Clinican's Corner
    World TB Day March 24th

    Unite to End TB

    Commemorated on the day in 1882 when Dr. Robert Koch discovered Mycobacterium tuberculosis, the bacteria that causes tuberculosis (TB).

    TB is the second most common infectious cause of death in adults worldwide (human immunodeficiency virus [HIV] is the most common).

    Six countries account for 60% of the total, India with the most, followed by Indonesia, China, Nigeria, Pakistan and South Africa.

    How TB spreads

    · TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

    · TB is NOT spread by: shaking someone's hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes or kissing.

    Latent TB and TB Disease

    · Latent TB: TB can live in the body without causing any symptoms. People with latent TB do not feel sick and cannot spread the infection to others. Many people who have latent TB do not go on to develop the disease. However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of becoming sick. Latent TB is detected with a positive skin test reaction or positive blood test.

    · TB Disease: TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active -multiplying in the body, this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria. TB disease is detected with a positive skin test, followed by an abnormal chest x-ray, or positive sputum smear or culture.

    Signs and Symptoms

    · Symptoms of TB disease depend on where in the body the TB bacteria are growing. TB bacteria usually grow in the lungs (pulmonary TB). TB disease in the lungs may cause symptoms such as: a bad cough that lasts 3 weeks or longer, coughing up blood or sputum, chest pains, weakness, weight loss, fever and night sweats.

    Who Should Be Tested

    Certain people should be tested for TB infection because they are at higher risk for being infected with TB bacteria, including:

    • People who have spent time with someone who has TB disease
    • People from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia)
    • People who live or work in high-risk settings (for example: correctional facilities, long-term care facilities or nursing homes, and homeless shelters)
    • Health-care workers who care for patients at increased risk for TB disease
    • Infants, children and adolescents exposed to adults who are at increased risk for latent tuberculosis infection or TB disease.


    · TB is a treatable and curable disease. The decision about treatment for latent TB infection will be based on a person’s chances of developing TB disease by considering their risk factors. Four different treatment regimens are available for latent TB infection.

    · Active, drug-susceptible TB disease is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support by a health worker.

    Student Health Resources

    The TB risk questionnaire can be found under “forms”

    All students are required to complete this questionnaire

    · TB testing is available at the Student Health Center by appointment

    · All required immunizations can be found at:

    Emergency Contraception (aka “The Morning After Pill”)

    Utilizing Emergency Contraception (EC) following an episode of recent unprotected intercourse (including failure of the primary form of contraception, such as the condom breaking or falling off, forgetting or losing birth control pills, missing your appointment for the depo injection) can help to prevent an unintended pregnancy.

    There are several different forms of EC available to women (including the Copper IUD and different pill formulations) and here at the Student Health Center at UC Merced we offer EC in the form of a single dose of the hormone levonorgestrel (Next Choice One Dose).

    · Next Choice is most effective when taken within 72 hours (or 3 days) of an episode of unprotected intercourse (although it can be taken up to 5 days following unprotected intercourse, but its effectiveness at preventing pregnancy is decreased.

    · Next Choice is very safe and has not caused any serious complications (or deaths). Common side effects include nausea, vomiting, and irregular vaginal bleeding.

    · UC Merced students with the UC Ship insurance requesting Next Choice can have their insurance billed for the cost of the medication. It is also available to students without UC Ship insurance who wish to pay an out of pocket fee ($40 at this time).

    It is important to note that while EC can help to prevent unintended pregnancies, it is not as effective as regular forms of contraception (such as the birth control pill, depo shot, implant, etc) and it should not be used as a primary form of contraception. Also, efficacy can be decreased in overweight and obese women.

    For more information on EC please contact the Student Health Center to schedule an appointment with the nurse or another health care provider.

    All About HPV

    Human Papilloma Virus (HPV) is the most common sexually transmitted infection (STI) in the United States, with 79 million currently infected Americans and 14 million becoming infected each year. Unfortunately testing for HPV is currently only recommended for women aged 30 and older, so if you are younger than 30 years old and requesting STI testing from your health care provider you are not going to be tested for HPV. It is important to prevent HPV, as it is associated with genital warts and cancers of the cervix, vulva, vagina, penis, anus, and certain head, neck and throat cancers.

    Luckily there are ways to prevent HPV infection and complications due to HPV:


    Your Student Health Center at UC Merced offers the 9 valent vaccine that helps protect against 9 different strains of HPV (some of which are associated with genital warts and some that are associated with cancer). This vaccine is recommended to males and females ages 26 and under, has been proven to be very safe, and is has been shown to be up to 97% effective in preventing cervical cancer in women.


    It is recommended that all women ages 21-65 have routine screening for cervical cancer with pap smears. This is the best way to detect changes in the cells of the cervix BEFORE they turn into cancer.


    Condoms can markedly decrease your chances of getting HPV and other STIs (although it is still possible to contract HPV from skin to skin contact during sex where condoms do not cover).

    If you have any questions about HPV or the HPV vaccine please contact the Student Health Center to schedule an appointment with a health care provider.


    In the United States, an estimated 22% of people diagnosed with HIV in 2014 were aged 13-24 years. Despite the disproportionate number of new HIV infections occurring among youth, the percentage tested for HIV is low compared to other age groups. Only 1 in 5 sexually experienced U.S. high school students have ever been tested for HIV.

    What can you do?

    • Get Educated.
      Learn the basic facts about HIV transmission, testing, and prevention
    • Get Tested.
      CDC recommends that everyone between the ages of 13 and 64 years get tested for HIV at least once as part of routine health care. Contact your health care provider about testing.


    CDC: Healthy Youth Website


    Flu Season
    Flu season is approaching and we want everyone to be prepared. What is influenza (also called flu)? The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year. Please refer to our website for flu information and answers to commonly asked questions. Please consider coming to one of our weekly flu vaccination clinics to receive this year’s flu shot!
    10 Tips for a Healthy Semester

    1. Make sleep a priority. The amount of sleep each person needs varies, but most adults need 7-9 hours to feel rested. A full nights rest will help you concentrate and perform at your best.

    2. Create a routine. Setting a schedule early in the semester will help you get in the habit of studying, working out, and sleeping at certain hours. A routine will make it easier to fit in all the things you need to do in a busy day without causing too much stress.

    3. Give yourself a break. Leave some time in your daily routine to relax, walk outside with a friend, meditate or do yoga. Let your body and mind relax so you can come back refreshed and ready to go.

    4. Eat healthy. Vary your food choices, choose fruits and vegetables at each meal, and limit junk food, processed foods and high sugar treats. Fill your dorm refrigerator and backpack with healthy snacks so you always have healthy food choices available.

    5. Build new friendships. Part of the college experience is meeting new people and forming new friendships so get out there and meet new people whenever possible.

    6. Have fun without alcohol and drugs. Enjoy activities and social events that don’t revolve around alcohol or drugs, spend time doing activities that keep you safe and healthy.

    7. Get moving . Do something physical every day. Walk the long way to class, take the stairs, go to the gym between classes. Join a club or group that revolves around physical activity so you can be active with friends.

    8. Get a flu shot. Flu clinics start September 28 and are free for students.

    9. Keep in touch with family and friends. You can help beat homesickness and loneliness by keeping in touch with friends and family.

    10. Avoid all-nighters. You may feel like you need to study all night to do well, but not getting enough sleep can impair your ability to concentrate, regardless of how much you've studied. Make sure sleep is a priority.

    Coping with Test Anxiety

    A little nervousness before a test is normal and can help sharpen your mind and focus your attention. But with test anxiety, feelings of worry and self-doubt can interfere with your ability to perform well in an exam situation. Below are ten strategies to help reduce anxiety.

    1. Prepare well . Develop good study habits. Study at least a week or two before the exam, in smaller increments of time and over a few days (instead of pulling an "all-nighter"). Not sure how to study correctly? Ask friends for help who you know study regularly and do well, join a study group, or find a tutor. Also, find out what you can about the exam in advance, such as the types of questions and length, so that there will be no last minute surprises.

    2. Watch Self Talk . Learn to replace negative self-talk with supporting self-talk. When you're thinking something negative like "I can’t do this, it’s just too hard," imagine a stop signs and change it to something more positive, like "This is hard but I can get through it." It is useful to make a list of the negative thoughts you often have and write a list of positive, believable thoughts to replace them

    3. Visualize Success . While studying imagine yourself feeling confident and clearheaded in the exam. Visualizing yourself doing well on the test can help you to make it happen in real life.

    4. Relaxation Strategies . Make use of relaxation exercises such as deep breathing, progressive muscle relaxation, and guided imagery. Use these strategies in the weeks leading up to the test and during the test as needed.

    5. Stay Healthy . Get enough sleep, eat healthfully, exercise and allow for personal time. If you are exhausted—physically or emotionally—it will be more difficult for you to handle stress and anxiety.

    6. Arrive Early . Nothing will heighten anxiety like the feeling of rushing to get to a test. Arrive at least 10 minutes early. Avoid people who are anxious before a test and do not second guess what you know.

    7. Focus During the Test . During the test, do everything you can to maintain focus. If you find yourself becoming anxious, stop and regroup. Sharpen your pencil, ask a question, or focus on taking a deep breath.

    8. Accept a Little Anxiety . Recognize a little bit of anxiety before a test is a good thing. If you did not feel nervous at all, you might not be motivated to do your best. It is only when anxiety becomes unmanageable that it is a problem.

    9. Expect Setbacks . If you have a bad experience, realize that there will always be road blocks along the way. Plan for a better experience next time and know that one bad test result does not mean you cannot improve in the future.

    10. Reward yourself . Plan on a reward after the test. Take some time to relax and clear your mind.


    image In the United States, an estimated 22% of people diagnosed with HIV in 2014 were aged 13-24 years. Despite the disproportionate number of new HIV infections occurring among youth, the percentage tested for HIV is low compared to other age groups. Only 1 in 5 sexually experienced U.S. high school students have ever been tested for HIV.

    What can you do?

    • Get Educated .

    Learn the basic facts about HIV transmission, testing, and prevention

    • Get Tested .

    CDC recommends that everyone between the ages of 13 and 64 years get tested for HIV at least once as part of routine health care. Contact your health care provider about testing.


    CDC: Healthy Youth Website


    The Scoop on Poop

    Many students come in to the student health center with concerns regarding the frequency of their bowel movements (BMs). The “normal” range for BM frequency is anywhere from 3 times daily to 3 times weekly and everyone has a different level of regularity within this range. More frequent and loose stools could indicate diarrhea. Less frequent and hard stools is indicative of constipation.

    Constipation can cause painful and difficult passage of stool.

    Some common causes of constipation include:

    • Poor diet (high in animal fats and sugar, low in fiber)
    • Irritable Bowel Syndrome (IBS)
    • Travel
    • Hormonal disturbances
    • Pregnancy
    • Underlying medical problems (such as neurological diseases, spinal cord injuries, or tumors)
    • Medications

    For most people, constipation is usually temporary and resolves with lifestyle changes and time.

    Ways to prevent constipation:

    • Increase dietary fiber with foods such as beans, fresh fruits and vegetables, and whole grains
    • Eat less foods that are low in fiber such as processed foods, meat and dairy
    • Increase exercise
    • Drink more water
    • Reduce your stress levels
    • Do not use laxatives regularly (using them habitually can cause your body to become dependent on them)

    Constipation rarely indicates a serious underlying medical problem. You should make an appointment with a provider at the student health center if your symptoms are severe, persist longer than three weeks, and/or you experience passage of mucus and/or blood with the stool.


    Acne is a very common problem during your college years. It affects between 43 and 51% of people ages 20-29. It is the most common skin disorder in this age group. Acne can be embarrassing, cause scarring and be psychologically impactful for those that have it. If you suffer from acne, we can help. Our clinicians are experienced in the management of acne and know when to refer a patient to a dermatologist for other treatment options.

    The Anatomy of Acne

    · Skin is covered with tiny holes called hair follicles, or pores. Follicles contain oil glands, called sebaceous glands.

    · These glands make oil, called sebum. This keeps your hair and skin moisturized.

    · During puberty, hormones can cause the skin to make too much oil, and it can get stuck together with cells inside the pore, and with outside dirt or oil. This can cause a sticky plug in the pore, which becomes an acne a.k.a, pimple, zit, blackhead.

    · Genetics plays a role, too. If your parent had acne as a teen, it's likely that you will, too

    Myths About Acne

    · Acne is not caused by eating greasy foods like French fries or pizza, or by eating chocolate.

    · Scrubbing the skin does not stop acne. It can even make the problem worse. Clean your skin regularly and after heavy workouts. Just remember, don't over scrub.

    · Wearing makeup doesn't necessarily cause acne. Choose makeup carefully. All makeup should be oil-free so it doesn't clog up your pores. However, it does help to clean your face regularly to keep makeup from clogging pores, particularly if you are physically active.

    · Stress does not cause acne.

    Ways to Help, or Treat, Acne

    · Hormones have a lot to do with acne (and you can't help those!). But, you can help prevent oil buildup by washing your face morning and evening with warm water and mild cleanser. Also, wash your face after exercising.

    · Keep your hands away from your face. The oils and dirt from your hands can aggravate breakouts. Never pick or try to pop pimples—it can lead to scarring.

    · Wash your hair regularly, to minimize oil from hair getting on your face.

    · There are a lot of acne treatments available at your drug store. These creams, washes, and soaps work in different ways such as reducing oil production or helping to break down blackheads or whiteheads. You may have to try several to get the one that works best for you.

    · You can also make an appointment with the student health center to see a physician for other treatment options.

    Power Nap

    Did you know that a power nap can improve productivity and mood, lower stress and improve memory and learning?

    Sleep experts recommend that adults get between 7-9 hours of sleep a night, but the average college student, like most Americans, are sleep deprived and get between 6-6.8 hours of sleep. This lack of sleep can have numerous negative effects, such as a lowered immune system, more stress, and decreased academic performance.

    Napping Tips:

    · The first tip is psychological: Recognize that you are not being lazy- napping will make you more productive and more alert after you wake up.

    · Limit your nap to 20-30 minutes. Any longer than that and you may wake up feeling groggy.

    · Use your cell phone alarm clock to wake you in 20 minutes. Set it to vibrate, so it wakes you up gently and doesn’t disturb anyone else in the room.

    · Nap in the late morning or just after lunch. If you nap late in the day you may disrupt your nighttime sleep.

    · Minimize sleep distractions with a dark and quiet place to nap. Use eyeshades and earplugs

    · Remember that body temperature drops when you fall asleep. Raise the room temperature or use a blanket.

    Energy drinks, do you really need the boost?

    Energy drinks, beverages like Monster and Rock Star, are often marketed to increase energy, improve concentration and enhance performance. Most energy drinks contain large amounts of caffeine, other plant based stimulants like guarana and ginseng, simple sugars and other additives. The amount of caffeine varies between products, but can range from 75 milligrams to over 200 milligrams per serving. Compare this to 34 milligrams of caffeine in a Coke, 55 milligrams in a Mountain Dew, and 50-75 milligrams in a shot of espresso. Some energy drinks do not contain caffeine, but caffeine equivalents like guarana. If you recognize energy drinks as high caffeine drinks, you will have a more accurate picture of what they are and how they may affect you.

    What are the common effects of energy drinks?

    Energy drinks have stimulating properties and can increase wakefulness, alleviate fatigue and increase focus. Individual response to caffeine varies, but caffeine’s effects are felt about one hour after taking it and last from 4 to 6 hours. Caffeine can also cause unpleasant side effects including dehydration, nervousness, restlessness, increased heart rate and blood pressure, stomach upset and insomnia. Occasional use of energy drinks in the recommend serving size is not necessarily bad for you, but over use, or drinking large quantities can lead to serious side effects.

    How much caffeine is too much?

    Up to 400 milligrams of caffeine a day is considered safe in healthy adults; and no more than 100 milligrams in adolescents. If your caffeine habit totals more than 500 milligrams per day, or if you are having side effects it is time to cut back.

    Are energy drinks safe to use as sports drinks or to drink when I am working out?

    No, energy drinks are not sports drinks. Caffeine is a diuretic and in combination with fluid loss from sweating can lead to severe dehydration and other side effects like increased heart rate, palpitations, or elevated blood pressure.

    What about energy drinks and alcohol?

    This combination has serious dangers. Energy drinks are a stimulant and alcohol is a depressant, the effect of the stimulant in energy drinks, may mask the signs of intoxication from alcohol. This stimulant effect may give a person the impression they are not impaired from alcohol, and lead to dangerous consequences. When the stimulant effect wears off, the depressant effects of alcohol remain and could cause respiratory depression or vomiting in your sleep. Research also shows that people who combine alcohol and caffeine drink more and have higher blood alcohol concentrations. In addition, both energy drinks and alcohol are diuretics, and the combination can lead to severe dehydration. Premixed drinks containing alcohol and caffeine or other stimulants have been taken off the market because of the dangerous effects.

    What about caffeine powder?

    Powdered caffeine is very dangerous and should not be consumed. The FDA issued a warning in 2014, urging people to avoid caffeine powder after the reports of two deaths from ingestion.

    What are some caffeine free alternatives to increase energy?

    • Adequate sleep, 7-8 hours every night.
    • Daily exercise, 30-45 minutes of physical activity most days of the week.
    • Spending time outside with friends or family.
    • Keeping a daily schedule, getting up and going to bed around the same time each day.
    • Eating a healthy diet, rich in whole grains, fruit, vegetables and lean protein.

    Have questions or need more information:

    Call the Student Health Center at 209-228-2273 and set up an appointment to see a provider.

    Check out: The CDC

    The Mayo Clinic

    Vaccines and Autism

    Q: Have you ever heard that vaccines cause Autism?

    A: A parent’s desire to know exactly why something as serious as autism has struck her child is very strong. The fact is, science has not yet determined exactly what causes autism. But parents can be reluctant to accept a "we don’t know" answer when vaccines offer an easy and fairly plausible alternative.

    Nevertheless, there are explanations.

    The same explanation applies to vaccines and autism. Autism is usually diagnosed during the same age range when children are getting their routine shots. Naturally, if enough children develop autism during these ages, sometimes it will be noticed within a day or two after a vaccination visit. Even if it happens several hundred times, this is a tiny number compared with the millions of children who get vaccines every year and don’t develop autism afterward.

    Also, it is a very common logical error to assume that because one event directly follows another, it must have been caused by it. We laugh at the old folk belief that the rooster’s crowing makes the sun come up, but the reasoning is exactly the same. The difference is that the idea of a rooster causing the sun to rise is ridiculous, while the idea that vaccines can cause autism sort of makes sense. But that doesn’t make the argument any more valid. For the theory that vaccines cause autism to make logical sense, someone would have to show that children who get vaccinated are more likely to develop autism than children who don’t. And no one has done that.

    It would be nice to simply say that vaccines don’t cause autism, but it wouldn’t be good science. A basic principle of science is that you can’t prove that something is not true. We all believe that if you let go of an apple it will drop to the ground. But that belief is based on the observation that it has always happened that way in the past. It doesn’t prove that the next time you try it, the apple might not fly up into the air instead.

    So to say that vaccines don’t cause autism would be scientifically dishonest, regardless of how sure we are that they don’t.

    What we can say is that at least a dozen rigorous scientific studies — designed to detect a connection between vaccines and autism — have been published in reputable, peer-reviewed journals; and these studies have overwhelmingly failed to show any connection between vaccines and autism. The Institute of Medicine, an independent, objective "advisor to the nation" on health, reviewed these studies, and concluded that there is no plausible evidence that vaccines cause autism. But they went farther than that. They advised that money that could be used to fund more studies on vaccines and autism would be better spent on areas of autism research more likely to be productive.

    This isn’t exactly saying, "Vaccines don’t cause autism," but it is about as close as any group of scientists is likely to come to it.

    If you would like to read more about vaccines and frequently asked questions, please go to

    The information in this clinician’s corner was taken directly from the website on the web page cited above.

    To Drink or not To Drink? 09.02.2015
    Being a college student here at UC Merced means being faced with the responsibility to make decisions regarding your health and safety. An example of a situation that you may encounter in college is having to make decisions regarding alcohol use.

    Irresponsible alcohol use can have serious consequences:
    • More than 1800 college students die each year from alcohol related unintentional injuries
    • More than 600,000 students are unintentionally injured each year while under the influence of alcohol
    • Irresponsible alcohol use can also lead to sexual abuse, unsafe sex, assault, drunk driving, and academic problems.
    Abstaining from alcohol is always the safest choice to make, but if you do decide to drink, there are some things you can do to decrease your risk of alcohol-related harm:
    • Avoid drinking games
    • Know your limits of alcohol consumption, set your limit and keep track of your alcohol consumption
    • Eat before and while you are drinking
    • Always have a designated driver
    • Alternate non-alcoholic drinks with those containing alcohol
    If you think you may have a problem with alcohol please make an appointment at the Student Health Center at 209-228-2273
    Welcome Bobcats!
    Welcome to our new Health Services website.
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