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!

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!

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.

ABCs of HIV for National Youth HIV & AIDS Awareness Day

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!

STD Awareness Month 2016 "Talk. Test. Treat"

"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.

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. 

Drug Abuse from YOUR Medicine Cabinet

Prescription drug abuse is at an all time high- no pun intended. Sadly, studies have found that 1 in 5 high school students say they have taken a prescription drug without a prescription. What are they taking? Pain killers, stimulants, and anxiety medications. Specifically, the most common drugs are OxyContin, Vicodin,  Percocet (narcotic pain pills), Ritalin & Adderall (ADD stimulant drugs), and Xanax (called "bars" because of the shape-an anti-anxiety sedative like valium.)

Many people have a false sense of security using prescription medications to catch a buzz, especially adolescents. The prescription element seems to be a stamp of safety for them (similar to "organic" equals "better"-but I digress). Frankly, it terrifies me to hear of kids swapping any prescription medications, particularly ones as potent as these. Add in that these pills are often combined with alcohol, and you now have a recipe to take your breath away- literally. Both narcotics and alcohol can suppress your drive to breathe, and they are additive when taken together.  Accidental overdose is a frighteningly common cause of death for teenagers, and inappropriately used prescription drugs are a major culprit. When I prescribe codeine cough syrup (which is the most common reason I prescribe narcotics this time of year), I always remind my patients that this "cough" medicine is a narcotic, and NARCOTICS + ALCOHOL = DEATH.

Another common pairing of prescription medications and alcohol is "Pre-gaming" with ADD meds, with the intent of revving up with the stimulant so they can "handle" their liquor better...which is a fast track to alcohol poisoning.

What can parents do about this alarming trend?
Number one, TALK to your teen. Ask (in a non-threatening, conversational tone) if they are aware of anyone borrowing prescription medications from friends. Let them know this is DANGEROUS and ILLEGAL. Please throw in the fact that it is a FELONY to buy or sell prescription drugs, and that charge is a one way ticket the wrong direction. The truth is that there is a ton of "altruistic" sharing of medications in college, and that sharing often becomes buying and selling between friends. Kids want the stimulants to help them pull an all-nighter, and that seems like a good and worthy cause to them (although numerous studies have proven all-nighters don't help grades.) Students also want these drugs to lose weight, or "hold their liquor", or  to use as an escape. Acknowledging these issues up front can lead to a more productive conversation, and talking with your teen at least lets them know you are aware of this risky behavior in general.

Next step? Take a close look at your medication cabinet. Throw away expired drugs, and keep close inventory of any potentially abused medications. If your kid is on ADD meds, make sure they are taking them as prescribed. Finally, if you realize that you are using prescription drugs inappropriately, it's time for a difficult conversation with your physician. You can't abuse it if we don't prescribe it, so this is a problem we need to tackle together, and there are solutions beyond simply cutting you off.

BOTTOM LINE: Prescription drug abuse is out of control. Learn the facts and protect and educate your teens. Get more info at the National Institute on Drug Abuse.