Many of our students travel abroad in association with school-related studies and projects as well as for business or recreation. We are frequently asked about recommended travel immunizations.

Our policy at CSUSM Student Health and Counseling Services is to refer students to one of the local Travel Clinics where they can obtain not only specific CDC-recommended immunizations and/or disease prevention medication, but they can also obtain an individualized assessment of their own health risks as well as suggestions for a healthy travel experience abroad.

If you are involved in a Study Abroad program in association with CSUSM, a good place to start this process is by obtaining a course information sheet on travel itinerary and immunization recommendations from your instructor.

What does a Travel Clinic consultation typically include?

1. A questionnaire specifying travel itinerary and duration of visit;
2. Individualized health history including chronic diseases, medications, allergies as well as current immunization status;
3. CDC recommendations for country-specific immunizations;
4. Updates on new and emerging diseases;
5. Information and counseling about principles of healthy international travel including personal protective measures;
6. Answers to your travel-related questions and resource information about travel insurance, contingency planning for unexpected illnesses such as travelers’ diarrhea, motion and altitude sickness prevention, insomnia, traveling with disabilities and other travel concerns;
7. Immunization and vaccination administration.

When Should I Make an Appointment with the Travel Clinic?

The sooner the better!

The purpose of immunizations is to stimulate your body’s own immunity, and this process often requires a few weeks to establish optimum protection. If you need many immunizations, it may be desirable to get required immunizations in 2 or more visits, to reduce immunization side-effects. Although it may be best to obtain your immunizations several months before departure, you will still benefit from immunizations given closer to your departure date. If you are under the care of a Physician, Nurse Practitioner, Psychologist or Psychiatrist for management of a medical or psychiatric illness, or if you are receiving contraceptives or other medications, you may want to make an appointment with your Provider to discuss your travel plans as well as to discuss options for obtaining a prescription for a larger quantity of medication to last your visit abroad.

What Websites Could I Access to Inform Myself of Travel Information?

1. PPH.NET
2. CDC.gov/travel
3. CDC Health Information and International Travel Book, also referred to as “The Yellow Book”.

Please call SHCS for resource information regarding low-cost Travel Clinics in your area or to schedule an appointment with your medical provider to discuss and plan for your health and medication needs abroad. We will be happy to help you.

1. Have you ever felt the need to CUT down on your drinking?
2. Have people ever ANNOYED you by criticizing your drinking?
3. Have you ever felt GUILTY about your drinking?
4. Have you ever taken a morning EYE-opener to steady your nerves or get rid of a hangover?

The above CAGE screening questionnaire is one of many tools created to help you and your medical provider determine if you have an alcohol problem. Two or more affirmative answers to the above questionnaire may indicate a problem with alcohol. Any single affirmative answer deserves further evaluation. (Mayfield D, et al)

College is a time of life when alcohol plays a part in many social situations. It is well known that college freshmen are at a statistically higher risk for alcohol-related problems than other college levels. Students who live away from home for the first time, live in dorms, or join fraternities or sororities often add to this risk. Some of the problems resulting from excessive drinking include alcohol-related motor vehicle accidents and falls, STDs, assaults, rape-by-intoxication, poor grades and failed relationships. Other risk factors for alcohol-related problems may include a family history of alcoholism, other substance abuse history, cultural factors or a personal history of emotional or psychiatric disorders.

In our student health clinic we have encountered students with a variety of alcohol-related medical and mental-health problems such as irritated stomach or esophagus related to excessive alcohol ingestion and/or vomiting, bruises and sprains that the student can’t explain, STDs due to unwanted sexual experiences as well as anxiety or depressive symptoms which result in missed classes and poor grades.

When Medical Providers evaluate a student with symptoms related to excessive drinking, we will take a careful history and conduct a physical exam. We will ask you about your drinking history and problems you’ve encountered with your drinking. It may be necessary to do blood or other lab tests, depending on your medical health status.

We will discuss our findings with you and work with you to make suggestions and generate a plan for getting you the help you deserve for any alcohol or other substance-abuse issues you have. We have Counselors who can help you discuss your issues and assist you in developing a behavior change program to fit your individual needs. We have a Health Educator who can suggest on-line self-assessment tools and outside resources. We also have a staff Psychiatrist available if necessary.

We understand the pressure and stress our students face in college, particularly during the current economic recession. Student Health and Counseling Service is committed to supporting your educational goals by providing medical and counseling services that are aligned with your individual needs and circumstances.

If you are concerned about your drinking habits and want more insight and support, please call us for an appointment: (760) 750-4915. We look forward to talking with you.

You may also check out “College Drinking-Changing the Culture” on-line resources to help you make healthier choices, Alcohol Screening which provides online self-assessment, or visit SHCS website and scroll down to Alcohol and Substance Abuse section for more health links and information.

Mayfield D, McLead G, Hall P. The CAGE Questionnaire. Am J. Psychiatry 1974: 131:1121.

Is this a mole…or melanoma?
I have a headache…could I have a brain tumor?
I’ve been tired lately…maybe it’s a sign of AIDS!
 
   Students frequently come to our clinic for medical evaluation after they’ve searched the Internet, talked with their roommates or read magazine articles related to their symptoms. Sometimes these resources are helpful, sometimes they are anxiety-producing. It is often difficult for people to be objective about their own health concerns, making it difficult to put this information into the proper perspective.
   The term “cyberchondriac” refers to anyone who uses the Web to obtain health-related information. Whether you’ve got a sore throat, a back ache or a rash, looking on the Web for information about your health concerns has been getting easier over the last few years. More and more Americans are going to the Internet for answers to their medical questions.

   It is important to keep the following points in mind when you search the Web for medical information:
1. Are the articles written by reputable health professionals?
2. Are you looking at a commercial site that is trying to sell their products?
3. Are you aware that on-line medical information is for the general consumer and not tailored to the unique individual?
4. Have you considered bringing your questions about the information you obtain from the Internet to a Medical Provider to discuss?
   It is important to remember that even a few hours reading at medical site is not the same as obtaining individualized assessments of your health issues by a Medical Professional.

   Currently there are many search engines available for people wanting to learn more about their medical conditions. The following sites are among the top 10 most useful medical-related sites, according to the Medical Library Association. We often refer our students to these sites:

1. Medline Plus: this medical web site can be accessed by CSUSM students using our campus website. It is considered one of the best places on the Web for consumers, yet not well-known by the average person. The information is written in layperson’s language offering many links to credible organizations.
2. Familydoctor.org: this site has an A-Z index of conditions, easy-to-understand descriptions and diagrams as well as a guide to over-the-counter medications.
3. Healthfinder.gov: this site offers links to carefully selected Web sites from more than 1,500 health-related organizations.
4. Mayoclinic.com: this site also offers an A-Z list of diseases and conditions in clear layman’s language.
5. CDC.gov: The Centers for Disease Control and Prevention offers up-to-date, evidence-based information on many medical and disease conditions as well as Public Health issues.

   In addition, please check out our CSUSM Student Health and Counseling Service web-site where you can find pertinent health information and links to other resources and services.

   We encourage your interest in educating yourself about healthy living. If you have questions or concerns about your health, we invite you to schedule an appointment with one of our Medical Providers, our Health Educator or Counselors so we can partner with you in good health.

“You need to go to the Emergency Department because we think you have appendicitis.”

“Your PAP results were abnormal, and you will need to see a Gynecologist for a colposcopy.”

“You fractured your ankle skate-boarding, and you’ll need to see an Orthopedic surgeon.”

    These are the types of scenarios that we often see in our student health clinic and need to refer out for management by a medical specialist. Your basic student fees typically do not cover such conditions. Without health insurance, whether you have your own policy or are covered under your parent’s policy, you may face high out-of-pocket expenses for these services.

    Many of our students expect to get 100% of their health care needs met by our college health center and are surprised to discover this is not true. If you are a student at CSUSM, $65.00 of your fees automatically goes to the student health center every semester. This entitles you to see medical providers, counselors and a health educator for no additional fees although some lab services, medications and medical devices are provided at low cost to our students. We do NOT accept private insurance.

    Your health fee does cover care of minor illnesses and health problems such as upper respiratory infections, bronchitis and asthma, headaches, urinary tract infections, rashes and minor sprains. In addition, you can receive your routine PAP exams and STD checks, contraceptive counseling and immunizations. You may consult with our Health Educator to discuss weight concerns, family planning and nutrition counseling. 

    We share your concern about the costs of medical care and medications, and we try to help our students get the best care at the best price. This year we brought the Family PACT (Family Planning, Access, Care, Treatment) program into our health clinic to provide no-cost family planning services to qualifying low-income students, both men and women. Some of these no-cost services include STD screening, PAP exams, contraceptive counseling and contraceptives.  

   We strongly encourage our students to have health insurance. CSUSM offers a Domestic and International Student Health Insurance program at reasonable rates. Remember, the best time to get health insurance is before you need it! Nobody plans to get in a car accident or fracture their leg, but if this happens to you, you will have health insurance if you need it. Remember to always carry your insurance card in your wallet.

   If you’d like to learn more about our basic student health services, visit our website: www.csusm.edu/shcs. To see if you qualify for the Family PACT program, call the Student Health and Counseling Service to schedule an appointment with our Family PACT coordinator. To learn more about our supplemental Domestic and International Student Health Insurance option or to enroll on-line, please go to: www.CSUhealthlink.com.

Do I…weigh myself every day
skip at least one meal a day         
count calories and fat grams every time I eat         
exercise excessively or compulsively         
self-induce vomiting after I eat       
abuse laxatives or diet pills to control my weight?

Am I on my way to an Eating disorder? 

According to NEDA (National Eating Disorders Association), eating disorders -such as anorexia nervosa, bulimia nervosa and binge eating disorder-include extreme emotions, attitudes and behaviors surrounding weight and food issues. People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem overwhelming. Eventually, however, dieting, bingeing and purging will damage a person’s physical and emotional health.

Anorexia Nervosa is characterized primarily by self-starvation and excessive weight loss. Symptoms include a refusal to maintain a normal body weight, intense fear of weight gain or being “fat”, body image disturbance and loss of (3) consecutive menstrual periods. 

Bulemia Nervosa is a cycle of binge eating followed by compensatory behaviors such as self-induced vomiting in an attempt to undo or compensate for the effects of binge eating. Symptoms include regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior, regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting and/or obsessive or compulsive exercise and extreme concern with body weight and shape.

Binge Eating Disorder (BED) is recurrent binge eating without the  regular use of compensatory measures to counter the binge eating while feeling out of control, ashamed or disgusted over the behavior. Symptoms include frequent episodes of eating large quantities of food in short periods of time, feeling out of control over eating behavior, eating when not hungry or eating in secret.

If you think that you may be developing an eating disorder and want to discuss your concerns with a medical provider or counselor, please call the Student Health and Counseling Center for an appointment:  (760) 750-4915

We welcome the opportunity to discuss your concerns and help you get the appropriate treatment.

 There are some changes in testing recommendations for the annual women’s wellness visit that are approved by ACS (American Cancer Society) and ACOG (American College of Obstetrics and Gynecology). 

WHAT HAS NOT CHANGED?  

All young women who have ever been sexually active need annual testing for sexually transmitted infections (STI’s) which involves a vaginal exam by a medical clinician. By age 21, women who have not been sexually active are recommended to have their first pelvic examination. Statistics show that young women are at the highest risk for contracting STI’s, like Chlamydia, which can cause illness and infertility if not treated properly (with antibiotics) and in a timely manner. These infections often are present without symptoms of vaginal discharge or pain, so screening tests are necessary. 

WHAT HAS CHANGED?   

A woman’s first PAP test in now recommended at age 21 or within 3 years after she becomes sexually active, whichever occurs first.   The PAP smear is a screening test for cervical cancer, a cancer caused by longstanding persistent infection with the Human Papilloma Virus (HPV). This virus is sexually transmitted and is usually transient, with most infections being cleared by the woman’s own immune system in 6-24 months.     

Cervical cancer occurs only in the rare case an HPV infection becomes persistent and does not get treated and resolve. The peak occurrence of HPV infection is in women in their early 20’s and the peak occurrence of cervical cancer is 15 years later, in the 4^th or 5^th decade of life. Delaying cervical cancer screening 2-3 years after initiating first sexual intercourse, allows these transient HPV infections and minor associated cell changes to resolve, sparing the woman stressful testing and treatment. (Adapted from University of Maryland)   

Our clinic will be starting the FPACT program next week,  Feb 11, 2008. This program provides no-cost family planning services to low-income men and women, including teens.  Family PACT provides access to family planning services  as well as education, counseling and treatment to protect your reproductive health. If you are interested in finding out more about the FPACT program, please call Student Health and Counseling Services at (760) 750-4915 to schedule an appointment with our FPACT coordinator.   

Health promotion and disease prevention  is an important part of our service credo. Preventive services include offering Gardisil vaccine to eligible students. Gardisil is a vaccine that helps protect against diseases caused be the (4) most common types of HPV. Gardisil is a series of (3) immunizations given over a 6-month period and has been on the market for women age 26 and under for over a year. Studies on males will be completed in 2008. We will notify our students when Gardisil is available for men.  

If you have questions or concerns about any of the information above, please call our clinic to schedule an appointment with one of our medical providers, our Health Educator or our FPACT coordinator.

   Last week’s (October 2007) devastating wildfires have significantly impacted the air quality in San Diego. We are all breathing air filled with small particles that could be dangerous to our health.

Some experts compare conditions in the San Diego area, especially in areas closer to the fires, to that of Ground Zero in New York after Sept. 11, 2001. Smoke is made up of a complex mixture of gases and fine particles produced when wood and other organic matter burn.  The biggest health threat from smoke comes from fine particles which can get into your eyes and respiratory system  

We have seen an increase in students coming to our clinic this week reporting health problems related to smoke exposure, such as breathing difficulties, sore throats and eye irritation. Many students with asthma are  using their inhalers more frequently. Students are asking when it will be safe to return to their usual outdoor activities, sports, running etc. According to the American Lung Association, even as the wildfires wind down, lingering smoke and ash may present serious health risks for many weeks to come.

Recommendations from the ALA for the next few weeks:

1)      Limit outdoor activities to only what is absolutely necessary

2)      Check local air quality on a daily basis. The CSUSM has an excellentweb site which gives current Air Quality Index information:www.csusm.edu/rms. Click Firestorm 2007 for comprehensive information.

3)      When driving, keep car windows closed and air circulating.

4)      HEPA air purifiers are most effective.       

5)      Restrict strenuous exercise to indoor environments

6)      Keep pets indoors as much as possible

7)      Know that ordinary dust and surgical masks do not filter out many of the impurities in the air. N-95 masks, available at Home Depot, many hardware stores and medical supply companies, provide better protection.     

For the most up-to-date information on air quality in your area, check theabove referenced web site: www.csusm.edu/rms. Other helpful sites are airnow.gov or sdapcd.org.   

If you are experiencing symptoms related to the recent wildfires or are feeling anxious from being part of the evacuations and/or witnessing the losses associated with the fires, please call Student Health and Counseling Services to set up an appointment. We will be happy to help you.

    It’s the start of a new school year, and our Student Health Center has been seeing many students with sore throats, nasal congestion, body aches, ear aches, and other symptoms of the common cold, which is also known as a URI (Upper Respiratory Infection).  

There are many factors that contribute to an increase in URI symptoms. The stress of a new school year, coupled with new living arrangements and close quarters, where many other friends live together in the same apartment or dorm room, may increase your susceptibility to catching colds by lowering your resistance to viral infections.  

There are more than 200 viruses that attack and multiply in the cells that line the nose and throat. Colds are most commonly spread hand-to-hand. If you touch the hand of an infected person and then touch your face, you are likely to infect yourself with the virus. Touching a hard surface, such as a doorknob, shortly after an infected person has touched it, may also expose you to viruses.   

How can you protect yourself?

·        Wash your hands often or use Handi-Wipes,
·        Get 6-8 hours of sleep at night,
·        Eat a balanced diet,
·        Don’t over-schedule yourself,
·        Avoid prolonged contact with people who have colds,
·        Keep your stress level down.
·        Get regular exercise.

Treatment Do’s and Don’ts  
Every healthy person has an immune system capable of destroying cold viruses and will mount a response with symptoms about 3-4 days after exposure. Most cold-care suggestions are aimed at symptom relief and immune system support.·        Don’t treat your cold with an antibiotic.(antibiotics fight bacterial, not viral, infections. Unless your cold has progressed to a secondary bacterial infection, an antibiotic is not only a waste of money but may expose you to side-effects)
·        Don’t smoke
·        Do drink enough fluids and juices.
·        Do gargle with salt water to reduce swelling in your throat.(1/2 tsp table salt in glass of warm water every 4 hours)
·        Do get plenty of rest (helps  your body fight off the virus)
·        Do take Ibuprofen or Tylenol to ease aches and fever.

When should I call for an appointment with my medical provider?
·        If your cold persists, or worsens, after 7-10 days,
·        Persistent discolored mucus from nasal passages,
·        Persistent tenderness around eyes and cheeks, unrelievedwith decongestants,
·         Productive cough of colored mucus, and/or associatedwith wheezing or difficulty breathing,
·        Red throat with white patches.Please call for an appointment if your cold symptoms persists despite over-the-counter treatment. We will be happy to help you.

The NP Answers your FAQ: Why is it important to Know my Cholesterol Levels?   

 “I’m young and healthy, why do I need to be concerned about my cholesterol levels now?”      

  “Health Promotion and Disease Prevention” is a pro-active approach to good health. It is important to know what your general health risk factors are to help guide you toward healthy lifestyle choices, which will impact your health now and in the future.   When we see patients in our clinic, part of the process of making a diagnosis involves assessing the person’s risk factors. In terms of heart disease, risk factors include any family history of heart disease and high cholesterol. If you don’t already know this information, it would be a good idea to talk with your parents about your family’s health history, because it does affect your own health course.  

Cardiovascular risk factors can be divided into “non-modifiable” such as age, family history of early heart disease and gender. “Modifiable” risk factors include cigarette smoking, diabetes, abnormal cholesterol, hypertension, obesity and physical inactivity. As you can see, there are many factors you can change to improve your health risk profile and to improve your cholesterol values.  Cholesterol is a type of fat (also called lipid) made by your liver.  

Cholesterol is also contained in certain foods that you eat. Too much of the wrong cholesterol is a major risk factor for heart disease.  Hyperlipidemia is the medical term used to describe having abnormal amounts of lipids in the blood. Too much of the wrong type of cholesterol in your blood can raise your risk of a heart attack or stroke in the future due to plaque build-up on the arterial walls.

Cholesterol occurs in various forms in the body. Low density lipoprotein (LDL) is considered “bad” cholesterol as it increases your heart disease risk. High density lipoprotein (HDL) is considered “good” cholesterol as it protects your heart. Elevated blood fats called triglycerides are also associated with a higher risk of heart disease.   

It is recommended that you check your baseline cholesterol levels  at age 20 then once every five years. Depending on what your cholesterol level is, and whether you have other risk factors for heart disease, you may need to have your cholesterol checked more often.

What Should My Cholesterol Levels be?  

In general, if your total cholesterol is <200, your LDL is <130, your HDL is >50 and Triglycerides are <150, you’ve got a very good lipid profile. 

What Can I do to Improve my Lipid Profile?

“Therapeutic Lifestyle Changes” (TLC) that can positively influence your health, and your cholesterol levels, at any age include:

·         Stop smoking!

·         Reduce the amount of saturated fats in your diet,

·         Increase the amount of (soluble) fiber in your diet,

·         Maintain a healthy weight (Body Mass Index between 18.5-24.5),

·         Increase aerobic exercise 30-45 minutes at least 5 days/week.

Please call for an appointment with one of our Medical Providers if you want to discuss your health concerns and/or want to have your lipid profile tested. We will be happy to meet with you. 

The NP Answers Your FAQ: Is This a Spider Bite….Or MRSA? 

There is a new “Superbug” in the community which is a danger for even the young and healthy, and we are seeing more college students with these skin infections which look like spider bites, but are, in fact, MRSA infections.  

What is MRSA?
Humans are a natural reservoir of staphylococcus aureus. As many as 50% of healthy adults are colonized with Staph aureus at any given time.  Until the 1980’s, infections with methicillin-resistant staphylococcus aureus (MRSA) was thought to occur only in hospitals and other health-care facilities. But in recent years, community-acquired MRSA (CA-MRSA) strains have emerged. These aggressive skin and soft-tissue infections, if inappropriately treated, can progress to serious, even fatal, necrotizing conditions. 

What does MRSA look like?
Patients often develop itchy red bumps or boils that are often mistaken for spider bites. Often they are single lesions that get progressively larger, redder, warmer and more painful to touch. Sometimes pus drains from these infectious lesions. If the surrounding skin becomes red and warm (cellulitis) this means the infection is spreading. Sometimes fever, chills and lymph-gland swelling occur. 

How do I become infected with MRSA?
Infections caused by CA-MRSA are easily transmitted through simple skin-to-skin contact (even without a skin break) with an infected person or by contact with contaminated objects or surfaces. Outbreaks have been reported among athletes (especially football players and wrestlers), military recruits, correctional facility inmates, injection drug users, students and children in day care centers.

Outbreaks have been linked to sharing personal items (soap, towels, razors) and using shared equipment in gyms, health clubs and spas in cases in which people have had  bare skin contact with items contaminated with the bacteria.  

Remember the 5 C’s:

1)       Close crowded living quarters
2)       Skin to skin contact with an infected person or carrier,
3)       Compromised skin integrity,
4)       Contaminated surfaces,
5)       Suboptimal cleanliness. 

What is the Treatment for CA-MRSA?   
Patients with mild, uncomplicated skin and soft-tissue infections may need a culture sent to the lab for bacterial identification. If MRSA is suspected, antibiotics may be started immediately. Frequent medical follow-up visits to track the course of the infection is recommended. It is important NOT to wait and NOT to self-medicate if you have a serious wound infection. Delay in receiving proper treatment can result in a more prolonged healing time. More serious infections my be sent to the Emergency Department.  

How Can I Keep from Getting MRSA infections? 
1)       Frequent hand washing
2)       Keep open skin sores covered with dry dressings.
3)       Limit sharing of personal items (razors, towels etc)
4)       Avoid contact sports until skin lesions have healed.
5)       Wipe surfaces of shared equipment with disinfectantbefore and after use (dilute bleach solution)  

 We hope these precautions will limit your risk of acquiring  CA-MRSA infection. If you do have signs and symptoms indicating possible MRSA infection, don’t delay…call today for an appointment with your Medical Provider. Student Health and Counseling Service: (760) 750-4915