—Gordon N.*, Northern Illinois University
(*Name changed)

Kudos to you for acknowledging that there’s an issue here: your avoidance of seeing health care providers and perhaps getting tested for a health condition. It’s not uncommon for people to be uncomfortable about this. Asking somebody to help interpret your own body is a sensitive, even intimate, thing to do. Moreover, there’s an obvious power imbalance. The provider has knowledge and training that you (probably) lack. They may tell you something that will affect your sense of self.

So let’s take a step back. What do you really have to worry about?

Are you worried the provider might be a paternalistic, patronizing jerk? Check out your student health center.

No one should be made to feel ashamed by a doctor. If that’s the case, ask people you trust for a recommendation for a health care provider who is likely to be a good fit for you. You’re entitled to choose your provider not just on the basis of convenience, but because that person makes you comfortable and because you have reason to trust their sensitivity and expertise.

Student health center providers are usually excellent at making students feel comfortable. They’re very practiced in speaking with and helping students who don’t have much experience being on their own in a health care setting. They are good at discussing anxieties that patients may bring. They may also have systems in place to help mitigate some of these anxieties, such as same-day results for certain testing.

Are you afraid of what you might find out? Talk this through and take control of the timing.

I’ve had a number of patients over the years convinced they have contracted HIV and terrified to get tested. We sometimes spend two or three visits talking it through before actually doing the test. The point I emphasize is that testing doesn’t affect the diagnosis. If you have the condition already, you won’t have it any less by not getting tested. On the other hand, a positive test will start you on the path to treating the condition and potentially helping prevent the transmission of HIV to others. It’s also possible that you don’t have the condition at all and that you’re wasting enormous psychic resources worrying about having a disease you don’t have.

For non-emergency situations, most testing can wait. You may feel more comfortable if you can control the timing of testing while engaging with your health care provider. I suggest you talk with your provider about your discomfort.

Are you still stuck? Consider talking this through with a counselor.

If you remain absolutely unable to act, perhaps because of worries that you might have a particular diagnosis, consider talking this through with a counselor first. The counselors at your campus counseling center will likely have encountered this anxiety before, and can help you figure out ways forward. Good luck.

Cold-causing viruses circulate readily in college communities, and they disrupt students’ academics and other activities, so it’s absolutely worth minimizing our exposure to them. We have easy ways to do that. Bear in mind, though, that sometimes, you’re just going to get sick. I often tell students: “If you don’t have time to catch a cold every now and then, you’re probably overcommitted.” Here’s what you need to know to make catching a cold a less frequent event:

How to avoid catching or sharing a cold

• Wash your hands frequently: No other strategy is as effective, says the CDC.
• Train yourself not to touch your nose or eyes unless you’ve just washed your hands; this also helps reduce your risk.
• Stay home the first few days of being sick: Cold viruses are shed most heavily in the first few days of illness.
• When coughing or sneezing, cover your mouth and nose with a strong tissue, or use this handy gadget called a Coughcatcher (see the next slide).
• Do not take antibiotics; they do not prevent or treat colds. With no possible benefit here, the effects of taking antibiotics “for a cold” will be solely negative.

How colds are spread

• Via our own hands: Cold viruses are sneezed, coughed, or breathed into the air and land on surfaces like desks and tables. Viruses can survive for hours on everyday surfaces. When we touch those surfaces, we get the virus on our hands. Those viruses can survive on our skin for two hours. When we touch our eyes or nose, we allow the virus to infect vulnerable cells. This is why frequent, thorough hand washing is so important.
• Via droplets in the air that we inhale: Cold viruses can also be spread directly from person to person through respiratory droplets (microscopic germs that are sneezed, coughed, or breathed into the air).
• Via children, directly or indirectly (sorry, kids): Children are thought to be the reservoirs of colds in communities. The viruses spread from young children to older siblings or adults, and then through school or work communities.

How to treat a cold

• Colds get better without treatment after 5–10 days. Rest up, drink water and other healthy fluids, and try not to spread your virus to others.
• Again, do not use antibiotics. Colds are caused by viruses. Viruses are different from bacteria. Antibiotics are not effective against viral infection, and they have downsides—both for you personally and for the community.
• There is no compelling evidence to suggest that probiotics, zinc, vitamins, face masks, herbal products, or gargling are effective treatments for colds.

What a cold is and how a cold works

• When health care providers and educators talk about the “common cold,” we’re referring to a specific type of illness. It is not the same as influenza (flu), pharyngitis (sore throat), sinusitis etc., though some of the symptoms can overlap.
• A cold is a viral infection. More than 200 different viruses can cause colds, though about half of colds are caused by the rhinovirus.
• When a cold-causing virus enters a cell, it hijacks the cell’s machinery and begins replicating itself, producing millions of copies. This infection triggers an inflammatory response in the body, which generates the characteristic symptoms of colds, like runny nose, nasal congestion, scratchy or sore throat, cough, and sometimes fever (this is more likely in younger people).
• Not everyone develops symptoms every time they are exposed to a cold-causing virus. Children catch more colds than adults, suggesting that the body may develop some immunity to colds over time, though we never become fully immune.

What is a Coughcatcher and where do I get it?

—Addison P.*, New Jersey Institute of Technology

(*Name changed)

It’s generally recommended that people 18–25 years old get in touch with a healthcare professional once every year or two. A physical is also known as a preventive health visit, because the goal is to help you stay healthy. This includes spotting small problems early, before they become bigger problems.

Insurance covers one preventive visit a year Under the Affordable Care Act (“Obamacare”), one preventive care visit a year is covered by all insurance plans that are sold via state or federal government websites. Ideally, your healthcare provider should be someone that you’ve gotten to know and trust over time—someone you find it relatively easy to talk to—although this may not be possible if you’ve recently relocated for school.

It’s a valuable opportunity to talk with your doctor Studies suggest that for most people at a preventive care visit, the conversation with the healthcare provider is more valuable than the physical exam. If you’re completely healthy, checking in once every year or two is a good opportunity to ask questions that may have come up since your last physical. For example, you may want advice about returning to a vigorous sport after time away, guidance about a new diet plan you’re considering, or advice about a possible symptom.

Additionally, a wellness visit is a good opportunity for the provider to ask you some age-appropriate questions. There are questions designed to screen for health risks specific to your demographic, which cover topics such as sleep habits, diet, physical activity, sexual health, drugs and alcohol, mood, and risk-taking behaviors.

If you see a provider regularly, you may or may not need an annual visit If you have regular or occasional contact with a provider, especially if you have a chronic condition, this sort of check-up visit may be less important, especially if you cover these topics during your ongoing visits. Often, though, visits for illnesses or problems don’t allow the time and space for the broader “State of the Union” conversation I describe above. It may be worth taking additional time for a comprehensive health assessment. It’s not always easy to open up about personal issues, and having a visit that allows time for a broad conversation may help you raise a topic you’ve hesitated to mention.

—Alyssa O., California State University, San Bernardino

Here’s what I generally recommend to students:

• Go to school with ibuprofen (instead of aspirin)
• Keep a supply of acetaminophen too (Paracetamol and Tylenol are common brands)

To see why, read on.

Aspirin and ibuprofen do have quite a lot in common—I think of them as close cousins.

Aspirin is salicylic acid, a naturally occurring substance that Native Americans used to extract from willow bark. It’s an analgesic (meaning it blocks pain) and anti-inflammatory. It also inhibits platelets in the blood from clumping together. This can be a benefit, as when it decreases the risk of a blood clot after a heart attack or surgery. Aspirin can also be a risk, as it can lead to gastrointestinal (GI) bleeding (more commonly in the elderly).

Ibuprofen is a synthetic molecule based on the chemical structure of aspirin. It was originally a prescription medication, but proved safe enough that it went over-the-counter in the early 1980s. Ibuprofen is widely available in both name-brand and generic forms, as well as in combination with antihistamines or decongestants designed to treat colds or the flu. Ibuprofen shares many of the same risks as aspirin: Overuse can lead to GI bleeding or kidney damage. Occasional use, though, is generally safe. The over-the-counter doses are 200 mg a pill, which allows some flexibility in dosing.

Aspirin and ibuprofen are both useful medications for treating common pains (headaches, sore throats) and inflammation (ankle sprains). They also work nicely for the woozy headache one can get after sun overexposure.

I generally recommend ibuprofen instead of aspirin because aspirin carries the potential risk of a rare but serious condition called Reye’s syndrome. This can occur when a person under 18 takes aspirin while infected with the influenza virus (flu). Because the risks and benefits of aspirin and ibuprofen are similar, I keep it simple and recommend ibuprofen.

Acetaminophen isn’t an anti-inflammatory like ibuprofen or aspirin, so it’s not as good for musculoskeletal injuries. On the upside, it doesn’t have the risk of GI bleeding or kidney injury. It can cause liver injury if overused. The mechanism of action is different enough from aspirin and ibuprofen that it’s useful to have acetaminophen on hand too. Some pain responds better to one than the other.

“Is it possible to get too much sleep?”

—Ana H., Towson University, Maryland

Not exactly. But are there circumstances in which the amount of sleep someone is requiring would be concerning? Yes.

It’s common to meet with students who are tired all the time and seem unable to get sufficient sleep. Most of the time, people who sleep a lot need to. Young adults generally need 8–9 hours a night, ideally on a fairly regular schedule (same bedtime and wake time). Straying from this can lead to “sleep debt.” Just like student loan debt, sleep debt has to be paid off eventually. The more you accrue, the more intensely your body will want to pay it down—by getting more sleep.

This starts with REM (dreaming) sleep. Do you know that sensation of falling asleep suddenly and immediately starting to dream? It can be quite disorienting, especially when it happens in class. (Not that I’d know about that. OK, maybe a little.) That’s a sleep-deprived brain desperately trying to do some catch-up.

If you don’t need the sleep, it’s usually pretty hard to sleep. I think most people are familiar with the experience of leaving school for a vacation and sleeping nonstop for the first several days. I certainly remember times that I woke up at 11 a.m., had a little something, went back to bed until 2 or 3 p.m., did a little something, took a 5 p.m. nap… you get the idea. After a few days, though, staying awake wasn’t so excruciating. After another few days, I was back to sleeping 9–10 hours a night. This was my body paying off sleep debt then resetting to a baseline rhythm. Once I’d done that, I didn’t have the intense appetite or need for sleep any more.

When people just can’t seem to get enough sleep, regardless of hours sleeping, including naps, we start to worry that there’s an underlying cause, such as mono or another illness. Psychological causes can also be at play, especially depression.

So can you get too much sleep? Usually when we feel the need to sleep more than the standard pattern, there’s a good reason. Generally, it’s a good idea to listen to your body.

If after 4–5 days of intense sleeping, especially if you don’t know why you need so much sleep and/or don’t feel that you’re getting any benefit from all the extra sleep, it might be time to talk with a medical provider and maybe get some testing done.

“I make sure to get enough sleep, but I still always feel tired. Why could this be?”

—Ariel B., Red Rocks Community College, Colorado

This is a very common dilemma. It can be helpful to determine whether you’re experiencing fatigue, somnolence, or a combination of both.

• Fatigue means that you get tired more easily doing physical activity—even day-to-day activities, such as walking and climbing stairs—and that you just don’t have your usual energy supply.
• Somnolence means that you’re sleepy and can fall asleep readily at times other than bedtime.

These are two different problems with two different sets of possible causes.

Some people can’t really distinguish whether they’re fatigued or somnolent. That’s OK, too. It just makes it less likely that there’s a single identifiable cause.

If you’ve been feeling unusually tired for two weeks or less, the list of possible causes is different than if it’s a long-standing problem.

So what are the possible causes? Sometimes we can identify a single cause, but most often there are a combination of factors. Here are some:

Poor sleep quality

Many students overestimate the amount and quality of sleep they get. If you’re someone who needs nine hours a night and are consistently getting closer to seven, and those seven hours are on a variable schedule (sleeping in or waking early depending on that day’s schedule), you’re accumulating sleep debt.

The more sleep debt you accumulate, the groggier you feel. Chronic sleep debt can lead to poor concentration, decreased capacity for learning, increased risk of getting sick, decreased athletic performance, and more.

Aim for a consistent sleep schedule. Get up at the same time every day, and don’t sleep more than an hour later on weekends. (This is usually easier than going to bed at a consistent, early bedtime, and helps reset your body clock.)

Diet

Taking vitamins or other supplements is unlikely to provide a benefit for your tiredness. Most of us get the nutrients we need from our diet. Rarely, malabsorption (the inability to absorb essential nutrients from foods because of a problem with the function of the gut) can cause fatigue. There are usually accompanying symptoms that a clinician can identify.

Mood

Another common cause of feeling tired all the time is depression. Classic symptoms include anhedonia, the inability to take pleasure in things that used to be enjoyable, and hopelessness or feeling like there’s no point to getting out of bed in the morning. If this seems familiar, make an appointment with your school counseling center.

Illness

One potential cause of increased fatigue among college students is mononucleosis (Epstein Barr virus infection). Mono is usually transmitted by saliva, like colds and many other viral infections. It often causes a terrible sore throat but sometimes presents as fatigue only. People typically complain of feeling drained, of needing to take long naps, and of diminished ability to exercise. Other illnesses, as well as certain medical conditions such as sleep apnea, can also cause fatigue. Sorting through the possibilities may take a few doctor visits and some lab testing

When to seek help

If you feel tired all the time, especially if the symptoms have lasted more than a week or are accompanied by other symptoms such as fever, diarrhea, rash, sore throat, cough, etc., contact your primary care provider or school health center and schedule an evaluation. This is especially important if the symptoms are hampering your academic, athletic, or social pursuits, or are otherwise getting in the way of your life.

“Do I really need to get a flu shot?”

—Leah M., Michigan Technological University

Yes.

An emphatic yes if you are in one of these categories:

• You are at higher risk for complications from influenza; for example, asthma or any other chronic lung issue.
• You are at higher risk for complications of infections; for example, if you are immune compromised because of illness (such as immune deficiency or diabetes) or treatment (some people with Crohn’s disease, for example, use medications that suppress the immune system).
• You have sickle cell disease.
• You are pregnant.
• You are of American Indian or Native Alaskan descent.

A strong yes if you are in one of these categories:

• You are a student in a residential setting. Young adults tend to congregate. When they congregate, they tend to share things like food and hugs and kisses. This kind of close interaction, wonderful as it may be in many regards, is very effective at transmitting illnesses.
• If you like the idea of not feeling miserable for a week to 10 days. Influenza can be brutal. Flu symptoms include fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue. Most students with flu are unable to attend class or even keep up with reading/studying for several days. Complications of influenza can include sinus infections, ear infections, pneumonia, and more serious conditions.

The influenza virus is highly contagious and has three particularly devious traits:

• It can be spread in the day prior to onset of symptoms—before the affected individual feels sick enough to separate themselves from others.
• It can be spread to someone as far as six feet away (cover that cough!). Here’s what the CDC website says: “Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.”
• It can last a long time on surfaces; particles ejected by an uncovered cough or sneeze can land on a counter or tabletop and survive there for a day or two. If an unsuspecting person touches that surface, and then touches a mucus membrane such as the eye or mouth, they can get infected by the virus.

Does the flu shot have a downside?

There aren’t really any significant downsides to influenza vaccination. It is usually covered by insurance, or is inexpensive. It has minimal side effects: sometimes a little soreness in the arm for a day or two, sometimes some fever and mild muscle aches for a day. Each year, a new flu shot is available that provides protection from the influenza viruses that are expected to circulate widely that season. The 2015–16 flu shot was a very good match for the types of flu that were circulating. The match is not always perfect, but even if the flu vaccine doesn’t contain the influenza virus that you are exposed to, it may make an influenza infection less intense and shorter than it would otherwise have been.

Unfortunately, the protection we get from a flu vaccine wanes within a year. An annual vaccination is needed to get the best protection against the flu. On the plus side, young healthy people get a strong, relatively long-lasting immune response from influenza vaccine. Get yours in September before you are at greater risk of exposure and while supplies are plentiful.

+ Find fine flu facts (CDC)

Reading Time: 3 minutes Not sure if your sickness requires a doctor’s visit? Here’s how to tell.