Medical Examiner 1-20-23

It’s safe to say nearly everyone in the area has thought about dog bites more than once in the past few days. The attack in Grovetown on Justin Gilstrap (right) by three loose dogs has been a major news story. The 11-year-old had most of his scalp torn off, an avulsed ear, and lacerations and abrasions from head to toe. His immediate future is a laundry list of medical and cosmetic procedures to repair the injuries and restore his health and appearance as much as possible. Thousands of people have already contributed to his medical expenses (gofundme.com/f/justin-gilstrap-medical-bills).

As unfortunate as it is, the incident is a good reminder to pet owners to be conscientious and responsible. When they aren’t, the results can be tragic and deadly. And it offers everyone an opportunity to call to mind the best ways to practice safety around dogs, whether they are your own or belong to others. Please see the box to the right.

TOP 10 DOG BITE PREVENTION TIPS

— from the American Kennel Club

1. Always ask for permission: “May I pet your dog?”

2. Show me your hands! Don’t do it. Offer the back of your hand for a dog to smell first before trying to pet it.

3. Approach a dog slowly. A fast approach might feel threatening. Give the dog time to accept you on its timetable.

4. Don’t bark or growl at a dog. That can come across as aggressive or threatening.

5. Accept that every dog can bite. If they have teeth, they can bite.

6. Never leave young children and dogs unattended. A recent analysis by the CDC found that 80% of dog-bite-related fatalities occurred among children.

7. Teach children proper pet manners. They should know things like not to pull their ears or disturb them when they’re sleeping or eating.

8. Stand still around loose dogs. Running away can trigger dogs’ predatory instincts.

9. Service dogs should not be disturbed. They’re working.

10. Remember: dogs are not people. They are animals. They may feel scared or threatened for reasons we don’t understand and react sharply, even toward familiy members they have been around for years.

My wasweakness cured

I’d like to share my story with your readers. I’m sure that family ties in the occurrence of the disease I have has been proven multiple times, but it has taken 50 years to see it in my case.

I had been a sickly child, inheriting asthma from my mother and her father. I never outgrew it. I married at age 16. We hadn’t been able to produce a pregnancy for 8 years and were considering adoption.

A friend and I were grooming poodles in Aiken back then at The Doggery. At around age 24 I began experiencing a strange weakness in my muscles. When using the clippers, my hand and arm would weaken to the point that I would need to lay my hand on the table and let it rest. After a minute or two I could lift my arm and work a little longer. I would repeat that process until my work was done. I decided exercise might help, so I started to run. Within about 2 minutes I fell

flat on my face. I had to rest my body a few minutes, but I was able to get up. I went to a local doctor and he gave me B-12 shots, which didn’t help at all.

The next symptom I encountered was double vision. After some testing, my optometrist called an ophthalmologist and sent me directly to his office. He examined me and called Dr. George Mushet at the Medical College of Georgia Hospital and sent me over to him. He tested my strength in several ways, then gave me an injection. Wow! The problem was solved! My diagnosis was myasthenia gravis (MG). It was Dr. Mushet’s “pet disease.” He was the expert. No one I told about my diagnosis had ever heard of it.

There was a medication I could take to relieve the symptoms, or a surgical procedure which could lead to full recovery. I was so fortunate to have MCG in Augusta. I chose the surgical option and

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 9 year-old daughter has started biting her fingernails. You are worried that this will grow into a bad habit that will be difficult for her to break. What do you do?

A. Slap her hand whenever you see her biting her nails.

B. Tell her that it makes her hands look ugly when she bites her fingernails.

C. Just ignore it. It will pass.

D. Explain to her how difficult it is to break bad habits once they get started. Tell her that the two of you are going team up and work on this together. Set up a time each week to look at her nails, and let her know that she will get a reward if she has not bitten them.

If you answered:

A. A child biting their nails is usually a nervous habit. To slap her when you see her doing it will just put her more on edge and more likely to bite them.

B. As above, to tell her that her hands are ugly when she bites them will just make her more nervous and more likely to bite them.

C. Nervous habits like nail biting will not go away by being ignored. You are going to have to take some action.

D. This is the best response. Work with her in a positive way to stop biting her nails and reward her progress.

Nervous habits arise out of anxiety. Methods of dealing with them that lead to more anxiety will almost never work and are much more likely to make the problem worse.

Dr. Proefrock is a retired local clinical and forensic child psychologist.

WEARING GLOVES PREVENTS THE SPREAD OF GERMS

You may not have realized it, but we are living in the Golden Age of Gloves. Never before in human history have so many gloves been worn by so many to prevent the spread of so much bacteria, germs, and viruses like COVID.

There are hundreds of pages of human history that saw nary a single glove in sight, and even the start of this very decade would have seen just two groups regularly wearing gloves for the protection of health: medical personnel and restaurant workers.

But with the dawn of the pandemic, suddenly millions of people were wearing latex gloves all day every day: postal workers, convenience store clerks, bank tellers, grocery store cashiers...the list of non-medical people emulating the sterile practices of medical professionals was seemingly endless.

There was just one major

difference: doctors and nurses typically put on gloves for a specific task (like surgery, or a basic examination of a single patient) and take them off immediately afterward. If another situation calling for gloves presents itself (like another patient in the exam room next door), they’ll put on a fresh set of gloves.

By contrast, the postal worker, the convenience store clerk, the bank teller and the grocery store cashier all do something completely different: they wear the same pair of gloves for hours at a time. During those hours they touch dozens, if not hundreds or even thousands of surfaces and objects, and in so doing they can transfer germs and bacteria as effectively from surface to surface as if they were not wearing gloves. In reality, their gloves accomplish nothing protective (unless the person had an uncovered open wound on their hand), other

than perhaps giving the person a false sense of protection.

And wearing gloves can look good to others, too. One study found that customers who could see their food being prepared (like at a Subway, for example), were not comfortable seeing workers doing so without gloves. But the same study found that many food service workers in such situations wore the same pair of gloves for hours at a time, going from unloading trucks to preparing food to mopping floors, all wearing the same pair of gloves.

When researchers asked the workers about their sanitary habits related to food prep, the answer was always the same, a variation on, “Hello? I wear gloves!” Yes, but didn’t you just take some trash out to the dumpster out back? And then go straight to food prep? “Yes, but I’m wearing these latex gloves!”

It seemed that wearing gloves conveyed the sense of a magical barrier against germs. When a companion study looked at food service workers who did not wear gloves, researchers discovered much cleaner kitchen environments, more frequent hand-washing and greatly reduced presence of bacteria as compared to workers in similar situations who relied on the magical power of gloves.

Gloves are great. Even though they are dispensed by the millions, they are indispensable. But they can only do so much. And for only so long.

Football season is concussion season, plain and simple. Football is a sport that seems to lend itself to concussive injuries.

Before we dive in to the subject of concussions, a brief comment about Buffalo Bills player Damar Hamlin and his collapse during a recent Monday Night Football game. News reports commented on his “injury” and the violence inherent in football. He experienced cardiac arrest from a garden-variety tackle that in a one-in-a-million event disrupted his heart’s electrical rhythms. The event was not

an injury and was not particularly violent either.

That isn’t the case with concussions, which are a mild form of traumatic brain injury (TBI) resulting from the brain being bounced around by some impact. A concussion may result in dizziness or confusion, or even temporary loss of consciousness.

About five years ago saw the first appearance of the now ubiquitous blue medical tents, originally developed at the University of Alabama and these days used everywhere. They offer a private

space free of distractions to conduct the initial assessment of a player, a series of questions that are basically the same whether it’s at the Super Bowl or a high school game. They’re called Maddocks questions, named after a clinical neuropsychologist from Australia named David Maddocks. The questions are simple, but if someone’s bell has been rung, they can be difficult to answer:

• At which field are we?

• What quarter is it?

• How far into the quarter is it—the first, middle or last 10 minutes?

• Which side scored last?

• What team did we play last week?

• Did we win last week?

There are variations, such as asking a player for their name, day of the week, the name of the current U.S. President, etc., but Maddocks discovered that questions about very recent events are more likely to reveal whether there is a problem or not.

If a player passes with flying colors, they are often cleared to return to play. If there are issues, caution is the byword.

The NFL Concussion Protocol has 5 stages. Initial diagnosis mandates rest until his neurological signs (cognition and balance) are normal, which is followed by (2) Light Aerobic Exercise; (3) Introduction of Strength Training under supervision; (4) Non-Contact Football-Specific Activities; and finally (5) Full football Activities and Clearance to Return to Play. Each case is different, so the 5 phases are dependent upon a player’s progress, not the calendar.

In the non-NFL world in which 99.99% of us live, it’s important to seek medical attention when a blow to the head results in any of the symptoms shown. Don’t make a Google diagnosis; let a trained physician make the call. It is, after all, the brain we’re talking about. +

There is a possibility this man, Robert F. Borkenstein, has saved your life multiple times and you never even knew it. Or maybe he has caused you untold trouble, grief, lost wages, and thousands of dollars in expenses. If so, he has no apologies.

You see, he invented the Breathalyzer. In so doing, he has been responsible for removing countless thousands of unsafe drivers from roads all over the world. And no doubt many of those caught by his invention have many tales of self-inflicted misery and woe to tell.

Borkenstein was born in Fort Wayne, Indiana, in 1912 and had the misfortune to graduate from high school right as the Great Depression was beginning. Unable to afford his planned college education, he went to work as a technician in a photography lab. He showed his skills from the start, inventing a color camera. That innovation led to a position with the Indiana State Police Criminology Laboratory. There he helped improve the use of photography in law enforcement.

At some point during the 1930s, Borkenstein began to work with Professor Rolla Harger at the Indiana School of Medicine. Harger was working on an invention he called the Drunkometer. It was accurate and effective, but cumbersome and complicated to use. Police officers practically had to have a degree in calculus to compute test results.

Borkenstein continued to tinker with the concept of mobile alcohol analysis, leading to the 1954 release of his famous Breathalyzer. It revolutionized field sobriety testing due to its compact size and ease of use. Most importantly, it was established as reliable and accurate.

Police all over the world use Borkenstein’s invention, and over the years it has enjoyed a steady run of various improvements and new applications. In 1970, for instance, Borkenstein introduced a coin-operated model “that could be installed in cocktail lounges.” For 25 cents, a person would blow into a straw that popped out of the machine. Depending on their blood alcohol content (BAC), the machine would give the user one of three messages: “Be a safe driver,” “Be a good walker,” or “You’re a passenger.” Today it is even possible to get constant real-time BAC readings from a smart watch.

While working on his and Dr. Harger’s inventions, Borkenstein attended classes at Indiana University part-time, making good on his original plans to further his education past high school, finally earning his bachelor’s degree in Forensic Science in 1958. That same year he became a faculty member at IU, named as Chairman of the just-created Department of Police Administration. He was a life-long innovator and researcher who was not afraid to go where the facts took him. One such case: Borkenstein was involved in the noted Grand Rapids Effects study, which established that people who have had a little to drink (2 oz. or less) are actually safer drivers than those who abstain completely.

When Borkenstein was elected to the National Safety Council’s Safety and Health Hall of Fame International in 1988, the Council noted that, “This technological innovation (the Breathalyzer) enabled traffic enforcement authorities to determine and quantify blood alcohol concentrations with sufficient accuracy to meet the demands of legal evidence.” +

ON THE ROAD ON THE ROAD TO BETTER HEALTH

A PATIENT’S PERSPECTIVE

Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com

by Marcia Ribble

I’m going in this morning for a CT scan, but first I need to drink two large bottles of nasty goo. Oddly enough, I am far less concerned about the test results than I am about ingesting the barium without tossing my cookies. I have been working to distract myself from even thinking about it.

So far, I have used my watercolor pens to occupy myself, painting several complex pictures; run through posts on Facebook, and snuggled and petted the dog. I cannot eat or drink anything so that option is out, but I can go out and ret rieve the newspaper and read it. I’m already dressed warmly to deal with the cold weather. I’ve taken out the trash container to the curb for pick up day. I need to call and cancel Meals on Wheels for this morning. Feeding the dog and making sure she has water is another small task to accomplish before I leave.

I drank the bottles of nastiness without throwing up and the CT was completed as scheduled. I still am having rumbles in my tummy, but I’ll live. It’s time to wait for the results. They should be available in two days. Now to catch up on the sleep I missed last night!

No news yet. It’s very early on Friday and I’m surprised at how little I’ve worried about the test results. There are two basic possibilities: one is a mass of some kind messing with my insides, and the second is scar tissue from surgery in 1984 that is also messing with my insides. At my age I have learned not to jump the gun and imagine all possible bad things that could conceivably

happen to save energy for what actually happens. Then I can deal with it as well as is possible. I’ve learned that panic is not an effective mode of operation. I’ve also learned that I am a very competent problem solver and very strong and tough when facing uncomfortable issues with my health or otherwise.

I just ordered another set of watercolor brush pens to replace the ones I have now when they run out of juice. They were on sale, with a $160 pen set on sale for $44. Pen brushes have a pen shape and cavity for the watercolors, and a flexible pointed brush tip that allows for both fine and broader lines. This set also comes with heavy paper stock that makes more creativity possible; no patterns, just empty space waiting to be filled.

I love painting, but it’s pretty messy. These brush pens will allow painting that is much neater because they require no cleanup. I just pop the top back on so they don’t dry out and I’m done. This allows me to paint whenever I have a bit of time and space in whatever space I happen to be in.

The act of painting intricate patterns demands that I focus control and stay attuned even to my breathing, because calm bodies allow hands to function to their maximum efficiency. In addition, I need to pay attention to colors and their mutual effects on one another. Because these are watercolors they can run and blend with one another easily, allowing for shading and other effects not easily available in other mediums, and the colors are strong, too, not wishy-washy.

Just like I try to be. +

Who is this? I LOVE THE MEDICAL

Middle Age

BY J.B. COLLUM

We just crossed the frontier into a new year, and we’ve had the typical bumper crop of celebrity deaths that seem to happen every new year. It isn’t just celebrities though, since it seems that marking another trip around the sun for our planet and those aboard is a risk factor for death for all of us, except children. This is especially true for us middle aged folks. I base this, not on anecdotal evidence, but on a study I read about the subject.

Okay, I didn’t read the whole study (and wouldn’t unless I was suffering from some really bad insomnia), but I did read the abstract and even that helped me take a nice little nap. I did eventually wake up and finish it and the study revealed that deaths from natural causes spike right around the new year. My own dear grandmother passed away on New Year’s Day back in 1999, so I also speak from personal experience. That day never goes by now without me being reminded of it. There are probably a lot of readers of this journal that can attest to this in their personal lives as well.

When it comes to the deaths of celebrities, it is something most of us notice and we share in the grief collectively. When I heard about the premature death of Lisa Marie Presley at age 54, it hit me pretty hard because she is younger than me, so it made me think about what I’m doing or not doing to take care of myself. I’ve already started back on a diet to both work harder at getting my A1C down to a healthier number so that I can get my diabetes under better control, and to reduce my weight for all of the other health benefits that come along for that ride. Perhaps this goes through your mind too when someone so young dies. Well, young to us in the over-50 age group.

Speaking of that, I remember shedding a little tear the first time I had to fill out a questionnaire and I had to check the little “55-64” age range box. Before I passed that threshold, I was always thinking something like, “wow, I feel bad for those folks. Glad I’m still in

with the hep crowd.” You know what? I just looked up hep to make sure I spelled it right, and the definition even made me feel old. It said that hep is an old-fashioned term for hip. I kid you not. Look it up.

Anyway, I was just trying to recount the famous folks we lost in the past few weeks, and they are a Who’s Who list of people that we grew up with. Along with Lisa Marie Presley, they were people like Christie McVie of Fleetwood Mac, all-world guitarist Jeff Beck, Fred White, the uber-talented drummer of Earth, Wind, & Fire, Adam Rich, the cute little kid we remember from Eight is Enough, Robbie Knievel, Evel’s son and fellow daredevil, Robbie Bachman of Bachman Turner Overdrive fame, and there are probably many more that I forgot about, but these were ones that hit me a little harder than most. In the cases of at least three of these, they were only in their fifties or early sixties, so that also gives me pause about what I need to do to stay alive and be there for my family as long as I can. It makes resisting that brownie a little easier and making myself go out and walk seem like a worthwhile venture.

I don’t know why deaths spike around the passing of a new year, and the study that I referenced earlier admitted that they did not find a reason either, but no matter the cause, it is a real thing. So, I plan on making an effort to check in on my friends and family around this time of year from now on, in case a little visit or phone call might make the difference in helping them to hang out with us a little longer. I think it is a good investment of my time, along with diet and exercise, of course.

These statements have not been evaluated by the FDA.

J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.com

WEAKNESS

… from page 1

they performed the removal of the thymus gland just behind my breastbone, and determined that it wasn’t malignant. I had completely recovered within one year.

Vocational rehabilitation offered to retrain me, and I chose medical laboratory training because medical help gave me my life back, and a good one. Within a year and a half we had an adopted son and I was working in the lab at Aiken County Hospital.

In my 30 years of medical experience I only knew of three patients with MG. All of them were men. I just found out recently that one of my first cousins, a female who was born two days after I was, has also been diagnosed with MG. We are 77 years old now. Her main symptom is double vision. If any other relatives have been affected, I am not aware of it.

I hope that some of the people who helped treat me at MCG and worked with me in Aiken will see this.

— Wanda Twitty Ridgeland, South Carolina (formerly Wanda Yarbrough)

SHAME, SHAME, SHAME

Near daylight, the shades of night crept back. But not enough to fully awake me. My mind wandered back to my high school days. Through the haze of times past, I heard Jimmy Reed’s mournful Shame, Shame, Shame. His guitar looped along hypnotically and his harmonica shrilled high. It was New Years and I was at peace with the world as far as I could tell … or so I hoped.

But the peace did not hold. My focus slipped into my half-century high school class reunion. Many had already gone to Jesus. Others stayed home. Others were hospitalized. Wheel chairs squeaked. Walking canes plodded along with uncertainty. Maybe the miracles of modern medicine were selective. We talked small and struggled with who was who. Advancing maturity

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy Laveau

does that, to some more than others.

Joann was there. We had dated briefly, if you can call it that. I wasn’t very hip back then. Courted in our well-worn ‘54 Ford farm pickup truck, back before pickups were muscled up and a kool tool for dating.

Joann had married a solid man after she got rid of me. Had children. Then grandchildren. Successful by any measure. Then she shocked my soul when she held up a rumpled blue balloon and a crumpled yellow tie. Joann related how I had

given her a box of chocolate covered cherries for her birthday. Shortly thereafter, she dumped me before my birthday, but she had bought me the yellow tie and blue balloon … out of spite, I guess. Somehow, she had retained this undelivered gift for half a century. Woman never forgive slights and remember out of spite. It is a rule

The blue balloon and yellow tie flashed to the world my lack of coolness, my youthful awkwardness for all to behold. Without a doubt, that was me.

My head hung in shame, shame, shame. Shame enough to make a grown man cry. Shame, shame ‘til the day I die. Some might have thought this stunt funny, but not me. My face had fallen from grace. Was Joann’s husband aware she had kept this awful secret all

these years, just waiting for the right moment to pounce?

Soon I would awaken from these hazed moments. Time to begin anew. Never is there a right time to ruminate over things unfixable. We all have shortcomings. Boxers say: It is not how many times you get knocked down. It is how many times you get up. Getting up is a choice. It costs nothing, but is frequently troublesome.

One thing is for sure, never again will I give chocolate covered cherries for a birthday. I must be more thoughtful.

Before long, I awaken into a new day. A new year. The reality of a troubled world hovered. But I worried not about this mythical faux pas of my long-gone youthful indiscretion.

With Covid ravaging our population and economy, I have bigger monsters to

dispatch. I am careful where I go. And when I go. I shop in the off-hours. I use debit cards instead of cash, thereby avoiding touching change previously handled by Lord knows whom. I avoid groups whenever possible. No bars. No clubs. No buses. No airplanes. No gyms. Am I overdoing it? Probably, but it is how I feel right now.

And certainly, no class reunions. Not because of balloons or ties, but because I don’t relish Covid again. I have had Covid twice, and that is more than enough. Plus, I do not want to transmit Covid to elderly classmates … or anyone else for that matter. They may not be as fortunate as I have been to survive.

Not only is it our responsibility to protect others; it is our duty. Shield them from our germs. Lest we have to hang our heads in Shame, Shame, Shame

Funerals caused by us, directly or indirectly, are not desirable social events.

SHORTSTORIES

HEARTBREAK Working in medicine you have to get accustomed to having your heart broken. There is joy too, but plenty of heartbreak. One of the saddest events I’ve ever seen, however, wasn’t directly about a patient. It was her family that broke my heart.

She was elderly and I had been seeing her in my office for many years. She started to decline but still lived alone and could take care of herself. Eventually I had to admit her to the hospital for pneumonia, if I recall. She did well and after several days I discharged her home.

I was still at hospital making rounds later that day when the ER called me down to see a patient of mine. It turned out to be the very patient that I had just discharged, the elderly lady. The ambulance transport service said they took the lady to her home but when they got there the door was open and her house was empty. There was nothing in the house — no furniture, food, anything.

Apparently her granddaughter or niece or someone like that had sold everything in the house while she was in the hospital, and threw away her pictures and everything else that was personal. Her entire life was gone.

As might be expected, she was inconsolable. I admitted her back into the hospital, and since she had no other family and no where else to go I had no choice but to send her to a nursing home. At least I was able to get her into a nursing home that I visit, so I could keep an eye on her and be a familiar face for her. Unfortunately, she never regained any semblance of her previous self. She remained profoundly sad and depressed, and died about 4 months later, and I’m convinced that it was a premature death.

It’s probably a very good thing I never saw whoever that family or family member was who did that to my patient. I’m sure I would not have been able to maintain a professional demeanor. It has been a number of years since this happened but I still remember everything about her, and it still saddens me what her so-called family did to her. I do believe in karma though.

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES

Registered

Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

SPICED BUTTERNUT SQUASH SOUP

---with Cardamom and Ginger

Today’s soup is brought to you buy the color orange and the letter “A” as in vitamin A. Vitamin A is great at maintaining the integrity of the immune system while the spices, including ginger, cumin, and coriander, have outstanding anti-inflammatory properties.

Ingredients

• 2 tablespoons extra-virgin olive oil

• Sea salt

• 1 teaspoon ground cumin

• ½ teaspoon ground coriander

• ¼ teaspoon ground cardamom

• 4 carrots, peeled and sliced 1-inch thick

• 1 pound butternut squash, peeled, seeded and cut into 1-inch cubes

• 6 cups Magic Mineral Broth (http://bit.ly/2ioCCgh) or good quality store bought vegtable broth

• ¼ teaspoon freshly ground black pepper

• 1 teaspoon grated fresh ginger

• ¼ teaspoon orange zest

• 2 tablespoons freshly squeezed orange juice

• 1 tablespoon freshly squeezed lemon juice (more if desired)

Directions

Preheat the oven to 400°.

Line a baking sheet with parchment paper. In a large bowl combine the olive oil, ¼ teaspoon sea salt, cumin,

coriander, and cardamom; stir until well combined. Add the carrots and butternut squash and toss until evenly coated.

Spread the vegetables in a single layer on the prepared baking sheet and roast for 30 minutes or until tender.

Pour one-third of the vegetable broth into a blender. Add the pepper, ginger, orange zest, and one-third of the roasted vegetables and blend until smooth, adding more liquid as needed. Transfer to a soup pot over low heat and repeat the process two more times. Stir in another ¼ teaspoon sea salt, the orange juice and lemon juice. Taste; you may want to add another spritz of lemon juice or a pinch of salt. Store the soup in an airtight container in the refrigerator for up to 5 days

or in the freezer for up to 3 months.

+

Yield: 6 Servings (serving size: 1 ¼ cup).

Nutrition Breakdown: Calories: 110, Fat 4.5g (0g saturated fat), Cholesterol 0mg, Sodium 420mg, Carbohydrate 17g, Fiber 3g, Protein 1g, Potassium 445mg, Phosphorus 25mg.

Percent Daily Value: 70% Vitamin A, 40% Vitamin C, 6% Iron, 8% Calcium Diabetes Plate Plan: 1 ½ Vegetable, 1 Starch, 1 Healthy Fat

Recipe from and used with permission from: CLEAN SOUPS: Simple, Nourishing Recipes for Health and Vitality. By Rebecca Katz with Mat Edelson. For more information see: http:// www.rebeccakatz.com/

Young Juliet was hopelessly enamored with Romeo, yet their families were always feuding, so dating was out of the question. She pined that his name was the only thing keeping them apart and concluded “A rose by any other name would smell as sweet!”

So is “rehab” just “rehab” no matter where you go to get well? Do they all smell the same?

Not. In this article, the second in our series on how to find a good rehab program, let’s look at the differences before you begin your search or you may end up with a real mess.

For a severe case, in an ideal world the levels of care would be on a sliding scale from Medical Detox, Inpatient Treatment, Partial Hospitalization Treatment, Intensive Outpatient Treatment, then a Sober Living Facility. Let’s take a look at them one by one.

• Detox – why? When I was a college student (start-

ing at age 16!) I flunked out in a year or so because when I went to class I was often chemically impaired, craving, or hung over. I couldn’t absorb anything the teachers said due to my mental state. In most cases an addict cannot use heavily one day and expect to go to treatment and be on a sharp learning curve the next. There is medical detox for some chemicals and not for others – trust a good evaluator to make a good recommendation for you. This phase could last anywhere from 3 to 14 days or so on average.

• Inpatient Treatment – the best for everybody, correct? After all, there’s no temptation there, right? Don’t believe it. Physical and mental cravings persist for some time despite being “locked up.” But at least there’s no drugs there! Maybe. Addicts can be very creative in finding their drug of choice! For the most part, true, you can hope that it’s a drug-free

environment. Just know that sooner or later your loved one has to come back to the real world, and even though a short separation from it can be a good thing, know that inpatient treatment alone is not a panacea. Research has shown that length of time in treatment, not intensity of treatment, is the critical factor.

• Partial Hospitalization Treatment – in hospitals only, right? No. This is a term used for treatment lasting 4-6 hours per day with nursing available, and at least weekly contact with a medical doctor and is usually done in an outpatient setting. It is a nice step-down from inpatient treatment and more intense than the next level of care.

• Intensive Outpatient Treatment – not as good as inpatient, right? Not necessarily. Addiction is classified in several phases from Beginning, Early, Middle, and Latter. It is usually not indicated for someone in

the Beginning stage to go inpatient treatment. Back in the day (referring to the ‘70s and ‘80s), the buzzword in treatment was “a 28-day Program.” One size fits all. Then some professionals in the field got together and reasoned, “when our cars aren’t running right we don’t all start out with a total engine rebuild! Sometimes we just need spark plugs.” Treatment can be overdone.

This level of care ranges from 9 to 15 hours per week of group treatment and works well for someone who keeps his/her job and stays at home and who is able to follow instructions well enough to stay clean/ sober while receiving help. Trust a good professional to determine which level of care your loved one needs, based on the ASAM Patient Placement Criteria (research this!).

• Sober Living Facility – short or long term? One month or 12? This level of care is where someone in

early recovery lives with others and usually finds employment and goes to recovery meetings often to shore up their sobriety skills. Sometimes due to financial constraints, people who need inpatient treatment start out in this phase – some do ok and some do not.

From the outset, do know what you’re looking for based on guidance from a treatment professional. Unlike roses, all rehabs certainly do not smell the same.

A monthly series by an Augusta drug treatment professional

PATIENT HERO

by Samantha Bowick, MPH, Board Certified Patient Advocate

HOW TO HELP SOMEONE WITH A CHRONIC ILLNESS

It can be challenging for someone who doesn’t have a chronic illness to know how to help someone who is chronically ill. Here are some things that can be helpful to someone who has a chronic illness.

• No judgment: While you may have an opinion on your loved one’s chronic illness, what they are/are not doing, treatments, etc., your loved one doesn’t need to feel judged. Judgment will lead them to isolate themselves and feel like they can’t share what they are going through.

• Listen: Listening can be a hard task to master, but it’s essential. Listening involves sitting there with your loved one while they talk about what they are going through. Without offering your opinion or solution.

SHORT

UNUSUAL RX My primary care provider told me she wanted me to eat an eclair at the local bakery every week and watch at least one football game a week. Then at my next appointment, she asked if I ate the eclairs and watched the football games. I thought it was weird so I asked her to explain her unusual instructions.

She said she knew I am so self conscious about

one asks for it. Try to put yourself in their shoes. If they can’t get together, go out, etc., don’t get upset. Don’t take it personally. There is a legitimate reason that they can’t do those things.

• Offer to help them research their illness if that’s something they (and you) feel comfortable doing.

• Offer to cook a meal or get take out. Cooking can be a challenging task. Standing for long periods of time can increase chronic pain. Your loved one may not eat healthy or May eat out a lot. A home cooked meal may mean so much to them.

• Be present with your loved one. Let them know they aren’t alone.

• When they say something about their health, believe them, even if doctors try dispute it. Your loved one is living with the chronic illness and knows better than anyone what they are going through.

• Do things you know they can do like watch a movie at home.

• Offer to take your loved one to doctor appointments. Maybe your loved one has a hard time getting out of the house by themselves or they don’t like going alone. Maybe they like having another person there to listen to what the doctor is saying. Offering to take your lovers one to a doctor appointment can go a long way and not make them feel alone.

• Offer to shop and do household chores. Maybe your loved one has chronic pain and can’t get around well. Because if this, their shipping and household chores may fall on the back burner. Offering to help do these things will be meaningful to your loved one.

• Show compassion and empathy. Think before you speak. Try not to offer your opinion unless your loved

• Ask what they need. Depending on how close you are with this person, they may tell you exactly what they need in that moment, in the next few days, or next few weeks. If the person isn’t forthcoming about what they need, try to think of ways you can be helpful. If it’s someone who doesn’t have a lot of visitors or see a lot of people, they may just need someone to talk to on the phone. Schedule a day and time to talk. Maybe it’s once a week in at Tuesday at 5pm. That gives them something to look forward to.

• Assure them that they aren’t a burden if this comes up. Many people with chronic illness often feel like a burden because someone is helping it take care of them. However, they aren’t a burden, they are loved, and they need to know this.

my weight that I don’t eat for several days before an appointment. An eclair is enough to stimulate your appetite, she told me, so I know you will eat enough to sustain yourself. I also know that you are so self conscious about your weight that you will never over indulge.

She also told me that I’m a workaholic and she knew that I enjoy football. “As

long as you are watching some football, I know you are taking some time to care for yourself,” she said.

I was shocked. Everything she said was true. I obviously didn’t hide it very well. But I learned that my doctor was paying attention to me and truly cared about my well being. She didn’t just treat the condition or the diagnosis. She treated the person.

CRASH COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined

How do you feel about roundabouts? Or as some people call them, rotaries? People seem to either love them or hate them, with the smallest group, the “I don’t care much either way” group, in the middle.

But like them or not, they are here to stay, and traffic engineers say they will be appearing in ever-growing numbers. Some states (New York is one) have mandated that every new intersection, and every intersection up for an overhaul, upgrade, or redesign, should be converted to or originally built as or a roundabout whenever possible.

Of course, not every intersection is a candidate for the roundabout treatment. They aren’t well suited for intersections where one road has very heavy traffic and the other road has very light traffic. Sometimes there are geographical limitations; there just isn’t enough room, or there are physical barriers that can’t easily be removed.

Why are roundabouts the next big thing in road design? (Believe it or not, the Insurance Institute for Highway Safety says the first modern roundabouts in the United States were constructed in Nevada in 1990.) Two factors come into play that are at first glance opposing objectives.

One goal is to keep traffic moving. The smooth and orderly flow of traffic is a key safety consideration on all roads, but increases in importance as the vehicle count on any roadway increases. Anything that isn’t smooth and orderly — sudden lane changes, stop-and-go traffic, driving much slower or much faster than surrounding cars, construction zones — increases the chances of accidents and injuries. Smooth and orderly traffic flow is Safe Roadway Design 101.

But the second goal of roundabouts, conversely, is to slow traffic down. The very design of these intersections make it an absolute necessity. But in doing so, roundabouts accomplish a huge boost in safety. Consider typical accident scenarios in traditional intersections: someone runs a red light or a stop sign and T-bones another vehicle. Both are traveling at full speed. The consequences are often devastating. Or maybe a driver starts a left turn and doesn’t see the approaching car behind a large truck. One car is traveling full speed, the other is almost stopped. The resulting crash is almost head-on.

Collisions like that are eliminated by roundabout design. All traffic is traveling in the same direction, and at slow speeds, typically only 15-20 mph. At worst, roundabout collisions are minor rear-enders or low speed scrapes. Fatal accidents are no stranger to traditional intersections, but are extremely rare in roundabouts.

One study found that drivers viewed new oundabouts unfavorably, but a follow-up study a year later discovered opinions had improved dramatically, illustrating the point that sometimes the problem with roundabouts is nothing more than a lack of familiarity. Once we get the hang of them we’re good to go.

One of the keys to their safety, however, is good design. Unlike the illustration above, a flat center circle is inviting accidents. Drivers unfamiliar with the area driving in conditions with poor visibility (at night, in fog or rain) could easily see headlights straight ahead and not even notice that the intersection is a roundabout until it’s too late. Signage, landscaping, and lane markings are all important elements in helping roundabouts live up to their full potential in making travel safer. Then it’s up to drivers to go with the flow.

the blog spot From the Bookshelf

HOW TO SWALLOW A PILL

You’ve been swallowing things your entire life. But did you know that swallowing pills is different?

Let’s start with how not to swallow a pill.

Sorry, but Bruce Willis in all five Die Hard movies is incorrect. You don’t just take a small handful of aspirin, toss them into your mouth, and jerk your head back while swallowing.

Not to mention, if you have a dry mouth (xerostomia) or trouble swallowing (dysphagia), the pills will likely get stuck and make you choke. Or, they’ll just roll around your mouth and stick to the inner part of your cheek.

Mission not accomplished! So, what is the best way?

First, these tips and tricks apply to all pills: prescription medications, over-the-counter medications, supplements, vitamins, and other oral remedies (not dissolving or liquid formulations).

Pills can often be more comfortably swallowed when taken with something that is not water. Try “nectar-thick” liquids, applesauce, pudding, and the like. Or, even a mouthful of food that you have chewed. Pop a pill in just as you are about to swallow.

It is easier for many people to swallow something with substance because when it gets to the back of the mouth (posterior oropharynx) the tongue base has an easier time propelling it downward.

The technique is also important. Do not toss your head backward and chug them down; you are not drinking beer. Actually, tilting your head forward can help avoid pills “going down the wrong way” (translate: ending up in your airway and causing lots of coughing and gagging).

I’ll never forget when my late grandmother was in the hospital. She was not used to taking many medications and couldn’t get her morning meds down. Gently redirecting her to tilt her head forward did the trick.

This brings up another reason for trouble swallowing pills, a condition called presbyesophagus. No, it is not a religious term. It literally means changes in the appearance of the esophagus. As people age, there are many factors that can lead to the esophagus not working well––it is a muscular tube, and many things impact muscular function. So, if a pill is “not going down,” it can get stuck and cause many problems.

Here’s where things get counterintuitive. Bigger pills are easier to swallow than smaller pills. Yes, I realize those “horse pills” are daunting. But, swallowing a tiny pill — you know, the ones that when you drop on the floor you can’t find — can be tricky because they are so tiny and hard to propel downward. Chugging some water afterward can definitely help.

Another tip is to ask your pharmacist or check online resources to see if your pill(s) can be crushed before taking it. Not all pills can, and sometimes crushing will destroy how the medication or supplement is to be absorbed. So, be sure to find out.

Do you have a bitter pill to swallow? And, yes, I mean an actual bitter pill, not the metaphorical one! Another trick is to learn where the taste buds are generally located on your tongue. If you carefully place a bitter pill (prednisone, for example) on the center of your tongue, you’ll get less of that horrible aftertaste upon swallowing.

Lastly, I would encourage everyone taking any medication, supplement, or oral remedy to get into the habit of naming every one before swallowing. Also, name why you are taking it or for what condition. No doctor wants to hear your medication list as “a couple of little white ones and a yellow one.”

Susan J. Baumgaertel is an internal medicine physician

Here’s a book that is at the same time both trivial and educational. It’s great.

It’s trivial in that it takes a detailed and scientific look at some seemingly insignificant issues: what about the 5-second rule? Was George Costanza unfairly criticized for double-dipping? Is it really like putting your whole mouth in the dip? What about electric hand dryers? Do they blow bacteria everywhere? Is it dangerous to share a bucket of popcorn with your date? Is it bad that the chef in a 5-star restaurant tastes the sauce he’s preparing, then keeps stirring with the same spoon? Or does the heat kill any germs?

Those are just a few of the food myths (or are they?) addressed in labs up the road at Clemson University that are then recorded in this book.

As it turns out, there is no such thing as a 5-second rule, or if there is, it’s that germs aplenty can hitch a ride within 5 seconds of anything dropped on the floor. But then, you already knew that,

right?

As for double-dipping, sure, it’s a violation. But how about this variation: you take a healthy scoop of dip using a huge chip, take a bite, then flip it around so the unbitten portion of the chip is used for the double-dip. Do you know if that’s pretty safe?

Here’s a question you may have never considered: does blowing out the candles on a birthday cake increase the likelihood of spreading germs all over the cake?

Spoiler alert: yes. But only by 1,400%.

A compendium comprised only of such questions and answers might seem a bit

pointless and sophomoric. After all, many aspects of perfect hygiene are beyond our control, and no one wants to be grossed out by hypothetical scenarios.

But the book actually bases everything on a pretty comprehensive lesson about bacteria. Call it Bacteria 101. Read it cover to cover and you’ll have a pretty good grasp of the world of microbes — and it’s quite a world. It’s right under our noses and all around us, but we can’t see it.

Just one nugget from the book: the number of bacteria in and on one human being is greater than the total number of all humans who have ever lived.

So yes, by all means read this book. Then go wash your hands. With bleach.

+

Did You Just Eat That? — Two Scientists Explore DoubleDipping, the Five-Second Rulle, and Other Food Myths in the Lab, by Paul Dawson and Brian Sheldon, 224 pages, published in November 2018 by W.W. Norton & Company

— posted by Susan J. Baumgaertel, MD, on 11/11/2022 (edited for space)

EXAMINER CROSSWORD

THEBESTMEDICINE

Moe: Gas stations used to offer free air. Now it’s two bucks.

Joe: That’s called inflation.

A man loses three fingers in a work accident. At the emergency room he asks the doctor, “Will I be able to play my guitar with this hand when it heals?”

“Maybe,” the doctor replies. “But I wouldn’t count on it.”

Ason approached his father and said, “Dad, can I please get a cell phone? Please?”

“Sorry son,” the father replied. “You know the rules. You can’t get a cell phone until you get your first job and you can pay for it yourself.”

“Come on, Dad! That’s not fair! All my friends have cell phones!”

“That may be true,” said the dad, “but your friends aren’t forty-two-year-old men still living with their parents.”

Moe: Why should you never annoy a pediatrician?

Joe: Because they have very little patients.

Moe: Why was Cinderella so bad at basketball?

Joe: Because her coach was a pumpkin.

Moe: My friend got angry when I called him a flat-Earther.

Joe: Yeah. They’re supposed to be called bulldozer operators.

Moe: Why do sharks live in salt water?

Joe: Because pepper water makes them sneeze.

Moe: Did you hear Sting was kidnapped?

Joe: The Police have no lead.

Moe: No offense Joe, but if you had a nickel for every time you failed a math test...

Joe: I’d have 37 cents.

Moe: Did you ask that cable guy what time it is?

Joe: Yeah. He said it’s between 8 am and 4 pm.

Moe: What did Chuck Norris do when his parachute failed to open?

Joe: He brought it back for a refund.

Moe: Why was there no congestion after that big rig crashed on I-20?

Joe: Because the truck was loaded with Vicks VapoRub.

Moe: This morning at the park I saw a guy dragging a clam on a leash.

Joe: You gotta give him props for being there with a pulled mussel.

Dear Advice Doctor,

On the basis of an excuse that turned out to be completely bogus, my supervisor asked me to do a job that was his responsibility. Not to brag, but I nailed it and he got all kinds of praise for the project, yet he never told anyone that I did the work. Not only did he fail to thank me (even privately), he offered a left-handed compliment about the job that was really more insult than commendation. Do you think I should go upstairs and tell his supervisor the whole truth?

— Wants to Return the “Compliment” (if you know what I mean)

Dear Wants to Return,

Once upon a time this would have been a simpler topic to discuss, but as more research is conducted and analyzed, some former “facts” are relegated to myth status by new and unexpected discoveries. Even so, very little about left-handed anything (except compliments) is carved in stone.

For instance, in the days of old, wishing left-handedness upon someone was like putting a curse on them: left-handers were believed to be more susceptible to sickness and have shorter life spans. Scientists now generally accept that being a leftie or a rightie has no effect on longevity.

There are differences, however. Some studies suggest that being left-handed affects early learning and school performance in areas like vocabulary, reading, writing, social development, plus gross and fine motor skills. Oddly enough, ambidextrous or mixed-handed kids perform at a lower level than southpaws.

Some studies also suggest a link between left-handedness and a greater incidence of mental health issues like dyslexia, attention deficit hyperactivity disorder, and some mood disorders. Being left-handed may also be connected to a higher risk of breast cancer, sleep problems and PTSD. On the plus side, being lefthanded can help protect against arthritis and ulcers.

But keep in mind that despite the findings of any ten studies, there are millions of left-handers who don’t exhibit learning disabilities, mental health issues, or any other negatives for which lefties are supposedly at higher risk.

Ultimately, what researchers don’t know about this topic is far greater than what they do know.

I hope this answers your question. Thanks for writing! Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

CARE

SHORT

This is the story of my boss showing up unannounced at my door.

Two weeks before, I delivered my forever-sleeping little boy at full term. I was heartbroken. The world stopped turning. All my footsteps felt heavier and everything I did was the most effort.

She showed up on a Tuesday just after 10 am. She had two cups of coffee and two donuts. I let her in and we sat in the living room with my dog and barely spoke. After half an hour she headed back to the office after leaving me some leaflets about occupational health and my rights to time off work following the stillbirth.

The next Tuesday, she’s at my door again. two coffees, two donuts. She suggests we take the dog for a walk. We do, and we chat about nothing in particular and the silences are plenty, but they dont feel awkward. Her visit lasted about an hour. When she left I noticed she had left me some lunch in my fridge with a note telling me to eat it. It was appreciated.

This Tuesday thing went on for 6 months. She missed maybe two or three times, but otherwise she turned up every week with a coffee in hand and no expectations of me. The silences gradually got filled with conversation. Sometimes we would talk about the birth and I’d cry. Getting emotional in front of her became less shameful. Sometimes we would just talk about nothing much. She made the transition back to work significantly easier; she became a friend and not just my manager. I will always be grateful for the time and effort she put into me when I was at my lowest.

SHORTSTORIES

RED FLAGS Here are a few warning signs I’ve observed in my years in the ER:

• A possible red flag is when they ask during initial registration, “Which doctor is on tonight?” Sometimes they’re just asking out of curiosity. Other times, they’re asking because they’ve had run-ins with some of the doctors in the past.

• When patients or family members immediately start barking orders at me, that’s a sign that I’m going to need a lot of patience. “No, I’m not putting on a gown. They didn’t make me put one on last time.” (But Mr. Smith, last time you were here it was for a toothache.) “She needs a drink of water right now.” “I called ahead of time, and they told me they’d see him

right away. Go check on that NOW.” “You get ONE try.” (This when I’m getting ready to start an IV.)

• When patients or family members start taking pictures of the room, the bed, the monitor, me starting the patient’s IV, etc., as if they were photographers investigating a crime scene.

• When a patient arrives at the ER, accompanied by eight concerned but obviously intoxicated friends.

• When the patient is obviously intoxicated, especially when s/he’s a known polydrug user, and we’re not sure what s/he has ingested.

• When the patient is a toddler who promptly starts screaming bloody murder as soon as s/he lays eyes on me. Most toddlers are (understandably) afraid of hospital settings and strangers wearing scrubs. But some toddlers, who are rarely exposed to anyone outside of their immediate family, are terrified at the sight of ANY stranger.

• When a patient (or family member) has googled his symptoms on the internet, and starts giving me orders related to his findings.

• When a patient comes in by ambulance with a very minor problem. Often this happens because the patient has no other means of transportation, and is expected to be given a voucher for a free taxi ride home after being treated.

In most cases, these are just minor setbacks indicating that I’ll have to make an extra effort to defuse the situation. Once in a while, they can lead to bigger problems.

Less than a million people can’t be wrong.

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