Monday, September 19, 2016

Can College Students Get Ulcers?

"Does STRESS cause stomach ulcers?"

In a college health center, this is a question I hear fairly often, especially around midterms or finals. Certainly most of us have experienced stomach discomfort when we are anxious- whether that is nausea, cramping, diarrhea or pain- but the vast majority of people with those symptoms do not have actual ulcers.

However, people who are stressed may have COPING HABITS that can irritate the stomach lining, causing a gastritis (inflammation of the stomach lining) which might facilitate the development of ulcers:
  • Drinking too much alcohol (more than one drink/day for women, or more than 2 drinks/day for men) 
  • Using too many NSAIDs (Non Steroid Anti Inflammatory Drugs) like ibuprofen (aka. Advil/Motrin/etc).
Of course, college football weekends with prolonged tailgating and subsequent hangovers (treated with ibuprofen) are the perfect set up before "stress" from midterms is even a factor.

Stomach ulcers, meaning an abrasion or "ulceration" in the inside lining of your stomach, are actually primarily caused by a bacteria called H. pylori, which lives in the GI tracts of approximately 30-40% of Americans. It may be present for decades before it causes any symptoms. This bacteria is identified within 70-95% of ulcers that are biopsied in the stomach and the first part of the small intestine, the duodenum.

What are symptoms of stomach ulcers?
The discomfort of ulcers starts off feeling like hunger to many people- a deep ache, located below your breastbone and above your belly button. The pains may come and go at first, and may also be associated with feeling nauseated or bloated after meals. Initially, taking an antacid such as TUMS will relieve this sensation. The timing of the pains tends to vary with the location of the ulcer, and the pains might come and go for weeks at a time.

How does a doctor check for ulcers?
For young people (under 55 years) who are otherwise healthy, the current standard of care is to test for the presence of H. pylori bacteria, and treat immediately if that is positive. There are blood tests, breath tests and stool tests available. For older patients or those with risk factors for stomach cancer, direct visualization with endoscopy is recommended to allow the doctor to biopsy any suspicious areas.

How are ulcers treated?
If your doctor finds H.pylori, you will be treated with not one, but several medications: one acid blocking medication called a proton pump inhibitor, and two antibiotics. There are different regimens, but all include at least these medications at different dosages and timing.

If it's not an ulcer, what else could it be?
Persistent, recurrent upper abdominal pain and nausea could multiple other medical issues, including (but not limited to) gall stones, pancreatitis, hernias, colon disease (including celiac or inflammatory diseases like Crohn's) or other systemic illness. The key point here is not to worry you, but to encourage you not to suffer in silence. Avoid the temptation to self-diagnose or to try every over-the-counter remedy before heading in to see your family physician.

BOTTOM LINE: If you are having recurrent pain in your upper abdomen, nausea, bloating or other discomfort, stop taking NSAIDS and drinking alcohol, and head in to see your doctor. 

Monday, September 12, 2016

6 Tips for Freshmen Insomnia

Freshmen college students have many challenges as they adjust to their new environments, and sleepless nights in dorm rooms can trigger a downward spiral of fatigue, trouble concentrating, and poor grades...which leads to anxiety and more difficulty sleeping. What can students do to try and stop this cycle? Certainly there are multiple causes for insomnia, from roommate noise to seasonal allergies, to homesickness or academic stressors, but here are six basic steps to try first:

  1. CONSISTENT SLEEP (& WAKE) TIMES- with MWF and T/Th schedules, often students have drastically different sleep and wake times each day, which doesn't jive with our body's internal clock. Getting up and going to bed at consistent times (within an hour's window) will help set your body on a schedule. Create a morning library study period for yourself on later start days that you treat as another class, or commit to an early exercise class.* (Daily aerobic exercise is a wonderful stress reducer, but because of the adrenaline it produces, make sure not to exercise within three hours of your normal bedtime.)
  2. SLEEPING MASK- this is a great way to physically block out light in a shared space. Spend the extra few bucks for one that fits right, is easily washable and comfortable (usually around $15-$20). Side note- keep the mask ON during the night...resist the temptation to check the time. If you can't cover your eyes, cover the CLOCK. Our brains are clever, and can consistently wake us up at the exact time every night if we allow ourselves to look at the clock. 
  3. BLOCK the NEW NOISE- like snoring roommates, hallway traffic or loud face-timing neighbors- with a combination of comfortable ear plugs or extra white noise from a portable fan (even if you have A/C). 
  4.  GUIDED MEDITATION APP: consider one from Healthline's "Best Meditation Apps of 2016"
  5. AVOID SCREENS at least the last hour or two before bed. Numerous studies have confirmed the detrimental affect of blue lights on sleep cycles. Students live on screens both socially and academically, so this is a tough one, but simple modifications include saving your actual book reading or off-screen math assignments for the end of your study evening, and taking your showers at night. And...not playing games or stalking social media as your "relaxation" time when you get in to bed. 
  6. GO TO TUTORING. If academic stress is the primary source of your anxiety and subsequent insomnia, do not suffer in silence or wait till you "have" to talk to your professor! Almost everyone is initially overwhelmed by the volume and intensity of college courses, especially if you got in to your "dream" school. Learning to utilize study partners or groups, attending tutoring sessions, and discovering new interactive memorization techniques will help dramatically. Locking yourself in a room "until I finish", skipping fun activities as you try to force-feed yourself the information will be minimally productive, if at all. Alternating study locations, prioritizing sleep, and taking practice tests will improve your grades. All-nighters do not. 
BOTTOM LINE: College life is tough on sleep cycles- try these steps to start improving your chances of restful sleep, so your brain has the energy and focus to succeed!

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 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.