Tuesday, August 9, 2016

College Student Essential: the Medication Box

August has arrived, which means panic is setting in for many families as they pack up their high school graduate and send them off to college. Pinterest-driven dorm room cuteness shifts much of the focus (at least for girls) to inspirational quotes, picture displays and twinkling lights.  Mothers alternate between doing everything for their "baby" one last time, to cramming in last minute instructions on washing clothes and paying attention to car maintenance. If your child takes any medications on a regular basis (prescription or not), then I would like to add one or twoVERY important items to your college shopping list:

  • Weekly medication dispenser 
  • Medication lock box
Why do kids need an "old person's" medication box? The same reason that birth control pills come labeled by the day! Taking medications can be so routine that we often do not pay full attention to what we are doing as we pop in the daily antihistamine (or vitamin, or whatever). How many times have you finished brushing your teeth, then wondered- wait, did I take my pill yet? If your pills are in a day-labeled container, you have your answer. If they are in a bottle...you have to guess. This is particularly an issue for freshmen college students, because in many households, parents set out the medications each morning with breakfast...which means that students who have not been in charge of their own medications have not had to create this habit on their own. I regularly see young people who are having side effects because they accidentally took their ADD medication twice in one morning (especially when have an early class, then go back and sleep before their next class, and basically repeat their morning routine when they wake up the second time).  On the opposite end, students who take medications for depression or anxiety often forget to take their medications (especially when they are feeling fine), but then deal with aches, pains and brain "fuzziness" the next day that they may not even realize is from skipping a pill. Using these simple day-labeled boxes takes the guesswork out of whether or not you have taken your pills.

Keeping prescription medications- especially ADD meds- in a lock box reduces the temptation for others to "borrow" any pills. Unfortunately, ADD medications are abused as "study aids" and "weight loss pills" on most campuses. Let me note here that it is a FELONY to buy or sell these drugs- even ONE pill to ONE "friend".  WARN YOUR CHILD. If your student takes ADD medications, encourage them to keep these prescriptions in a locked box, tucked away in their room. Once a week, they can fill their daily dispenser, and keep that in a safe but easily accessible place. For girls- there are cute med boxes that look like make up pouches or wallets- and some even have a spot to keep a copy of your insurance card. By the way...if you have a senior in high school, consider putting them in charge of their medications in this same fashion, so next year isn't so challenging!

BOTTOM LINE: For students (and the rest of us) who take daily medications, using a simple daily pill dispenser improves accuracy and keeps us healthier!
(Disclaimer- I have no ties, financial or otherwise, with the makers of these products, but they both work great.)

Monday, August 1, 2016

Moving in to a DORM? Double Check Your Vaccinations!

Why do COLLEGE STUDENTS need the Meningitis Vaccine?

What is meningococcal disease? The bacteria Neisseria meningitidis causes a range of illnesses that can rapidly progress to be fatal if not immediately recognized and treated. Meningitis is an infection of the lining of the brain that can cause coma, sepsis and death. Early symptoms start like the flu- fever, headache, body aches, and possibly nausea and vomiting, then the headache progresses in severity, the neck becomes very stiff and painful, and the person may become confused or even unconscious. A very specific RASH can alert clinicians to this dangerous disease- it is dark red/purple and does not whiten if pressed upon. This rash is caused by leakage of blood vessels as the bacteria releases toxins into the blood stream. Survivors of a severe meningococcal infection may have lost fingers, toes or even limbs as a direct result of this blood vessel damage.

Meningococcal disease is especially noteworthy here in Texas, where we were the first state to pass legislation to require the meningococcal vaccine for every college student. Sadly, this legislation came after one student at Texas A&M died (Nicolis Williams) in 2011, and a University of Texas sophomore (Jamie Schanbaum) had lost both legs, fingers, and narrowly survived meningococcal infection. The Texas law is named for both of these students. Jamie has remarkably gone on to not only champion efforts to educate about vaccine prevention for meningococcal disease, but to win a gold medal in the paralympics.

Who needs this vaccine?  The meningococcal vaccine has NEW RECOMMENDATIONS- all adolescents should still receive their first shot (the MCV4) at age 11-12, as previously recommended, but now we know they need a BOOSTER DOSE at or after age 16, before they head off to college. Although initially thought to offer protection for a decade, it turns out that the immunity begins to wane in this age group after 5 years. Yes, they still needed that earlier vaccine to protect against the herds of kids joining them in close quarters at school and summer camp, but we want them maximally protected as well when they move into that dorm!

In addition, military recruits (also living in crowded quarters like a dorm) and anyone who has had their spleen removed should get this vaccine.  Travelers to sub-Sahara Africa during the dry season are also at increased risk, so vaccination is recommended for this group as well.

BOTTOM LINE: Protect your adolescent against this rapidly progressive, dangerous disease by making sure they received not only their initial vaccine at 11-12 years, but also their BOOSTER before they head off to college! (If they are already in college but missed their booster, add this to their holiday wish list...)

Image above from NY Times

Friday, July 1, 2016

Top 6 Non-Medication Items in a College First Aid Kit

A College First Aid kit is my favorite personalized gift for graduating high school seniors, and a MUST for every young person heading off to college. As an urgent care physician seeing students at the University of Texas, I have significant insight as to how teens handle their first illness away from home. As you start your child's first aid kit, here are SIX NON-MEDICINE items I suggest:

1. THERMOMETER- Preferably two inexpensive digital thermometers (because  I've found their shelf-life is often less than a school year.) 
  • Knowing whether or not you have a true FEVER (temperature >100.4*) is a very helpful piece of information, especially when you are calling in to a nurse hotline.
  • Allergies frequently cause a mildly elevated temperature (99*) 
  • Viral infections often will cause a SUBnormal temperature of around 98* (especially after the first day), even though you feel "feverish" or chilled. 
2. ALCOHOL WIPES- purchase a small box of individually packaged wipes (~$1). Remind your student that they should USE these wipes on the thermometer BEFORE & AFTER checking temps.

3. BANDAIDS- do NOT go cheap here, splurge for the $4 box that includes flexible fabric finger tip and knuckle strips, because these actually stay on effectively. If your student is studying architecture, buy several boxes (seriously!) They work with exacto knives- enough said. A box of "blister" bandaids is nice for students headed to large campuses- their FitBit step count is about to skyrocket.

4. COMPRESSION ("ACE") WRAP- I prefer the 3" size. Remind your student of the RICE pneumonic:   Rest * Ice* Compression * Elevation for injured extremities. Add in a ziplock bag for a DIY cold pack for bonus points.

5. BULB SYRINGE- If your child is an ear-wax-builder-upper, encourage them to use this tool to periodically flush out their ears (INSTEAD of Q-tips, which typically pack in the wax further).

6. PAPERWORK- stick in an extra copy of your family's health insurance card, along with a medication list (if your child takes prescriptions regularly, prescription or not). Write the date of most recent TETANUS shot on the med list. Yes, you fill these things out on line for the school, but your student may end up at an outside urgent care clinic at night or on a weekend, and it's wonderful to have these physically on hand (or at least on their smart phone as a picture.)

BOTTOM LINE: A college student's first aid kit should start with a thermometer, alcohol wipes, "good" bandaids, an ACE wrap, bulb syringe & copy of your family health insurance card.  

PS. Virtually every university now has a 24 advice line staffed by an actual, live human being- be sure your college student has that number programmed in to their smart phone!

Wednesday, June 1, 2016

Summer Travel First Aid Kit

Packing up for your summer vacation? If you are driving, may I suggest you prioritize finding a small space (maybe under the passenger seat as above) to stash a first aid kit? If you already keep one in your car (hello, fellow soccer/dance/volleyball moms!) then let this be your reminder to pull that kit out of your car, CHECK EXPIRATION DATES, and replenish all your used up supplies.

What's in my kit? Although I will confess my kit is over-stocked with "extras", here is my basic essentials Top Ten First Aid Kit List:

1. Ibuprofen (trade name Advil/Motrin)- for headaches, muscle aches, fevers or menstrual cramps.
2. Acetaminophen (trade name Tylenol- to supplement the ibuprofen if the ache or fever is severe.
3. Antacid tablets (TUMS or Rolaids)- still the fastest relief from heartburn/stomach acid.
4. Hydrocortisone cream (Cortaid)- for anything that itches (bug bites, allergic skin reactions.)
5. Triple antibiotic cream- for cuts/scrapes (after washing copiously with water.)
6. Bandaids- the GOOD kind that really stick, with specifics for knuckles, knees, and most commonly, HEELS (for those blisters!)
7. Benadryl tablets- for an intense allergic reaction to food, stings, etc; also may be used to help nausea or insomnia.
8. ACE wrap- handy to limit swelling of a sprained ankle, knee or wrist.
9. Aspirin- one daily helps prevents blood clots from prolonged sitting while traveling; also I like to  keep this in case an adult has symptoms of a possible heart attack.
10. Imodium- I do NOT recommend this to stop infectious diarrhea (so do not take if you have a fever), but if you get a "nervous stomach" with the thought of flying, driving, or simply being cooped up in a car with your relatives, consider this medication to calm down your bowels.

Bonus: THERMOMETER! Not a medication, but definitely should go in there

BOTTOM LINE: These few basic first aid supplies should get you through 99% of the medical urgencies that crop up on your trips. Remember the creams may count as "liquids" so slip them into your airline-specified ziplock baggie if you are flying!

Monday, April 25, 2016

Doctor's Help for Fear of Flying

If your fear of flying is putting a damper on your summer travel plans, know that you are not alone- and that your family physician can offer you a few different medications that may reduce your stress. Many patients have told me they were afraid to ask for any medication, because they did not realize these drugs could be used situationally for a single event such as a flight.

Beta-blockers- this class of medication simply keeps your heart from racing, and lowers your blood pressure. This drug is used for public speaking anxiety as well.

Sedatives- although when used frequently these medications are definitely addictive, using a short-acting sedative for a flight is a very reasonable option. Alprazolam (trade name xanax) is commonly prescribed in small doses (and very small quantities). Note that these pills should never be combined with alcohol. 

Sleep aids-these are longer acting sedatives indicated for treatment of insomnia; physicians consider prescribing these for flights longer than 6 hours, such as fully across the country or overseas.

Behavioral modifications are also key to help the time "fly" by; consider:

  • Noise-cancelling headphones make a world of difference, especially if you can use them to engross yourself in a visual media as well, such as your favorite television series or movie. 
  • Music by itself, particularly a very familiar whole album or musical 
  • Crazily addictive games on your phone or iPad 
  • Puzzles or word searches

Avoid stimulants like caffeine and decongestants- no need to ramp up your heart rate before you even get on the plane!

If you have the luxury of time before you travel, consider biofeedback, hypnosis, or meditation training.

Bottom Line: Fear of flying is common- plan ahead and talk to your doctor if you would like to consider a medication to lesson your stress.

Sunday, April 10, 2016

ABCs of HIV for National Youth HIV & AIDS Awareness Day

April 10th National Youth HIV/AIDS Awareness Day logo with red ribbon on multicolor background

Today, April 10, 2016, is National Youth HIV & AIDS Awareness Day. Why do we need a YOUTH awareness day? Because in 2014, nearly 10,000 young adults were newly diagnosed with HIV (age 13-24 years, 9731 cases). And that is only young people who got TESTED and therefore were DIAGNOSED. Nearly half of young people already living with HIV are UNAWARE that they are infected. In honor of this HIV Awareness Day, here are my quick HIV ABCs:

  • A: ALL people ages 15-64 should be tested for HIV at least once, regardless of risk factors. Why?Widespread testing will help identify the estimated 1 in 8 people living with HIV infection who do not know their are infected, and now with our highly accurate rapid testing, false positives are extremely rare.
  • B: BISEXUAL- meaning remember that HIV occurs in BOTH genders, as well as emphasizing the fact that HIV is most prevalent in gay, bisexual and other males who have sex with men (but not all MSM identify as gay or bisexual.) Nearly 20% of the 44,000 new HIV diagnoses in the US during 2014 were female, and the vast majority (87%) were infected through heterosexual sex. 
  • C: CONDOMS- "Safe Sex" means using condoms consistently and correctly, for all forms of penetrative intimacy. To be specific, use condoms for oral, anal and vaginal sex. (While oral sex is low risk for HIV transmission, other STIs such as gonorrhea and herpes simplex are easily transmitted this way.) Condoms do not make you bullet-proof, but they work extremely well -up to 98% decrease in transmission of HIV.

BOTTOM LINE: HIV has not disappeared, and many who are infected do not know. GET TESTED!

Friday, April 1, 2016

STD Awareness Month 2016 "Talk. Test. Treat"


Perfect theme for the CDC's 2016 STD Awareness Month! We can't have AWARENESS if no one is talking about these diseases. And because these diseases are mostly SILENT, you can't have AWARENESS that you have an STD unless you TEST for it.

The Bad News: 

  • Sexually transmitted infections affect over 20 MILLION Americans every year, and young people ages 15-24 make up over HALF of these cases. 
  • Chlamydia, gonorrhea and syphilis are on the rise for the first time in a decade.
  • Gonorrhea is more difficult to treat because it has become very resistant to antibiotics
  • Curable bacterial STDs, if not diagnosed and treated in a timely fashion, can have lasting impact by causing chronic pelvic pain or even infertility. 
  • Young people are the least likely to get tested and treated for numerous reasons, including ignorance that their non-intercourse sexual activities can transmit STDs, fear and embarrassment of telling their parents, inability to pay for or access healthcare on their own.

The GOOD News:

  • Many of these infections are preventable, and testing is easier than ever (no pelvic exam required in most cases- only a urine test for gonorrhea and chlamydia, and a blood test for HIV and syphilis). 
  • Gardasil vaccine prevents the vast majority of genital warts and HPV-related cancers.
  • Hepatitis B vaccine prevents Hep-B related cirrhosis and liver cancer.
  • Proper and consistent condom use greatly reduces transmission of most STDs.
I have found that sharing stories (with accurate medical information) is a powerful tool for teaching about sexually transmitted infections. Check out the newly released second edition of Seductive Delusions: how everyday people catch STIs.

BOTTOM LINE: TALK.TEST.TREAT  and learn how you can help spread KNOWLEDGE and stop the spread of DISEASE.