The Ultimate College Student Health Handbook with Jill Grimes M.D.

A lot of times people don't think that taking an over-the-counter medicine, too much of it, can be harmful. But honestly, we probably see more damage from ibuprofen from people.

So meaning Advil type things.

The Advil, Motrin.

You get like an erosion in your stomach, right? Right.

And it also can damage your kidneys if you take too much. And you need to read labels because especially, I really stay away from the cough and cold combinations because a lot of times people don't realize there's acetaminophen, which is Tylenol, in this one. And then there's also more of it over here. And then, oh, maybe they also take a pain pill that has acetaminophen in it. And before you know it, you're having a Tylenol overdose because you didn't realize it was in multiple different products.

Welcome to RxChill Pill, the podcast that strengthens your resilient mind every time you listen to the extraordinary stories, expert tips, and meditations to elicit your relaxation response. The Antidote to Your Stress Response. I'm Dr. Juna Bobby MD. I'm a physician and mom specializing in mind-body and lifestyle medicine. Find out more about me, my personalized online courses on procrastination and mindset coaching for kids, teens, and adults at mindbodyspace.com.

Hello, Jill. Dr. Grimes, how are you?

I'm doing well. How are you?

I'm good. Thank you so much for joining me today.

I'm thrilled to be here.

My son actually just called me and he was wondering— Text?

Wait, text or call? Because calls are way more serious.

He was actually at CVS. He was asking me, should I get my flu shot? Flu shot, yes. And I was like, yeah. But so I actually posted this on my physician's mom group. And you know physicians, we all love to give advice, so. And also physicians who are moms. Yes. So I posted like, is there any downside to getting a flu shot at a pharmacy? Because that's why he called me, 'cause he was wondering if he should wait for the pediatrician or, you know, if he can get it at CVS. And do you have any thoughts about that? 'Cause I've never gotten it at CVS. I always get it at my doctor's office.

I have actually had it at CVS, at Walgreens, at Randall's, which is a grocery store. I don't think it matters where you get it.

Okay, so it's the same stock, same type of vaccine.

It's the same stuff. It's not like it's a generic. There's no concerns about the vaccine itself. And as you know, it's really not hard to give a shot. I had concerns about that, honestly, years ago when pharmacies started giving the shots. I was like, Well, you know, they should be getting it at my office and my nurse should be giving it, or my medical assistant. And then I went with my daughters. I was like, oh yeah, no, it's really not that big of a deal.

One of the doctor moms said that there's some sort of shoulder injury that you can get if somebody's inexperienced and gives you a flu shot the wrong way. So that was the only downside. All the other moms were like, yes, definitely. They did have some concerns. They said some of the places didn't give you the, the sheet that you could take to work?

Um, I've never had a problem asking for it because I have to have proof of it at work as well. So I mean, I can also get my flu shot at work, but sometimes timing doesn't work out. And especially since I'm part-time, it, you know, they may not— I may not be there on the day they're doing all the doctors. So I just run to the CVS or Walgreens and get my flu shot there. So yeah.

Okay, awesome. And the only thing you need is really the lot number. Make sure that they give that to you just in case there's a recall or some issue. Right?

If you're talking to a college kid, just say, give me the usual documentation. I'm thrilled that if any college student is asking to get a flu shot, my answer is yes. That's the battle there is getting them to go. So.

Okay. Well, I mean, it is good to have the lot number in case there's a recall or some issue with the lot.

They can always take a picture of it on their phone. Like I always said, they should always have a picture of their health insurance card front and back on their phone, favorited under their photos.

Absolutely. So if you were sending your child off to college right now, and a lot of parents are because there's no universal sort of standard right now. True. What would you tell them? What would you tell your child as they're leaving? In addition, this is in addition to what you would normally tell them to stay safe and healthy. So now we're in a pandemic. Make good choices. We're in a pandemic, so what would you tell them in addition? To your usual.

In addition, I would double-check that they have their health insurance card picture front and back on their phone. So I always ask them to do that. And, um, one— I have one who's staying home and doing college remotely, and, um, one who is in grad school far away. And so I really didn't tell them a whole lot different this year because Part of this because they're living in a medical household. I mean, so it's— and our girls heard, you know, sat at the dinner table with us for the last 6 months while we were all together again on quarantine and listened to all these different stories about COVID and how it can overrun the hospitals and why it's so important to try and stay healthy. And so all of that. So for mine, I've said, you know, give them a hug, I love you. And sent them on their way. But in general, I think, you know, parents, if you haven't been talking about COVID which I can't imagine anyone hasn't because we've all been quarantined, but if you haven't been talking about it specifically for your kid, do you know your child? Is your child an experience seeker? Are they very social? Are they the kid that's going to go off to college and honestly be out partying a lot? And if they are, you really need to talk about choices and choosing outdoor events rather than indoor events and how to make safer choices in the college environment.

Mm-hmm.

Let's start with the basics. So do you wanna go ahead and talk through like a college first aid kit and what I would send with them this year?

Sure.

Specifically? Okay. Yeah. So every year I've been making first aid kits as gifts for a decade, literally.. And, um, nice. So I wanna emphasize a few things that are extra important this year. Um, the first thing is a little packet of powdered— this is powdered Pedialyte.

Mm-hmm.

So an electrolyte solution, whether it's a sports drink like Gatorade or Powerade, or whether it's actually an electrolyte solution that's medical quality, make sure that you pack extra set, you know, little packages of these in the first aid kit because If you get dehydrated, which with COVID you can get such high fevers and get dehydrated so quickly, and that's one of the things that would push you to need to be hospitalized if you couldn't rehydrate yourself. Um, so that's extra important there. We also rehydrate for food poisoning, for hangovers, for lots of different things. So any— so make sure that you've got some hydrating solution powder in your first aid kit. That's something people may not think about. Um, I also like to include a, um, of course a thermometer. That's always been important, and digital oral thermometers are the most accurate, but they're honestly a bit hard to find right now. So going for the other types of thermometers that are the touchless thermometers. Um, I still have my first aid kit, the digital oral thermometer, and the new addition this year is this little number, which of course you know is a pulse oximeter.

So those were really hard to come by also for a while.

Yeah, not anymore. $23 on Amazon. And honestly, I found them to be very accurate. Um, we've compared them with our hospital ones and they're identical. So the thing I like about the pulse ox is that it's not just looking at your oxygen saturation. If— look, if anyone's short of breath, I don't care what your oxygen saturation says on the pulse ox, you need to be seen. You need to be seen emergently. But for people, I like it because it gives you your actual pulse reading as well. And as you know, when you have high fevers, your temp— your, um, when your temperature goes up, your pulse goes up. And sometimes the thermometers are not all that accurate, particularly these, these ones that you just point at the forehead. And so that's another indicator. And when you're— and I'm not saying that this— college students don't need to be making these decisions, but they need to be calling and talking with their whether it's a 24-hour nurse line or every college has their own, some version of healthcare. And some of us have huge clinics and some have small ones, but you can call and say, when you can give them extra data points and say, well, my pulse is 120 and my temperature is, you know, say my temperature's only 100, but my pulse is up really high. You know, that's going to give the triage person more information, help them know when it's time to bring you in. So that's an extra thing that I've added in this year. Um, trying to think in terms of COVID the other things of course are— I like the, um, any brand will do. This happens to be Cold-Eeze, but I like the zinc lozenges. We've known from old studies were done probably 15, 20 years ago, were done on children's cancer wards, and they found that the zinc lozenges prevented respiratory viruses from coming in and, you know, attaching and setting up shop in your body. And that's true of all respiratory viruses, including coronavirus. Is it a— it's not, it's not the cure, it's not the answer, it's another thing you can do, another layer of protection that you can put a zinc lozenge in your mouth underneath your mask if you're going to be out in a crowded situation.

So yeah, I was going to ask you about the zinc. So that's good to know. Any sort of milligram dosage for the zinc or you don't care? It's just whatever you get.

I actually, you know, well, you don't wanna ever exceed 30 milligrams of zinc in a day. And the lozenges, it's less about how much zinc you're absorbing and it's more kind of a protective barrier is my understanding from the older studies. Now zinc at 10 milligrams a day, a pill that you swallow of zinc or getting zinc from meat and beans, which is where you get zinc from, that is shown to help decrease the duration and/or intensity of cold symptoms. Okay. There's actually conflicting data. You know, I try and really be evidence-based medicine, and there's actually— we try, we try, we try, but you know, evidence changes. Well, that's right.

And sometimes—

and on zinc, frankly, there's conflicting evidence. So my whole thing is the law— the law is just won't hurt and they might help.

I like that Emergen-C also. Do you like vitamin C as well?

I do. I do. I'm not like a Linus Pauling 2000.

No, no.

But like 500 milligrams a day.

Oh, you're not killing cancer with vitamin C.

Yeah, no, no, no, no. I'm, I, you know, the nice thing—

Well, C is pretty safe because you pee it out.

You pee it out.

It's fine.

That's what I always say. You might have expensive urine. If you get too much, but that's about the worst thing that's gonna happen. So yeah.

Well, the Emergen-C brand has that packet and they have the ones with the zinc and the vitamin C. So I like that one. I do too.

I like those. And then of course, if you get COVID, let me tell you, you're gonna be, well, if you get symptomatic COVID, I should clarify, you are going to be coughing a lot. So you wanna have an over-the-counter cough suppressant. And I like the liquid ones. You know, whether that's any of the brands will do, Robitussin, Triaminic, but I always think you should have some amount of liquid cough syrup. You should also have cough drops so that you can be sucking on those as well. So, those are the extra things. Also, in terms of fever reducers and pain relievers, please do not just put Tylenol or Advil and I spy, okay, acetaminophen or ibuprofen. I just always say Tylenol and Advil. Generic is perfectly fine, but everyone knows what Tylenol and Advil are. But they work, as you know, they work differently. And for high fevers, you need both. They work on different pain pathways. They work, they have different mechanisms. And when you have 103 fever that can't come down, you need both Tylenol and Advil to get it down. And we're seeing a lot of that with COVID in people who are symptomatic. Oh, wow.

Mm-hmm. And I always tell everyone to never, ever, ever take a pill right before you go to bed. 'Cause there are those crazy wild cases where, you know, they swallow an Advil and it erodes their esophagus and then you're basically messed up for life.

Yeah. I have a chapter on that. I love it. And why? Because we see that. What happens if a pill gets stuck? Because it's not, it is stuck, but then it just erodes your esophagus. Exactly.

And I know somebody who had a fistula from their esophagus into their lungs. And now it's debilitating them for their whole life.

Yes.

And people don't think about it. They don't. And a lot of kids will take a pill and not drink water.

Dry swallow. Oh, this is my thing.

Yes.

So, yes.

I'm so glad you have a chapter on it. You're the first doctor I've had this conversation with.

And honestly, I only— Oh, it's a pet peeve of mine.

I love it. I only take liquid.

Yes. You know? I have no problem with that. And chewable.

With me. And I can't believe there's a whole chapter. I love it.

Yes.

Yes.

The kids come in and they say, I, you know, swallowed a pill and it got stuck. And that was 3 days ago.

Oh no.

Anyway, so there are things.

And hopefully that didn't erode and you can get, you know, you can heal after that. I don't want to frighten people.

Right.

Most of the time we can.

In fact, I like old-fashioned liquid carafate, sucralate.

Okay.

That actually can help with those. But the tetracycline, doxycycline, so in college students, acne, right?

Yeah.

Doxycycline. Doxycycline is a major culprit and dry swallowing ibuprofen is the other one. People do this. So yeah, I always tell them when you, you know, when you take a pill, if you're swallowing it, drink at least like twice as much, at least a cup of water is what I'm saying.

And maybe don't go to bed right away.

And don't lie down right away. Let gravity work. Give it 30 minutes.

Is that why they tell you to take these pills with food sometimes? Or is it just something else?

Not, not so much. That's more of a direct stomach irritation. But yeah, I see. Speaking, speaking of chewables, I've got one more chewable that needs to be in the kit, and that is Tums or whatever. And I like that they have these new ones. Where are they?

And that gives you calcium.

Yes, it gives you calcium. And for people who can't stand the old chalky ones, now they have— I know I don't have stock or any financial investment in this company, but this thing is called Chewy Bites, and I'm sure there's probably a generic of it too.

Maybe I could get a sponsorship from Tums.

Yeah, I am not working this right.

You're right.

I should be going after this. Just kidding. Just kidding. I say we do that.

Okay, so Tums chewables.

Chewable, because this works faster than any of the pills that you swallow that decrease the acid production. Things like Tagamet, Zantac, Prilosec, all of those, all of those work, but they don't work rapidly. And for college students particularly, okay, midterms, finals. People are— they're doing their coffee, they're, they're— oh, they're doing those horrible energy shots that I don't like and I don't recommend. Yeah, um, because that's basically just, you know, 75 milligrams of caffeine and a few vitamins thrown in. But people will do multiple ones not realizing it, and then they, then they feel awful, but they also chew up their stomach and they get reflux. And so anyway, it's good to have an antacid in that first aid kit, so don't forget to pack that.

And again, like even, even those things, if you're chewing a whole packet, you really should follow the instructions because you can overdose on calcium.

Absolutely. Absolutely. Yeah. No, you don't want to be, you don't want to be, you know, going through bottles of this stuff. I'm just saying when it's 2 in the morning and you need something, that's what's going to work quickly. So you want it. That's why you want it in the kit in the dorm room.

I had a boyfriend in medical school who would just chew them like they were candy. And I mean, you can literally overdose on it.

Yes, you can. You can get too much calcium.

Yeah.

And we know, bones, groans, and hypertones, right? Hypercalcemia pneumonics.

Can you tell them, uh, tell the listener what that means?

So yeah, sorry, if you get too much calcium, if it actually— if the levels go up high in your bloodstream, you get all kinds of different side effects. Um, everything from You know, pain. You can get psychosis, you can get— which is the— anyway, it's a—

it's a moaning and the groaning, the moaning and the groaning.

You get pain, aches and pains. It hurts your bones. It changes your calcium turnover in your bones and it causes all kinds of problems.

So I just want to reemphasize that even though we're talking about like over-the-counter stuff and vitamins, you really should follow instructions.

Absolutely. I— yes. And you need to read labels because especially I really stay away from, from the cough and cold combinations because a lot of times people don't realize there's acetaminophen, which is Tylenol, in this one. And then there's also more of it over here. And then, oh, maybe they also take a pain pill that has acetaminophen in it. And before you know it, you're having a Tylenol overdose. Because you didn't realize it was in multiple different products.

Oh my gosh. Yeah. And that happens a lot too, right? I'm sure you've seen those, the Tylenol overdoses, and that could really mess up your liver.

Oh, yes.

You— yes. Yeah. Tylenol.

A lot of times people don't think that taking an over-the-counter medicine, too much of it can be harmful. But honestly, we probably see more damage from ibuprofen from—

So meaning Advil type things where you get like an erosion in your stomach. Right?

Right. And it also can damage your kidneys if you take too much. And we've got people that pop this stuff and we, and I have to say, sometimes doctors' kids are the worst. They'll take 800 milligrams of ibuprofen, which is 4 over-the-counter, which I don't recommend. You don't even really absorb that much. We used to prescribe it in that dose, but really we don't anymore. Okay. And anyway, the take-home for the listeners is that you absolutely can get too much of a good thing here. So follow the instructions, read the ingredients, and actually there's an app called Know Your Meds. Disclaimer, I am on the medical board for that.

Oh, fantastic.

It's a free app.

Okay, Know Your Meds.

Know Your Meds. And you can punch in there, oh, I'm taking this and this, and it will tell you if there's any drug interactions and it will start. That was part of the impetus for, that company coming to be.

All right, well, I'm looking it up right now. I'm going to put a link to it on the notes, show notes.

Okay, so just finishing up the first aid kit, make sure— sorry, back to that—

make sure money, you need some cash in there.

Honestly, I, I, a lot of times I'll just stick a $20 bill in there just for my kids, for my kids, you know, they know that, that, that's in there. Um, and Ace Wrap, at least two, because roommates always, you know, suitemates kid down the hall, these things disappear. At least 2 ACE wraps. And then do not go cheap on Band-Aids. Get the good Band-Aids. These are generic, but they're good. They, they're the finger ones. If you have an architecture major, just invest in the company because you're— they're going to have a lot of cuts. Architecture majors work with these X-Acto knives and they— we do a lot. We stitch up a lot of hands and fingers from architecture majors. And I'm not picking on them. I mean, they're working hard at 3 in the morning.

We have some computer science majors and statistics majors, and I think their problem is that they're sitting at the computer all day. And I noticed that you had a blog about Zoom neck or something.

Yes, Zoom neck. Yeah, there's text neck. So in the book, pre-pandemic, I was more talking about text and computer neck. But so one thing is—

Wait, are we done with the package? Is there anything else you would add?

Don't forget a decongestant, an antihistamine, and then two creams. You want a topical steroid cream and a topical antibiotic cream. And there's a few, a few other things also, like, um, if your kid is a wax builder-upper, you'll know if they are because every single time you took them to the doctor, the doctor went, oh, I can't see your ear, you're a wax builder-upper. Then you need, you need this little gadget, which is a a child's nasal syringe, and this can be used to flush out earwax. We do not use Q-tips. Q-tips jam stuff in.

How do you use that thing?

So you go to a sink, you get lukewarm water.

Okay.

You fill up this by squeezing it, and then you pull your ear back and out and put the tip just inside, and you squeeze, and you're over the sink here. So the water flushes out and it flushes out the wax out of your ears. With all the use of earbuds, we are seeing so many people with wax buildup. And so when you get to the point where, you know, someone else gets in the car with you and your radio is super loud and you don't think it's loud, you may have wax buildup.

So you just like squeeze it and it's not shoving the wax back in?

No, it flushes it out.

So is the bulb tip inside your ear or just outside? You put it inside, okay, but you leave enough space that it could— the other stuff could come out?

Yeah, I mean, you're not— it's— the tip is skinny. It's, I mean, you know, it's, it's thinner than your ear canal, and you're not jamming it way in there, just, just inside. And again, ear is back and pulled out, your head's over the sink, flush it. And you only do it about maybe 8-10 times max. You do it more than that, you're gonna start feeling dizzy. And if you do hot— if you do hot or cold water, that's not a good idea. That's a medical test. Don't do that.

That's something I would do because I get very overzealous. Yes. And then I start—

goal-oriented. I will get the wax out. Yeah, that's funny.

Yes, because your inner ear makes you dizzy.

Yeah, so the pressure And I have that in the book too, because that's something we see a lot.

Okay, nice. I have— yeah, this is awesome. Okay. Anything else to pack in there? I would put some aromatherapy and some acupressure mats. I love those where they lie down on the spikes and then they just feel so relaxed.

That's a new one.

Love those.

That's not really going to fit in a kit though.

Well, it's just like it's— you can roll it up. They have like a smaller version of it, like a neck one. And then they— and I would also recommend those silk lavender eye pillows. Oh yeah, for headaches and stuff.

Yes. And also just to block for— that's, that's part of my insomnia recommendation for sure.

Okay.

Is a good quality eye cover.

Nice. You know, and then what about chalazions and like styes? I always think that they should have one of those packs like, um, I— there's a really good brand called Bruder. I've suffered from this, that's why I know. B-R-U-D-E-R. If your child gets these chalazions or eye things, Bruder, B-R-U-D-E-R. What is that? It's just like an eye pack and it's filled with stuff. You can put it in the microwave for like 10 seconds and it's really nice and warm. And you know, they always say like put an egg, a hard-boiled egg on your eye. You've never heard of that?

No, we do rice in a sock.

Oh, I like that.

Yeah, you do uncooked rice in a sock in the microwave for about 20 to 30 seconds, and that, that stays hot. You have to be careful. You test it first so you're not burning.

Yeah, but that stays hot on your eyelids. Again, overzealous, I can burn my eyelids. Yeah, yeah.

So yeah, the rice in the sock works well too. That's a college student remedy.

All right, great. Um, and of course, if you're sick then you should always let someone know, right? Don't just sit in your apartment by yourself and not tell anybody. Like, in fact, I think you should probably call Student Health and let someone know and your parents know, right?

Yes. Absolutely.

And what about proxy?

Don't suffer in silence.

Yeah. What about proxy, healthcare proxy?

So something that's a big surprise for students and parents alike is a parent cannot call a college health center and say, hey, my— is my kid there? They, you know, they, they had a sore throat and they were— they were— I told them to go this morning and, um, are they there? I need to talk to them and they're not answering their phone or something because their phone died. We, we can't even say yes, they're here, or no, they're not. That's— wow, that's a HIPAA violation. So, wow, parents, especially this year, it's really nice. You don't have to do it ahead of time. Every single clinic has the, has the paperwork there, but it will speed things up. And when you're scared and nervous about your kid, you know, extra time to get papers filled out and get that communicated somehow. You're texting your kid telling them to go sign the paper so the doctor could talk to you. Just do it ahead of time. And, um, so get that proxy. There's— well, there's, there's just the straight HIPAA release, which most schools have that on their, um, health website.

Mm-hmm.

There's also— there's a company I found out about. Again, I don't have any ties to them, but I've used them myself. Is Mama Bear Legal Forms. And I think it was $49 to get medical power of attorney and a HIPAA release. And so, you know, it's nice to have those forms done ahead of time.

Very nice.

You put in your information. And you actually print it out and you just have to take it to a notary and boom, you're done.

Very nice. I also had a podcast episode with an attorney, Alessandra Long. They can also listen to that too to figure out all the legal paperwork that they need. Excellent. Okay, yeah, that's good to know. Yeah, 'cause you're like, what? It's my child. All of a sudden, right? Even at 18 years of age.

Or 21 or 22. They're still in college.

Right, but at 18 you can't find out.

That's a HIPAA violation. Right, right. But I thought you meant from the mom standpoint. From the mom standpoint, you're just like, "I have to talk to them." Forever.

Yes. But what if they're sick and you want to bring them home? Like, I know a lot of parents, me included, would probably feel horrible letting them stick it out by themselves. They'd be worried and nervous.

So a couple things on that. A lot of kids are going to test positive for COVID at college because hopefully the college is doing screening, which, which I am obviously, and everyone in the medical profession is a huge proponent of that. We would love to catch people when they are asymptomatic. So if your kid calls and says, hey, I tested positive, and they either have no symptoms, so they were just, they were just screened or they have mild symptoms, you're not gonna go pick 'em up if they have a cold. You shouldn't go pick them up if they have mild COVID symptoms. All you're doing is, you know, taking them out of a, assuming, let me step back, assuming that the college has a place to quarantine them. It becomes tricky if they're living off campus, if the college does not have quarantine. Many of the schools though have a dorm set aside or a hotel or an apartment that's right by campus that they are using for quarantine space. And so, you know, it's highly college dependent. If your kid calls and they are very symptomatic and you're worried about them, I'm not gonna tell you as a parent not to go get them. It really, some of it depends on your personal risk factors. You're a physician, if you know, you're, you're already getting exposed. Maybe you've already had COVID.

I actually don't work in an office. I just only teach resilience now.

Oh, awesome. Okay, so then you're, you're in your little bubble here.

Well, my husband goes to the hospital though.

My husband's an anesthesiologist.

Yes.

The good thing is that we know so much more about COVID than we did 6 months ago. And 6 months ago, I was terrified for him every day going to work, honestly, especially being an anesthesiologist, because for listeners, I mean, they're, they're at the highest risk because they're putting a tube into someone's, you know, uh, airway. And that's, that's how this is transmitted. But the good news is that with proper PPE, which his group is fortunate enough to have, um, that, you know, the transmission is been extremely low to healthcare providers.

So what is he using? He wears an N95, goggles, shield.

The whole thing looks like a spacesuit.

Yeah, the hazmat suit, kind of. Okay. Does he have like the ventilator on the waist?

They have that for if someone is positive or high risk. Otherwise, they're using just an N95 and goggles.

Goggles. Okay.

For, you know, and they're testing. I mean, and again, it's, we're in such a different position now because now his patients can be tested and actually get test results before they're going to surgery, which is where he would come in being the anesthesiologist or, and for the surgeon.

But, um, and now when he comes home, does he like take all his clothes off and like go straight in the shower and all of that?

He, um, He actually changed, you know, he changed clothes at the hospital and then, you know, comes home and still changes, immediately goes in, showers, and, you know, that stuff goes directly into the wash. Yeah.

We're so thankful for people like him doing this job. So my husband is a high-risk obstetrician, a perinatologist. Oh, so, but his team, nobody got sick so far. Knock on wood. I mean, they really did the proper PPE and no one has, you know, and they started testing and screening pregnant ladies because there's a lot of asymptomatic pregnant women.

Oh, absolutely. It's crazy.

Absolutely. Anyway, so thank you for that. And so I guess if I'm going to pick up my kid, I would actually get like a trailer maybe. I mean, honestly, put a plexiglass between the seats or wear an N95.

I mean, I don't want to— I don't want to be— I mean, look, we don't have lots of N95s. Doctor— plenty are, you know, plenty of doctors in Austin, Texas are still reusing their N95s for a long time. So I am not encouraging people to go out and buy them. But if you were going to be in a— the safest thing, if you were going to be in an enclosed car for many hours with someone who's freshly positive They should have, I mean, ideally you should both have an N95 on. But short of that, both with surgical masks would be okay.

We were thinking put like plastic between the rows of seats too, and like plexiglass.

I guess if you have that handy.

Home Depot.

Well, that's true.

Okay, so thank you. That was really informative.

One thing I do want to say, and this is a little depressing, But I think it's an important thing for parents. I think we really need to have perspective.

Yeah.

Right now I have probably, I mean, no less than 6 friends whose kids are in college who have COVID right now that are in quarantine. And honestly, only one of them is significantly sick.

Wow.

Fever, cough, uncomfortable muscles.

And what do you mean by significantly?

And, uh, and the others are more annoyed that they have to be in quarantine because they tested positive. And I mean, you know, they're, they're dealing with it, but I don't want to minimize severe COVID. Severe COVID is awful. Um, very awful. But, um, 80% of this disease is still relatively mild. And I don't know how many college students— people say, how many college students are going to die from COVID Well, I don't know. I saw a prediction that because there's 20 million college students in the United States, that there was gonna be 8,000 deaths. And this was by an epidemiologist. I don't think that, I don't personally think that that's gonna happen. I certainly hope that's not the case. And I don't think that's going to be the case based on, as we're starting to see these surges in different campuses, we're not hearing about there was 100 hospitalized. We're hearing about there were 100 diagnosed each day. You know, they're having big numbers, but in general, again, I don't wanna minimize it, but I wanna reassure parents that your child's chances of having severe disease are low. Now, there's a whole extended thing there about they're exposing the cafeteria workers, they're exposing custodial staff and the professors, and that's a separate issue. A bigger issue to me, or an equally big issue to me, and something I worry about a ton, is that we have nearly 2,000 deaths every year— deaths every year that are alcohol-related.

Mm.

I wanted to talk about that.

Hi, everyone. I just wanted to jump in here and remind you that September is Suicide Awareness Month. And I just want to say that we don't have to wait until we're worried about somebody to start talking about suicide. We should be talking about this topic even when our kids are well, or even when we ourselves are well. This is something that we can prevent way before even any signs of depression start. Let's start talking about mental wellness.

And we have 1,100 suicides.

Mm-hmm.

Deaths by suicide, I should say.

Yeah. So, and now with, uh, with legalization of marijuana, please talk about that a little bit.

Uh, I'm in Colorado right now.

Oh my goodness. So please talk about that because honestly, you know, a lot of kids feel that it's legal and so that it's not an issue for them, but I, I've seen the issue. It's addicting. It can be addicting to certain people. It's just like alcohol, you know, you may One in six. And if you have the propensity to become addicted to whether it's alcohol or drugs or pot, which is legal now in some states.

However, it's available, widely available on every single campus. Don't kid yourself that it's not.

No, I mean, they get, they get the medical marijuana.

No, they're getting marijuana from their They're buying marijuana from the same people they're buying their attention deficit disorder medications from.

Oh, okay. But also they can also get medical dispensary. I've, I've heard of that too, where the kids can get that. So let's talk about that.

In Texas it's not legal, and so you cannot get it from the medical dispensary. Mm-hmm. In Colorado you can.

Mm-hmm.

So here, so here's my issues with pot.

Yes. Yes.

And definitely I'm listening because it's another chapter.

I love your book.

Thank you. So here's, here's the conversation that I have with college students on a daily basis.

Mm-hmm. Um, yeah, pretend we're your college student. Yeah. You're talking to us.

So look, number one, if you didn't grow it, you don't know what's in it. Let me just tell you that people who sell pot illegally add sand, they add, because that increases the weight. And you know, would you purposely inhale sand into your lungs? I wouldn't. And worse, we see people who all they had was a little pot, and guess what? Their urine drug screen shows LSD. That's acid. And that's one of the things that gets added. So drug dealers know that if they have a reputation for selling more potent pot, they get more customers. So they'll put whatever in it to make it more potent. And I see the bad outcomes. I see people coming in, and this was true of my private practice, um, in a, you know, affluent part of town. I had someone come in who, honestly, it was her 50th birthday over the weekend, and she and her husband decided they would kind of have this little flashback to their college days, and they smoked a joint, uh-huh, and she came in talking to aliens. She was sending and receiving messages from aliens. And guess what? We found LSD in her urine.

Wow.

So anyway, so number one, if you didn't grow it, you don't know what's in it. I'm not encouraging people to grow their own. I'm just making a comment. Okay. Number two, it's not legal in Texas. It's not legal everywhere. And it's not legal if you're not 21, even in the places where it is legal. So you can still get in trouble for having it. Next thing, it is not your parents' pot. And not, not all parents smoked pot. Not all of us thought that that was cool. A lot, a lot of us did, a lot of us didn't. I actually didn't, but you know, I was kind of a nerd, so there's that.

But, um, but it's not your parents' pot because it's potent. The potency is different.

Exactly, exactly. Yeah, it is up to 30 times more potent.

Wow.

Than it used to be. The THC, which is the active component that makes you hallucinate. So, um, you know, that's not good. And the next thing is that on a college campus, here's what I see happen. Somebody decides, you know, they smoke pot their freshman year, they're, you know, they're drinking, they're smoking pot, they're partying, they're experimenting. They're like, oh, I'm just, you know, this is a college thing, it's just part of the— it's part of the college experience, it's no big deal. And either A, like you and I were talking about, 1 in 6 get addicted and they can't stop. Or fast forward to junior year, they've got this great summer internship. You know, that's back when we still had internships this summer. Actually, that's not fair. There are plenty of internships that are online. But anyway, but the whole thing is they know that they have to quit smoking for 3 weeks before they have their drug screen. And so they quit 3 weeks before they have their drug screen, and they go into their— maybe it's their job after graduation, or maybe it's an internship— and they go in, and guess what? They get a hair sample. That's 90 days. So they didn't quit soon enough, and then they lost it. And I see them because, frankly, they're coming in and they're in crisis. They're, they're they're, they're in a depression, anxiety crisis because they just lost their dream job after they worked so hard to get it. So those are the things I talk to college students about. And aside from that, if you have asthma, it certainly exacerbates that. There's, you know, a lot of things that are not great about pot.

Yeah. What about, what about if somebody comes in and says, but, you know, they— I'm anxious and I use it for my anxiety, and now, you know, they're prescribing it for anxiety. So it's actually just medical. It's, you know, it's good for me. But I know they're having panic attacks.

I don't know any psychiatrist on a college campus that would ever prescribe— this is me, I'm not saying there isn't one somewhere. Yeah, but I will tell you, our psych department hates pot because, because it makes people more anxious. It's like alcohol. You say, oh, well, it helps me calm down, it's a sedative. It'll help me sleep. Well, it may help you calm down initially, but then it impairs your quality of sleep. With POT, some people, yes, it may decrease their anxiety transiently, but ultimately, for more people, it aggravates your anxiety, it makes you paranoid, it causes all kinds of additional problems. It is not the answer to anxiety.

And by transient, you mean immediately you might feel relief for like 15, 20, 30 minutes? And then you rebound back to even more anxiety.

An hour later.

Yeah. Okay. So I want to go back to what you said about alcohol, 2,000 deaths. Can you talk to us about that a little bit? Because this makes me so upset because, you know, we're parents, like, paying lots of money for our kids to go to school. And, you know, alcohol is rampant. It's almost like the culture.

Okay. So— Right? Here's the things I want to say.

Yeah, sorry, you tell—

okay, no, I'm gearing up.

Yeah, we're kindred souls because, yeah, I'm, I'm the same as you.

So number 1, 30% of college students do not choose— I'm sorry, 30% choose not to drink, 30% choose not to have sex, 30% choose not— probably more than 30% choose not to do drugs, but The big number is 30% of college students don't even drink alcohol. And if you ask most college students, you pluck a college student up and say, hey, how many, how many college students, what percentage drink? Most of them are going to tell you 90 to 100%.

Yeah, everybody.

And honestly, in some circles it is 100%, definitely. And, you know, the Greek system can be very good in a lot of ways for a lot of people, giving them a sense of belonging and doing service projects and lots of good things. But the Greek system, um, as a whole, fraternities more than sororities, still by and large really glorify the binge drinking. And, you know, 30 years ago, binge drinking was beer bongs and getting tons of beer inside you, maybe a shot of whiskey. Now it's routinely vodka shots, and you can just get so drunk because you get so much in you so quickly with shots. And so one of the things that I talk to students about is if you choose to drink, and I tell them, do you know that not everybody drinks? And some of them are like, right, everybody drinks. I'm like, no, actually not. Survey here at our school showed us that not everybody drinks. But if you choose to drink, drink beer or wine because you fill up on that, you have to work at it. To— I mean, you certainly can get alcohol toxicity from those, but that's not, that's not what we treat. You know, we see the kids who are doing shots.

And so it's the main, like, pure—

or, sorry, or kids who took their ADD meds, which are stimulants, and then drank. Because if you, if you have a stimulant on board and then you drink, you don't feel it because that counterbalances. So you don't feel it till you, you miss all those warning signals of Oh, I'm a little bit on buzz and now I'm kind of happy and now I'm slurring my speech and now I'm feeling nauseous. Because all of that just waits and comes like a freight train all at once if you've got a stimulant on board. So that's another problem.

Mm-hmm. So I did see this in a psychology paper where they did a public service announcement showing that college students don't actually drink, not all of them, like you said, just only, you know, 1 out of 3 don't. So once people found that out and they found out a lot of people weren't binge drinking, then they felt more comfortable not drinking as much. And they were surprised, actually. So it's this belief that everybody's doing this.

Yes.

And that actually facilitates.

And so one of the things that in College Health in general, college health centers try and educate about that, that that not everybody does this. And actually, you know, if you're, if you're consuming 5 or more drinks in an hour, that's really dangerous. And that is not okay.

In an hour only, or just in the evening, even? It depends on your weight, your weight, how much you drink, how much you ate that day, like all those things matter, right?

Sure, it all adds in. And you know, one of the things that I tell them, I'm like, you know, outside of the college setting, For the general population, we ask, when's the last time you had 5 or more drinks in 1 day? And, you know, and it's a little tricky because like if it's a whole day, like if you're at a family reunion and you're there with all those people. Family reunion. High stress. Drink more. Because that's high stress. That's exactly. That doesn't count. Or football game, all day tailgating, you know, which of course, again, not so much an issue right now. But not so much an all-day thing. But, you know, in the span of a couple hours, if you have 5 or more drinks, that's like— that's a trip. Like, we start asking about alcoholism. And so that's, you know, that's not okay. That's not a— that's not an okay social norm.

So recently they lowered that. Yeah. And, uh, recently they lowered the number of drinks for men as well. They used to say 2 a day, and now they're I'm winning one. So that was the most recent recommendation.

Fight those battles one at a time.

Yeah. So what would you say to parents before they head off to college? When would you start talking to your kids about this so that maybe you could prevent it altogether?

Oh, definitely, you know, early high school because—

I'd say 5th grade. Maybe it's New York, but I'd say 5th grade. 8th grade, start talking to them. Middle school. Yeah, yeah.

I mean, there— I mean, it depends on your— excuse me— it depends on your peer group for sure.

Yes. Go ahead, drink some water.

So, um, but you know, the— I will say, so I, I think Uber has really cut down on, um, Uber and Lyft. Has really cut down on drinking and driving, and that's huge.

And I think now they can binge because they call the Uber.

And that is true, that is true. Some people consider that a ticket to do it, and it's not. But, um, and there's so many other issues related to alcohol. If you talk about sexual assault and, and choices, and there's so many different things that, that are all tied into that, particularly in a college setting and particularly for the experience-seeking young adults. They have a high risk tolerance. And, um, and then obviously if you have any of the mind-altering substances, alcohol or pot or whatever, you have more risk tolerance because you have less inhibition. And so, and also you should watch it if you're family history.

Right. You have addiction in your family history also.

And, and, you know, you need to think about as parents when you're, when, um, I started to say, you know, we're not really going out to restaurants that much anymore, but, but, but think about what you are role modeling. You know, do you, between your family, do you know, do you, do you drive after you drink? If you all go out for a Mexican restaurant in Texas, you know, Tex-Mex, margaritas, queso, chips and queso, you know, Do you have a couple margaritas and then drive home? I mean, we're— your actions are going to speak a whole lot louder than your words when you're talking to your kids about this stuff. But, um, the one of the biggest challenges is getting through to kids that binge drinking is not a complete social norm.

Mm-hmm. That's a great point. And, um, that leading to the suicide rates. So how much of the binge drinking and drug use and— and I also want to get to lack of sleep if we have a few minutes for that— how much of that rolls into the whole depression suicidal risk?

I was going to say that it's a great question. Honestly, a lot of— although certainly kids and adults self-medicate.

Yes.

With, with these substances quite a bit.

So meaning you're meaning that if they have depression or anxiety, they will use substances to feel better.

Exactly. And, and in reality, what we know is it actually makes things worse, even if it— like we talked about earlier, if it temporarily makes you feel better and temporarily makes you forget about your anxiety, but then it drives up other neurotransmitters and gets you going the wrong direction.

Uh-huh.

So, um, you know, I, I can't fully speak to the role of, of all of that with the actual suicide rate. Uh, what we see more is people just, you know, withdrawing, withdrawing, withdrawing, anxiety going up. There's so much pressure. We're putting so much pressure on our kids just to get into college, to get into the right college and the the, you know, the higher achieving student, honestly, the higher the stress and depression and anxiety that we see. We just see so much of it. And, um, so, so as a family medicine doctor, I always look at the whole picture. So I talk about nutrition, I talk about exercise, and I talk about sleep. Sleep is hugely important. And college students may You know, I'm fine. I don't care when they sleep. If they have, you know, our younger daughter's an animation major. Her classes start at like 7 o'clock at night.

I love that.

And so they, you know, the classes go from 7 to 10 PM and then, you know, they stay up animating and then, you know, her sleep-wake cycle gets very shifted and that's fine. I just want her to be sure she's getting 8 to 10 hours of sleep. And I know that's, everyone's going, oh my God, nobody gets that. Actually, A lot of kids can get that. They just get it from, you know, 3 AM to 11 AM.

Uh-huh.

So it doesn't matter when they get their hours in, but they need to be consistent with the time. If you have to get up early, yes. If you have to get up for an early class Monday, Wednesday, Friday, you need to get up at the same time Tuesday, Thursday, Saturday, Sunday, more or less, at least within an hour, and then take a nap later in the day if you need to. But So that consistent routine is going to improve the quality of your sleep and restfulness, and it's going to really help with anxiety and depression. Because of course, with more anxious people get, they get insomnia. And there's a lot of things that you can do to help with insomnia, one of them being the eye mask we talked about.

All the mental health problems that come up are related to sleep too.

Yes, it's, it's, it's the single most important thing. If we can fix If we could fix sleep, we can help people a lot.

Um, and how many hours do you recommend for the college kids? Because I, because I always say like, you guys still need like 8, 9 hours, but you know, they don't really get that.

So actually, it's very interesting. Um, some kids guard their sleep like it's the most— which it is— the most precious commodity that they can control. And, um, I mean, I do actually recommend 8 to 10 hours. It just Realistically, 8 is going to be more the norm and a lot. But when I start seeing them getting down to 6, 5, 4 hours sleep, and then they're, you know, and then you get into that whole cycle, then they're doing stimulants, caffeine, um, or their ADD meds to get them going. And, you know, then you just get in this whole vicious cycle and it's, it's just a spiral downhill. So talk about regular sleep-wake schedule. Doing everything you can to optimize your sleep. Um, you know, noise-canceling headphones that make— they have like, um, a sweatband-looking thing that has— they have the, the earbuds in them because it's, you know, it's uncomfortable to lie down on a, on an earbud. But they have ones that are comfortable, so you can do that. You can do all the— there's so many great, um, sleep meditation apps.

Mm-hmm.

I'm sure you have your favorites, but I actually like Peloton. I just— let me just a little side note here, and I don't have any stake in Peloton other than I love the second physician now talking about Peloton.

I'm going to have to call them up for sponsorship.

Yeah, there you go. But, but seriously, I didn't even realize that they had all these other portions of it. And there I really like their meditation apps and I've tried So many different meditation things that I don't like, but there's a lot of different— Headspace is good. Calm is really good. There is a—

I'm on Insight Timer. I love Insight Timer.

That's a new one to me.

It's free. It has like—

That's free is good.

50,000 meditation teachers. It has— I'm on it too. I'm there as a meditation teacher.

Oh, great.

So you can get free meditations. It's great. I mean, some of the quality varies sometimes because there's so many different teachers, but if you find one that you like— But there's a paid version too.

So yeah, well, and you have to— and that's, and that's what I tell everybody is like, you just keep trying a couple until you find one you like. Because even within, within an app, like I like one person out of four on one app. Yeah, the other, the voices just—

it depends.

Yeah, just, you know, it just hits me and what works for me doesn't work for you necessarily.

Right.

So, but I, I love meditation apps, whether that's to help with sleep or during the day.

And, um, and if you'd like Moby— do you like Moby, father of electronic music? He has a free album, it's called LA, LA 1 to 10. And he had insomnia, so he made all these recordings and he made it free for everybody. So I'll put a link to that too.

Yeah, absolutely.

But yeah, sleep is like a meditation.

Right. And exercise is a prescription. I mean, I literally, you know, I prescribe 30 minutes a day of getting your heart rate up and keeping it up 7 days a week, period. We know that that helps with depression and anxiety.

And college kids need more than that. But 30, if they are not getting it, then 30 minutes at least. But 60 to 90 minutes would be perfect.

I would not complain about that. But I start with 30. And because a lot of times, like, if they're walking to class and I mean, Now, okay. So if they are fortunate enough to be on campus and walking to class and it may take them 15 minutes to class, I say, take it, take an extra 15 minutes right then. You've already, you know, because they're like, I don't have an extra 30 minutes later in the day, but they might have an extra 15. And so tack it onto that so that they do it right then. Right now with the, with the pandemic, I'm very concerned about people not exercising. And I'm not thrilled with gyms because obviously Yeah, yeah, yeah. I'm not thrilled with gyms, but that great outdoors is your friend. And in the South, it's still really hot.

Um, you know that, you know, people drive 5 hours to go skiing and put on layers of clothes. Why can't you just walk outside with your ski clothes on and you're fine even if it's cold out? It's funny. Yeah, but the thing that I say all the time about sleep is that we have what's called the glymphatics. G-L-Y-M-P-H-A-T-I-C-S, in our brain. Sleep is the main time where we get rid of all the byproducts of metabolic waste in our brain. Like, we don't have the lymph nodes in our brain. We have lymph nodes all over our body. In our brain, it's called the glymphatics, and that comes on mostly during sleep. So that's a really important thing to know.

It is.

It is.

You cannot, you cannot underestimate the importance of a good night's sleep.

It's not— it's like not brushing your teeth.

Anyway, that's another thing. Oh, that's another thing I put in the first aid kit, by the way, because after you've had any— it's toothbrushes, because, um, disposable toothbrushes. Because, you know, if you've had a cough or cold, forget about COVID I mean, certainly with COVID as well, but anytime you've had a respiratory virus, you need a new toothbrush. So I always put a couple of those in there to remind them that when they're—

when they're—

when they're in there grabbing their decongestant, oh yeah, That's a great point.

That is a great point. I love it. Okay, thank you so much, Jill, Dr. Grimes. I want you back, hopefully.

We'll do a whole nother one on test anxiety. How about that?

Oh, yes. We have so much to talk about, you and I. Yeah. Anyway, this was great and informative. Thank you, Jill. Stay well and stay safe.

Thank you.

Thank you so much for listening and strengthening those neuronal resilience connections in your brain.

I know it's a mouthful.

That's my inner science geek just telling you that you're changing your brain and boosting your resilience just by listening, reflecting, and learning. Email us at info@mindbodyspace.com if you have questions you'd like answered on the podcast, or you have guests that you'd like to suggest. Most importantly, please share this podcast with your friends, family, and community. We can all use our brain's chemistry to boost immune systems and resilience right now. Also email me at info@mindbodyspace.com to sign up for my SMART program, stress management and resiliency training, for the first time given completely online. The SMART program was developed at the Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital, Harvard Medical School. 40 years of robust research backs this program. Again, that's info, I-N-F-O, at mindbodyspace.com. Looking forward to seeing you. This is Dr. Juna signing off, wishing you and your loved ones wellness.