Spring Break 2018: Know Your Limit

Spring Break is here, and students everywhere are gearing up for a week-long party. ALCOHOL is typically a focus of these festivities, so let's review some facts about alcohol dangers. In recent years, studies show that about a third of college students admit to binge drinking (consuming 5 or more drinks in a row.) The good news is that this number is down over 15% from over the last two decades, and actually, drinking trends in ALL categories are decreasing- whether the measurement is annual consumption, monthly, weekly or number of binging episodes. A great tool to educate yourself (or your favorite college student) is this VIRTUAL BAR  where you can enter in your gender, age and weight, and then "pour" yourself drinks and watch your blood alcohol levels rise...

Another wonderfully informative program/website is Aware Awake Alive. Check out their table with drinks/blood alcohol concentrations, and SHARE THIS WITH YOUR FRIENDS. Ultimately, know that if you have a THIRD drink, you are most likely legally drunk. AND, please note, this is a third drink measured by the book (not a "college pour" of alcohol into a plastic red cup- those cups hold several servings in just one glass). The biggest mistake friends make is leaving their intoxicated friends alone to "sleep it off".  If someone has "passed out," they NEED supervision. The alcohol level in their bloodstream will continue to rise, which can cause them to either vomit (and potentially choke, because their gag reflex is dulled by the alcohol) or to stop breathing. If their breathing is less than 8 breaths/minute, CALL 911 immediately.

Pain killers often find their way to spring break as well, whether that is courtesy of a knee injury skiing, or simply part of someone's personal medicine cabinet. Please take note:

Pain Killers (narcotics- think codeine or vicodin) + ALCOHOL= DEATH.

This combination accounts for far too many accidental suicides per year- NEVER MIX THESE.

BOTTOM LINE: Enjoy spring break, but if your festivities include alcohol, make sure you know your limit AND know exactly what to do if one of your friends drinks too much. 

Pre-Gaming with ADD Meds...A Dangerous Party Plan

Binge drinking in college students is not exactly breaking news.  My patients repeatedly explain "if you can't handle five shots of vodka, you are pretty lame".  They toss back multiple shots, have beers, then top off with mixed drinks. Hit the replay button once or twice, and the weekend is over. On Monday morning, they head back to class, seeming none-the-worse for wear beyond a headache.  How is this possible? Especially for adolescents who are only STARTING to drink, how exactly can they tolerate this volume of alcohol?  I started asking...and heard the same answer, over and over. "Well, to be honest, I pre-game with my ADD meds". 

PRE-GAME? Yes. Young people have figured out that when they take a prescription stimulant right before going out to party, they can "hold" more liquor. The stimulant takes away the typical buzzed, relaxed sedation of the first few drinks. Many have told me they "feel absolutely nothing at all from the alcohol...till I reach a certain number of shots, then suddenly I go from sober to super buzzed, and then either puke or pass out."

At first this confused me...wasn't the POINT of their drinking to catch that buzz in order to feel more social or confident? It seems counterintuitive. But if the peer pressure now is not only to drink, but to show you are so comfortable with drinking that it doesn't affect you- then this plan makes total sense. Except that this plan is so very dangerous, which makes it terrifying instead.

Unfortunately, not "feeling" the effects of alcohol does not mean that the alcohol is less potent within your brain, liver, bloodstream or nerves. This practice makes it far too easy to reach ALCOHOL POISONING levels, because you have turned off all your body's warning signs. Short term, you can hit toxic levels of alcohol that make you stop breathing. Or enough to "just" pass out...but then throw up and choke on your vomit. Long term, you are taking the HOV lane to end-stage alcohol complications because although you may only drink on weekends, you are getting huge quantities in at one time. And socially, this practice is normalizing binge drinking, because everyone sees their friends routinely drinking numerous drinks without it seeming to affect them.

A recent Cochrane meta-analysis Social norms information for alcohol misuse in university and college students examined 70 studies, including nearly 45,000 students. The premise was that college students have an inflated misperception of how much their peers are drinking, and therefore educating them about the true social norms may reduce alcohol-related consumption and subsequent problems. Although there were some significant effects, the "substantive meaningful benefits" were not enough to recommend policy changes.

As a side note, many students are taking ADD meds they have borrowed or purchased from a friend, which is not only illegal but magnifies their medical risk.

Yes, binge drinking in college has been around for a very long time, and thankfully the majority give up this habit when they hit the real world- if they survive their risky behavior. Note that a standard screening question for alcohol abuse is "have you had more than 4 drinks in one day during the last year?" 

Wondering how many drinks it would take for YOU to get alcohol poisoning? Check out one of my favorite resources: Aware, Awake, Alive

BOTTOM LINE: Doctors, parents and teens ALL need to know the dangers of "pre-gaming" with ADD meds. 

Mixing Drinks & Medications?

People have become increasingly cavalier about mixing medications. In our age of polypharmacy, we think nothing of taking this pill for our heartburn, plus this one for ADD, and that one for anxiety and depression. In fact, our doctors prescribe these combinations all the time, usually with good reasons and positive effects.

Why am I writing about this? Because there are (at least) two major problems that result from this mindset.

1. People like to SHARE. We want to help our friends, and often people share their PRESCRIPTION medications-from saved up antibiotics, to cough suppressants, pain pills and anxiety medications. When you remove the medical professionals (both providers and the pharmacy team) from the equation, there are no checks and balances to watch out for drug interactions.

2. People forget ALCOHOL is a drug. Especially this time of year, alcohol is offered and consumed without a second thought to whether or not it might interact with prescription medications. The most DANGEROUS combinations are ALCOHOL, NARCOTICS (pain pills and cough suppressants) and ANXIETY MEDICATIONS (like Xanax/Valium, etc.) Please note- your SLEEPING PILL falls into this category as well!
In this case, 1 +1= 3 or more, as the additive effects are much greater than the individual effects simply combined. In particular, you can STOP BREATHING when you combine these drugs. And BREATHING is good, right?

PLEASE, before you toast the season, picture your prescription bottles sitting in your drink. Is this MIXED DRINK safe?

BOTTOM LINE: PLEASE, do NOT share prescription medications, and do not COMBINE alcohol, narcotics, and/or other sedatives!

Caffeine, Alcohol and Peppermints, Oh My!

As if the cough last week weren't enough, are you now plagued with with heartburn? Yes, in our commercial-literate world, we may call it GERD (Gastro-Esophageal-Reflux Disease), but heartburn is still a great descriptor. December is often a very tough month for health! We are fully into cough and cold season, and at the same time, we are frantically running around in crowded public areas...touching the same escalator handrail, doors, etc. as the sneezing, coughing folks ahead of us. In addition, we are meeting old friends for our annual "catch up" coffee, drinks or meals, and burning the candle at both ends.

Caffeine, alcohol, and peppermints (did someone say candy canes?) abound, and ALL THREE of these have one common side effect in the body- they loosen the sphincter between the esophagus (food tube) and stomach that is supposed to function to keep acid down south in the stomach. Instead, these substances allow it to relax, and acid can slosh back up into the esophagus, and voila- HEARTBURN FOR THE HOLIDAYS!

What to do? Okay, first things first, stop the burn by popping a few antacid tablets. Not enough relief? Add in an OTC acid relief product like cimetidine (Tagamet) or ranitidine (Zantac) or even the next level up of acid blockers such as omeprazole (Prilosec). Still no relief? Time to see your doctor! Of course, it SHOULD go without saying that you need to STOP THE OFFENDING CAUSE (yes, the coffee, drinks and mints) if your symptoms are persisting beyond the occasional event!

I'd be remiss if I didn't add NICOTINE to the the list of irritants for GERD, by the way, so here is my chance to beg you to make QUITTING SMOKING your number one New Year's Resolution!

BOTTOM LINE: Caffeine, alcohol, peppermints and nicotine all cause HEARTBURN- watch out for the symptoms and recognize the cause!

Alcohol and Arthritis- Cheers!

Okay, after a week of discouraging one habit, I thought I'd start of Thanksgiving week with an interesting study about alcohol. As opposed to nicotine, which we know is NEVER beneficial, there is absolutely medical evidence that small amounts of alcohol can be beneficial for different aspects of our health. Now, the key words here are SMALL AMOUNT and BENEFICIAL. When we pour our own glass of wine, for example, chances are that it may not be that small 4oz glass that doctors recommend...
The new study I'd like to mention today is from the journal Rheumatology, and is entitled "Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis."There were around 900 patients with rheumatic arthritis (RA) in the study, along with around 1000 people without RA. Basically, with trying to account for other variables such as gender and age, those patients with RA who consumed more alcohol reported less severe symptoms of their arthritis.
Why is this? We're not sure, but possibly because of the role that alcohol plays in suppressing the immune system (and RA is basically a result of the body's immune system over-reacting.) Evidence already supports that small amounts of alcohol decrease the risk of heart attacks and strokes via similar anti-inflammatory and anti-blood clotting effects.
Keep in mind that this study is not suggesting people with RA need to drink heavily, but simply that patients who report drinking alcohol fewer than 10 days per month reported more pain.
BOTTOM LINE We can now add reduction in the severity of rheumatic arthritis to the list of potential benefits of consuming SMALL amounts of alcohol.