly irritating but according to POISINDEX (the resource used by Poison Control Centers) a 50-pound kiddo would have to eat about 500 leaves to have any toxic effects.  And while I myself have never dined on a poinsettia salad, the leaves are reportedly not very tasty, so it’s highly unlikely that kids or even hyperactive pets would be willing to eat that many! The most common side effects that have been reported from poinsettia ingestions are upset stomach and vomiting, and some people with serious latex allergies have had a skin reaction after touching the leaves.

If you or any of your relatives happen to nibble on a poinsettia (or any other plant for that matter) and you are concerned, you can always call your Poison Control Center at 1-800-222-1222 to speak with an expert.  But in the mean time, go ahead and get decorating for the holidays – with your crazy Uncle Louie coming over to celebrate with his famous High Octane Egg Nog, the plants are the least of your worries!   

Angela Walker (OSU COM)

John A. Vaughn, MD (OSU SHS)

What can I do to prevent chapped lips?

click to enlarge

Q: Why are my lips so chapped and what can I do about it?

A: Ah winter, that time of year when the freezing wind whips past your face and dries out your skin. Lips have a very thin layer of skin compared to the rest of the face, so they are especially susceptible to drying out in the cold wind and low humidity of winter. Add to that your natural tendency to lick your lips to rewet them, and you’ve set yourself up for dry, cracked and painful lips.

So what can you do to prevent and/or treat your chapped winter lips? Keep ‘em covered!  Balms and ointments containing petrolatum or beeswax are the best for sealing in moisture and creating a barrier between your skin and the elements, although if you have acne you might want to look for petrolatum-free products as these are less likely to cause blackheads and breakouts.  Try to look for one with some SPF protection as well, especially if you spend a lot of time outdoors. You can get burnt even when it’s cloudy!  In general, ingredients such as eucalyptus, menthol, and camphor tend to be irritating so try to stay away from them.

Make sure to apply treatment before you go out into the cold and especially before going to bed, as many of us tend to sleep with our mouths open, which leads to lips drying out. You may also want to consider investing in a humidifier to use during the winter, when the heater tends to dry out the air indoors. Also, make sure you drink plenty of water and stay hydrated.  If you’re doing all of the above and still have trouble with chapped lips, take a look at your cosmetics and skin care products – sometimes, the ingredients can cause an allergic reaction that irritates your lips.

There are some common lip ailments that may be confused with chapping, the most common of which are cold sores and angular cheilitis.  Cold sores are caused by a herpes virus and may be improved with oral antiviral medications.  Angular cheilitis is a painful inflammation of the corners the mouth.  It can be caused by Vitamin B deficiency, mechanical irritation or a fungal infection.  It is treated by correcting the underlying cause and/or antifungal medication.

If you have persistently chapped or irritated lips that do not improve with the simple steps listed above, make an appointment at Student Health Services – we are always happy to see you!

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



Do I need to avoid the sun if I’m on medication?

PhotoTOXIC reaction

PhotoALLERGIC Reaction

Certain medications cause your skin to become more sensitive to the sun.  Contrary to popular belief, they don’t make you more likely to burn, but actually cause a separate type of painful and itchy rash that can look like a bad burn.  There are two types of photosensitive reactions: phototoxic and photoallergic. 

Phototoxic is the most common.  This happens when the drug itself gets dispersed throughout the body and ends up in the skin, where it absorbs UVA light and causes cellular damage.  A phototoxic event typically happens within hours of initial exposure to sunlight.

Photoallergic reaction occur when the UV light alters the chemical structure of the drug and the body’s immune system sees this new compound as an intruder and attacks it.  A photoallergic reaction doesn’t usually happen right away; it requires longer, and often multiple, exposures to sunlight before it happens. 

Many commonly used medicines can cause photosensitivity:

Antibiotics such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), sulfamethoxazole/trimethoprim (Bactrim®) and doxycycline, tetracycline, and minocycline.

Acne medicines such as (isotretinoin (Accutane®/Claravis®), tazarotene (Tazorac®), and tretinoin)

Medicines to prevent malaria while traveling like atovaquone/proguanil (Malarone®) and chloroquine).

If you are taking a medication that can increase photosensitivity, you should avoid excessive exposure to sunlight and tanning beds.  (Of course, you already know that you should avoid tanning beds anyway).  If you don’t want to be a shut in while the sun shines, make sure you wear a broad spectrum (UVA/UVB) sunscreen with a SPF rating of 30 or greater.  This will decrease that amount of sunlight exposure to your skin and therefore the risk of a bad reaction.      

Sun Screen Tips:

  • Make sure it is broad spectrum (UVA & UVB)
  • Apply roughly one ounce of sunscreen for the full body
  • Apply one-half teaspoon of sunscreen to smaller body parts i.e. face/neck, each arm and shoulder
  • Apply one teaspoon of sunscreen to larger body parts i.e. legs, back
  • Apply 15-30 minutes prior to sunscreen exposure to ensure optimal protection
  • If swimming or being physically active use a “water resistant” sunscreen
  • Reapply liberally, especially if excessive swimming , sweating or toweling off
  • Minimally use a SPF of 15, optimally use a SPF of 30
  • If applying insect repellant, put the sunscreen on first, wait 15 minutes and then apply the insect repellant

If you are planning on spending a lot of time in the sun while on a medication, be sure to ask your pharmacist about possible photosensitivity side effects.   The pharmacy staff at the Wilce Student Health Center is always willing to answer any questions you may have.  Feel free to stop by or call us at (614) 292-0125.

Dean Wagner, PharmD candidate 2012
Student Health Services
The Ohio State University

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


15 Things No Dorm Room Should Be Without!

It's a blanket!  That you can wear!

Shower caddie?  Check.  Combination iPod, laptop, cell phone charger?  Check.  Officially Licensed Ohio State Snuggie?  Check. 

Ok, you and the rents are just starting that list of things you simply must have in your door room.  But have you thought about what stuff you should have to keep you healthy on campus this year?  Here are the 15 health care items that no dorm room should be without:

1. Thermometer

2. Pain and fever medication: Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin) or Naproxen (Aleve)

3. Ice pack and/or heating pad

4. Band-Aids

5. Antibiotic ointment

6. ACE wrap

7. Antihistamine medication for allergies or itchy rashes: Diphenhydramine (Benadryl), Loratadine (Claritin), Cetirizine (Zyrtec)

8. Cough and cold medication

9. Anti-diarrhea medication: Loperamide (Imodium AD)

10. Antacid medication: TUMS, Pepto-Bismol, Ranitidine (Zantac), Famotidine (Pepcid), Cimetidine (Tagamet), Omeprazole (Prilosec)

11. Sore throat lozenges

12. Hydrocortisone cream for itchy rashes

13. Alcohol-based hand sanitizer to prevent spread of germs

14. Lotion for dry skin

15. And last but not least, our phone number: 614-292-4321

You can pick up all of these things at our pharmacy.  They’re cheap, they don’t take up a lot of space, and they’re much more useful than that Justin Bieber pillow you plan to sneak in on Move-In Day. 

Welcome to Ohio State!  We look forward to seeing you on campus this fall!  

Sheila K. Westendorf, MD
Student Health Services
The Ohio State University

Safe biking tips from Pelotonia

The Pelotonia folks posted a great article about how to beat the heat on your bike this summer on their blog The Rider on Monday.  You should check it out – lots of great advice. 

And while you’re there, take some time to look around the site and learn more about Pelotonia and all of the people here in Columbus and beyond who are raising money to help Ohio State researchers understand, prevent and treat cancer.  You can join the fight or donate to the cause while you’re at it!

Go Bucks!

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

As easy as riding a bike?

Your old childhood friend the bicycle is suddenly hip again!  It’s a healthier, greener, cheaper and more fun way to get around than that gas-guzzling car.  But things have changed since your grade school Huffy-banana seat-riding days, so we thought it was time to test your bike safety knowledge with a little True or False quiz. 

  1. You are more likely to get hit by a car when riding on the sidewalk than in the street.
  2. When riding in the street you should always hug the shoulder as close as possible to allow cars to pass you. 
  3. When riding in a bike lane, you don’t have to follow the rules of traffic. So if the light turns red and there’s no cross traffic, you can blow on through!
  4. Riding a bike home is a safe way to avoid a DUI if you’re too drunk to drive.


  1. TRUE Cyclists who ride on the sidewalk are 2-9 times more likely to get hit by a car! This is because cars aren’t expecting bicycles to be riding on the sidewalks and may not look for them at crosswalks. You run the risk of getting hit at every intersection!!
  2. FALSE This is a tricky one because it depends on the road you’re riding on. If there is a wide shoulder with plenty of room for cars to pass, then by all means ride on the side. But if there is a small shoulder or narrow lanes that would cause a passing car to have to “squeeze” by you, then don’t feel bad about taking up the whole lane. This prevents you and the driver from getting into a risky situation.
  3. FALSE Even when riding in the bike lane, you are still considered to be a “vehicle” on the road and are subject to the same rules as cars (and can get the same tickets). That means no running red lights, blowing stops signs, or making illegal turns.
  4. FALSE If you aren’t able to drive, you aren’t able to ride. Both modes of transportation require that you have the coordination, awareness and alertness to follow the rules of the road. And you can get a ticket for DUI while riding a bike, so just call a cab!

As spring approaches, it’s important to take your bike into a local shop to make sure it’s safe for you to ride.  But it’s equally important to make sure that you are safe to ride it!  Always wear your helmet and check out the links below.  Happy riding!

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

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

Making Polio Disappear for Pennies a Day

While Student Health works to educate and inform our campus about getting your vaccines updated, efforts are ongoing around the globe to deal with vaccine-preventable diseases, and the toll they take around the world, a toll that is unfortunately measured in the lives of children.  Take a look at this video from the Bill and Melinda Gates Foundation to see what they and countless others are doing to make polio go the way of the dinosaurs.

Roger Miller, MD
Student Health Services
The Ohio State University

Winter Safety Alert! Being a couch potato really could kill you!

It’s winter.  It’s cold.  We’re all staying inside.  You wouldn’t think that spending an afternoon on the couch could be a life-threatening activity, but if you don’t have a carbon monoxide (CO) detector, it could be just that.  There have already been several deaths by CO poisoning in Ohio this year, so we thought it was a good time to review what CO is and why it’s so important to have a CO detector in your home!

What is CO and how do poisonings happen?

Carbon monoxide (CO) is a toxic gas produced by devices using gas, oil, kerosene, or wood.  Room space heaters, furnaces, charcoal grills, fireplaces, water heaters, and automobiles all produce CO.  Older appliances (such as old furnaces or water heaters) can produce dangerously high levels if they haven’t been checked and serviced in a while.  Winter is an especially risky time for CO poisoning because homes are usually closed up tight to keep out the cold.  And because CO is colorless, odorless, tasteless and non-irritating, dangerously high levels can accumulate in homes without any warning signs. 

What are the signs and symptoms of CO poisoning? How will I know if I have it?

The initial symptoms of CO poisoning can be similar to the flu: dizziness, headache, fatigue, nausea, confusion, shortness of breath and feeling faint.  However, death can occur without any of these warning symptoms being experienced

If you’re experiencing symptoms that you think could be related to CO poisoning, get fresh air immediately and go to the emergency room.  A blood test called an arterial blood gas (ABG) can confirm CO poisoning if it’s done soon after an exposure.  (We can’t do ABG’s in the Student Health Center – you have to go to the ER). 

The ONLY sure way to make sure that your house is safe is to have a working CO detector so please make sure you have one in your house.  And if you already have one, be sure to test it – replacing those batteries could be the best ten dollars you ever spent!

To learn more about carbon monoxide and how to prevent poisoning, check out these links. 

United States Environmental Protection Agency

United States Consumer Product Safety Commission

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

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