March 2015 Health Bulletins

	Ask the Doc Dr. Davis Smith is director of health services at Westminster School, Simsbury, Connecticut

When is the best time to start treating a cold sore?
—Amanda N.*, New York University

The best time to start treating a cold sore is before you get one—that is, when the first symptoms of an outbreak occur. This is usually the tingling, burning phase, before any skin changes. This is most easily achieved by having a supply of effective medicine on hand.

I typically treat cold sores with valacyclovir: 2 grams by mouth every 12 hours (i.e., two doses a day). This treatment can decrease the duration and intensity of outbreaks, and make you less contagious.

The earlier it is started the more effective it is likely to be. I typically give someone a prescription for two or three courses of treatment, so they can have it on hand in case of outbreak. 
For people who are getting very frequent outbreaks, I typically prescribe valacyclovir: 500 mg once a day for several months. This is especially helpful to wrestlers with herpes gladiatorum (see below). Topical treatments (creams) are also available, but have not performed well in studies. 

Why do so many people get cold sores?
Most cold sores (93 percent) are caused by type 1 herpes (HSV1). More than half the population has this infection, though many don’t realize they do. Studies involving blood tests suggest the virus is present in 58 percent of Americans. Most people are thought to have acquired the infection in childhood, usually by kissing an infected relative. Most people don’t know from whom they got their HSV1 infection, and it really doesn’t matter.

What is “shedding”?
In any infected person, the herpes virus is sometimes present on the surface of the skin and can be transmitted through skin-to-skin contact. This is called shedding. Infected individuals may be shedding the virus from the site of recurrence (the place they get the cold sore) at any time, but they shed most aggressively when an active lesion is present. In principle, a person could have asymptomatic infection (never had cold sores) but still be contagious.

Why is my HSV1 different from their HSV1?
How an infection behaves in one person does not predict how it will behave in the person to whom they transmit it. Just because the person who gave it to you never had cold sores doesn’t mean it will behave that way for you.

How might HSV1 present?
A first orolabial (mouth and lips) infection with HSV1 often presents as herpes gingivostomatitis. This is a very unpleasant inflammatory condition of the gums and hard palate (imagine the worst pizza burn of your life). It sometimes requires quite aggressive treatment with antiviral and anti-inflammatory medications.

HSV1 infections recur periodically, usually in the same location. Many people describe a tingling or burning sensation before the cold sore begins to appear. When it does, it usually starts as a tender cluster of tightly packed tiny blisters with clear or yellowish fluid. After a day or two these blisters turn pus-filled. After another few days the blisters break down and the whole thing has a dry, honey-crusted appearance. The whole outbreak usually lasts about 7—10 days. Outbreaks can be triggered by illness, stress, sun over-exposure, and other events. About 2—4 outbreaks a year is typical.

Can HSV1 cause outbreaks anywhere else?

Other parts of the body, e.g., arms and legs
Herpes gladiatorum is a condition affecting some wrestlers, martial artists, and others who grapple or share mats.

Genital herpes
Approximately 60 percent of diagnosed genital herpes cases are caused by HSV1 as opposed to HSV2 (which is commonly known as genital herpes). If you had to choose a type of herpes to get genitally, I recommend HSV1: Outbreaks tend to be less frequent and intense than those for HSV2 infection.

	Ask the Trainer Frankie Romeo is a certified personal trainer, small group training coach, and graduate student at Lipscomb University in Nashville, Tennessee

How long should I stretch before a workout to prepare my muscles?
—Allison M.*, second-year student, University of West Georgia, Carrollton

*Name changed for privacy

This is an intriguing question! Believe it or not, stretching has been a topic of debate in recent years. Stretching is linked to flexibility, performance, and injury prevention. We have the tendency to stretch either too little or too much, and current research suggests neither of those is good for us. So, how much is just right?

To prepare the muscles before a workout, perform a warm-up for about 10 minutes that consists of primarily dynamic stretches; that is, active stretching with movement.

Make sure the dynamic stretching consists of full-range movements similar to those being performed in the workout. For example, perform deep bodyweight squats if you’re preparing for weighted squats, or arm circles for shoulder routines.

Static stretching, while safe and recommended for older individuals, may be more suitable for cooling down after a workout. Holding a stretch for an extended period (longer than 20—30 seconds) may inhibit performance.

Two exercise science concepts can help us better understand and manage stretching: the length-tension curve and the stretch reflex.

The length-tension curve
The length-tension curve is about the relationship between sarcomere length and tension. Sarcomeres are essentially the structural units of muscle fibers, which we can’t see. Optimal sarcomere length is 2.0—2.5 micrometers. At that length there is maximum tension, or strength. Tension decreases when sarcomeres are less than or beyond the optimal length. 

The stretch reflex
The stretch reflex explains the “tight” sensation we often feel when stretching. Muscle spindle fibers, which surround muscle fibers, provide sensory information about changes in muscle fiber length and tension. They produce a reflex response by contracting the muscle when it’s being stretched. This acts as a protective mechanism. Our bodies are incredible!

	Ask the Nutritionist Karen Moses, director of wellness and health promotion at Arizona State University in Phoenix.

How bad is ramen for you?
—Cole M., first-year student, University of Wyoming, Laramie

Ramen 101
Packaged ramen noodles are inexpensive staple meals for many college students. The package typically includes a block of wavy pre-fried noodles and a packet of seasoning. To prepare the noodles, cook them in water, drain them, and add the contents of the seasoning packet. This process takes about five minutes and costs next to nothing.

According to the label on a package of Top Ramen, these noodles are high in sodium, saturated fat, and carbs, and low in fiber and protein. (For a listing of nutrients, scroll down.) A package of ramen noodles is considered to be two servings. It’s clear that a diet of ramen noodles alone will not sustain a healthy life for long.

Ramen can be nutritionally redeemed
However, take heart. When you add a few ingredients, ramen noodles can contribute to a healthy meal without breaking your budget or adding too much time to the preparation process. 

FIRST  Buy vegetables. There are many pre-cut, pre-washed, packaged options:  broccoli, cauliflower, carrots, sugar snap peas, and spinach, to name a few. Choose something you like, or try something you might get to like. You’ll need about a cup of veggies (equivalent to the size of two fisted hands). 

SECOND  Buy a protein source, e.g., diced pre-cooked turkey or chicken from the frozen food aisle (obviously you need a freezer for this).

THIRD  Make dinner. You’re going to cook the ramen according to the directions, except you will add the vegetables and defrosted (thawed) diced protein to the boiling water with the noodles.

Tips

• Before boiling the water, defrost about a ½ cup of the meat in your microwave oven, or thaw it in your refrigerator. ½ cup is about the size of a tennis ball or small fist. 
• Before boiling the water, make sure your vegetables are ready to cook. If your veggies are in large pieces, add them to the boiling water before adding the ramen noodles. They will cook more thoroughly. I usually just add vegetables after the noodles soften a bit.

FOURTH  Now you have a bowl of noodles with lots of nutrients. The flavor packet is still high in sodium—so use less of it, or limit the amount of salt/sodium you eat the rest of the day.

FIFTH  Additional choices to balance your nutrition for the day should include: 

• More veggies—especially dark green or yellow/orange ones.
• A calcium source like low-fat milk or yogurt.
• Another protein source like peanut butter, sliced meat, or beans.
• A serving or two of complex carbohydrates,
  e.g., bread or potatoes.
• Bon appétit!  

POSTSCRIPT  Ramen nutritional info
A quick look at the nutrition contents shows a package of Top Ramen, prepared according to the directions, contains:

• 380 calories
• 14 grams of fat (half is saturated; none is trans)
• 52 grams of carbohydrate
• 10 grams of protein
• 20—30 percent of the daily value for iron
• 2—4 grams of dietary fiber
• 1600 mg of sodium 

	Ask the relationship educator Dr. Rick Hanson is a licensed psychologist and the director of the counseling center at Rockhurst University in Missouri.

Why do people perceive being a virgin as negative?
—Hugh T.*, fourth-year student, Wayne State College, Nebraska

People certainly do have different reactions to the concept of virginity. For many it is negative, but for others it is quite positive.

The sexual revolution vs. virginity
While negative perceptions have probably always been around, the sexual revolution of the 1960s and ’70s challenged the idea that someone or something else (e.g., society or religion) should decide what’s right for you. The college years are associated with claiming one’s independence and personal expression,
so there’s a natural tendency to disparage ideas that feel imposed. 

Negative stereotypes relating to virginity
Stereotypes of young adults who are not fully and openly sexual tend to be negative. When you read the word “virgin,” what images come to mind? Are they images of people who are confident, socially engaged, leaders, “sexy”? If not, why not? If we buy into the common media portrayal that something is wrong with virgins, we are likely to view virginity negatively and not want to be associated with it. 

Positive reasons for choosing virginity
On the other hand, there are many positive reasons students choose to be virgins, including:

• Religious faith
• Medical or health issues
• Timing and priorities
• Asexuality

The value placed on being sexually active 
For some, sexuality is a critically important part of their identity and relationships. They would not stay in a relationship that does not include the freedom to express themselves sexually. Others want the freedom to express and explore their sexuality without the commitments associated with relationships.
For these people, the choice to refrain from full sexual expression makes little sense. 

Religious beliefs and traditions around sexuality 
Most faith traditions pass on not only what “ought” to be, but also accumulated wisdom about what works best. People with positive views of their religion tend to view concepts like virginity more positively than those who are not associated with a religious tradition or those who are frustrated with religious teachings.

The perceived risks and benefits associated with being sexually active
Having friends who contracted STIs, became pregnant accidentally, or had negative sexual experiences leads some to choose to delay being sexually active until they are in a situation where they feel personally and emotionally ready.

For ideas and trends relating to celibacy, see Celibrate.org.

Brain Awareness Week

This month (March 16—22) brings us Brain Awareness Week: seven days in the year when scientists tell us how much they’re learning about our brains and ask for funding so they can learn more. Turns out brains are complicated.

Emerging adulthood
Young adulthood (defined as 18—22 or 18—25) is a time of dramatic change in the brain, particularly its thinking structures. Scientists call this developmental period “emerging adulthood” or “the frontier of adulthood.”

Change, change, change
Brain development in early adulthood opens up more complex thinking, especially around relationships, moral problems, and abstract concepts. Young adults become better able to regulate their emotions and manage relationships.

Check out the research on emerging adulthood.

Raise your STI-Q:

Which sexually transmitted infection (STI) is making a comeback?

What’s up?
Syphilis rates. They’ve nearly doubled since 2005, and approached 17,000 new cases in 2013, says the CDC.

In whom?
Men (90 percent of cases)—especially men who have sex with men (75 percent of cases).

How is this happening?
Via skin-to-skin contact during sex.

How can we stop it?
Condoms, dental (oral) dams, STI screening, abstinence.

Which dead celebs had syphilis?
Bram Stoker, Henry VIII, and Vincent Van Gogh, according to Medscape.

For much more on preventing STIs and getting tested

Get LinkedIn to your future

Every second of every day, two new members join LinkedIn. Students account for 20,000 of those new subscribers each month, according to the site’s administrators. Why? Because a strong profile on LinkedIn can open up more options for internships and the job you want after graduation. “LinkedIn is the first place most employers or recruiters will look to get more information about applicants,” says Allison Cheston, career development and advancement advisor at New York University.