Teen and College Health from Hangovers to STDs

Transcript Generated by AI.

Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Erich Schramm: 0:11

Hello and welcome back to another episode of the MedEvidence Podcast. I'm your host, Dr. Erich Schramm, sitting in for Dr. Michael Koren today. I am a board-certified family physician and longtime clinical research investigator with more than 10 years experience with the ENCORE Clinical Research Group. And I'm really excited to be talking to Dr. Jill Grimes today. For those who don't know Dr. Grimes, she is a board-certified family physician. So shout out to board-certified family physicians, of course. She specializes in teen, adolescent, and young adult health. And so she is also widely known as the TikTok college doc. So she's on multiple uh social media platforms. She goes on TV. She's an educator. And uh most importantly, for our purposes today, she is the author of the ultimate college student health handbook. I'm holding the third edition in my hand right now, so I'm really eager and excited to dive into that discussion. So welcome to the Med Evidence! Podcast.

Dr. Jill Grimes: 1:19

Thank you so much. I'm really excited to be here.

Dr. Erich Schramm: 1:22

So, Jill, um, you've got such a fascinating background. Um, maybe you could tell us a little bit about where you grew up, what got you interested in doing uh medicine and how you ended up pivoting into adolescent and teen health. What did that look like for you?

Dr. Jill Grimes: 1:40

So I grew up a lot of places. My father was a professor and as an administrator, and as he moved up the academic ladder every couple of years, we moved. So I was born in California, but lived a lot of different places. But I went to middle school and high school in San Antonio, Texas. And uh, so that's how I ended up in Texas. And my dad, again, being a professor, I have a brother and sister. My sister is a doctor, my brother is an engineer, but also has an MBA and teaches. So we we were all very much indoctrinated into the more education is better. And uh the doctor part part of it is a funny story. Literally, when I was in fifth grade, I had all A's and a C in handwriting. True story. Teacher pulled me aside and she said, That's okay, Jill, you can be a doctor. And my handwriting has not improved. This is actually a plus of electronic medical records.

Dr. Erich Schramm: 2:35

Uh, but I was just gonna say that. That's great.

Dr. Jill Grimes: 2:39

And I was not the only doctor with bad handwriting. I am not. But the the reality is that I had teachers and educators along the way who were constantly saying, you know, be everything, do everything. And I loved science and I loved helping people, and I loved animals. I thought about being a veterinarian briefly, but mainly I just was focused on being a doctor. And to me, family medicine will love this, but to me, being a doctor meant being a family physician. And sure enough, in medical school, I loved every single rotation except anesthesia and my husband's an anesthesiologist. Um, I have an issue about spit, but anyway, I really loved every rotation. And the cool thing about family medicine is we get to do a little bit of everything. And so I did private practice for 20 years. And during that time, I ended up doing some writing. And I'm always I'm a problem solver, um, or I want to be a problem solver at any rate. And so I saw a problem in my very wealthy, educated private practice community about lack of education about sexually transmittable infections. And that is not a cool or fun topic, but it was something that the education that I was doing in the exam room and that classrooms were doing with sex ed, clearly it wasn't hitting home. And that's because nobody thinks it's their group of people, right? We always think it's them over there. And so, what started as a couple pamphlets for my office, which were stories, because stories are more powerful than statistics. My patients could tell me every story from Gray's Anatomy or ER. So I'm like, hey, let me try this method. But anyway, that ended up coming together and becoming a book. And that is how I started publicly speaking in general about health advocacy and teaching about how STDs are really passed around and how great, smart, beautiful, wonderful people catch them.

Dr. Erich Schramm: 4:40

Wow. So I love that. So inherent in your course is curiosity, obviously that drew you into family medicine, as most of us do, um, but also uh uh uh wanting to write and communicate. And had that was that always natural for you, or was that something uh a skill you really had to develop?

Dr. Jill Grimes: 5:01

Uh I would say it was rather natural to me. It's getting me to shut up, that's the problem. So I I am the person who always uh spoke up when I saw that something I at least perceived to be an injustice. And sometimes I was right and sometimes I was wrong. But I was gonna be, if I'm gonna be wrong, I'm gonna be all out there wrong. So uh the speaking up part wasn't hard. The awkward topic was hard, partly because I was a parent and I was a parent of two young girls, and it's a little awkward when your mom's on the radio talking about STDs. So uh there was some balance, there's some give and take there.

Dr. Erich Schramm: 5:41

Well, but but that's a that's an important point. And and by talking about it and and you know being open and and educational, right? Then you can help to to destigmatize a lot of that for patients. And so in the course of your um the the many years in your in your primary care practice, were you really focusing on doing you know adolescent and teen health and pediatrics, or were you kind of full service um you know, uh kids to to to the elderly, doing all kinds of all aspects of the of the practice?

Dr. Jill Grimes: 6:15

I I absolutely did all aspects of it and loved it. And you know, started off wanting to still go in the ORs, but that ended up just not being practical with having your own private practice and um the whole business part of medicine, not my favorite, uh, wasn't particularly good at it and didn't like it, but I definitely loved seeing all ages. And I had patients from I stayed, I did my residency in Austin and I stayed there for private practice, and so I had patients who I delivered their babies and then I delivered their babies, babies in you know, in residency and early private practice. And um, so I had the full, the full range and I loved, I loved all ages, but I have always had a special passion for teens and adolescents, and I think a lot of it was because, again, as being an outspoken person, sometimes I felt that adults were perhaps talking down to me or not not appreciating the depth of the intensity of things that I felt. And so I've always tried not to do that. I really genuinely, I think, I think my special gift with patients is has always been that I can hear them. And even if I disagree with something where it wouldn't be a choice I would make, I'm not a finger pointer. Um, because you know point back at you, right? So I I I think that's that's how I especially connected with teens and I love the potential that teens have. And then circling back to the STD thing, that when a young person who is just kind of getting started in the world and and they're in high school or college and they're trying to figure out what they want to do and what pathway and who they want to do that with, and they end up with a sexually transmittable infection, they are often just destroyed, far, far more so than you know, medically. It might be something we can completely cure. It might be chlamydia, it's a bacterial infection. Boom, we're done. But they're not done. They are, oh my gosh, I'm, you know, their image of themselves has completely changed. And so I am all about prevention. And that that's that's always my push is let's get ahead of things, let's educate so that young people can make different choices and informed choices, because it's it's nobody's fault if they make a choice about a behavior or a medication or a drug, if they literally have no idea of the negative potential side effects.

Dr. Erich Schramm: 8:56

Well, I tell you, you know, and I think the credit to your book, because you spend a great deal of time talking about uh prevention there, treatment, prevention, very holistic uh approach to um all the different aspects and into what you're treating. I think, again, I love the family practice holistic element. I I think as as I read through the book, I'm like, well, you know, this is this is great for college kids, but you know, adults would get a whole lot out of this, right? Because it's it's a it's a very holistic approach.

Dr. Jill Grimes: 9:26

Um I've been asked to just change the cover and make it one-on-one.

Dr. Erich Schramm: 9:32

Your uh daughter did a great job on the uh on getting doing uh the illustrations for the cover. So some it's a lot of talent there. So the that's

Dr. Jill Grimes: 9:42

she has a degree in animation.

Dr. Erich Schramm: 9:43

Oh, wow. Okay.

Dr. Jill Grimes: 9:48

Still pictures are quick and easy for her, But I was the that was such a surprise. I had when I submitted my brook proposal, and they you've of course include sample chapters, and I just included her illustrations because I've always had her illustrate for me when I give talks like at the AFP or whatever. And it never crossed my mind that they would let her or not let would ask her to be the illustrator for the book. So that was that was a wonderful surprise.

Dr. Erich Schramm: 10:13

Yeah, it's it's quite good. So that's that's great. Thank you. Um, so you spent uh a number of years as doing student health at the University of Texas, is that right?

Dr. Jill Grimes: 10:24

Yes.

Dr. Erich Schramm: 10:25

So you're an Aggie, but you're in on the campus at the University of Texas. How did that work out for you?

Dr. Jill Grimes: 10:31

Uh it was quite humorous, actually. And yes, this is an Aggie ring while I'm holding up my hand for the people who are watching. Uh, it's actually pretty hilarious that a good chunk of the doctors that work in the University of Texas health services are actually Aggies. So the truth is that, you know, it's all just good fun. The students, you know, love to raz me if they saw my Aggie ring and I'd tease them right back because they're, you know, their Texas ring looks kind of like a copy of the Aggie ring. So now that I've just offended a huge group of people, but um, but no, it was it was really great. And uh I do need to have a disclaimer that I I am no longer currently working at the University of Texas and um love them, had a great experience there. Nothing I say though reflects them um legally.

Dr. Erich Schramm: 11:22

Okay, duly noted. Um so during this time, so obviously that's solidifying your experiences in student health, adolescent, teen health, and is that kind of solidifying your commitment to really putting that together into something more tangible? Is this kind of where the idea for the book's coming out at the same time? You know, your you said your daughters are heading off to college. But was this kind of a thought in the back of your mind at that time?

Dr. Jill Grimes: 11:53

Actually, it was more than a thought. So when our girls were fairly young, their babysitter, who's our next door neighbor, who's about eight years older than them. So eight years before they graduated high school, she graduated high school. And their mom, who's a dear friend of mine, asked me if I would put together a first aid kit for Elise when she went off to college. So I did that. And I took it over and I was so proud of this first aid kit, had everything in it. And I'm real crafty. I was a Girl Scout leader, you know, love to do all the artsy stuff. And my friend looked kind of disappointed as she opens it up and she's like, Well, Jill, this is great, but it doesn't have you in there. How is she gonna know when to take Tylenol versus Advil? What cream to use? What does she do? She gets food poisoning. So she runs to her kitchen and she gets index cards out and she starts rapid fire asking me questions, and I'm rapid fire answering. So the next kit that I made for the next babysitter that graduated, I had a little laminated booklet that I put together, which grew to be a 26-page laminated booklet. And that by that point, I think our girls were in, you know, like late middle school. And I was like, oh, I have way more I need to include. This needs to be a book. And I had already written a couple other books. So it's like, this is what I need to do. So the book came first. And then um actually, uh when I was taking a leave of absence from my clinical practice to finish up a book, um, my my I didn't, this was this I had my own practice for about 10 years, and then I worked for another practice for about 10 years. And while I was out on leave, that practice was sold to the hospital, and I didn't want to go back into that different setting. And so I was kind of looking around and I had always volunteered a couple, I mean, sometimes it was like one day a semester. It's not like it was a ton, but I had worked over at the University of Texas here and there for the whole 20 years, just really sporadically. And so I called them up and they were, oh my gosh, yes, come over, join us. So it just worked out, the timing was perfect. And then it was so great for me as my girls did, our girls did go off to college that I was literally around kids their exact age and you know, kids that needed mom hugs too. And uh, you know, so it it it was really a win-win.

Dr. Erich Schramm: 14:09

Wow. So terrific. So what what are your uh what does your practice look like now? Are you uh are you seeing patients or what's what's what's what's-

Dr. Jill Grimes: 14:17

so right now I I do not have time to see patients right now, actually. This this um I I do I wear a lot of different hats. Um I'm a clinical instructor for UMass Medical School, but basically that's sort of grading papers and interacting that way. Obviously, that's not a huge commitment, but I do that. I work with Thread Health, which is a digital health for teens startup, and really focused on teen access to accurate, evidence-based, you know, med medical information. And so I'm doing creating content for them and writing and speaking. And this has just sort of taken over my current practice.

Dr. Erich Schramm: 14:57

Well, that's great. You're you multitasking and it looks like you're doing on great on every front for that. So congratulations. Thank you. So maybe maybe we could talk a little bit more about the book that I'm holding up. So um so this is so, like you said, it's organized from head to toe. That's right. So and um things that I thought were very impressive is um uh the preface at the beginning and the introduction, which is gee, uh, how to prepare your kids to interact with the health system, what to do, you know, to walk into a doctor's office appointment. Uh maybe you could say just a little bit about uh about that.

Dr. Jill Grimes: 15:37

Yes, and I'll tell you that is was one of the major additions, uh major things that we added to the newest edition. So I, you know, I've been getting feedback, and that was a big thing of my kid doesn't know how to go to the doctor on their own. And so the it starts off with something really simple. What is the first thing when you walk up to any health care, anything? So emergency room, urgent care, private practice, the first interaction you have is with the receptionist and they're gonna ask you for your health insurance card. So you need a picture of that on your phone, front and back. They actually need both sides. And as long as it's at least on your phone, you know, you can email it to them standing right there and you have it always. So that's just a really simple but really important thing because when it's three in the morning and you're at an emergency room and you're puking your guts out or whatever the issue is, and you don't have your health insurance card with you, it it just it understandably makes kids just kind of decompensate. You know, they're they're holding it together until a certain point and then they're like, I can't even get in.

Dr. Erich Schramm: 16:38

There's not a lot of processing going on when that's happening. So you're that's that's right.

Dr. Jill Grimes: 16:44

So that's one. The second thing is that I think it's really important to teach our kids two things. And that is number one, lead with your most important concern. In an emergency room with a broken arm, it's obvious in our family medicine practices, less so. If your real concern is that you're having terrible test anxiety, but you're too embarrassed to say that. So you got an appointment for stomach pain because it's giving you stomach pain that you have test anxiety, just jump right in there with what you're there for because unfortunately, time slots are so limited. And then the next thing is I the biggest source of dissatisfaction with doctor-patient interactions is that the patient uh doesn't know what's next. So literally teach them just just remember those two words, what's next? So at the end, they get told they get their prescription, they get uh a prescription for physical therapy, they get sent to the x-ray. Um they need to ask what's next. If it's normal, what do we do next? If it's, you know, if I don't get better from the antibiotic, what do we do next? When should I get be getting better? How do I contact you? Is it's gonna be usually through a patient portal nowadays. But you have to ask. So lead with the most important thing and ask what's next when you're done.

Dr. Erich Schramm: 18:03

Right. And I'm I'm hoping all the adults out there are taking heed and do exactly that at your next doctor's visit because that'll you'll be well prepared. And it's like you said, what's next? That's always always the biggest uh question, and you want to make sure you're clear about that. So that's that's excellent. Um can we dive into chapter one? So chapter one is hangovers. And I was like, wow, that's really cool because put it right up front, right out there. Um, and I tell you, it's quite a it's quite a really good chapter because it talks about um how to treat a hangover and how to prevent hangovers, and you know, uh, you know, and it's a it's a really holistic approach to that. But uh, but yeah, so um, you know, and you make some recommendations about, okay, uh, you know, clear versus uh colored alcohols. And so uh so how did how did you come about uh coming to all that, uh knowing all that and that determination?

Dr. Jill Grimes: 19:05

Well, quite honestly, I wanted the the title of the book that I submitted to the publisher was hangovers to hangnails. I wanted it just, you know, just head-to-toe, boom. But publishers are smart about marketing, and the reality is that while many people might have typed in hangovers, probably they wouldn't have typed in hangnails, and it doesn't fully convey that this was a head-to-toe, you know, guide. So hangovers was always at the forefront, partly because as our babysitters and their friends and our, you know, our kids were in dance, so they always had friends three years older than them. As and I was giving these these laminated booklets and then first aid kits, uh, which they all still have. It warms my heart. I get texts probably, I don't know, once every few weeks with one of these. I mean, I've I've given out many, many, many of these. And I'll get texts saying, Dr. Jill, I just want you to know that I went through all my medicines were expired and I redid them and I re I re-upped it, or they had a baby, and they're like, Oh, I've I've added new things for my for my baby.

Dr. Erich Schramm: 20:09

Wow. That's that's great.

Dr. Jill Grimes: 20:10

Which is kind of wild. But anyway, so there's always a lot of questions about hangovers and about specifically all the things surrounded, so alcohol toxicity and hangovers, which are different animals. But when do you need to get help? You know, what were the signs of that? I wanted to be sure to communicate that. Some of the mistakes we see of people that are hungover is number one, they'll take their ADHD medication. They're they're hung over. They have been throwing up, they have a headache, they're dehydrated, and their heart is racing. And they take their ADH medicine, which I will admit may actually help with their hangover, not recommended, 100% not recommended. But then they go into kind of panic attack because their heart rate that was already fast is going a whole bunch faster. And that is a, you know, so I wanted to warn against that. I wanted to make sure if they're rehydrating as they should be, that they're ideally using an official oral rehydration solution like Pedialyte. And because that's gonna be more effective than just water and don't drink coffee. People try to wake up. It's the same thing with the ADHD medicine concept. You know, I'm gonna wake you up because you have this brain fog. No, the brain fog is from inflammation and anything that just is a stimulant is not gonna fix that. So that's really important to address some of those things that they can do that are actually harmful. And by the way, pro tip don't use a straw when you are rehydrating after vomiting if you're still nauseous for any reason, because it can actually you get more air into your stomach, and that can actually make you more nauseous.

Dr. Erich Schramm: 21:51

Wow. See, these these are gonna be great pointers. So I'm uh I'm gonna have to have all my kids and their friends all take a listen to this when this comes out. So um, but also too, and that I think you make mention that um, you know, sometimes sensitive topics there did if the if the patients have concerns like, well, gee, could you uh put yourself in a compromising position and getting back to testing and talking about STDs because you know people get blackout drunk, they may so that's it's vulnerable people. So they have to be you have to consider that too. So um yeah, and it's cool.

Dr. Jill Grimes: 22:29

If we could talk about that for just a second, I want to emphasize because because now blackout drunk is not just so first of all, blackout is not passed out. So for for the parents in the room, blackout means that you have a memory gap the next day, whereas passed out is unconscious, and that's that's super serious. And you know, you need to call for help if someone is unconscious, they're unconscious if you cannot wake them up. Um, but a blackout means that you have a memory gap. And there has been in the party culture, unfortunately emphasized in the party section of TikTok, which is why I'm there, by the way, um, the the party call of blackout or backout. You know, if you don't get drunk enough that you forget part of the night, you have apparently not had a good time. And obviously, not everybody is doing this. It is, you know, less than a third of college students, but it's a significant number. And it's concerning because there is this misperception of if you can't remember, it doesn't matter. Uh family medicine, we can immediately think of a couple outcomes where it matters, right? Any kind of accident, uh, whether it's just stepping off a curb and getting a concussion, or whether it is sexual assault, pregnancy, STDs, all of these things. So it does matter even if you don't remember. And it's these are the kind of things that I think it's really important to have real conversations with teens and young adults, because other people are not having those conversations. They're saying don't drink or you can't drink till you're 21. Well, that would be great. That would be ideal. I would have no problem if no one drank until they're 21. But that is not the reality of our culture in the United States today.

Dr. Erich Schramm: 24:14

Right. And as a physician, you're always daily having to face with reality, so and doing the right thing for your patients. So um, so yeah, that's that's real that's a really good point to make. Um another chapter that uh struck a um a chord with me was the talk on the chapter on anxiety, um, depression, and homesickness. And so um, and and again, you give some really good uh, you know, some some pointers there, and maybe you could elaborate on that a little bit.

Dr. Jill Grimes: 24:47

Sure. Well, this time of year, the biggest thing is homesickness. We've got kids who who just moved in or are about to move in, and we've got kids who maybe moved in early and went through the Greek system recruitment, used to be called Rush, and maybe they didn't get that sorority or fraternity that they really wanted. And these are tough ways to start the year. Um, so the biggest thing about homesickness is looking forward rather than back. The more that you are looking on social media at your friends who are all at different schools and obviously posting their highlight reels, as are you, uh, it just makes you feel more lonely and you're missing the past. The best thing you can do, I have this rule of three. Pick three organizations to join. And I'm talking join, not try out for, not audition for, just straight up join. And I encourage people to pick three completely different organizations. So maybe a service organization, maybe something just super fun if you like intramural sports, something like that, or if you love movies, joining a movie club. There's there's trust me, there's something for everything, but something, something service, something I'll say frivolous, like foodie or movie or whatever, and something maybe in your major. And that way you'll meet three different groups of people. They all share one thing that you like, and you'll start being able to see who you really truly jive with, because at first there's all this pressure to be friends with your roommate or your suite mates, and that may be great. Or you may, you know, they may be somebody who sort of is a ship passing in the night. So you gotta dive in.

Dr. Erich Schramm: 26:35

And you know, I think another important uh point I recall reading is like um, you know, the kids that might want to come home on the weekends, you know, and try to try to reconnect there, right?

Dr. Jill Grimes: 26:46

Yeah. So honestly, I see this just as frequently, if not more frequently, from the parent perspective of if your kid goes to college within say an hour, hour and a half radius, there is a big drive to, especially if it's the oldest, oh, come home for your sister's volleyball game. Come home for Sunday dinner. Oh, come home, I'll do your laundry for you. And and and none of it is, it's not trying to control them, but what's happening is they're being pulled backwards and they are not having the sitting around in the laundry room where you meet some other random person who's also sitting around in the laundry room. You know, you that's when those friendships are formed. And I found like Austin, Texas, obviously you have the huge University of Texas right there. But some of the people who are the most homesick literally live in the same city. So it's it's not correlated with how far away you are. Sometimes I think the people who are far away, and both of our girls actually went over a thousand miles away, different directions. But you know, you're kind of forced to jump in and do things because it's not an option to go home. So I think sometimes that that's helpful.

Dr. Erich Schramm: 27:53

Wow. Um, so uh talk, I want to go back and uh you would have been seeing a patients during COVID. Uh, is that recall that time frame and and how COVID what that how that affected um those kids growing up and then going off to college? And did that you know contribute to some of the issues that kids are seeing now?

Dr. Jill Grimes: 28:15

Well, I don't think there's any question that COVID disrupted all of our lives. And certainly there's a good argument that students in general all ages got disrupted the most. But it's very uh I I actually only saw students during the first year of of COVID, really first six months or so of COVID. Um but the the hard thing is that you know each each challenge is unique to each grade that they were in when they were completely on virtual school, right? And now we have a whole group of college students who were affected all to some degree or another during all of their high school. And I certainly I think we're seeing a lot more difficulty interacting with other people in person. Um, seeing a uh a reliance on virtual classes and more and more colleges, it's quite a surprise to parents paying tuition that there are a lot of really outstanding schools who still have a lot of classes that are also offered on online or maybe only offered online. And it it's a big transition to go from what they had as a COVID high school class online to now a class in university online. And I I just, you know, that think it's really important for students to recognize that it is a different situation. They need to jump in, they need to be responsible for connecting with that professor. Again, my dad was a professor. We when My brother and sister and I went to school. The rule in our household was if you're in college, the first two weeks of every semester, you go around to office hours and you meet every one of your professors. It doesn't have to be a long conversation, but go to their office hours. So you're going when they expect students and just introduce yourself and you know, use context clues. Look around the room if they've got pictures of something that you like. There's maybe they're skiers or they, I don't know, whatever they do. But comment on that and talk to them as a person. And it's going to just set you up for so much more success. And I think it's important to even do that with your virtual classes. And all the professors I know feel very strongly that those the kids who do that are the ones that succeed the most.

Dr. Erich Schramm: 30:47

I always feel strongly that we're so much better in person, and hopefully one day uh we can do a podcast in person. And, you know, uh, but yeah, and I'm I'm glad to see it, you know, with my kids that they've really embraced um doing a lot of that, showing up and and being there and knowing their professors and their TAs. And so I I totally agree with one other thing, um, so one of the things that's really impressive about uh your book is it's evidence-based. So um say let's take, for instance, the chapter on sinus infections and runny nose and sore throat. So um, and you again kind of reiterating the point, look, you know, this really isn't uh the place for antibiotics. And you know, and you can and you know, for those all of your recommendations um can go back and you can go back and reference and say, look, you know, this is this is really evidence-based practice. So it it is that time of the year when everybody's catching the things that are going around. And so um maybe just to kind of reiterate a little bit about um, you know, an approach to when you get that cold, when you're getting that sinus infection, um, you know, kind of the best approach for that.

Dr. Jill Grimes: 31:57

Right. And it is I I want listeners to know that from the doctor's standpoint, it is way easier to give an antibiotic unnecessarily than to have a five-minute discussion about why you're not giving an antibiotic. So we're not doing that, and we don't make money from the sale of antibiotics. There's there's no conspiracy there. But trying to convince people that they don't need antibiotics for a viral, you know, green snot does not equal antibiotics. That's that's the take-home message. So we what we want is for students to treat symptoms. And one, have a thermometer so that you can check your temperature. If you have 103.7 fever, we probably want to see you, you know. Uh, if if you've got 99 temp and a stuffy nose and sore throat and you know, you're functioning fine, probably that's a time for over-the-counter medicines. And, you know, obviously I can't give individual personalized medical advice, but by and large, most respiratory viruses and sinus infections are going to be viral. And we want you to, we don't want you to come in at the first sniffle, but we also don't want you to wait until you're in crisis. And that's true whether it's a whether it's a horrible, you know, sinus pain or whether you're in crisis from test anxiety or anything. Don't, don't, we're we're there to help. And if you have questions, and particularly young college students, this is the first time they're managing these symptoms on their own. But that's why we have most places have 24-hour nurse hotlines, and you can call and you can get recommendations. And if you just keep in mind, if you take other medications, like if you're on prescription ADHD medications or antidepressants, anti-anxiety medications, some of those interact significantly with cough and cold medications. And so that there needs to be a discussion with a medical professional, including a pharmacist. If you're getting over-the-counter medicine, the pharmacists are well versed in what is going to interact and what is not.

Dr. Erich Schramm: 34:06

Right. And I think a great point about your book is making it clear, you know, at what point you need to engage a doctor. You know, it's one thing to nurse symptoms at at home, but you know, when in doubt, here's where you need to go and and how to how to contact those resources. So that's very, very helpful. Um, I'm also now looking at towards the bonus section of the book called Do It Yourself First Aid Kit. And I'm like, holy cow, this is fantastic. Um, you've got any. Yeah, I mean there's literally a checkbox. I love that. First aid kit. So um to that point. So the the if you're uh at home with a sniffle, sore throat, or cough, or whether you've got a rash, or whether you've got whatever you have, uh upset stomach, um diarrhea, dehydration, I mean, there's all kinds of things here. Um, and you know, you really it's it's it's very clear, very concise. So uh again, um, you know, us adults need to have something like this at home because uh, you know, again, these are gonna be so helpful.

Dr. Jill Grimes: 35:12

Right. And when you need it, you need it. You know, when you're when you're throwing up all night at 3 a.m., you don't want to have to make a run to the store to get an oral rehydration solution. So I keep those single serving uh powders in there. So you've always got it on hand. That's really important. And even if it's just that you need an ace wrap, again, if you're hobbling around, it'd be nice to have it at your fingertips. If your roommate's coughing all night and keeping you from sleeping, it's really nice to have some over-the-counter cough syrup if it's appropriate for them to take that. Uh, and also I'm gonna put in a plug for Narcan. This is something new that we've added to the first aid kit. Narcan, everyone knows about the fentanyl crisis, the opioid crisis in our country. And I think what a lot of parents miss is that they expect that these fentanyl overdoses are only going on in like party, you know, raging parties, right? And there are kids that will take all kinds of substances to party, but they know that they're taking a risk. And I certainly hope that they have Narcan on hand as well. Something that a lot of parents don't think about, however, is that kid who is so anxious that they just they can't sleep. They've got a chemistry test, you know, Gen Chem test coming up and they can't sleep. They've been studying for three nights, and their roommate says, Oh my gosh, just take this Xanax and so you can get a good night of sleep, right? Well, if that's a prescription Xanax that was prescribed for that roommate, one, you still shouldn't be taking it. But two, that might be safe. But if it's a Xanax that they got from somebody else because they were having trouble sleeping, now if it's a street drug Xanax, there is a very strong chance that there's fentanyl in there. And that's why it's one pill can kill. It is college students, young adults who are looking for a simple fix to a problem. They think they're getting something that is not risky, and yet it can stop them from breathing. So Narcan is a spray that can reverse that. So I think that's an important thing to have.

Dr. Erich Schramm: 37:22

Yeah, that's a great point. I mean, Narcan saves lives, you know, and that's the reality we are we're living in right now with uh with the opioid epidemic. So absolutely. Um, I know we talked a bit about uh sexually transmitted disease STDs, and I'm referring back now to look at chapter 45, uh, very well written, but um maybe touch a little bit about how um, because a lot of people, a lot of you know, young people think, well, if I've got an STD, I'm gonna have symptoms, right? Something's gonna show up, and so I must be okay, right? Hey, if I must be all right, right? I mean, what could possibly go wrong?

Dr. Jill Grimes: 37:59

Or or I had symptoms. Oh, thank God those symptoms went away. I had some burning there when I was peeing at first, but that was it's been two days and it hasn't happened anymore. So I must be fine. So, yes, we have to get the message across that sexually transmittable infections are honestly most often silent, and yet they can do damage, particularly in young women. The you know, biggies that we worry about missing are chlamydia and gonorrhea. And those can go on to create problems, scarring, chronic pelvic pain, and even infertility in women. They're easily treated. They're bacterial illnesses. Actually, gonorrhea, let me step back. It is a bacterial illness that is not easily treated because it's got so much antibiotics resistance. I shouldn't be laughing at that.

Dr. Erich Schramm: 38:46

The super bugs.

Dr. Jill Grimes: 38:48

Yeah, it's it's actually gotten a little scarier. But chlamydia is very easily treated, but we have to know it's there. So if you are sexually active, meaning that you are being sexually intimate with other people, then you need to be checked once a year at least.

Dr. Erich Schramm: 39:04

Yeah. Do you think in terms of the treatment then as far as as a as a clinician, are you just gonna, you know, go ahead and just presumptively treat, you know, somebody comes in and says, I think I might have something. Um, are you gonna just say, Okay, well, look, we're gonna presumptively treat you for gonorrhea and chlamydia or are you gonna wait for the test to come back?

Dr. Jill Grimes: 39:24

It depends on the setting. Nowadays, I you know, in a in a college health setting, uh students are highly, highly motivated and likely to come back. So typically we would test first. There are certainly uh public health clinics where there may not be as consistent a follow-up where there is presumptive treating.

Dr. Erich Schramm: 39:44

Yeah. And and that that makes sense. I mean it's your patient population at the end of the day, and then you know them and what's best for them. And but you also make a point, an important point about follow-up. So if you're gonna get treated, go back and make sure you're you you're clear. Is that right?

Dr. Jill Grimes: 40:00

Absolutely. And the other thing is I've always said that STDs travel in packs. You know, people are are always shocked, almost always, 98% of the time, pulling that number out of my head. But from my experience, the vast, vast majority of people are just shocked when they're diagnosed with a sexually transmittable infection. Like, how could this happen to me? How could that person have given that to me? But they're even more shocked when they have more than one STI and see that all the time. A lot of times it's genital herpes and chlamydia, or you know, pick, pick, pick your match. But the reality is that they're all transmitted the same way. So of course we see a lot of them together. And gonorrhea and chlamydia have been together so much that a a lot of times we empirically do treat for both when you're positive for one. So it the but the the the major message I want to get across though is just get tested and be understand that if we are offering testing for say HIV, so many times people will say, Oh, they're not that kind of person. Like there is no that kind of person. Exactly. We're all that, we are all that kind of person, right? It's these bugs don't care what you look like or how much money you have or where you live or any of that stuff. And yes, they are more prevalent in certain populations, but the reality is anyone can get any of them. And if you're positive for one, you should be checked for all of them.

Dr. Erich Schramm: 41:24

That's right. And I think the advice you'd give in there was don't don't ever hook up with an X, right?

Dr. Jill Grimes: 41:32

Oh, if there's one, don't do the X.

Dr. Erich Schramm: 41:35

Don't do the X, right?

Dr. Jill Grimes: 41:37

Every every primary care physician. So then uh yeah, yeah, we broke up, but then I ran into him or her at this bar, and we all know what's coming next.

Dr. Erich Schramm: 41:46

And and adults too. Let's be clear that it's not just college kids, but maybe adults should be heeding this advice, yes.

Dr. Jill Grimes: 41:54

So even more so if it's an ex-spouse. Guaranteed you're gonna get it from exactly okay.

Dr. Erich Schramm: 41:59

So that's an important take home message for everybody. So, Jill, thank you so much. You've been very generous with your time. Um, and like I said, the the the book is uh tremendous. Um, I can't wait to to spread the word because I know it's this is is gonna really uh sink home for a lot of people. Um anything, uh any question that I should have asked that I didn't ask you or a point that uh you'd like to make.

Dr. Jill Grimes: 42:26

I just want to reiterate the biggest thing, biggest mistake that I see in young adults and and actually really everybody is waiting until you're in crisis to seek help. And part of that's because of all the barriers we have with access to care. And I understand that. And but whenever possible, I'm not don't go in at your you know, second flake of dandruff or your first sniffle, but also don't wait until you're so miserable that you cannot cope with it because then it's even harder to get in. And and we can intervene with things, especially with anxiety and depression, and you know, mental health is equal to everything else. It is a valid reason to see a doctor if you have insomnia. That is a valid reason

Dr. Erich Schramm: 43:11

And and this ties into what you're doing through your um in your virtual health uh project that you're doing, right? That's that that's that kind of access. Um, and that's and there's confidential uh confidentiality in that uh for uh for those patients.

Dr. Jill Grimes: 43:26

Oh absolutely.

Dr. Erich Schramm: 43:28

Because I think a lot of times, you know, kids are like, well, are my are my parents gonna find out about this stuff? And you know, they're they're hesitant.

Dr. Jill Grimes: 43:35

We should add one thing since you said that, especially this time of year. College students are mostly still on their parents' insurance. And what they need to know is that while there is complete confidentiality between the doctor and the patient, there is something called an EOB that is an explanation of benefits. And it is just it's not gonna say your diagnosis, but it will certainly say pregnancy test or chlamydia test. We can't change the names on those things. And so students need to understand that if their parents are paying the bills, their parents are going to get this explanation of benefits that does have names of tests on there that would strongly suggest with context clues what's going on. So I think it's really important to have open communication about that.

Dr. Erich Schramm: 44:28

Can those patients go to, say, like a public health office, public health department, and avoid the-

Dr. Jill Grimes: 44:32

if those patients pay cash, if they go to a uh public health office, uh if you're not, it's purely if you're using your parents' insurance. If you're using your own insurance, you will be the one getting it. Uh, if you're paying for the insurance, it's whoever's paying, the guarantor, who is going to get it. So the what the workaround is there are many free clinics um and there are many places you can pay cash. And almost all college campuses now have free SDI testing in particular.

Dr. Erich Schramm: 45:03

That's that's that's a great point to make. So well, great. Well, thank you so much. Um, I hope we'll have a chance to talk again soon. Um, is there another book in the in the works?

Dr. Jill Grimes: 45:14

There may be another edition in the works, but not not right now. Honestly, we I've got my plate full for the next year.

Dr. Erich Schramm: 45:23

That sounds that sounds good. All right. Well, thank you so much. And you have a great rest of the day here, and uh we'll hopefully talk again soon.

Dr. Jill Grimes: 45:31

All right, thanks so much for having me. Sure.

Dr. Erich Schramm: 45:33

Bye bye.

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