Dear Reader

Dear Reader,

            This is my last column of the semester. This means most of you are too busy to read it, having higher priorities like studying for finals or writing papers. This is fine; I’m not offended. There is a time and place for everything.

            For those of you who do have a few spare minutes to spend with the Daily Lobo, I am glad that you are taking a breather. It is important to slow down from time to time. Still, I will be brief.

            Before I leave you for several weeks, I just want to take a moment to acknowledge you, whoever you are, reading this. It is an odd feeling, writing for  unknown readers. I never know whose eyes are scanning my words, how and where my thoughts land, whether you find them interesting, irrelevant, helpful or boring.

            Perhaps you are a student at the end of a long semester, or a staff person on a break. Maybe you are having coffee and a Frontier roll, or waiting for a bus, or putting off grading papers for a few more minutes. Possibly you just grabbed a newspaper to line your bird cage or pack up your belongings.

            When I was a child my mother read to me and my sisters from Rudyard Kipling’s Just So Stories. Kipling wrote as if he was speaking, and he referred to his reader as “O’ my best beloved.” When I heard that, I always felt specially acknowledged. Writers write for their readers, after all, so thank you for reading.

            What I most want to say to you is that I hope you acknowledge yourself. Whoever you are, there is only one of you in this universe. You are the definition of unique. Nobody else has your experiences, your struggles and accomplishments, your exact take on the world. You have your own preferences, habits, quirks and your very own style.  Your strengths have saved you; your weaknesses have cost you. Life has hit you in the gut, one way or another, leaving you a little wiser and a little stronger each time.  You are a changing, growing human being, shaped by your changing, growing life.

            Between nature and nurture, the forces that mold us are endless and varied. It takes every single one of us to complete the complex, wondrous picture that is life on earth. I personally find it fascinating that there are no two of us alike anywhere, and I thank you for your contribution to the landscape.

            Have a good winter break.

Take a Flu Shot for Raymond

Raymond Plotkin was a freshman at UNM in 2009. A native of Texas, he was one of 18 freshman accepted into the Learning and Living Community for Engineering. He planned to become a nuclear engineer, and he was very happy here. He loved living in Redondo Village and eating at La Posada. He was a friendly young man who liked his roommates and got involved in student engineering clubs and the local Hillel House. He kept in close touch with his parents and older brother in Houston. His mother Elaine said, “Raymond fell in love with UNM. He really connected with his School of Engineering advisors and did very well in school. He made good friends and was having fun. Everything was falling into place for him and the future looked bright.”

The Fall semester was going well. Raymond carved a jack-o-lantern for Halloween and reveled in his first snow experience, even saving snowballs in his dorm room freezer. When the time came, he got a flu shot. Sadly, that was the year that the H1N1 flu took the nation by surprise, and the regular flu shot, the flu shot that was available to Raymond, didn’t include protection from H1N1.

In early November, 2009, Raymond got his first symptoms. He came to the Student Health Center and was treated for flu. A few days later, on a Saturday, he got much worse and his roommates took him to UNMH where he was admitted to the Intensive Care Unit. For four days the doctors did everything they could, fighting to save his stricken lungs and heart with all that modern medicine has to offer. Tragically, nothing worked. On November 11, just weeks shy of his 19^th birthday, Raymond died from H1N1.

A week before his death, Raymond posted a quote on his Facebook page. “Life’s challenges are not supposed to paralyze you, they’re supposed to help you discover who you are.”  Raymond’s parents, rather than allowing themselves to become paralyzed by the terrible grief that losing a child brings, have become passionate advocates of influenza immunization. They don’t want anyone else to lose a son or daughter to flu if it can be prevented. “Take One for Raymond” is the name of their initiative that has now become a foundation, spreading the word about influenza immunization.

Writes Elaine Plotkin, “All we ask is that everyone considers taking a flu shot, and if you’re on the fence about it, please think about it again. No family wants to hear that a loved one is sick in bed with the flu. It is our intent to educate and inform everyone about the importance of flu immunization. We do this because we wouldn’t want any other family to have to go through what our family has … without our son. That is why we will do everything we can do to ask each of you to take the flu shot, if you are able to do so.”

Stu­dent Health & Coun­sel­ing (SHAC) and UNM Hos­pi­tal part­ner to offer free “Take One For Raymond” flu shot clinics for the UNM com­mu­nity. The influenza vac­cine will be offered to UNM stu­dents, staff and fac­ulty (any­one 18 years old or older) Tuesday-Wednesday, Sept. 25–26, and Tuesday-Wednesday, Oct. 23–24 from 10 a.m. to 2 p.m. in the Stu­dent Union Build­ing atrium.

  Elaine and Ronnie Plotkin, Raymond’s parents, also established a scholarship in his name, starting the fund with a generous donation the same year they lost Raymond. Each Fall, the scholarship is awarded to an incoming freshman engineering student. Recipients so far are Paul Gilbreath and Sean Chavez. To contribute to the scholarship or for more information, contact the UNM School of Engineering at 277-5064 or visit http://www.unm.edu/~soeschol/freshman.html .

For the past two years, Elaine Plotkin has written an article like this one for the Daily Lobo. This year the honor is mine.  I take this task very seriously because, you see, I have a son almost Raymond’s age.  And that same year, my son also contracted H1N1. To my profound relief, he survived it. So every Fall when flu season breaches the horizon, I imagine the pain Raymond’s parents have endured, and my heart hurts. And every Fall I find inspiration in the courage they have shown by moving beyond the paralysis of unimaginable challenge, and I go “take one for Raymond.”

I hope you will too.

Meditation

Last week I had the great good fortune to attend a meditation retreat in the high country of northern New Mexico. For three days I sat for many hours on a cushion, silently bringing my attention back to my breath over and over again, or walked slowly upon the earth, soles alert to every pebble on the path. During the breaks I savored delicious food, wandered flower-bedecked meadows, and immersed my senses in fresh air, stars and running water. There was no phone service, no internet connection, no television. By the end of the retreat I felt a depth of rejuvenation and calm that still sustains me.

Why am I telling you this? Beyond wanting to share my joy, I thought you would be interested to know that meditation is actually good for you. For starters, it can improve your GPA. Meditators have more gray matter. This has been measured. Gray matter is what does your homework for you, so presumably more is better. More specifically, the gray matter growth that has been observed in mediators occurs in areas associated with learning and memory, sense of self, empathy and stress management. Further, long-term meditators have more folds in their cerebral cortex, which allows for faster information processing. “Sitting” makes you smarter.

Meditation is also good for your health, both physical and mental. Scientists have studied this, in typical scientist fashion, by plastering electrodes all over the heads of meditating Buddhist monks, surveying thousands of people with a smart phone app, and of course using more conventional methods like basic lab measurements. Meditation can lower blood pressure and pulse rates, improve your immune system and decrease your experience of pain. People who meditate have less anxiety, depression, and insomnia, and respond better to stress. If you have a chronic illness like AIDS or cancer, meditation can help manage the physical and emotional symptoms. Meditation and exercise are the only two activities proven to prolong brain function in old age. And perhaps most importantly, meditators are happier and more resilient in times of stress.

What is meditation anyway? In the simplest sense, it is the practice of relaxing the body and clearing the mind. Another way to describe meditation is focused attention on the present moment with awareness and without judgment. There are different kinds of meditation, but they all have the same goals. Mindfulness meditation uses awareness of the body and mind to bring the attention to the here and now. Other traditions use an object or an image for focus, and some use a prayer, a mantra, or a wish for widespread happiness. Yoga was traditionally a way to prepare the body for sitting meditation, and can be used as a kind of movement meditation. There are many choices. The concept of meditation is simple, but that doesn’t make it easy. The nature of the mind is wild and wandering, and getting to even a few moments of calm, present-moment awareness can take years of practice.

Sakyong Mipham, a great Shambala Buddhist teacher, likens the mind to a wild horse that gallops off at every opportunity. Jack Kornfield, an internationally renowned meditation teacher, writes that meditation is like training a puppy to sit and stay. The puppy always gets up and runs away, and you just pick it up and put it back down over and over again. If you have never tried it, meditation might sound mysterious at best, useless at worst. But more and more people are trying it, liking it, and keeping it up. It is sweeping the globe. In fact, just last weekend people in over 100 cities around the world held a special meditation for peace. This included 100,000 meditators in Buenos Aires alone.

If you think you might be interested in meditation, you could start with some reading. In addition to the teachers mentioned above, I recommend Thich Nhat Hanh, Pema Chodron, The Dalai Lama, or Jon Kabat-Zinn. These are just my personal favorites: there are many others. You could also check out a DVD, find a meditation center near you, or take a class.

Amy Gross, former editor in chief of O, the Oprah Magazine, retired from her highly successful career to become a full time meditation instructor and practitioner. She writes, “As you meditate, the grip of your history loosens and you get a little saner, lighter, less entangled.” Maybe that is what I was feeling up in the mountains last week. It’s somewhat indefinable for me at this moment. All I know is that it felt good, and right, and if you’ll excuse me, I’m going back to my cushion.

H1N1 is here

It’s true. Swine flu is here. It is all over New Mexico including here at UNM. Have you had it yet? How about your friends and classmates? How many are out today with flu? I’ll bet there are at least a few, and there will likely be more next week.

We have seen lots of H1H1 influenza or “Swine Flu” at Student Health and Counseling. Since September 1st we have had over 100 cases of “influenza-like illness.” Most of these were H1N1. All have recovered. And those are just the ones who have come to the clinic. There have been many more cases where people just stay home and take care of themselves.

The virus continues to spread. It is very contagious and likes young people. Chances are good that you’ll get it, and chances are excellent that you’ll survive. Here are some tips to help you manage before, during and after you get H1N1.

Before you get sick: Get the regular seasonal flu shot. Make sure you have basic medications at home for fever, cough and congestion. Buy a thermometer, and maybe some soups and juices. Once you have flu you won’t feel like going out to the store for this stuff, and they won’t want you there spreading germs. So stock up. Try to avoid getting the flu by staying away from sick people, keeping your hands away from your face, and washing your hands often. Get plenty of sleep and eat well so your body is strong for the fight against germs.

Once you are sick: Flu symptoms are fever over 100.5, cough, body aches, sore throat, headache, chills, fatigue, and sometimes diarrhea and vomiting. If you have some or all of these you might have flu. Take to your bed! Drink lots of liquids and treat your symptoms. Expect to be out of commission for five to seven days. Please do NOT go to work or school or out to eat at a restaurant! I know students who have done all of these things. If you go out in public you are putting others at risk. Be considerate and stay away. Contact your professors by email or phone to let them know you are sick.

Should you get medical care? If you are a basically healthy person who gets the flu, you probably don’t need to see a doctor. Self treatment at home is usually adequate. If, however, you are pregnant, have asthma or other lung problems, are under 2 years old or over 65, or have any chronic medical condition, you should seek care. There is a medication called oseltamivir (Tamiflu) that is recommended for people in these high risk groups, to decrease the risk of flu complications like pneumonia.

If you are not in these risk groups, there is a small chance that you could still get seriously ill from flu. We have all heard the stories of people who died from H1N1 who had no underlying medical problem. Those stories are scary to be sure, but thankfully also very rare. It is unlikely to be you. That said, if you do get any of the following symptoms, regardless of who you are, please hustle in to the nearest emergency room:

Severe difficulty breathing, severe pain in the chest or belly, sudden dizziness or confusion, severe or persistent vomiting.

After you recover. First of all, this takes a while. As I said before, expect to be out of commission for five to seven days. That means at home resting. Even after the worst of the symptoms have passed, you’ll be weak and easily tired for several days. Take it easy. Don’t return to sports until you feel really good.

Once you are well, step outside and take a deep breath of our crisp Fall air. Stretch your strong body, look up at our New Mexico Blue sky and give yourself the gift of gratitude for your life and good health.

H1N1 - article in last week's Daily Lobo

In polite company we call it Novel H1N1. It’s the Influenza Formerly Known as Swine Flu. Originally thought to come from pigs, this flu virus is actually a mix of pig, bird and human. Believe it: only a virus could pull off that combination.

This rascal made a big splash last Spring, as you no doubt remember. After making its debut in the southern hemisphere it worked its way north, and by late summer there were so many cases the CDC stopped counting.

The media hype is hopping about this new germ, and lots of people are afraid. Since it is a new germ, and we haven’t been through a winter with it yet, there is a fair amount we don’t know. But what we do know is reassuring. Most of this comes from statistics but some comes from experience: we have already seen several cases here at Student Health and Counseling.

So far it looks like H1N1 is going to be gentler than the regular flu. Most cases of H1N1 are mild, and over with in a few days. Yes, there have been deaths around the country, but mostly in people who had serious medical problems. If you are otherwise healthy when you get the flu, you can put money on your survival.

Still, any flu can be miserable, so I suggest you don’t catch it. How to avoid it? Keep your hands off your face! That’s the best thing you can do. The flu enters your body through your respiratory system. That means through your mouth or your nose. How often do you pick your nose or your teeth? Don’t answer that. Just know that if the virus is on your hands when you touch your face, you’re toast.

Before I go further, I need to teach you a new word. Fomite, pronounced with a long O and a long I, accent on the Fo. Fomite is a medical term that means any object that can carry germs and pass them along. Fomites are things like towels, drinking glasses, pens, money. Here’s why this word matters.

The H1N1 flu is passed in large droplets. That means if a flu patient coughs, the virus flies out of their mouth in droplets. The droplets then fall onto the nearest surface. H1N1 doesn’t hang around in the air for long, unlike some other viruses that are passed in smaller, lighter droplets. How do you catch the flu then? Either you were unlucky enough to be in the line of fire when that person coughed, or – and here’s where that new word comes in – you touched a germy fomite and then touched your own face.

Think about it. Our hands are everywhere. We use them for everything. Opening doors, using a phone, handling money. As soon as you touch a fomite, your hands are host to whatever little nasties got on there from the other people who touched it. Then you wipe your nose or rub your eyes and wham. Germ transfer.

Yes, it is important to wash your hands, especially before you eat or otherwise touch your face, but washing your hands isn’t enough. The germs don’t soak in through your hands to make you sick, after all. So wash and sanitize, by all means, but mostly keep your hands off your face. If you have to touch your face, like to eat or put on makeup, wash your hands thoroughly first.

Besides washing your hands and keeping them off your face, take good care of your body in the usual ways so that your immune system is on max alert at all times. Sleep enough. Eat well. Exercise regularly. You know the drill.

If you’re already sick, please be responsible and protect others. Keep away from people! If you get symptoms of the flu, stay home! Symptoms are primarily fever, cough, and body aches. You might also have a sore throat, stuffiness or stomach upset. H1N1 typically comes on over a short period of time. Like a Ferrari that goes from zero to 60 in a matter of seconds, H1N1 will rocket you from well to miserable in a matter of hours.

If you are sick, cover your cough. Not with your hands! The latest official advice is to bend your arm at the elbow and cough or sneeze into your elbow, or the fabric of your sleeve above the elbow. If you choose to spray your germs into a tissue, fine, but then please discard the tissue and wash your hands.

The best treatment for H1N1 is rest. Your body is a pretty efficient virus-killing machine, but it needs your support. Stay in bed, drink plenty of fluids, and take medicines for your symptoms. Acetaminophen or ibuprofen for fever and body aches, dextromethorphan for cough, phenylephrine for congestion, or pick your own personal favorite.

If you decide to go to the clinic for H1N1, you’ll probably leave with nothing more than good advice. There are some anti-viral medications on the market, but so far they’re only being used for flu victims that are so sick they need to be in the hospital. Those are the folks with chronic medical problems like asthma, emphysema, diabetes and others. If you have a chronic medical problem and you get sick with flu, you should definitely seek medical care, and you might get treated with antiviral medication. But if you are the typical UNM student, young and healthy, it’s better for you and the rest of the community if you stay home.

UNM is doing its part. We’re expecting an H1N1 vaccine, probably in October, and we’re planning for campus-wide vaccinations. In the next few weeks, watch for announcements about the regular seasonal flu shots, which will be free of charge this year. Meanwhile, you’ll see hand sanitizers around campus, along with signs reminding you to wash your hands. SHAC has provided flu kits to the dorms, with thermometers, surgical masks, hand sanitizer and Tylenol. If you get the flu and you live in the dorms, LaPo will bring you "flu meals." Professors have even agreed to lighten up on asking for doctor’s notes if you have the flu.

For more information, visit our website.

Viral vs. Bacterial ?

Q:

If you are feeling “sick” is there a way to determine if you have a bacterial versus viral infection without going to the clinic? For example, temperature? Swollen glands? Green snot? Coughing up stuff?

A:

The short answer is no. There is no sure fire way to tell without going to the clinic. However, if I were a betting woman, I’d put money on a virus, and I’d win big. Viruses cause the vast majority of respiratory infections. That includes most colds, sinus infections, bronchitis, and most ear and eye infections. It includes most cases of fever, swollen glands, green snot, and coughing up stuff.

For those readers who need it, I’ll explain the difference between viral and bacterial infections. Very broadly speaking, viruses are more common, and bacteria are more dangerous. The practical difference comes in with the question of antibiotics. Antibiotics kill bacteria. Antibiotics do not kill viruses. Your body does, for free. No clinic charge, no pharmacy charge. All it needs is some rest and time.

Now, everyone has a story of going to the doctor for a respiratory infection and leaving with a prescription for antibiotics. We hear it all the time. “Last time I had the same symptoms, and I got antibiotics, and it cleared right up.” Naturally, the patient wants the same treatment this time. The truth is she probably would have gotten better anyway. The timing of the antibiotics with her improvement convinced her that the antibiotics were responsible for her recovery.

Unfortunately, sometimes doctors prescribe antibiotics when they aren’t needed, “just in case.” This causes a couple of problems. For one, it sets up a patient like the one above to expect antibiotics for viral infections. That creates busy clinics and dependent patients, who think they can’t get over a simple cold without professional help.

On a wider scale, when we carpet-bomb bacteria with antibiotics, most bacteria will get killed. But a few will develop resistance to the antibiotic, and survive. Those will multiply and create a whole new group of tougher germs. Now science has to create a stronger antibiotic to kill these super-bugs. There have been some very scary germs created by this exact scenario.

I trust I’ve made my point about viruses. But remember, I said most respiratory infections are caused by viruses. That means some are caused by bacteria. For example, the bacterium Streptococcus pyogenes causes a throat infection commonly called Strep Throat. That definitely requires an antibiotic, to kill the bacteria and prevent dangerous consequences of the infection. Some kinds of pneumonia require an antibiotic, as do some ear and eye infections and, rarely, sinus infections.

If you’re looking for criteria, I suggest the following. If you get a respiratory infection, with the usual sore throat, congestion and cough, give your body a few days to work on it. Take over the counter remedies if you like. Drink lots of liquids to keep the mucous flowing. Try a sinus rinse. But if you have a high fever, a really bad sore throat that lasts for more than a few days, trouble breathing, or symptoms that last longer than a week, come in to the clinic for evaluation. Err on the side of caution, and come in anytime if you have doubts. Call ###-#### for advice or for an appointment.

Heroin and Opiate Addiction

Dear Dr. Peg,

I have been addicted to heroin for over six months now. While I have never used the drug intravenously, I still must smoke every day to function normally. I have wanted to quit since school has started but I’m so scared my school work, job and general life will suffer. I have researched multiple treatments but haven’t yet tried using one. As a doctor what would you recommend as a course of action? At the moment I am only engaging in counseling at the student health center. Thank you.

Sincerely,
Anonymous

Dear Anonymous,

You have several things going for you already. You want to quit. You have only been addicted for 6 months. You are already in counseling. Those are three giant steps along your new path, and you are to be commended. I’m going to answer your question, but first I’ll fill in some background for those who don’t know.

Heroin got its name from the fact that users feel powerful and invincible, like a hero. It is one of a class of drugs called opiates, derived from the opium poppy. Some other opiates are prescription narcotic painkillers like oxycodone and hydrocodone, Narcotics are addictive, like heroin, and are sometimes sold on the street and used illegally. Narcotic addiction is a huge and growing problem, with an estimated 2.2 million new non-medical users in 2005.

Ironically, heroin was developed originally as a treatment for morphine addiction. Oops! As soon as it was discovered that heroin was in fact more addictive than morphine, heroin
was made illegal, and remains so.

Of all the opiates, heroin is the most addictive. Called “dope,” “horse,” “smack,” and “tar” on the street, it gets into the brain easily and quickly, resulting in peak levels shortly after injection or inhalation. This is called a “rush.” After the rush, active metabolites stick around in the body for several hours, resulting in a prolonged but less intense “high” than the initial peak, described as a relaxed, contented state.

So what’s not to love, right? Wrong. The problem is, your body gets very attached to those sensations, and it complains when it can’t have them. That’s called addiction and withdrawal. Addiction leads to physical problems, discussed below. Not only that, the more you get high, the less useful you are, to yourself and to others. Eventually the addiction takes over your life, and you spend a huge amount of energy and money feeding it. You might even commit more crimes in this pursuit.

Heroin can be injected in the veins, smoked, or snorted. In the 1960’s, when heroin use was highest, most users injected it. Injection is the most efficient if the heroin is low purity, but can result in nasty skin infections and blood borne diseases like Hepatitis B and C and HIV if needles are shared. Overdose is most likely from injection, partly because the purity of the drug is so variable.

Nowadays, as the heroin supply is generally more pure and the risks of injection are well-known, more people are smoking it and sniffing it. Smoking gets it into the brain fastest. Snorting requires the least equipment but can eat a hole through your nose lining. However you get it into your body, it is highly addictive.

Lest you think you’re the only opiate addict on campus, here are some stats. According to the Office of National Drug Control Policy, in 2003 one percent of college students reported using heroin at least once during their lifetime. Another survey, done by the National Household Survey on Drug Abuse, reported that among users 17-22 years old, the rate of use was higher for college students than for non-students. The rates of prescription narcotic use are higher. Abuse of prescription drugs for non-medical purposes went up by one third in 18 to 25 year olds in just one year from 2000-2001, and most of that increase was due to OxyContin and other painkillers. This is according to the National Survey on Drug Use and Health.

Back to you. It sounds like you are still in the early stages of addiction, where you are still able to manage a job and school. You say you’re worried that your life will suffer if you quit. It is hard to quit: I won’t lie to you. But your life will suffer much more if you don’t quit but stay on what will surely become a downward spiral.

How to quit? The old tried and true is the methadone clinic, which basically replaced one addiction with another, less dangerous one. That is still available, but a new drug called buprenorphine has made narcotic addiction treatment more successful. Buprenorphine is a prescription drug, available only from health providers who have special training. It attaches to the same receptors that opiates do but has a less intense effect. The idea is to avoid withdrawal symptoms while you slowly taper down the dose, meanwhile going through counseling to help you recover from your addiction.

Ask your counselor about "bupe." And hang in there; you can do this!

Second Hand Smoke

– Peggy Spencer, MD

UNM is considering becoming a completely smoke-free campus, indoors and out. Smoking is already prohibited inside the buildings and within 20 feet of the entrances. I’m a physician, not a politician, but, as a physician, I feel moved to offer information about the health effects of second-hand smoke and smoke-free workplaces.

In case you think this doesn’t apply to you, you should know that 15% of UNM students smoke cigarettes, according to a 2006 survey. Twenty percent of New Mexico adults smoke. FYI, that puts us roughly in the middle. Utah is the lowest, with just under 10% of adults smoking, and Kentucky is the highest at almost 30%. So even if you are a nonsmoker, chances are very good that you will be exposed to second hand smoke.

Second hand smoke (SHS) is made of sidestream smoke, from the burning end of the cigarette or cigar, plus exhaled mainstream smoke, from the smoker’s mouth and lungs. Everyone knows that cigarette smoke is harmful to the health of the smoker. Now we know that second hand smoke is harmful to the nonsmoker as well. In fact, SHS has higher concentrations of some toxins, due to cooler temperatures and other factors.

There are more than 250 toxic chemicals in SHS, including at least 50 that are known to cause cancer (carcinogens). SHS has been classified as a “known human carcinogen” by the Environmental Protection Agency. An example of a carcinogen in SHS is formaldehyde. Formaldehyde is used to preserve biology tissue specimens and to embalm dead bodies.

Besides carcinogens, SHS contains many toxic gases, like carbon monoxide, the deadly gas in car exhaust. Also chemicals, like hydrogen cyanide, which is used in chemical weapons, and heavy metals, like arsenic, which is an ingredient in pesticides.

The health effects of SHS on nonsmokers have been studied quite extensively, using household members and coworkers of smokers who smoke indoors. The degree of SHS exposure can actually be measured. There is a chemical named cotinine (an anagram of “nicotine”), C₁₀H₁₂N₂O, that is a unique metabolite of nicotine. In other words, it doesn’t exist anywhere except in the blood, urine and saliva of people exposed to nicotine, including second hand smokers. More about this below.

Outdoor studies are difficult to do, as outdoor SHS is difficult to quantify, but I have no doubt the evidence is forthcoming. Meanwhile, a degree of extrapolation to outdoor environments is reasonable.

SHS is a respiratory irritant. An irritated respiratory system is more susceptible to colds, bronchitis, allergies and asthma. It is also, as I mentioned above, a carcinogen, estimated to cause 3,000 lung cancer deaths per year in nonsmokers.

Smoking increases heart disease, as you probably know. So does SHS. There are immediate and long term effects. The moment you inhale SHS, the platelets in your blood become “stickier,” and the lining of your blood vessels is damaged right away also. This increases the risk of a clot forming inside your blood vessels, which could translate into a heart attack or stroke, especially if you already have vessel disease.

Long term, SHS causes heart disease just like first hand smoke. In fact, a conservative estimate is that SHS causes 35,000 heart disease deaths a year in nonsmokers. That’s equivalent to the whole UNM student body.

Babies and children are especially susceptible to SHS. Low birth weight, Sudden Infant Death Syndrome (SIDS), and respiratory infections are some of the problems that can be caused by SHS in babies.

Another group that can be adversely affected by SHS is ex-smokers. For some, even a whiff of smoke in the air really triggers their craving and makes it tough to stay quit.

If you can smell smoke, you’re second hand smoking. Will one puff kill you? Doubtful. But if you already have asthma or heart disease, it could trigger an asthma attack or a heart attack. Far more likely than instant death is temporary irritation, of mood and respiratory system, and long term gradual buildup effects discussed above.

How much is too much? The surgeon general has issued a conclusion that there is NO SAFE LEVEL of second hand smoke. The only way to really protect nonsmokers from smoke is to have separate, indoor, isolated buildings for smokers. Called “smoking pavilions” or “butt huts,” these do exist in some places.

Naturally, I would be happy if nobody ever smoked again, for the sake of their health and everyone else’s. But smoking is a legal activity, and we can’t stop people from making legal behavior choices. Since smoking affects others, however, it becomes a public health issue. Over the years, measures to protect the public from SHS have broadened in scope, from smoke-free sections of rooms to whole.

Our neighbor Arizona was the first state to institute bans on smoking in public buildings. Most other states have followed suit. Federal measures have led to smoking bans on airplanes, federal buildings and facilities that provide federally funded services to children. New Zealand and Norway have laws that all workplaces must be smoke-free. In this country, some businesses such as Nike and Scott Paper now have 100% smoke-free campuses. Over 100 colleges and universities in the US are completely smoke-free as well.

Public health policy is only as good as the health outcome. It turns out, smoking bans actually help people quit, and that is good for their health. Their coworkers and household members benefit as well. Body fluid levels of cotinine, that nicotine metabolite, have fallen 70% overall in the last 15 years. However, there are still measurable levels of cotinine in 43% of nonsmokers in the US.

The healthiest way to deal with cigarette smoke is to avoid it. Don’t start smoking in the first place. If you smoke, quit. This is far easier said than done. Tobacco addiction is extremely tenacious. Most smokers who quit take a long time and several tries to get there. But it is possible. The good news for UNM students is that there is free help available to help you quit.

My sources for this article are the US Dept of Health and Human Services, the National Cancer Institute, the Centers for Disease Control, and the National Institutes of Health.

Urinary Tract Infections

Q: Are all UTI’s caused by sex?

A: Thank you for this great question. The answer to your question is, “No, but…”
UTI stands for Urinary Tract Infection. It might also be called a bladder infection or cystitis. We see a lot of it at the Student Health Center, mostly in women. It is often related to sex, but indirectly, and not always. To explain, I need to subject you to a mini anatomy lesson. Bear with me.

The urinary tract is the system of organs that makes, collects and excretes urine. You have two kidneys, one on each side, located roughly behind your stomach. Each kidney makes urine and sends it down two tubes called ureters to your bladder, which collects it. Your bladder is located inside your body above your genitals. It is a soft, stretchy container with thin muscles in its walls. When your bladder is full, the urine is expelled from your body through another tube called the urethra. You control this process by consciously relaxing a muscle called a sphincter, which opens the urethra. Your bladder helps by contracting the muscles in its walls. The outside end of the urethra, called the meatus, is at the tip of the penis in men. In women, the meatus is on the vulva, between the vagina and the clitoris. This anatomical difference is why women get UTI’s more often than men, and why it is related to sex, as I will explain, after a mini microbiology lesson. Hang in there.

Urinary infections are caused by bacteria. Bacteria are everywhere. You think you’re clean? You probably are, but that does not mean you are bacteria-free. We share our personal space with more than 200 species of bacteria. In fact, there are ten times more bacteria in our intestines than there are cells in our entire body! Imagine that. Now, before you get all grossed out, know this. These little guys are your friends. They are called, as a group, “normal flora,” and they do lots of good. Good bacteria crowd out and kill bad bacteria. They also stimulate our immune system and help it develop, and some of the bacteria in our gut even make vitamins that we can use.

What kind of normal flora you have depends on your genetics, your age, sex, nutrition, stress and hygiene. We all have bacteria on our external surfaces and some internal surfaces, like nose, mouth, throat, intestines, and vagina. As long as they stay where they belong, there’s no trouble. But sometimes during sex, some of these critters can end up where they’re not wanted, like in the bladder. This happens more easily in women, due to the proximity of the meatus to the vagina and anus. Fluid, friction, moving body parts…use your imagination and you can see how it happens.

Sex is not the only way for bacteria to get near enough to the meatus to go in and cause a UTI, but it is the most common in college-aged people. One simple way to reduce sex-related UTIs is to urinate after sex. What this does is wash out any bacteria that have begun their sneaky trek up the urethra. Most of the time this works great. But if you find that you are experiencing burning when you urinate, blood in the urine, or the urge to go frequently, you might have a UTI. This goes for guys and gals. Please do not try to treat this yourself with cranberry juice, vitamin C or any other folk remedies. While some of these things can help you feel better, a true UTI is caused by bacteria, and the only way to kill bacteria is with an antibiotic.

Traumatic Stress Response

Remember the moment you heard about the shootings on the Virginia Tech campus? How you heard of it and where you were? Your reaction? The reactions of your friends and those around you?

Reactions to traumatic events are as varied as people are. Your response may be very different from your roommate’s or your mother’s. We’ll discuss what is normal and what is not, what to do now and when to get help.

Traumatic stress reactions can be loosely divided into physical and emotional, short term and long term. Many people initially feel shock and disbelief, even denial. Also common are anger, fear, anxiety, sadness, hopelessness, compassion, helplessness, and survivor’s guilt. You may feel emotionally numb, or conversely find that you are irritable and jumpy. Your moods may change back and forth quickly. You may struggle in your mind with why this happened, trying to find answers, to make sense of the tragedy. You may worry about something similar happening here. You may have physical responses, like nausea, headache, jitters, chest pain, trouble breathing, difficulty sleeping, or decreased appetite. All of these are normal. However, if you have severe emotional or physical symptoms in these first days, please get professional help.

This is already a stressful time on campus, with finals and graduations just around the corner. A background of existing stress can magnify the effect of a major tragic news event. If you have some kind of connection to Virginia Tech, your reactions may be even stronger. For example, if you knew one of the victims, or know a student at VT, or have friends or relatives or experience in the area, your feelings will probably be more intense.

If you have a history of previous trauma, as many of us do, the news of this tragedy might bring that past trauma to the front of your mind, and you might find yourself thinking, dreaming, reliving or having feelings about the other incident. The previous incident may seem totally unrelated, or it may be a similar event. This can be unsettling at best. The severe form of this kind of reaction is called PTSD, or Post Traumatic Stress Disorder, but most cases are milder, a temporary resurfacing of memories which fade into the background again.

How can you cope with your own feelings and thoughts during this time? Connect with those you care about. Spend time with friends. Call your family. Talk about your feelings and reactions, or write about them. Post your condolences online, along with thousands of others. Above all take good, healthy care of yourself. Eat well, get as much rest as you can, exercise. Avoid the temptation to “drown your sorrows” with alcohol or drugs. Again, if you’re having severe reactions, get help.

While initial reactions to trauma may vary in kind and severity, most people return fairly soon to a competent pursuit of their normal activities. You don’t forget, but you aren’t immobilized either. An abnormal response is when you are affected to an extreme, or when your feelings or thoughts persist after the initial shock period. Next week and beyond, if you find yourself unable to concentrate or sleep well, or if you are having trouble performing your usual activities due to continuing trauma responses, please seek help.
Delayed responses to trauma can happen up to weeks and months after the initial event. Keep this in mind as you observe and care for your own mental health in the near future.

Stinky Feet

Dear Dr Peg,

My girlfriend told me I have stinky feet. She thinks it might be a fungus thing and wants me to get it taken care of. I don’t notice it, but she said that her socks even stunk when she washed them with mine. I mostly wear the same pair of shoes, which my brother handed down to me, but I shower every day and put on fresh socks. I’m a clean person. Please help me. She’s sleeping on the couch.

Dear Fragrant Feet,

Your girlfriend is probably right (aren’t they always?). You likely have a fungal infection of the feet, also known as tinea (fungal infection) pedis (of the foot). This is also called athlete’s foot, but you don’t have to be an athlete to score this deal.

We all sweat, and sweat has odor. Foot sweat by itself can have a strong odor, but if your girlfriend’s socks pick up this odor in the washer, it is more likely to be caused by fungus. You said you don’t notice the odor, and she does. This is common. We adjust quickly to our own body odors and often don’t notice them, whereas others might.

There are “fungus among-us” everywhere. We don’t have as many in our dry climate as someone who lives in say, Florida, but we have plenty. Fungi (the plural form) live on and off people, and on gym mats, shower stalls, rotting logs and old food.

A fungus is a life form. It is closer to a plant than an animal, but rates its very own kingdom in the 5-kingdom taxonomy of life forms. Within the kingdom Fungi there are over 100,000 species. A few of these have a special affinity for human skin. They cause ringworm (not a worm at all), jock itch, diaper rash and athlete’s foot, among others.

The ideal habitat for certain fungi is somewhere dark, warm and wet. Shoes fit the bill perfectly. You might have even inherited your tinea along with your brother’s shoes. That’s one reason that, although I’m a big believer in recycled clothing, I don’t recommend buying used shoes (or underwear or hats for that matter). Your brother might have had his own case of resident fungus, which went on living quietly in the cracks of his shoes until your feet came along and spiced up the place, allowing the fungi to multiply and prosper. And reek.

So what to do? Basically, the approach to tinea pedis is two-pronged. First, slaughter the beasts. Second, clean up the neighborhood so their skuzzy relatives don’t move in.

Killing fungus is a fairly straightforward proposition. There are a variety of anti-fungal products available over the counter at any pharmacy. I believe the creams and ointments work on the skin better than the sprays or powders, because they stick to your skin better. The usual dose regimen is twice a day, after washing your feet. Please note: if the fungus has gotten under your toenails, making them yellow and thick, you will need medical help.

You can kill the fungi in your socks by washing them in hot water. Add bleach to whites. Do the same with your sheets. Oh, and your girlfriend’s socks. You can also spray bleach (a 10% solution in water is strong enough) on any mold or fungus you see growing in your shower.

Getting rid of fungus in shoes is much more difficult. Wash them if they’re washable. Spray them with antifungal spray and put antifungal powder in them. Best is to accept that you might have to get rid of them and shell out some dough for a new pair or two.

Keep your feet as cool and dry as possible. Change socks twice a day. Try a pair of super-absorbent odor eating inserts. Change shoes often, or go without when you can. Open shoes or sandals give your feet more air, and fresh air is poison to foot fungi.

Here’s something that might surprise you. You can have “fungus feet” with no odor at all. You know those foot and heel cracks that so many people have? We think it’s just desert dryness, but often it is really a type of fungal infection. After-shower treatment with a pumice stone and antifungal cream will clear those cracks right up. Make this a regular part of your routine and they’ll stay gone.

Having tinea pedis does not mean you are unhygienic or somehow bad. It’s just an infection. And in spite of her socks taking on your Eau de Foot aroma, your girlfriend is not likely to catch it, unless she starts wearing your brother’s shoes too. People are much more likely to get tinea from the gym than from their partner. Take the steps above and soon she’ll ditch the couch and be back in your fragrance-free bed.

Molluscum contagiosum

Dear Dr. Peg,

I went to see my dermatologist a few days ago about small bumps I noticed on my penis. My dermatologist said they were molluscum contagiosum and she used a liquid nitrogen spray to freeze them off. I had 5 bumps and now they have all increased in size, popped, and are starting to scab up (as my dermatologist explained they would). Something I’ve noticed is that it seems like my penis is smaller now in its flaccid state. Is this common? Will it go back to normal size after the scabs fall off? I started to google side effects of liquid nitrogen and really got myself scared seeing things like necrosis and nerve damage. Have you ever heard of this?
Thanks. A very nervous guy.

Dear Nervous Guy,

Bottom line: liquid nitrogen treatment will not change your penis size. If that’s all you wanted to know, you can heave a sigh of relief and stop reading. If you want to learn a little more about this disease and treatments, keep reading.

Molluscum contagiosum is a skin infection caused by a virus of the same name. Humans are its only host. It is passed by skin to skin contact, or by skin to object (e.g. towel) to skin. Little kids get it from playing together and sharing toys. In adults, if it’s in the genital area, it’s assumed to be sexually transmitted. We see it quite often at the Student Health Center.

Molluscum contagiosum causes small firm bumps with waxy centers. They usually don’t itch or hurt. It can take weeks from the time of contact for the bumps to appear. If you leave them alone, they will go away eventually, but this can take several weeks to months. In the meantime, you are contagious. If you get treated, the duration of the infection is shortened, and your period of contagiousness is also shortened.

Treatment means removing the waxy centers. This is usually done with a tool called a sharp curette, with which we scoop out the center in one swift move. Yes, it hurts a bit, but only for a second. Alternatively, they can be treated with liquid nitrogen, like your dermatologist used. Nitrogen is normally a gas, at room temperature. It’s part of the air we breathe. When it’s cooled and pressurized, it is a very cold liquid. We use liquid nitrogen to treat various different skin conditions, including molluscum, warts, and small skin cancers. By freezing the lesion, we destroy most of it, and your immune system sends cleanup crews to finish up.

There are several other methods of treatment documented for molluscum, including various toxic solutions and lasers. As I said above, the bumps will go away eventually even without treatment, but since it is contagious as long as the bumps are present, I recommend getting them treated.

You asked about complications of liquid nitrogen freezing. This kind of treatment is also called cryosurgery or cryotherapy. As with any kind of intervention, there are possible complications. First of all, pain. It hurts to have tissue frozen, and the area usually stays tender for several days. Bleeding is common, under the skin as a ‘blood blister.’ Infection is possible but uncommon. If the site becomes opened or raw, cover with antibiotic ointment and a bandaid. Long term complications might include scarring, pigment changes, recurrence of the initial lesion, particularly warts, and yes, nerve damage. This last is very rare, I hasten to assure you.

The way your lesions blistered up and fell off is exactly the reaction we’re looking for. Once the underlying sore heals up, everything should be back to normal, including your penis size.

You mentioned that you did an internet search on liquid nitrogen. Let me take this opportunity to comment on internet searching for health problems. Many of our patients do this. Personally, I like it when my patients do some research ahead of time, if it is good research. I especially like it if they have new information for me and can teach me something. I would caution you, however, against sloppy googling. If you’re going to look up health conditions, use reputable sites. Googling by symptom can be especially problematic, because many symptoms can be caused by a wide variety of different illnesses. For example, fatigue can be caused by anything from stress to cancer. Dizziness can simply be from standing up too fast, or it could be from a major heart problem.

One excellent site is http://familydoctor.org. This site is created and maintained by the American Academy of Family Physicians, and can be searched by disease or symptom. A web search is never a substitute for a visit to the doctor, but it can provide you with lots of good information.

Herpes revisited - a followup Ask Dr Peg question

Dear Dr. Peg

Recently my girlfriend was diagnosed with vaginal Herpes Type 1 that I’ve given her orally. We are both pretty good kids and haven't kissed too many other people. But my question is, seeing as how it can pretty much be assumed that I’ve transmitted the disease to her, is there any danger in me continuing to perform oral sex on her? If I already have it and we know that between the two of us all we have is herpes Type 1, is there still a danger?

Dear Kisser,

This is a great question, because it brings up two issues: virus spread, and herpes in relationships. I’ll address them one at a time. In my column Curious About Cold Sores, I explained that there are two Types of Herpes Simplex viruses, Type 1(HSV1) and Type 2 (HSV2). Usually HSV1 lives on the face and HSV2 lives on the genitals. However, as you and your girlfriend so clearly illustrate, Herpes viruses are flexible, and can take up residence in either location.

I’m not sure exactly what you mean by danger, but I’m guessing you are referring to contagion. As it stands now, you have oral herpes and she has genital herpes, both HSV1. You have already passed the virus to her genitals, so continuing to perform oral sex on her won’t do anything, except make her happy. Go for it.

It is possible, but unlikely, that she could now develop oral lesions and/or that you could develop genital lesions. Once you have one established herpes site on your body, it’s rare to develop another, probably because your immune system makes antibodies to the virus. Also, now that you have HSV1, you are less likely to catch HSV2. There appears to be some cross-protection in the antibodies that are formed. Finally, people with HSV1 tend to have fewer recurrent outbreaks than those with HSV2. So you could even consider yourself lucky.

The second issue this brings up is how to handle herpes as a couple. What do you do if one of you has it and the other doesn’t? How do you talk about this with a prospective partner?

The couples I’ve known who deal with herpes in the healthiest way are those who tell me, “We have herpes.” In other words, they see it as a shared problem. They don’t expend a lot of energy trying to prevent passing it to each other, or let it put a crimp in their sex life. Their love for each other and their desire to express that love sexually overrides their worry about contagion.

I’m not suggesting you blithely rub your open sores all over each other. It still makes sense to avoid contact with open sores, for comfort’s sake if nothing else. I’m just pointing out that, for the sake of your relationship, it makes sense not to obsess about it. And medically speaking, herpes is very rarely a big deal.

If you have herpes and are in a new relationship, I think it’s only fair to inform your prospective partner before you have sex. Ideally, you’ll be close enough emotionally by that time that you can talk freely about such things, and figure out how you as a couple want to handle the situation. I realize this isn’t always easy, since our society still has lots of judgment and stigma around sex-related topics of any kind, and having a sexually transmitted infection can be emotionally upsetting. If you need help, the medical practitioners and/or the counselors at the Student Health Center would be happy to meet with you and your partner to answer questions and help you discuss it together.

Hooked on Hookah - the latest Ask Dr. Peg column

Dear Dr Peg,

Some friends introduced me to Hookah smoking a few months ago, and we’ve been getting together to smoke a couple of times a week. It’s fun to hang out, and the smoke smells nice. I know cigarette smoking is dangerous, so I’ve never done it, but hookah smoking is safe, right? Doesn’t the water filter out all the bad stuff from the smoke? And isn’t hookah tobacco healthier than the tobacco in cigarettes?

-Hooked on hookah

Dear Hooked,

I’m sorry to disappoint you, but you are wrong on all counts. As usual, I’ll start with the basics.

What is a hookah? A hookah is a water pipe. Other names for hookah include nargile, sheesha, okka, kalyan and hubbly-bubbly. It is a device for smoking a flavored tobacco mixture. The mixture is placed in a small bowl at the top of the device. From the bowl, a hollow pipe leads straight down into a chamber called the base, which is partly filled with water. The pipe extends below the surface of the water. From the side of the base, above water line, a hose leads to a mouthpiece. To smoke a hookah, you light a piece of charcoal, place it on top of the tobacco mixture, put the mouthpiece in your mouth, and suck hard. The smoke goes down the pipe, bubbles up through the water into the air at the top of the base chamber, up the hose and into your lungs. Hookahs can be quite ornate and beautiful, and can cost hundreds of dollars.

Hookahs have been around for centuries, probably originating in the Middle East or India, where it is a common social custom for men to gather, smoking and chatting for hours. In the US, the hookah has become very popular in recent years, especially with young people of both sexes. Hookah smoking is promoted as an aesthetic social activity, touting the sweet smell of the tobacco and the bubbling sound of the water as pleasant, relaxing influences. A typical hookah session lasts 2 or 3 hours and involves several friends smoking from the same pipe. Commercial Hookah bars have sprung up all over the country. There are at least five here in Albuquerque, where you can go just to smoke.

What does one smoke in a hookah? Typically, the mixture is 1/3 tobacco and 2/3 flavorings. The flavorings may include molasses, dried fruit, honey and other ingredients. The resulting aroma was likened to a baking apple pie by one hookah-selling website. Sounds pretty benign, doesn’t it? It isn’t. Like many fads, it has been hyped with false claims in order to increase its popularity and profits.

What are the dangers of hookah? Tobacco is tobacco, no matter how you get it, and tobacco smoke is hazardous. In fact, hookah smokers get more smoke than cigarette smokers, and here’s why. Cigarette smoke is uncomfortably hot if you inhale it deeply. Hookah smoke has been cooled by its passage through the water. In addition, you have to inhale hard to pull the smoke through the hookah. The result is cooler smoke going farther into your lungs. Add to that the duration of a typical hookah session, and the result is huge volumes of smoke being deposited into your lungs. A study done by the World Health Organization showed that one hookah session of a mere few hours can deliver as much smoke into your lungs as 100 cigarettes. Five packs! It’s a rare cigarette smoker who gets that much in one day.

Tobacco smoke contains nicotine, a highly addictive substance that is not filtered out by the water in a hookah. In addition to nicotine, you are pulling other dangerous substances through that hose. Tar is not water-soluble, so it comes on through the pipe, the same amount in one session as in a whole pack of cigarettes. Tar causes cancer. Other carcinogens (cancer-causing agents) also make it through, like heavy metals and carbon monoxide. In fact, because of the charcoal which is burned on top of the tobacco mixture, hookah smoke has a higher level of heavy metals and carbon monoxide than cigarette smoke. Hookah smokers risk cancer of the lung, lip, tongue and bladder.

As you doubtless know by now, tobacco smoke affects the cardiovascular system, causing an increased blood pressure and heart rate, and increasing the risk of heart attack and stroke. Smoke of any kind is also a lung irritant, which can trigger asthma and allergies. And of course, there are all the second hand smoke issues to consider.

In addition to the tobacco, there are the smoked flavorings to consider. Unfortunately, nobody has yet studied the effects of inhaling dried apricots, but I would bet they aren’t all good.

Finally, think about sharing the mouthpiece. It’s like kissing everyone in the group. Hookah pipes can spread herpes, flu, strep throat, a cold, even tuberculosis. And wiping it on your sleeve doesn’t sterilize it.

I’m a big believer in social gatherings and relaxation time. By all means, gather away, and relax like crazy. But if you are concerned with the health of your young lungs, think about gathering around a cup of tea, or relaxing with exercise and a bath instead of a water pipe. And if you are already addicted to any form of tobacco, I strongly urge you to quit. The Student Health Center has people and programs to help you.

Blood Pressure (My latest Ask Dr Peg column)

Dear Dr. Peg,

While shopping at my local Smith's store, I stopped by the pharmacy to measure my blood pressure. The machine told me that it was 127/75. Is this a healthy blood pressure? Also, what's the relationship between blood pressure and cholesterol levels? What can I do to maintain a healthy blood pressure?

Dear Smith’s guy,

The short answers to your questions are: probably, nothing, and plenty. But I’m not one for short answers, so pull up a chair.

What exactly is blood pressure? It is the amount of pressure that your blood exerts on your blood vessels, from within them. You might liken it to air pressure in your tires, or water pressure in your pipes.

Air pressure is measured in PSI’s, or pounds per square inch. Blood pressure is measured in mmHg, or millimeters of mercury. This is because blood pressure cuffs originally used a vertical column of mercury to measure pressure. A pressure reading of 100 meant the mercury column was pushed up (against gravity) 100 millimeters.

There are two numbers in a blood pressure reading, the top number and the bottom number. Basically they are maximum and minimum readings. The top number,127 for you, is the systolic (say “siss-TALL-ick”) blood pressure. This is the pressure present in the arteries during systole (SISS-toe-lee) , which is the active squeezing phase of the heart’s pumping action. The bottom number,75 for you, is the diastolic (say “dye-uh-STALL-ick”) blood pressure. This is the pressure present in the arteries during diastole (dye-ASS-toe-lee) which is the inactive, relaxation phase of the heart.

What is normal for blood pressure? Pretty much anything less than 120/80 and still standing. Too low is when you pass out because of it. A person’s blood pressure changes throughout the day, depending on many factors. Your blood pressure is lowest when you are asleep, and highest when you are exercising strenuously.

If your blood pressure always reads between 120-140 systolic and/or 80-90 diastolic you could have pre-hypertension, meaning you could be at risk for developing the disease of Hypertension, or high blood pressure. In the pre-hypertension range, lifestyle changes like losing weight, exercising more, and eating less salt are often all that’s needed to bring your blood pressure down to normal.

If you get repeated readings with a systolic pressure over 140 and/or a diastolic over 90, you may have Hypertension. This is a bad thing. Imagine what would happen if you filled your bike tires with as much air pressure as you put in your car tires. Ka-blam, right? That’s what happens in your tiny blood vessels if they get too much pressure. The result is damage to all your organs, especially your heart, kidneys and brain.

What can you do to keep your blood pressure in a healthy range? Maintain a normal weight. Exercise regularly. Don’t smoke. Limit your alcohol intake, or don’t drink. Minimize your stress, or manage it as best you can.

Hypertension is sometimes genetic. If it runs in your family, you can decrease your chance of getting it by following the advice above, and by getting a professional blood pressure measurement once a year, during your yearly physical.

Blood pressure and cholesterol are not directly related to each other. High blood pressure doesn’t cause high cholesterol or vice versa. However, they both contribute to the same health problems (heart attacks, strokes, organ damage) and each alone can kill you. It behooves you to keep both blood pressure and cholesterol as low as possible. Beyond that, cholesterol is a topic for another day.

Finally, a word about supermarket blood pressure machines. Take them with a grain of –oops, I mean, they may not be exactly accurate. To maximize your chances of an accurate reading, rest first for ten minutes, then put your bare arm into the machine. If you get worrisome or wildly differing readings in Smiths, come in to the Student Health Center and let the professionals check it. Call ###-#### for an appointment.

Cold Sores (my latest "Ask Dr. Peg" column)

Dear Dr Peg:

I have read your Health Columns in the Daily Lobo and have found them to be very informative and helpful. I have been concerned about a health issue since school started and would like to submit this question.

Is there an unusually high number of people at UNM with cold sores/oral herpes? It seems that they are everywhere and I am afraid that I will come down with lip sores like that. I have never had one. Is there a way to prevent getting them? Why do you think so many people on campus have this problem? What is causing this?

Thank you very much.

-Curious About Cold Sores

Dear Curious,

Great questions! I’ll do my best to answer them, but first, a few basics for those who might need them. A cold sore, also commonly called a fever blister, is actually neither. I’m talking about those round, raw-looking sores that bloom on the vermilion border of the lip, which is the junction between lip and face. They aren’t caused by cold weather, a cold, or a fever. They’re actually caused by a virus, as you suggested. Herpes Simplex, to be precise. The medical term for “cold sore” is “Oral Herpes.” Like any virus, Herpes Simplex is contagious. Oral Herpes is usually passed by direct contact (kissing, oral sex) but can also be passed by sharing items like razors or towels.

I don’t think UNM students have more Oral Herpes than anyone else. I can’t give you statistics to prove this, however, because we rarely test for this condition. It’s pretty easy to diagnose just by looking at it, and the test is expensive, so students usually decline it. Having said that, I have to tell you that Oral Herpes is extremely common in this country in general. You say you have never had a cold sore, but you might be mistaken. The American Social Health Association asserts that “50-80% of the adult population in the United States has oral herpes, with as many as 90% having the virus by age 50.” Most of us get it as children, when some well-meaning but infected relative gives us a smooch and a squeeze. Nice, huh?

Now, to cut Aunt Blanche some slack, she probably didn’t have a nasty, oozing sore when she kissed you. The problem is, she could have passed it along to you even without an active sore, or outbreak. Herpes, once it gets under your skin, takes up residence deep in the root of a nerve. It can stay there forever without ever coming out, or it can venture up to the surface and wreak havoc. Unfortunately, before the havoc, i.e. the actual sore, you can shed viruses and be contagious. Some people can tell they’re about to have an outbreak because they feel tingling or pain at the site. Triggers for the virus to make a surface foray include sunburn, stress, illness, lack of sleep….yes, basically the college lifestyle. This might be why you see a lot of Oral Herpes. Students may have more outbreaks than other, less stressed adults, even if the infection rate is the same.

How can you keep from getting oral Herpes? Stay away from Aunt Blanche! Naw, but you shouldn’t be kissing anyone with a sore on their lip, or letting them kiss you. Anywhere. Herpes Simplex comes in two subspecies – type I and type II. Type I generally prefers lips, and Type II usually prefers genitals, but they’re adaptable. Either type can live in either place. And either type can be passed from one place to the other. I deliberately left Genital Herpes out of this discussion, due to space restraints and the fact that you asked about Oral Herpes, but I’d be happy to address that another time.

If you have a cold sore, avoid kissing and performing oral sex, don’t share eating utensils or cups, and wash your hands often.

If you develop a cold sore, know that it will clear up in about a week. In the meantime, you can ask your pharmacist for topical creams or ointments to soothe your discomfort, or you can come to the Student Health Center for a prescription for antiviral medication. These medications can decrease the severity of the symptoms and shorten the duration of the outbreak. Try to keep your hands off the sore. Take a pain reliever if needed, and apply ice or warm compresses, whichever feels better.The good news about Oral Herpes is that it causes a sore and that’s all. Yes, it takes up residence in your body for life, but it doesn’t damage your internal organs, cause cancer, or kill you. Ever since HIV has come on the scene, Herpes seems a lot less of a big deal.

The other good news is that many people “grow out of” cold sores. They may have outbreaks for several years after the Aunt Blanche episode, but stop having them by the time they’re adults. Adults who catch the virus may notice that their outbreaks diminish over time and eventually stop.

I hope this is helpful. If you or anyone else have more questions, email me at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous in the Daily Lobo.

The Science of Stem Cells

written for the Daily Lobo (University of New Mexico newspaper) on request for a special issue on Stem Cell research.

Immortality and unlimited potential. That’s a stem cell in a nutshell. It is an unspecialized ancestor cell, capable of living practically forever or morphing into any cell type from any tissue. Talk about power in a small package!

There are two kinds of stem cells: embryonic and adult. Embryonic stem cells come from fertility clinics. In the fertility laboratories, donor eggs are fertilized in vitro (in a test tube) and watched for a few days. After 4 or 5 days, successfully fertilized eggs have become blastocysts, which are tiny balls of cells. Some of the blastocysts are used for implantation in a woman’s uterus. The rest are frozen, destroyed or donated for stem cell research, with the signed consent of the donors. Stem cells are extracted from the center of the blastocyst and grown in cell cultures in a research lab. As long as they aren’t crowded or signaled to change, the stem cells can multiply unchanged for years. Or, given the right signals, certain genes within these cells will “turn on,” causing the stem cell to differentiate into a very specific cell type from a certain tissue. Embryonic stem cells are pleuripotent (pleuri- as in pleural, implying many, or multiple potent as in potential, meaning these cells have the potential to become any other cell in the system.

In recent years, scientists have discovered that adult humans actually retain a few stem cells. Tucked away in the lining of our intestines and the recesses of our brains, tiny swat teams of these cells huddle, breaking cover only when their home tissue is diseased or injured. These cells, also called “somatic stem cells,” help repair damage, and differ from embryonic stem cells in that they seem to be limited in their potential. In other words, unspecialized stem cells from a certain tissue can become specialized cells of that tissue, or possibly of another tissue type or two, but they are not pleuripotent like embryonic stem cells. So far, adult stem cells have been identified in brain, bone marrow, blood vessels, peripheral blood, skeletal muscle, skin and liver.

Adult stem cells have already been used in medical treatments. Have you heard of a bone marrow transplant? That is a stem cell transplant. Bone marrow stem cells become blood cells. If someone’s bone marrow is wiped out, say by radiation for cancer, they can’t make their own blood cells anymore. Give them a bone marrow transplant, and the donor stem cells take over the job, saving the recipient from catastrophe.

What else are stem cells good for? To date, the answer to this is largely theoretical, since the research is in progress. There are three general areas of research and application: regenerative therapies (like transplantation), drug testing, and development research.

The fact that stem cells can differentiate into different tissues holds promise for tissue transplants. Many diseases cause destruction or degeneration of whole organs or types of tissues. Currently, donated organs and tissues are used to replace these damaged tissues, but the demand far outweighs the supply. Stem cells could be used as a renewable source of transplantable tissues. The possibility of using adult stem cells for this purpose is especially exciting, because if one’s own stem cells could be cultured and placed back in the body, the risk of tissue rejection might be less. Some of the specific diseases being considered for these cell-based therapies are Diabetes, burns, heart disease, spinal cord injury, arthritis, Parkinson’s and Alzheimer’s diseases.

Drug testing for safety and efficacy is an obvious necessity, before new drugs are made available for medical use. At present, some cancer drugs are being tested on cells, on cancer cell lines, which are grown in a lab like stem cells. The scientific hope in this area is that stem cells can be induced to specialize into certain cell types, on which tissue-specific drugs could then be tested.

Finally, studying stem cells and the way they differentiate could give scientists a lot of information about the complex events that occur during human development, normal and abnormal. What tells cells to divide and differentiate? What goes wrong in this process to cause birth defects? What signal makes cells turn cancerous? Stem cell research is being used to understand these very complicated processes, in hopes that one day birth defects and cancer, among other conditions, might be prevented.

Exciting as these medical applications might sound, they are a long way from reality. Many fundamental questions remain. What causes a cell to differentiate? Are the signals internal to the cell or external? How do certain genes get turned on by these signals? How do stem cells remain unspecialized and self renewing for years and years? How can scientists direct a stem cell to become a specific tissue cell? How can a somatic stem cell from one tissue be used to make a different tissue? These are some of the basic questions that are being asked in research labs around the world. Only when they are answered can the medical promise of stem cells be fulfilled.

Scared Sexless (my latest "Ask Dr Peg" column)

Dear Doctor Peg,

I’m freaking out. I went to a great party last night, and had a fantastic time, but, well, I guess I had too much to drink, and there was this really attractive person, and one thing led to another, and we had sex. We didn’t use protection. This morning I’m sober, I have a roaring headache, I feel like an idiot, and I’m terrified. What have I done? What could happen to me? I can’t believe I did that. I’m never having sex again!

Scared Sexless

Dear Scared,

What have you done, you ask? You made some choices that put your health at risk. You are clearly regretting this as you look back with the clarity of hindsight. What could happen to you? That depends on a few things.

If you are Scared Susie, you’ll be worrying about disease and pregnancy (unless you had sex with a woman, in which case you’ll still be worrying about disease). If you are Scared Sam, it’s the possibility of disease that’s making your headache worse. Let’s take these issues one at a time.

Pregnancy. For pregnancy prevention, come to the Student Health Center for Emergency Contraception. You need a prescription for this hormone treatment, but soon it will be available over the counter. The sooner you take ECP the better, but it can be effective up to three days after unprotected sex. ECP is not an abortion pill. While you’re at the SHC, you can get more information about birth control methods.

STI’s. This is the new and improved acronym for Sexually Transmitted Infections (formerly ST Diseases). There are several. For practical purposes, I’m going to divide them into two categories, curable and incurable.

Curable STI’s. These are infections that can be cured with antibiotics, after which they are gone from your body for good, unless you catch them again. Please note that most of these can be “silent,” meaning you can have them and not know it. We can find them for you, though, with blood, urine or swab tests. When they do cause symptoms, they are typically as follows. Trichomonas, or “trich” (pronounced “trick”) is a parasite that can cause an itchy, smelly, greenish discharge from the penis or vagina. Chlamydia is a bacterium that can cause burning with urination, a penile or vaginal discharge, painful sex or vaginal bleeding. We see several cases of Chlamydia at Student Health every year, especially after Spring Break. GonorrheaPubic lice (“crabs”) cause severe itching and rash in the pubic area. If you look closely, you might be able to see the lice themselves or their egg cases on your pubic hair. Crabs are treated topically with a cream or liquid. Molluscum contagiosum virus causes bumps that look and feel like hard pimples. Removing the core of each lesion, which we do in the clinic, helps the infection clear up more quickly. (“the drip”) causes a goopy, yellow discharge from the penis or vagina.

Incurable STI’s. For this group of infections, modern medicine has no cure. We can give you drugs to make you feel better, or to decrease the intensity and duration of your symptoms, but we can’t kill the viruses. Herpes causes exquisitely tender sores, in your mouth or on your genitals. Human Papilloma Virus (HPV) causes warts on your genitals, and some strains can cause cancer of the cervix. The good news about HPV is that there is now a vaccine that will protect you from the most dangerous strains. If you get genital warts, we’ll freeze them off, but unfortunately that doesn’t get rid of the virus, which usually lives about two more years under your skin. Hepatitis B, for which there is also a vaccine, can be silent or cause an illness with nausea, fever and bodyaches. And finally, HIV, which has a variety of symptom presentations and for which there is no known cure at this time.

I know that is quite the parade of scoundrels, and I’ve probably scared you worse by listing them all. However, chances are very slim that you’d have more than one or two of these after your wild escapade last night, and it’s likely that you don’t have any of them. The problem is, it can take weeks to months for these infections to show up in your body after you catch them.

So how long should you wait to be seen by a health professional? If you’re Susie, don’t wait for pregnancy prevention. Anyone else, make an appointment for “STI Screeing” with one of the SHC practitioners or the Women’s Health department. We will listen to you, examine you, educate you, and advise you. We might do labwork to find out if you’re positive for any of these STI’s now. We can tell you when to come back and get tested the next time. If you develop symptoms before your scheduled visit, come to the Walk-In clinic or make another appointment to be checked.

Finally, go easy on yourself. Everyone makes mistakes. Everyone does stupid things. You don’t have to swear off sex forever, or brand a big L for Loser on your forehead. Just take steps to be healthy now, and in the future, if you choose to have sex with a stranger, please, protect yourself.

The Scoop on Coffee

This is an article I wrote for our University newspaper, in response to a question someone sent in about coffee. They wanted to know if it is good or bad for them, whether it is true that coffee after heavy drinking protects the liver, and what about energy drinks? They said "like Tom Petty I have a Need To Know."

Dear Coffee Cat,

If you’ve heard good and bad things about coffee, you’re paying attention. And if you’re confused, there’s good reason, because the truth is, it’s both. Allow me to explain.

How is coffee good for you?

1. It stimulates the brain. We all know that. It’s the whole reason many people indulge. And face it: even though you are smart enough to have gotten into college, there are those times when your brain could use a little extra boost. When that big paper is due tomorrow and you’re farther behind than you thought. When it’s the “morning after the night before,” and you need to function at work. At times like these, an extra mental lift can be highly useful. There is also some evidence that regular coffee drinkers have less “age related cognitive decline” than non-coffee drinkers. In other words, they kept their “marbles” longer into their old age. (The same study, by the way, found these benefits and more with green tea.)

2. I’m glad you brought up the liver thing. It gives me a chance to debunk some rumors. The answer to your question is no, coffee cannot heal the liver after a long night of drinking. Coffee can’t sober you up either, contrary to popular misconception. The only thing that will get alcohol out of your blood is time, sweet time. What may be true is that – now, read this carefully – people who drink alcohol heavily, and we’re talking heavily and long enough to cause cirrhosis of the liver, can get some protective effect for their liver over the years by drinking coffee too. This is not the same thing as saying that if you binge drink all night, you can reverse the beating you gave your poor liver by going out for a latte in the morning. No. If you really want to protect your liver from cirrhosis, a far better way to do that is not to drink too much alcohol in the first place.

3. Finally, coffee is often at the center of meaningful social interaction. Relaxing with a friend and having a real conversation while you sip your caffeinated beverage of choice is, in my opinion, a ritual worth honoring.

How is coffee bad for you?

1. Too much coffee can give you uncomfortable jitters, headaches, anxiety, insomnia, and stomach and bladder irritation. Coffee aggravates the painful fibrocystic breast condition. It can affect the kidneys, acting as a diuretic (makes you pee). Coffee can increase your pulse and your blood pressure and contribute to ulcers. It can worsen PMS (now that is truly frightening!). All of these side effects are what we medical types call “dose related responses.” In other words, the more coffee you drink, the more likely you’ll suffer.

2. Is coffee addictive? Oh, yes. If you’ve ever been a regular coffee drinker and tried to quit, you know what I’m talking about. Headaches, drowsiness, lack of concentration and focus…those, my friend, are withdrawal symptoms. Withdrawal from caffeine, the drug of choice of millions of Americans. Whether we’re “guzzling coffee like crazy fools,” taking “big gulps”of sodas or sipping tea, we consume tons of caffeine-containing products each year. If you want to jettison your caffeine addiction, I suggest you cut your consumption in half for a week, then quit. Be prepared to feel lousy for another week, but then you should be fine.

There are some “positive negatives” to the coffee story. In other words, some bad things that coffee does not do. It does not cause cancer. It does not increase your heart disease risk. In moderation, coffee and other forms of caffeine do not have significant health risks. How much is “moderation? That depends on the person. Different people have different caffeine sensitivities. For the average Joe, 2-3 cups of “Joe” a day counts as moderate consumption.

Finally, you asked about energy drinks. Those little power cans vary widely in their ingredients, including the amount of caffeine and other stimulants. Some have a lot of sugar. Some use artificial sweeteners. Most use artificial flavors and colors. Most have less caffeine than a cup of coffee, yet cost more. Since the full health effects of food additives are not yet completely known, I myself am more inclined toward the natural stuff, meaning “the bean” or “the [tea] leaf.”

I hope this satisfies your Need To Know, Coffee Cat. Now tomorrow when it’s Wakeup Time you can enjoy your java with No Second Thoughts.