Medical Examiner 1-24-20

MEDICALEXAMINER

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HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

JANUARY 24, 2020

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AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

t seems like just yesterday we Breakthroughs during the decade were in The Roaring Twenties, include the discoveries of insulin yet here we are — boom! — right and penicillin. Vitamins A, B, C, back in the Twenties again. What D, E and K and various subtypes label might our decade of twenof each were discovered during the ty-something years garner before it’s 1920s, along with their crucial role all over? in maintaining health. Huge strides We have no crystal ball here at were made toward conquering our luxurious Medical Examiner such scourges as pellagra, scarlet world headquarters, but we can look fever, measles, hookworm, syphilis back. In the grand scheme of things and tuberculosis. Uncovering their one hundred years is a tiny blip in causes led to vaccines that preventthe stream of time, and because of ed measles, diphtheria and tuberthat the people of those Twenties culosis among up to 98% of those were not really very different from who received the newly developed us: they were dazzled by an explovaccines. R.L. Kahn devised a new sion of exciting new technologies. and more accurate test for syphilis.

Nothing seemed beyond man’s abil- George Papanicolaou, a Greekity to conquer with a suitable mixborn physician who had moved to ture of brawn and brains, and the the U.S., discovered a more effective evidence was everywhere. Horses test for cervical cancer in 1923. It and buggies were relics of the past. became known as the Pap smear.

Shiny new black cars were every Medical tools we view as ordinary where. Skyscrapers were reaching today were also first seen during the previously unimaginable heights.

Roaring Twenties. The 1924 Nobel Things were definitely humming.

Prize in Medicine was awarded to There was no denying that they Willem Einthoven of the Netherlands were living in modern times. for his development of the electro Medicine did not escape the Roar- cardiogram. ing Twenties’ march of progress. Please see ROARING TWENTIES page 16

AUGUSTARX.COM

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AUGUSTAMEDICALEXAMiNER PART 5 OF A SERIES BY JONATHAN MURDICK

Editor’s note: Our correctional nurse isn’t quite as fetching as the nurse on the cover of the pulp novel shown. Ours isn’t even a female. But our nurse has at least one exceptional advantage over the nurse in the picture: he’s real.

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PARENTHOOD

by David W. Proefrock, PhD

Your 14 year-old daughter has lost a great deal of weight recently. She is eating as usual, but seems tired and irritable most of the time. She says she needed to lose weight because she was fat. She looked healthy to you before she lost the weight and is probably too thin now. What should you do?

A. Talk with her about eating disorders and how dangerous it is for her to not eat properly.

B. Adolescent girls go through many physical and psychological changes. Keep an eye on her, but don’t worry too much unless the situation gets worse.

C. She may have an eating disorder. Take her to a mental health professional for an evaluation.

D. Take her to her physician for a physical exam.

If you answered: A. Losing weight while eating normally is cause for concern. Talking with her is not a sufficient response. She needs to have a physical exam.

B. You shouldn’t ignore weight loss and fatigue. She needs to be taken to her physician for a check up.

C. These are signs of a possible eating disorder, but they are also symptoms of other, possibly serious, physical problems.

She should be taken for a physical exam first to make sure that one of the physical problems isn’t the cause.

D. This is the best response, plain and simple. Don’t delay.

Take her for a physical.

Early adolescence is a time of high risk for many physical and psychological problems. It is best to address the physical ones first. If it appears to be an eating disorder, her physician will make a referral to a mental health professional. + Dr. Proefrock is a retired clinical and forensic child psychologist.

IT’SStillNOT TOO LATE! V

You may have a Medicare Special Enrollment option

onths have gone by I gradually settled into the uncomfortable routine of security checks, frisks, and insults. The prison was starting to feel routine. It had been weeks since the last major violent outburst. The rejects had been culled after the lock-inthe-sock incident, and the most violent among them were sent to Max. All in all, a hesitant truce seemed to be holding across the prison.

I was informed that as a guy, I was the preferred choice for Max duties. I quickly found my duties consisting of preparing medication envelopes for nearly 200 inmates followed by the horrifying experience that is pill pass in a lock down max unit. Inmates screamed, refused their meds, cursed, spit, and made life as all around miserable as possible. They questioned their medications, told me they were different inmates, spit their pills back at me, and some even continued to impatiently satisfy their sexual needs despite my previous conclusions that it was the female director they were staring at.

Nearly two months of this drudgery had passed when I found relief in the form of sick call. Some new female nurses were the talk of the town and every inmate lined up to have his jock itch examined by the “hotties.” The director quickly found a clever solution to this problem in the form of a 6 foot 3 bearded nurse. The faces of the inmates who realized they weren’t going to be examined by the hotties quickly turned

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50¢ despondent and even repulsed when I called them in. To say this little turn of fortune cheered me up would be putting it mildly.

Months of enduring harassment, insults, and threats were now paying off as the inmates realized I wasn’t going to be run off, and they weren’t getting access to the hotties.

Although some were indignant and became even more bothersome, most simply lost interest and found their gratifications or entertainment elsewhere.

Soon only the truly sick began showing up at sick call, and suddenly we were actually helping people. It was during this amazing time that I found my true prison calling: removing toenails.

Case after case after case of severe fungal infections flooded through our doors. The state offered creams which ultimately offered little improvement since the cause of the infections (poor hygiene) was never remedied. I was startled when an inmate begged me to remove his toenails. He said he could barely walk, and indeed he did appear to be in severe pain. At the end of the day I had a whole list of inmates begging for their toenails to be removed. I was more than a little curious about how the N.P. was going to handle this.

The N.P. promptly said she wouldn’t handle it; an M.D. rounded at the prison once a

than s s e L

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begging for toenail removal to his visit, as well as the especially bothersome patients. I notified the requesting inmates that they were on the Doc’s list and I would call for them when he next rounded.

A few weeks passed and it was finally Doctor Day! I found myself biting my own nails in anticipation of the events forecast for that day. I thoroughly briefed the doctor on the patient list, explaining their complaints, history, and observations while he dutifully gathered supplies. The first inmate requesting toenail removal hobbled into the room and without a word Doc began his work. He showed me as he injected anesthetic around the toe and nailbed, and with little ceremony wielded a small flat-bladed instrument that resembled and cross between a cheese knife and a trowel.

I warn you readers: If you have a weak stomach or just hate getting the willies, skip this nextparagraph and just imagine something pleasant, like prisoners and butterflies.

With little warning the physician slid the blade under the toenail, prying at the corners as it quickly popped straight up. I grabbed the lifted nail with a pair of forceps and with a quick twist it was, unlike our prisoners, free. Toes don’t really bleed as badly as you would expect, but once the lidocaine wears off they sure do hurt.

Prisons are not known for their opioid pain medication availability, so the inmate hobbled off with a bandaged toe, a 16-pack of ibuprofen, and a profound sense of temporary relief. I left with a new skill in my nursing toolbelt, more than a little respect for the inmates enduring this process, and a clearer understanding about why the NP leaves this for the Doc. Clean your feet folks, and if you ever find yourself in prison, wear flip flops in the shower. +

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BINGEREAD

For most of us non-surgeon types, “Whipple procedure” is one of those phrases that is mentioned seldom enough that if we learn what it is, we’ll forget it long before the next time we hear it again.

This is not a procedure you want to have. Then again, if you need it and are a candidate you definitely want to have it.

The complex operation, named after Dr. Allen Whipple, a Columbia University surgeon who was the first American to perform the procedure in 1935, is used to help treat people with pancreatic cancer (See page 6).

Also known as pancreaticoduodenectomy (we told you it was complex), the Whipple procedure involves removal of the head or wide part of the pancreas next to the first part of the small intestine (duodenum). It also involves removal of the duodenum, a portion of the common bile duct, the gallbladder, and sometimes part of the stomach. Afterward, surgeons reconnect the remaining intestine, bile duct, and pancreas.

In the before and after illustrations above, incision A separates the head of the pancreas from its body (left illustration). B and C cut the small intestine (duodenum). The green bile duct descending from the liver is severed and the gallbladder (shown beneath the liver) is also removed. Then the closed-off bottom end of the duodenum (C in the left illustration) is brought up (right illustration) to be reattached to the pancreas, the bile duct is reattached, as is the stomach. The goal is two-fold: remove pancreatic cancer from the body, and restore digestive capabilities.

While pancreatic cancer overall has a 6% 5-year survival rate, a successful Whipple procedure can raise that to 25%. +

MEDICALEXAMINER

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AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER

www.AugustaRx.com The Medical Examiner’s mission: to provide information on topics of health and wellness of interest to general readers, to offer information to assist readers in wisely choosing their healthcare providers, and to serve as a central source of salubrious news within every part of the Augusta medical community.

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AUGUSTAMEDICALEXAMiNER

JANUARY 24, 2020

#107 IN A SERIES

Who is this?

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

S

ome people say this man is the greatest American of all time, a true hero deserving sainthood.

If so, he would probably be the first Jewish person awarded the honor. Not that he wouldn’t deserve it. You could accurately say this man saved countless thousands of lives, improved the quality of life for hundreds of millions of people around the world, and did so at the personal cost of as much as $7 billion. That’s some serious change.

And he did it all with change. As in spare change. His work was funded by the National Foundation for Infantile Paralysis (NFIP) and its March of Dimes, which began in 1938. Some twothirds of all Americans donated to the March of Dimes, which is an astonishing figure. All those dimes added up, and they funded the work of the man pictured above, Dr. Jonas Salk.

He was a pretty amazing guy, to say the least. He was accepted to the City College of New York at age 15, and was at NYU working toward his medical degree by age 19.

Yale might have been his first choice, but at the time (the early 1930s) Yale had a strict admissions limit of five Jews per year. NYU had no such prejudices. During his final year of medical school, Salk was taken under the wing of Dr. Thomas Francis as a mentor even though Dr. Francis would later note, “Dr. Salk is a member of the Jewish race but has, I believe, a very great capacity.”

The two collaborated on a successful flu vaccine released in 1938 while they worked in the Department of Epidemiology at the University of Michigan. Their basic 1938 formula was also the 2019-2020 flu vaccine, although it’s tweaked every year to most effectively attack whatever the predicted strain is for the coming flu season.

If that had been Salk’s sole contribution to world health, he would still be remembered fondly today, but you know the rest of the story: he invented the polio vaccine, ending a terrifying modern day plague. He was appalled by the realization that he had lost his identity as a scientist and had instead become a celebrity and folk hero, a situation he viewed as inappropriate for a scientist and a great personal burden.

But he was pragmatic enough to realize that fame also presented scientific opportunities. Had the vaccine been patented, its worth is the aforementioned $7 billion. Although it was officially declared at the time to be in the public domain since so many had contributed to its development, it’s difficult to imagine Salk wanting to amass a personal fortune from vaccine proceeds. He told newsman Edward R. Murrow that “the people” owned the patent, the same people who sent in their millions of dimes to fund the research. Aware that he was not personally profiting from the discovery, his Pittsburgh lab received piles of mail every day containing money. A letter writing campaign to the White House urged the federal government to give Salk a huge financial reward. Salk received free cars. He donated it all to scientific research and charity.

Jonas Salk continued research until his death in 1995. He once said, “The greatest reward for doing is the opportunity to do more.” +

encouraged him by telling him that therapy would get him home faster, he replied with The road to better health can be tricky a despairing voice, “I do not have a home to and convoluted. That is certainly true of go home to.” Thus, people get permanently many of the individuals I met while I was lost in the system. It means there are a at Amara, the nursing and rehab facility few desperate individuals who say, on a where I have recently spent so daily basis, “I just want to go many weeks, and for myself home!” These are the few who “It’s nothing more than are capable of taking care of as well. There is a subtle trap involving Medicaid that can themselves, but who can never jail in disguise.” arise at a certain point when go home. I said in the previous people have used up their own column how good the care is health insurance allowable days. They are at Amara, but that needs to be only for those persuaded to apply for Medicaid, unaware of individuals who need that kind of care and the trap that lies within that decision. who can’t take care of themselves, not those For example, I was not informed that who could leave but are unwittingly trapped. by applying for Medicaid, I would lose my One of the women only wanted a kitten to social security income. My home isn’t paid snuggle with. She can care for a kitten, clean for and my house payment is taken directly a litter box, feed the kitten, all the things she out of that check before I see a penny of would need to do, but she can’t have a kitten it. That payment would have ended, and I at Amara. She wants to go home every day of would have lost my house within a month. It her life. The hope of going home is most of makes sense for patients who are long term what keeps her alive. The psychiatrist comes residents to make such an arrangement, and talks to her, tells her that she can never but not for short term patients who need go home, but she remembers her home, to have a home to go home to when their and as far as she knows it is still sitting rehabilitation is complete. Some patients, there, empty and lonely, waiting for human who are not aware of that complication, find occupation. She remembers the clothes she themselves trapped into long term care from left behind and will recount how many shoes which they will never have enough money she had, how many dresses, coats, purses, to escape. They receive only $50 a month, and pieces of jewelry. She will sigh, asking which, even if they save every penny, will her grandson to bring her those things, but take 40 months to accumulate enough for he never does, and likely never will. a down payment on a modest apartment.

We need some kind of system in place That is not the case for those with families to prevent that from happening in the first with enough funds to bankroll them or who place and to ensure that such placements of can take them in to the family home. Sadly, otherwise healthy and capable individuals many do not have any of those options. never becomes permanent. That’s not I listened to one man who was refusing to healthcare; that’s jail masquerading as do his physical therapy. When the therapist health care. +

by Marcia Ribble

The Medical Examiner is what is known as a

GOLDILOCKS PUBLICATION At 16 pages every issue, we’re just right.

JANUARY 24, 2020

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AUGUSTAMEDICALEXAMiNER

Middle Age ADVENTURES IN

BY J.B. COLLUM

“You had a 98% blockage in the LAD (Left Anterior Descending) artery, AKA, the widow maker,” my cardiologist began, though honestly, I don’t remember anything he said after “widow maker.”

If he hadn’t already fixed it, I might have had a heart attack again. And to think, at first they told me everything looked fine. Let’s go back to the beginning, a month earlier.

In this column’s debut last issue, I told you about the severe chest pain I had on vacation and how I didn’t go to the ER while on the trip since I didn’t want to “ruin the trip.“ So it was the Tuesday after returning from our vacation when we strolled into the cardiologist’s office.

My regular physician had seen me on Monday and had done an admirable job in getting me this appointment with the cardiologist the next day. I didn’t even have to show up at the ER with chest pain. (By the way, I have since learned that this is the thing to do when you have chest pain. Fancy that, going to the hospital when you keel over in pain. Lesson learned.)

Anyway, the EKG my doctor had done came up normal as far as he could tell, but my continued chest pain concerned him enough to get me a cardiologist booking ASAP. They did the stress test, where you walk on a treadmill until your heart rate reaches a certain level while they look at the EKG results from the attached electrodes or, as I like to call them, chest-hair torture devices. Nurses swear that it’s easier if they just snatch them off, but I see the sadistic glint in their eyes followed by the disappointment when I say, “no thanks, I’ll take them off in the shower later.” In this case though, we nearly had a repeat of the vacation incident on the stairs. Before they could get all the information they needed, I collapsed in pain and couldn’t go on.

They sent me home with nitroglycerin tablets and sched-

uled an echo stress test for the following day, but I flunked that too. The cardiologist took a look at the findings and said he didn’t think it was a blockage but that we could go ahead and try a catheterization to be sure. He also said that my insurance might not cover it and that it was expensive, approximately $8000, and would be much higher if they found something and had to fix it.

They attached electrodes, or as I like to call them, chest-hair torture devices.

In my wisdom and frugality, I said that it was too much, but my wife and accountant gave me that look she reserves for naughty children and stupid husbands and we decided we had better do it.

We showed up in the wee hours of that Friday morning for the procedure. The funny thing is that the procedure itself was the easiest part. The preliminary work and what they did afterwards was the hard part, for me anyway.

First, they had to shave my groin area because that is where they would insert their probe to begin the search for arterial blockage. It’s hard to think of a more awkward position to be in than having my legs spread while a complete stranger shaves my nether regions. I’d have rather been on the frontline of a medieval battle line, I think. Next they rolled me into the operating room where new indignities awaited. After transferring me to the operating table, they pulled my gown up and exposed me once again.

When I asked for something to cover me down there, they provided a tiny washcloth. It did the trick, though I wish they had chosen something a little larger. It is a pride thing I suppose.

The cardiologist walked in, showed me the screen I could watch as they ran the probe up into me. Just a

couple of minutes, it seemed, (and $62,000) later, they were rolling me out and my wife was strolling along beside me saying words. English words I’m sure, but it is all a little muddled now. She told me that it was all done, the stent was in and the blockage was gone. The anesthesia they used makes you forget, I was told. After this, I was sent to recovery where my wife told me everything the doctor had told her about the procedure, except for the widow maker part. I had to wait to hear that from him.

Then came the worst part.

Yes, even worse than the indignities. They had to pull out the probe. And afterwards, I had to lie flat on my back for hours. Have you ever tried to urinate into a pan while lying completely flat on your back? It should be an Olympic event. I couldn’t do it. After multiple attempts and some arguments with the staff, they finally lifted the head of the bed up enough so that I could successfully pee.

A few hours later, the ordeal was finally over and they sent me home with a little card in my wallet to warn other medical folks not to use an MRI on me unless they wanted my stent to rip through my chest like the creature in the movie Alien. Comforting thought, huh?

It was a month later, on my follow-up visit with the cardiologist, when he told me about the widow maker.

Coincidentally, that is when I became diligent about taking my cholesterol medication.

In the next issue, I will tell you how my experience helped my father when he had a heart attack. Until then, remember: chest pain equals an ER visit pronto! + 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

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AUGUSTAMEDICALEXAMiNER M E DIC I N E

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T H E

F I R S T

P E R S ON

A Death Sentence?

Not necessarily.

Is a diagnosis of pancreatic cancer a death sentence? Not necessarily; I am living proof.

In March of 2011, I received that diagnosis.

I had gone to the doctor because my urine had turned bright orange. I knew that was not normal. My decision to visit the doctor was a good one. The MRI showed a blocked bile duct along with “suspicious” cells. The cells revealed Stage IIA cancer, which means that the cancer had not metasized to other parts of the body.

I had a Whipple procedure (See page 3) on April 11; spent twelve days in the hospital; had chemotherapy for six months; and had appointments with the oncologist regularly to check on the disease status.

Most pancreatic cancer patients are diagnosed in Stages III and IV, which generally are not operable. Seventy-five percent of patients die within the first year. Others pass away in years 2 and 3 with re-occurrences.

The 5-year survival rate is only about 9%

with specialized robotic surgery (which is still in its infancy.) This surgery is more effective due to a smaller incision and shorter hospital stays.

The disease is insidious and aggressive because noticeable symptoms do not appear until the latter stages and are not found in time for treatment.

Here is a summary of symptoms: • Jaundice of skin and eyes • Sudden weight loss • Back pain • Digestive problems • Dark urine and pale stools • Constipation and/or diarrhea • Diabetes • Fatigue and/or depression • Elevated liver enzymes and bilirubin In retrospect, my symptoms were jaundice which was first observed by my daughter who is a nurse; a loss of forty-two pounds over a 3-month period; Type 2 diabetes diagnosed in 2000; dark urine and pale stools;

JANUARY 24, 2020 fatigue and depression; and elevated liver enzymes and bilirubin, which my primary care doctor found in a routine blood test.

What are the risk factors for pancreatic cancer? They are the following: • Smoking • Persons who are 60 and older (slightly more men than women) • Obesity • Family history • Inadequate exercise • Excessive alcohol consumption • Exposure to chemicals (like pesticides) • Poor diet • Diabetes My risk factors were age; being overweight (but not obese); inadequate exercise; poor diet; and diabetes. In addition, there was a family history of diabetes which, I believe, was my chief risk.

In recent years, celebrities who have died from pancreatic cancer include Michael Landon, Patrick Swayze, and Steve Jobs. Alex Trebek was diagnosed in Stage IV in May, 2019. Some 56,000 persons are diagnosed with pancreatic cancer every year in the U.S. The statistics quoted in this article may be slightly “off” because I did the research and wrote a book-length manuscript entitled Surviving Pancreatic Cancer in mid-2017 which contains far more detail.

From the near-death experience (NDE) I had the second day in the hospital, I learned that “I am not finished here yet.”

Knowledge is power. Be powerful. If you question what you have read, make an appointment with your doctor. The life you save may be your own. +

IT’SYOURTURN! — Submitted by Dolores Eckles Evans, Georgia

Your turn for what? To tell the tale of your medical experiences for Medicine in the First Person. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. See our “No Rules Rules” below. Thanks!

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.”

“We had triplets.” “He was just two when he died.”

“The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.”

“I sure learned my lesson.”

“The cause was a mystery for a long time.”

“The nearest hospital “They took me to the hospital by helicopter.”

“I retired from medicine was 30 miles away.”

“I thought, ‘Well, this is it’.” seven years ago.”

“Now THAT hurt!”

“OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.”

“And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

Everybody has a story. Tell us yours.

Here’s our “No Rules Rules.” We’ll publish your name and city, or keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.

JANUARY 24, 2020

AUGUSTAMEDICALEXAMiNER

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GARDENVARIETY

Valentine’s Day is quickly approaching, which means mushy gushy cards, roses, heart decorations everywhere, and my favorite part, chocolate. Anyone trying to eat healthy in 2020 who enjoys chocolate might want to whip up this recipe of dark chocolate strawberry tarts for Valentine’s Day. Dark chocolate is a greattasting treat, and great news, science shows that dark chocolate is healthy for your heart. Dark cocoa powder contains bioactives called flavanols. Epidemiologists have long established a connection between the consumption of foods with flavanols and lower incidence of death from heart disease. Also, dark 70–85% cocoa contains fiber, iron, magnesium, copper, and manganese. It also has plenty of potassium, phosphorus, zinc, and selenium.

I wanted to create a recipe that was not only delicious but could be a guilt-free indulgence. These dark chocolate strawberry tarts have the perfect combination of fruity strawberries and rich dark chocolate. The tarts are gluten-free, with no refined sugars and dairyfree. They will keep for up to a week in the refrigerator and can even be frozen for more extended storage.

Dark Chocolate Strawberry Tarts Ingredients: Tart Shell • 1/4 cup dark cocoa powder • 1 cup old-fashioned oats • 1 2/3 cups almond flour • 1/3 cup pitted and coarsely chopped dates • 1/4 cup honey (maple syrup for vegan recipe) • 3 tablespoons coconut oil melted • 1/4 teaspoon salt Strawberry Filling • 1 cup raw cashews soaked for 1 hour in boiling water • 1 cup strawberries • 2 tablespoons honey (maple syrup for vegan) • 1 tablespoon coconut oil melted • 2 teaspoons lemon juice Chocolate Glaze • 3 tablespoons honey (maple syrup if vegan)

Dark Chocolate Strawberry Tarts • 3 tablespoons coconut oil melted • 1/3 cup dark cocoa powder Instructions: Tart Shell In a food processor combine dark cocoa powder, oats and almond meal.

Process for 1 minute until a fine powder forms.

Add dates, honey, coconut oil, salt and process until a smooth sticky mixture forms, about 2 minutes.

Firmly press 2 tablespoonsize balls of dough into mini muffin cup tins. Form a well in the center of each with your thumb. Place in refrigerator until ready to use.

Strawberry Filling Drain soaked cashews and place in a blender such as a VitaMix. Add strawberries, honey, coconut oil, and lemon juice. Process for 2 to 3 minutes until silky smooth.

You might need to scrape sides of blender half way through.

Place strawberry filling in a piping bad and pipe into the chocolate crust.

Refrigerate until ready to use again.

Chocolate Glaze Combine chocolate glaze ingredients in a small bowl and whisk to combine. Drizzle chocolate glaze over filled strawberry tarts. Refrigerate for at least an hour before serving. +

by Gina Dickson, an Augusta mom to six and Gigi to ten. Her website, intentionalhospitality. com, celebrates gathering with friends, cooking great healthy meals and sharing life around the table. Also on Instagram @ intentionalhospitality

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JANUARY 24, 2020

TEN COMMANDMENTS OR TEN MYTHS?

by Ken Wilson Steppingstones to Recovery

Myths walk into my office on two legs every day. In this case, a myth defined would refer to “a widely held but false belief or idea” according to the definition search I did just now. Well-meaning parents, loved ones, employers – myths are an equal opportunity device that people use as their Truth to help an addict or alcoholic. These “truths” are formed by personal experience, reading, teaching by others, or interpretations of their religious experience.

These myths sound so good to those who hold them, but have never been so wrong to ones like myself with years of experience in treating afflicted ones.

For instance, near the top of the list that I hear often is “It’s my fault.” That’s why my son is an addict. I mean, really, mom – if it’s your fault maybe you should get counseling instead of him! (By the way, not a bad idea…families that get coaching via family support programs or self help groups do better than those who practice their old self-defeating beliefs). If your addicted relative really believes it’s your fault they’ll often use your belief system to get what they want from you and it probably won’t be a good thing! And they won’t accept personal responsibility for getting well because, after all, it’s your fault in the first place.

Not! Some of the best parents in the universe have children who become alcoholics or addicts. I once heard a great truth: “God made two perfect children and look what happened!”

Next I hear “I’ve got to get him well.”

Good luck with that. I say, “If that was true, you wouldn’t be sitting in my office right now! Because you’ve certainly tried!” It’s particularly difficult if your loved one started using drugs in adolescence because when they use in earnest their emotional stages of development stop and do not progress to responsibility and adulthood, and they will rebel at any overture by you to change their behavior…they’ll rebel with ten times the energy that you exert trying to change them and things will regress and not progress. You didn’t make him sick in the first place so you can’t make him well either. You can provide conditions for him to change if he wants to…and if he doesn’t want to you can, at best, certainly make him “thirsty” by doling out some pain for him to try to connect the dots: using = pain. (Careful here…I’m not saying to take him out behind the woodshed

+ I

M.E. THEMEDICALEXAMiNER

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional even though you certainly feel like it! You don’t need a belt or whip…there are other tools to use that are more effective…consult past columns in this paper over the past 3 years for ideas. Online at issuu.com/medicalexaminer) Then comes, “he’s still using so I need to try harder.” Rarely do new interventions come into play at this point…usually old interventions take on a new foothold and they fail, too, because of the truth of an old adage: If you keep doing what you’ve always been doing you’ll keep getting what you’ve always been getting. If your child or loved one doesn’t respond to your pushing his buttons, it’s because you’re the one who installed them in the first place and he’s better at dodging your attempts than you are at pushing his buttons. Even the state of Georgia knows that continued drinking and driving, as one example, requires progressively stiffer penalties – a first DUI is bad enough but the 2nd DUI is not nearly as simple to deal with. Ask anybody out there who’s had a couple DUI charges! Loss of a license to drive instead of a limited permit, installation of an Ignition Interlock Device on the car that won’t crank up and go if there is alcohol on his breath and if he starts drinking after cranking up the car it will cause more problems than he wants when he blows into it at random with alcohol on his breath when the accountability buzzer goes off!

Oh no, not again. Space has run out and I’ve only listed 3 commandments! Oops, I meant to say, 3 myths. I’ll see if I can make a list of 7 more by next month! Bet I can. +

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JANUARY 24, 2020

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AUGUSTAMEDICALEXAMiNER

DON’T LICK THE BEATERS Useful food facts from dietetic interns with the Augusta University MS-Dietetic Internship Program

Beat the Winter Blues with Nutrition

by Emily Allspaw, MS-Dietetic Intern With winter season in full-swing, shorter days and cooler temperatures may cause sluggish and down feelings, commonly known as the “winter blues.” A healthy diet has been shown to have a positive impact on mental health and mood. Nutrients are needed to maintain the body’s many functions, including brain chemistry and mood. A diet rich in refined grains, sweets, and red meat is linked to bad moods, whereas a more nutrient-rich diet filled with whole grains, fruits, vegetables, and fish are associated with a positive mood.

One particular diet that may have a positive influence on mental health is the Mediterranean diet. This diet has strong evidence for reducing the symptoms associated with a negative mood and is generally recommended for optimal health and well-being. The Mediterranean diet is based on the eating pattern and habits of people living in the Mediterranean region.

It promotes fruits and vegetables, whole grains, beans, nuts, legumes, and olive oil, along with fish a few times a week. It provides many health promoting benefits that may contribute to mental and overall health.

Omega-3 fatty acids are considered to be the “good” type of fat and are very important for proper brain function and development. The Mediterranean diet contains high amounts of omega-3 fatty acids and has been shown to have positive effects on the brain. These fatty acids are commonly found in fatty fish, such as salmon, tuna, mackerel, and trout. Additionally, most nuts and legumes have high omega-3 fatty acids content, including walnuts, almonds, and soybeans.

Inflammation increases the risk for several chronic diseases and has a negative impact on mental health. Inflammation is a natural process by the body that is triggered when a threat is recognized. However, inflammation may occur when there is no threat and may be the cause of many health problems. Increased inflammation has been liked to chemical imbalances in the brain and negative effects on a person’s mood. The Mediterranean diet is rich in anti-inflammatory foods and plays a key role in reducing inflammation in the body, including the brain. Fruits, vegetables, whole grains, and fatty fish are rich in nutrients and compounds that may help to reduce inflammation.

The winter season tends to spark cravings for comfort foods that are high in refined carbohydrates and unhealthy fats.

Creating healthier versions of these foods will give the body the nutrients necessary to support overall health while providing the same comforting feeling. Try adding beans and legumes to soups and substituting refined grains for whole grains in casseroles.

Cook with olive oil instead of butter and incorporate vegetables as a pizza topping or as a side dish. Including healthy ingredients into your favorite recipes and paying special attention to the types of foods that are eaten may help combat the seasonal slump.

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IF YOU CAN’T WALK AND CHEW GUM AT THE SAME TIME, THEN AT LEAST White Bean Pasta with Spinach and Garlic Oil Ingredients • 8 ounces 100% whole grain penne • 1/4 cup extra virgin olive oil • 6 garlic cloves, peeled and thinly sliced • 1/4 teaspoon crushed red pepper flakes • 1 2-ounce tin of anchovies, drained and chopped • 1 6-ounce bag baby spinach • 1 can white beans, drained and rinsed • 1/3 cup walnuts, toasted • Parmesan, for serving Instructions Bring a large pot of salted water to a boil on high heat. Cook penne according to package instructions until al dente. Drain, reserving 1/4 cup starchy pasta water and place pasta back in the pot.

Heat olive oil in a large sided skillet on medium heat. Add garlic and red chili flakes. Cook 30 seconds until fragrant. Add anchovies and sauté 1 minute, breaking down anchovies further with the back of a spatula. Turn off heat.

Add anchovy garlic sauce to the pasta in the pot. Turn on medium heat. Add spinach and white beans and reserved pasta water and cook until warmed through and spinach is wilted. Season with pepper (should have enough salt from the sauce).

Pour into a bowl and garnish with walnuts and parmesan. + Source: https://www.rachaelhartleynutrition.com/ blog/2016/05/penne-with-spinach-white-beansgarlic-oil/

The recipe above is rich in omega-3 fatty acids and other nutrients. + Additional information on brain healthy diet and other nutrition information can be found at www. eatright.org.

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined If you are a seat belt user, congratulations. You are doing one of the safest things a driver or passenger can do. And because you are who you are, you might assume just about everyone else uses seat belts too.

On that score you would be wrong.

The most recent data from the National Highway Traffic Safety Administration (NHTSA, often pronounced “Nit-sah”) found that in 2019 overall seat belt use was only 90.7%. That may sound pretty decent, but it’s surprising that the rates aren’t much closer to 100%. Compliance is highest in the West at 92.4%, and next-highest in the South, where it stands at 88.5%. The Northeast is lowest at 83.5%.

NHTSA publishes annual reports on a variety of traffic safety issues. NHTSA research shows that over the past 15 years, seat belt use has consistently increased from lows in the 81% range in 2005 and 2006. What is interesting is pairing the annual numbers for seat belt compliance with the annual numbers for passenger vehicle fatalities. Whenever there is a dip in seat belt use, there is a corresponding increase in fatalities; whenever there is an increase in seat belt use, there is a matching drop in fatalities. Yes, seat belts save lives. It’s not a topic Be grateful for advancements in seat belt open to legitimate debate. design over the years.

Do fatalities occur in crashes when the driver and all passengers are buckled up? They do. It isn’t that seat belts magically provide complete immunity from serious injury and death, but they do drastically improve the odds of survival.

How do they accomplish this?

Data from the Georgia Traffic Injury Prevention Institute at the University of Georgia offers a very simple answer based on a very simple formula. The equation is W x S = CF. That is to say, weight (of a passenger) times speed equals crash force. To illustrate: if a 200 lb. driver traveling at 60 mph crashes, he will strike the vehicle’s interior surfaces, the windshield, or objects outside the vehicle (and without a seat belt, perhaps all three) with a force of 12,000 pounds (200 x 60). That would be exactly like something weighing 12,000 pounds (6 tons) striking the driver at a high rate of speed. Wearing a seat belt dramatically minimizes impact force, and usually any impact whatsoever other than the seat belt itself. It is so close to the body that little to no impact results from it. (Why use 200 pounds as the sample weight? No reason, except that drivers of pickup trucks have the lowest level of compliance of all passenger vehicles. Perhaps we are guilty of stereotyping.)

Remember the old days before seat belts when as kids we would even stand up in the front seat as mom or dad drove down the road? And how they would reach over and try to keep us from hitting the windshield or dashboard when there was a sudden stop? That was an understandable and automatic reflex, but it was completely useless: using the UGA formula, a 75 pound child in a car suddenly stopped at 35 mph would generate a crash force of 2,625 pounds. Unless mom or dad was a superhero, there was exactly zero chance they could do anything to help us or prevent us from sailing right through the windshield.

About three dozen states including South Carolina and Georgia have so-called “primary enforcement” seat belt laws, meaning that a driver can be pulled over solely for being observed driving without wearing a seat belt. 15 states have “secondary enforcement” laws. Under those statutes, an officer can only cite a driver for failure to wear a seat belt if he has stopped the vehicle for some other violation, such as an expired tag.

Only one state, New Hampshire, has no adult seat belt law. It is legal in the Granite State for anyone over 18 to drive unbelted. Wearing a seat belt is strictly voluntary, and as a result seat belt use there is by far the lowest in the country. Despite that, New Hampshire roads are comparatively safe and more or less in line with statistics from other states, but their lack of a seat belt law shows up in one startling number: 70 percent of their fatalities involve an unrestrained occupant, by far the highest of any state.

How many of those deaths were preventable? No one knows, but one of the state’s leading newspapers, the Concord Monitor, observed in June of last year that in New Hampshire more than any other state, “every crash is a tragedy.” +

JANUARY 24, 2020

HUMAN BEHAVIOR

How neuroscience works in everyday life

NEGATIVE THOUGHTS? JUST SAY NO

Why is it that remembering the offhand remark by your husband—“Yeah, the meatloaf was OK. My mom’s is better”—still

by Jeremy Hertza, Psy.D. makes you see red, five years later? Or recalling that humiliating experience when your presentation bombed at work. How can it still ruin your whole day?

It’s called negativity bias: We’re literally hardwired to remember negative actions or words more powerfully than positive ones. It’s why one mean word can change our moods, why we believe bad news more than good, and why a possible negative result (like being punished) is more likely to motivate.

But it’s hard on us—and the people we love—when we can’t seem to dig ourselves out of a pit of thinking that more bad than good is bound to happen.

It’s a Good Day. Right?

If one of your goals is to be more positive this year, guess what? Just thinking that is a great first step. Here’s what else you can do: • Check your attitude. Make the effort to recognize when your brain automatically reacts negatively, then flip the switch. For example, when your boss hands you a new project, don’t just grouse about how he’s trying to dump his workload off on you. Sure, it may sound cheesy, but tell yourself it’s an opportunity to show how great a project manager you are.

• Begin and end your day with good thoughts. The first thing you do when you wake up and the last thing you do before you go to bed should be thinking about the great things going on in your life. If you believe in God, this could take the form of a prayer; if you journal, jot these thoughts down; or simply list them out in your head. Then, follow that up with the good things that you hope to accomplish.

• Use the 5 to 1 ratio. As a general rule, five positive experiences overcome one negative one. So if you’re reeling from a fight with your spouse or a tough experience parenting your kids, work out five ways to replenish yourself, whether that’s a hot bath, talking with a friend, taking a run or walk, enjoying a show you like, or just laying down for five minutes with your eyes closed.

• Change your situation. If you feel stuck in a negative rut, one thing to try is changing your situation. Maybe you head to the beach for the weekend, or you rearrange the furniture in your bedroom it. Just do something to help change the dynamic of what’s going on.

• Do what makes you feel good. As adults, we spend most of our time making other people happy. But we have to— have to!—do some things to make ourselves happy. Even if you don’t really feel like it, make yourself do it, and see if you feel better afterwards. If you don’t, pick a new activity.

The point is, sitting around and feeling unhappy isn’t going to do anything to make you feel better, so do something.

But even before you do all of this, first things first: Do what you can to improve your sleep, eat better, and exercise more. And get a checkup to make sure nothing’s going on with your hormones, which can have a real effect on how you feel. Then, if you’re still feeling very negative, get professional help.

Remember this too—and this is true for all of us: The world is designed to bring us down. Our job is to fight against it. And yes, you really can do it. + Jeremy Hertza, Psy.D., is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC, in Augusta. Contact him at 706-823-5250 or info@nbageorgia.com.

JANUARY 24, 2020

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by pediatrician Christopher Johnson, MD, on January 20, 2020

WHAT TO DO IF YOUR DOCTOR IS EXCESSIVELY EGOTISTICAL Egotism is a common trait among doctors, although most of us keep it under adequate control when dealing with patients.

The ideal doctor-parent encounter has been described as a collaboration among equals, each of which brings expertise to the exchange; the doctor knows medicine, the parent knows the child. This is the ideal, although sometimes the reality falls short of it.

The way our medical system is now structured gives more power and influence to the doctor side of the relationship than the patient side. Things were not always this way; a century ago, a surplus of doctors with treatments of doubtful usefulness scrambled to attract patients. These days, however, physicians have many more therapies that actually work, plus the benefit of an enormous medical establishment behind them. So now doctors are usually the ones deciding who gets what treatment, which is on balance a good thing. In spite of that fact, good, experienced doctors will do their best to use their power over patients lightly, always inviting parents and patients to share in the authority.

Physician egotism can get in the way of good communication in several ways. A simple manifestation is the tug-of-war over whose time is more valuable, the doctor’s or the parent’s. A good example of this conflict is the doctor who schedules far more patient appointments than he can accommodate in a day, then seems unaware of how keeping a parent waiting for hours can poison the atmosphere even before the evaluation has even begun. Parents usually understand long waits when they take their child to the doctor for an unanticipated acute problem.

If the waiting room is full of children just like theirs, there is little the doctor can do except see them each in turn. But the subspecialist who packs his waiting room with too many scheduled patients is proclaiming, in effect, that his time is far more valuable than that of parents, who often must take off a full day’s work to bring their child to see him.

The egotistical doctor is one who tends to forget that the patient is the center of everything, the reason the parents are there in the first place. He forgets that the encounter is about the child, not the doctor. This attitude can show itself in a persistent tendency to turn the subject of the conversation away from the child and toward the doctor. The result may be harmless, as when a garrulous doctor is genuinely trying to relax the parents and their child with a friendly conversation about other things, or it may be more toxic, as when a doctor constantly talks about himself and what he does. The latter can be particularly trying to parents who have waited a long time to see the doctor, only to find their brief time with him taken up by extraneous chatter.

Although it can be annoying to parents, excessive egotism in your child’s doctor is generally a minor issue in the big picture of getting your child the evaluation she needs. I say this because, although there are exceptions to everything, for the large majority of doctors I have met who are more egotistical than the average, their self-centeredness does not get in the way of their medical skills. In fact, some subspecialties, such as high-risk surgery, almost require the physician to have a huge ego if he is to perform such surgeries effectively.

So it is largely a matter of the personal taste of the parents.

If you find yourself irritated when talking with an excessively egotistical doctor, and if you think this is interfering with his proper evaluation of your child, the best thing to do is to be persistent in turning the conversation back to your child at every opportunity. Of course, if you are really irritated by his manner or the way he treats you, do your best not to see him again. +

Long patient waits send a message

Christopher Johnson is a pediatric intensive care physician and author

There is perhaps no one in all of medicine held in greater esteem by both their fellow healthcare providers and the general public than the ER trauma physician. We think of them as the ultimate doctor because they’re ready to treat whatever comes through the door at any hour of the day or night.

In truth, however, most ERs are staffed by or connected with physicians in multiple specialties, so the same ER physician doesn’t usually have to set a broken bone one minute and deliver twins the next.

It’s a little different in this book, however, where there is exactly one trauma surgeon in a small hospital in a small town, the setting for sixteen life and death short stories.

Here is an excerpt from the Kirkus review of this book: Although the stories and characters in emergencymedicine physician Green’s debut collection are fictional, he bases them on real experience, giving readers an insider’s look at a rural trauma ward.

Unsurprisingly, several stories deal with loss, tragedy, and the difficulty of letting go. Others

touch on misdiagnoses of character: a seemingly neglectful meth-head mother turns out to be a good Samaritan (“Saviors”); in “Family,” an alcoholic and annoying ER regular redeems himself by running off a threatening pill-seeker and becomes the hospital’s trusted security guard (“sometimes all a person needs is a chance to prove himself”).

Big-city ERs are commonly the setting for medical dramas, so the particular challenges of an understaffed and remote emergency department will be less familiar to readers, and the stories exploring these particular challenges are among

the collection’s strongest. “This is the only ER in town. I am the only ER doctor awake in the county right now,” writes the narrator (also called Dr. Green) in “The Crew.” He’s awakened at 2 a.m. for an incoming trauma: four teenagers dead or dying from a car accident on prom night. In the big city, a team of 20 specialists might be on hand; here, the trauma team is one doctor (himself), two nurses, and a respiratory tech.

The title comes from a private joke—they call themselves “the crew that do,” which is “a quiet comfort in the middle of the night.” They need this comfort even more on this night; doing the math, Dr. Green realizes that there is a “one-in-fourteen chance that one of our kids was in that car.” It’s the paradoxical, poignant condition of their work that, to function well, they have become a tight knit family who can shut down their emotions— even if it could mean coding one of their own family members.

Here are well-written stories about keeping one’s head and humanity in the raw world of emergency medicine. + Trauma Room Two, by Philip Allen Green, M.D.; 162 pages, published in Sept. 2015 by Create Space

Research News Trying to quit?

Good for you, and congratulations on your goal.

You may not reach it without a few bumps along the way, but just starting down the road to stop smoking is a victory in itself.

But what if you’re struggling?

If you aren’t, you should be shocked. So struggling is not a sign of weakness or lack of resolve; it is to be expected.

But assuming you want to overcome the temptations and stay on the high road, what can you do?

The journal Addiction recently reported on studies showing that exercise helps in two ways: it offers a distraction, something else to occupy your attention until the moment passes. But it also helps the moment pass by actually decreasing the urge and desire for nicotine.

Ken Wilson, the Medical Examiner’s resident addiction specialist, wrote a year or two ago in one of his columns

about a simple strategy that he has seen employed successfully hundreds of times over the years: when the urge strikes to do something you’re trying to quit doing — be that smoking, eating Oreos by the bag or entire canisters of Pringles in a single sitting — do something — anything — for fifteen minutes. Set a timer if you must. Then iron shirts, do pushups, pray, go for a walk, brush your teeth, vacuum the house — anything. It works more often than not.

And if you employ exercise, you enjoy double benefits.

Those non-white coats. Eww. An article in the November issue of The American Journal of Infection Control reported on a study of white coats worn by attending physicians in a New York area hospital.

Admittedly, the sample size was small (62 participants), but the results, if typical, were surprising.

Fewer than 15% of the

physicians surveyed laundered their white coats every 3 days or less. More than a third (36%) wore their coats for 7 to 14 days between launderings, and 21% of the white coats were washed after more than 14 days of use.

Half of the respondents said they only owned a single white coat; 29% own two.

The same journal published a study in 2013 with 160 respondents which found the mean time between white coat washings was 12.4 days.

In 2014, the Society for Healthcare Epidemiology of America issued a recommendation for doctors who work in non-operating room healthcare settings.

It read in part, “Apparel that comes into contact with the patient or patient environment should be laundered after daily use. White coats worn during patient care should be laundered no less than once a week and when visibly soiled.” +

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AUGUSTAMEDICALEXAMiNER

The Examiners

JANUARY 24, 2020

+

by Dan Pearson

Why were you just scrubbing the toilet bowl This is so much fun! with that toothbrush?

You do realize a person I’m hazing our new could get very sick from the roommate. bacteria on the toilet, right?

The Mystery Word for this issue: RUTSEU

You didn’t. © 2020 Daniel Pearson All rights reserved.

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Hyper letters 5. Famous architect 10. Offers a price 14. Sullen 15. Augusta Mall anchor 16. Orinoco Flow singer 17. Supporter 18. Decorative 20. Famous Ott 21. Fairy tale beast 22. Where the big hit is on a record 23. Metallic compound 25. Not to 26. Grunge icon 28. ____ Grove of Little House 31. Wheeler County seat (GA) 32. The Band follower 34. 28-A is one 36. Vault adjective 37. Canal keeper?

38. ____ tap 39. Self-esteem 40. Every ambulance has one 41. Jefferson’s other name 42. Woman proficient in yoga 44. Medical District Blvd 45. Word often before (and after) old 46. Savannah, for example 47. Strict 50. Wait; stay 51. Big SC employer 54. Stubborn; strong-willed 57. Mr. Mondrian 58. Scottish Gaelic language 59. Jinx 60. Sicilian volcano 61. Corner of note 62. Measured (out) 63. Indian peasant or tenant farmer

ME

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Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, FEB. 3, 2020

We’ll announce the winner in our next issue!

E X A M I N E R

25

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Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com

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by Daniel R. Pearson © 2020 All rights reserved.

S U 1 D O K 9 U

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DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.

by Daniel R. Pearson © 2020 All rights reserved.

DOWN 1. 33-D’s partner 2. Clinton’s opponent 3. Uproar 4. Like some ice 5. Polygon having all angles equal 6. Downtown furniture vendor 7. Window element 8. Pitcher’s meas.

9. Doctrine or philosophy suffix 10. Berry, soldier atop Augusta’s Confederate monument 11. Inca sun god 12. Group of two 13. Transaction 19. Type of bird?

21. Potpourri 24. Feeble, as an excuse 25. Earth ____ 26. Headland 27. Study suffix 28. Small songbird

29. _________ Hospital 30. Site of 2006 Winter Olympics (in Italy) 32. Medical prefix 33. 1-D’s partner 35. Exam 37. Queue 38. Walk in water 40. Vital ______ 41. The D of DMB 43. Augusta’s Meadow _______ 44. Like most roofs 46. Wash lightly 47. Mets’ former home 48. Descriptive word or phrase 49. Relaxation 50. Low-quality diamond used in cutting tools 52. Most populous city in Nevada after Las Vegas 53. Quick!!!

55. Ted Turner’s movie station 56. Regret 57. For each Solution p. 14

QUOTATIONPUZZLE W C N G T P E S A T V C O H S I H I T O A H T E E S V A H D C E E T

by Daniel R. Pearson © 2020 All rights reserved

E I E O R N I C S T S

2 6 3 9 8 1 4 2 5G8 9U7 6 5 7 3 1 4

5 7 4 6 3 1 2 9 8

— Author unknown

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once.

Black squares indicate spaces between words, and words may extend onto a second line.

Solution on page 14.

1. 358 (health issue) ___

6. 2263 (health issue) ____

2. 2653 (health issue) ____

7. 84787 (health threat) _____

3. 2662 (health issue) ____

8. 83467 (internal anat.) _____

4. 4376 (health threat) ____

9. 84862 (external anat.) _____

5. 7246 (health issue) ____

10. 278473 (health issue) ______

Use keypad letters to convert numbers into the words suggested by the definitions provided. The is often a theme linking all answers.

Sample: 742 (body part) = RIB. Answers on page 14.

by Daniel R. Pearson © 2020 All rights reserved

TEXT

1

THE MYSTERY WORD

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JANUARY 24, 2020

13 +

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

M

oe: My wife has been missing for over a week now. The police called and said I should prepare for the worst.

Joe: Oh no.

Moe: Yeah. So I went to Goodwill and bought all her clothes back.

Moe: Tomatoes are fruit, right?

Joe: That’s what they say.

Moe: Well here then, this is for you.

Joe: This is just a glass of ketchup, isn’t it?

Moe: No, it’s a smoothie.

Moe: It’s amazing to think that a little over a hundred years ago only a few people thought manned flight was possible.

Joe: And only two of them were Wright.

Husband: I need to call the doctor today.

Wife: Which doctor?

Husband: No, the regular kind.

Moe: I have a riddle for you.

Joe: Fire away.

Moe: What is the only thing you have to stop running in order to catch?

Joe: Uh... your breath.

The

Advice Doctor

Two old friends who had not seen each other since their first days of college several years ago crossed paths one day.

“Bill Jones? Is that you?” said the first one.

“Oh. My. Word! Jim Wilson!”

“It’s me! What are you doing these days?”

“Me? Just my PHD.” “Wow! You’re a doctor?” asked Jim. “No, no. Pizza Home Delivery,” said Bill.

A lovely young woman happened to be seated next to a priest on a transatlantic flight. “Father,” she began hesitantly, “May I ask a favor?’

“Of course child. What may I do for you?”

“Well, I bought a very expensive hair curler for my Mother’s birthday that is unopened and well over the customs limits, and I’m afraid they’ll confiscate it. Is there any way you could carry it through customs for me?

Under your robes perhaps?”

“I would love to help you, dear, and I will,” answered the priest, “but I must warn you: I will not lie.”

“With your honest face, Father, no one will question you.”

When they got to customs, she let the priest go ahead of her. The official asked, “Father, do you have anything to declare?”

“From the top of my head down to my waist,” he said, “I have nothing to declare.”

The official thought this was a strange answer, so he asked, “And what do you have to declare from your waist to the floor?”

“I have a marvelous instrument designed to be used on a woman, but which is, to date, unused.” +

Why subscribe to theMEDICALEXAMINER? What do you mean?

Staring at my phone all day has had no Effect on ME!

Because try as they might, no one can stare at their phone all day.

©

Dear Advice Doctor, We have a fairly new employee in our office who is constantly bragging about all his accomplishments at his previous job. It was all very impressive until by chance I discovered that a friend of mine works at his old job.

Turns out he was a complete disaster there and didn’t do any of the things he boasts about. The guy must have a screw loose, but I don’t know whether I should confront him privately, go straight to HR, or continue to bite my tongue and just let him self-destruct. Got any tips for me?

— Co-Worker of Mr. Perfect Dear Co-Worker, You know the old saying that practice makes perfect? Not true! At least not always.

Exhibit #1 is eating. We’ve all been chewing food on a daily basis since our baby teeth came in decades ago, and yet as you remind us, we all still accidentally bite our tongue from time to time.

It’s a lot more common than you might think. People not only bite their tongue while eating, but also when playing sports, during a traumatic event like a fall or a car accident, after dental anesthesia, while sleeping, and for some, during seizures.

The tongue is a body site that bleeds a lot, even if the wound is small, so the first step is to assess the injury. With clean hands and a clean cloth or gauze pad, apply pressure to the site to stop the bleeding. Wrapping ice or a cold pack in the cloth can also help. Cold and pressure for five minutes is usually enough to stop the bleeding, although sometimes it can take a few minutes more. Once the bleeding stops, expect it to take anywhere from a day or two up to a week for your tongue to heal. During healing, avoid rough or scratchy foods in favor of softer foods that are easy to swallow. Sucking on a piece of ice or a fruit-flavored ice pop can help alleviate both pain and bleeding.

If the injury is more severe, if bleeding can’t be stopped, if the tongue is swollen or you still experience intense pain after a reasonable period of time, or if you suspect or see signs of infection, it’s time to contact your doctor or head to an ER or walk-in clinic for evaluation.

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.

SUBSCRIBE TO THE MEDICALEXAMINER +

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Why read the Medical Examiner: Reason #192

By popular demand we’re making at-cost subscriptions available for the convenience of our readers.

If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house!

NAME ADDRESS CITY STATE ZIP Choose six months for $20____ or one year for $36 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

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THE MYSTERY SOLVED The Mystery Word in our last issue was: RETINA

...cleverly hidden in the grass in the p. 15 ad for OVERHEAD DOOR COMPANY OF AUGUSTA

THE WINNER: KELLY SMITH! Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

JANUARY 24, 2020

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED A D A M

D O L E

C A P E

O L O G Y

H U L L A B A L O O

S H E A

T E R M

E A S E

D R Y

I S O O G L L O A I N M O E L S I G I N A G E R N D S T E C N M

M E R R Y P E R I R U E

P E I B A R S E N A M E N E A S F R O W A L N E R R Y V E E W E N D A R A D R I V E B I D E O N G P R S E E T E D R

I N T I

D Y A D

S A L E

U N I V E R S I T Y

T U R I N

T E S T

R E N O

S T A T

SEE PAGE 12

The Celebrated TheSUDOKUsolution MYSTERY WORD CONTEST 2 6 5 1 7 9 3 4 8

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package!

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

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Love to stare at your phone?

Visit issuu.com/ medicalexaminer and stare away.

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4 3 1 2 6 9 8 5

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QuotatioN QUOTATION PUZZLE SOLUTION “The path to success is acting on the advice we give others.”

— Author unknown

TEXT ME 1. FLU 2. COLD 3. COMA 4. GERM 5. PAIN

6. ACNE 7. VIRUS 8. VEINS 9. THUMB 10. BRUISE

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JANUARY 24, 2020

ROARING TWENTIES… from page 1

Karl Landsteiner won the 1930 Nobel for his discovery of various human blood types. Landsteiner also discovered the Rh-factor in blood.

Changes were being seen in the basic practice of medicine itself. Because of the landmark changes resulting from 1910’s Flexner Report in towns and cities from Augusta to Zanesville, medicine was becoming a more respected profession. The cultural influence of the medical profession was growing, as were doctors’ incomes and community standing.

At the same time, the more rigorous standards adopted in response to the Flexner Report were among the factors driving up the costs of healthcare during the 1920s. Don’t laugh, but the average American family in 1929 spent about $103 on healthcare each year. The average annual household income that year, incidentally, was $1,916, which puts the $103 into perspective: roughly 5 percent of a typical family’s annual income.

No wonder people needed relief. One of the earliest efforts to manage and insure against healthcare costs began in 1929. A group of Dallas school teachers contracted with Baylor University Hospital to receive up to 21 days of inpatient care per year if needed. But there was a catch. There always is. They had to pay 50 cents a month to participate in the plan.

Eventually these strategies caught on and became things like Blue Cross. They were win-win programs: healthcare consumers got an affordable way to pay for inpatient care, but such plans main purpose was to provide hospitals with a steady revenue stream to weather the ups and downs of patient census figures.

Hospitals became recognized centers of treatment and cure, not places where terminal patients went to die.

Not that death and disease were conquered during the Twenties. Far from it, as we well know in our own Twenties.

For starters, there were no antibiotics. Sulfa drugs weren’t invented until the 1930s, and even penicillin, accidentally discovered in 1928, was essentially unused until the 1940s. Infections, therefore, could and often did run rampant.

Insulin likewise took awhile to be universally and effectively applied. It was late into the Roaring Twenties and into the early 1930s before diabetes was no longer a fatal disease.

Cancer was not effectively treated and was also often a death sentence: chemotherapy and radiation were still decades away.

Without antibiotics, surgery or its aftermath was a risky proposition at best.

Broken bones were another casualty of poor infection control.

The advanced hardware of titanium pins and screws used to set bones today were still a distant dream in the 1920s, and infections led to many amputations that would never happen today.

During the 1920s, chicken pox, rubella, diphtheria and even the mumps were still marauding killers.

Blood transfusions came into use due to the mass casualties of World War II, and were not an option for doctors during the Twenties. (Ironically, the death of Charles Drew, the physician who developed the techniques of blood storage, matching and transfusion, is often blamed on his inability to receive a transfusion because he was black.)

The decade began with tuberculosis firmly affixed as a Top 3 killer in the U.S., later taking the lives of George Orwell and Vivian Leigh among countless thousands. It slipped off the Top 3 list by 1923, but the doctors of the 1920s didn’t have any more success against heart disease than doctors today. Bumping 1920’s #1 killer pneumonia to second place in 1921, heart disease took the throne and has never looked back. 137,157 Americans died of heart disease that year (1921), a rate of 156 people per 100,000 of overall population. The numbers went up each and every year of the Roaring Twenties, striking down 251,153 by 1930, a rate of 214 per 100,000.

The Roaring Twenties are much like our own dawning Twenties: amazing innovations are springing up left and right, and man’s dominant place atop every food chain, even our microscopic adversaries, seems more assured with each passing year. And yet there remain the pesky and unconquerable foes that still stubbornly refuse to bow down, some age-old, some new to the battlefield.

It will be interesting to see what our Twenties record on the pages of history. +

Proudly affiliated with Dr. John Cook of Southern Dermatology in Aiken

M.D. John Cook,

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