Medical Examiner 2-4-22 by Daniel Pearson

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FEBRUARY 4, 2022

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G(UN)SAFE

Among the topics of heated debate that will never be settled to the satisfaction of both sides is the one between advocates of gun control and those who champion gun rights. This article has no intention of wading into that swamp. However, gun safety is a worthwhile subject for discussion. Some people mistakenly think that not owning a gun shields them from danger. As 8-year-old Arbrie Anthony would tell us — if she hadn’t been shot to death in her front yard on Jan. 8 — not owning a gun does not offer immunity. Her tragic death underscores another tragedy: gun violence disproportionately affects the black community. As cited in the Nov. 11, 2021 issue of The Metro Courier, black males ages 15 to 34 comprise 2 percent of the US population, but they represented 37 percent of all gun homicides in 2019, a rate 20 times higher than white males of the same age group. Using Philadelphia as a specific example, the article reported that more than 80 percent of that city’s homicide victims were black males. Most people — citizens and law enforcement alike — believe something needs to be done, but that’s where the agreements end. Gun rights advocates are not about to give

up their guns, and they do happen to have the 2nd Amendment of the U.S. Constitution on their side. Guns equal personal protection for this faction; no guns means people are vulnerable and unprotected. The other side of the debate cites statistics left and right showing that weapons are rarely used for protection against intruders or other threats to personal safety that would require deadly force in response. Indeed, it’s possible that a person could live an entire lifetime (or two) and never be faced with such a situation. As acknowledged above, neither side is in danger of winning the other side over to its viewpoint any time soon. Where does that leave us in the meantime? Focusing on gun safety. Guns may be the only product that can cause instant death when used as designed. They are not toys. As lethal as they may be, however, the rules for their safe use can easily fit between here and the end of this article. Applying what follows could save thousands of lives every year. Assume every gun is loaded. Store guns and ammunition separately and securely. Never point a gun at anything or anyone you’re not prepared to shoot at. Keep your finger off the trigger unless you intend to fire. If the target is a human, be prepared for the possibility that you will be locked in a cage for decades as a result of your decision. Our recommendation: shoot hoops, not guns. +

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It is not easy to imagine a world without guns. They are an innate and legally established part of American culture. When guns are outlawed, only outlaws will have guns, right? Actually, there are places where guns, although legal, are very scarce, even for the bad guys. Yet people feel safe and have a strong sense of personal freedom. One such place is Japan. To become a gun owner there requires an all-day class, a written exam and a shooting-range test with a minumum score of 95%. There are also drug and mental health tests. Your criminal record (along with your relatives and co-workers) is checked, and FROM UNLAWFUL HOME INVASION police look for links to extremist groups. If you do get a license, it expires after three years and the process is repeated. Incidentally, this is all for shotguns and This message might sell guns, but air rifles only. Handguns are illegal. Does that make you wonder if armed it’s not a need based in fact. criminals are running wild all over Japan? According to a 2017 BBC report, Japan had a grand total of 6 gun deaths nationwide in 2014. Despite their lack of guns (0.6 guns per 100 people vs. 88.8 in the US), Japan has one of the lowest crime rates anywhere in the world. During all of 2015, Japanese police fired exactly 6 shots nationwide. By comparison, through just the first five months of 2021 in the US, gunfire killed more than 8,100 people, an average of more than 50 people per day. While gun ownership is often framed as an issue of personal safety, the vast and overwhelming majority of guns not used for hunting or sport shooting are fired for one of just two reasons: suicide or murder. 2019 CDC figures for people aged 15 - 64 list the combined number of murders and suicides in the US (most of which are perpetrated with guns) as 51,349. But FBI statistics for 2017 show just 298 justifiable homicides nationwide involving a private citizen using a firearm, compared with 10,380 criminal gun homicides. It may not be possible to imagine an America without guns. But it should be possible to imagine one without senseless gun violence. +

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD by David W. Proefrock, PhD

Your 6-year-old daughter comes in the house and tells you that the children next door have a real gun out in the yard. Obviously, you keep her in the house, but what else do you do? A. Don’t let her play with those children anymore and watch her closely when she goes outside. B. Call the Sheriff’s Department and report the situation. C. Call the children’s parents and tell them about the gun. D. Go out and take the gun from the children and then take it in to their parents. If you answered: A. This keeps her safe for now, but does not address the immediate problem that there are children in the neighborhood playing with a gun. B. You might have to do this, but you should call the parents first and give them a chance to address the issue. C. This is the best place to start, but if you can’t get in touch with them or they do not take the gun, you will have to call the authorities. D. This could be a little dangerous, but it is better than leaving children with a gun. It would be best to call the parents and let them deal with the issue first. Any of the responses listed above are better than the first one. However, you have to assume that the parents do not know that their children have a real gun out in the yard and give them a chance to deal with it first. Whatever you do, you cannot ignore the situation. + Dr. Proefrock is a retired clinical and forensic child psychologist.

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P IS FOR PLEASURE You think you like pleasure? Ask your brain, see how much it craves pleasure. There’s no room inside our skulls for anything useless or unproductive, so it’s no accident that there is a section of the brain known as the pleasure center. In fact, researchers believe there are numerous areas within different sections of the brain that are part of the Pleasure Department that chemically and neurologically motivates us to do pleasurable things, like eat, drink, sleep, procreate, and other associated behaviors that keep us (and the human race as a whole) alive and well. Sometimes called the reward center or reward system, evidence suggests the brain also has separate circuits that make up an anti-reward system, in effect putting the brakes on what could be the excessive pursuit of pleasure to our detriment. And therein lies the two-edged sword aspect of the brain’s pleasure center(s). Look up this subject in Wikipedia, as one example, and right away you’ll notice a sidebar about addiction and dependence. Alas, it’s not easy to find any information on the brain’s pleasure center that doesn’t include major references to chemically created pleasure. Words like cocaine and crack, heroin, speed, ice, methamphetamine, nicotine, and others pop up regularly. What researchers have discovered about the way these drugs affect the brain offers a clear picture of the intense power of addiction. When you think back to the first true romance of your life, you can probably recall the kind of euphoria that has been celebrated in thousands of love songs. The neurotransmitters in the brain

responsible for that high are actually close cousins of amphetamines. In the absence of new love, some people turn to methaphetamines for the same high. But while a teenage crush can give you a high that might last for weeks, a synthetic high not only lasts for mere minutes, but leaves behind a crushing low, way worse than a break-up. Cocaine offers the same roller coaster: a dizzying high followed by a desperate crash. Scientists are beginning to understand why so many people say they were instantly addicted to crack after the very first time they tried it. The mechanism is twofold. As we have established, the brain’s pleasure center routinely releases feel-good chemicals to motivate and reward certain behaviors. Being a highly efficient system, when the brain is already flooded with neurotransmitterlike chemicals from some outside source, there’s no need to produce more. So the aftermath of a chemical high is a distinct shortage of natural pleasure chemicals. The anti-reward system is also in play. The body is smart enough to instinctively know it can’t operate in a perpetual haze, so chemical extinguishers help to lower the high and reestablish equilibrium. Another component of the chemical crash after a high, perhaps the biggest factor, is one more aspect of brain/drug chemical interaction. Cocaine not only activates pleasure centers but in effect squeezes them dry. All the available feel-good chemicals — both the ones snorted or injected and the natural ones stimulated by the drugs — are in circulation. Please see PLEASURE page 3

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Cocaine even binds to dopamine reuptake transporter protein. As that name suggests, dopamine is normally “uptook” or reabsorbed, but cocaine interferes with that, prolonging the high. Eventually, though, the dopamine is reabsorbed and dissipates to normal levels. Over time, however — and sometimes after a single use of cocaine — dopamine nearly disappears. Pleasure circuits dry up, even as synaptic cells sprout new receptors in a vain search for fresh dopamine signals. The formerly euphoric user now lives in a constant state of anxiety and irritability, unable to experience pleasure without cocaine’s assistance. Ironically, each use can further deplete the supply of goodmood neurotransmitters as well as the ability to manufacture more. It can become literally impossible for such a person to experience happiness, joy or pleasure (without chemical assistance, that is), and deep depression and continual relapses are the common results.

It’s the classic vicious cycle of addiction. Not all clinical lows are evidence of post-drug binge highs, however. Various disorders are associated with malfunctions in the reward system. For example, schizophrenia is associated with deficits in motivation from various brain pleasure centers. For those with ADHD (attention deficit hyperactivity disorder), high-stimulation activity results in a surge of dopamine, but as dopamine reuptake removes dopamine from the system for recycling, the exuberant mood is followed by a sharp drop in mood and motivation. In real life, things that provide pleasure — eating delicious foods, listening to favorite music, having sex, visiting places of beautiful scenery — cannot be engaged in every waking moment. Pleasure by its very nature seems to be transient. Forcing it just doesn’t work; but there’s no need: pleasure comes and goes. And it always comes again. +

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I TESTED POSITIVE. NOW WHAT? This does seem to be the great unanswered question of The Great Pandemic of 2020. And 2021. And 2022. We don’t typically hear anything about getting to a doctor right away or what prescription or over-the-counter medicines we need to run out and get. Nothing. Well, not exactly nothing nothing. There is one thing that positive testees are all told to do, and that is isolate. There are a lot of jokes and sarcastic remarks in circulation about the CDC’s ever-changing guidelines, but the truth is they have been consistent about their most recent recommendations for some time. Quoting from the CDC website: “Everyone who has presumed or confirmed COVID-19 should stay home and isolate from other people for at least 5 full days (Day 0 is the first day of symptoms or the date of the day of the positive viral test for asymptomatic persons). They should wear a mask when around others at home and in public for an additional 5 days. People who are confirmed to have COVID-19 or are showing symptoms of COVID-19 need to isolate regardless of their vaccination status.” It’s pretty simple and direct. And a positive test is a positive test. Period. That means the recommendations apply even to people who are asymptomatic or vaccinated. What does isolation mean? Again, straight from the CDC: • Monitor your symptoms. If you have an emergency warning sign (including trouble breathing), seek emergency medical care immediately. • Stay in a separate room from other household members if possible. • Use a separate bathroom if possible. • Take steps to improve ventilation at home if possible. • Avoid contact with other members of the household and pets. • Don’t share personal household items, like cups, towels, and utensils. • Wear a well-fitting mask when you need to be around other people. +

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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. Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

(706) 860-5455 www.AugustaRx.com • E-mail: Dan@AugustaRX.com www.Facebook.com/AugustaRX Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., nor its agents or employees take any responsibility for the accuracy of submitted information, which is presented for general informational purposes only. For specific medical advice, diagnosis, and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2022 PEARSON GRAPHIC 365 INC.

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#158 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

hat’s Nobel Prize winning British physiologist Sir Robert Edwards on the left, and freight company employee Louise Brown on the right. The unlikely pair made medical history on July 25, 1978 in an event some say is “among the most remarkable medical breakthroughs of the 20th Century.” Nevertheless, it was a controversial breakthrough. Louise is inscribed on the pages of history as the world’s first test-tube baby, even though that isn’t true. She was conceived in a petri dish, not a test tube. Personally, Louise is said to dislike the test-tube term, but the title of her 2015 memoir was My Life as the World’s First Test-Tube Baby. Her parents, Lesley and John Brown, had been trying to conceive for almost a decade without success due to a blockage in Lesley’s fallopian tubes. As a last resort they turned to the clinic in England where Robert Edwards, gynecologist Patrick Steptoe, and nurse Jean Purdy had been doing research on human infertility. The team developed a suitable culture medium for the sperm and eggs cells they collected and isolated. Purdy, who began work with Edwards and Steptoe as a lab technician, ultimately became such an important member of the team that research at the facility paused when she had to take time off to care for her sick mother. It was Purdy who first saw the fertilized egg that was to become Louise Brown dividing in the petri dish and making new cells. Louise Brown has spent her life correcting people’s mistaken belief that she literally spent her embryonic phase in a test tube. Once the fertilized egg is deemed viable, it is transferred back to the mother’s uterus to develop and be delivered nine months later just like any other baby (although Lesley happened to deliver Louise by cesarean section). Although the breakthrough was considered a godsend to infertile couples, many in the medical and religious community then and now believe in vitro fertilization (IVF) to be anything but godly, raising ethical questions about procreation, the family unit, and physicians “playing God.” Despite the controversy, Louise’s birth launched many more so-called test-tube babies, including her little sister Natalie, born 4 years after Louise as the world’s 40th IVF baby. Since then the floodgates have opened to the tune of millions of babies born to previously infertile couples via in vitro, artificial insemination, surrogate mothers, frozen eggs and frozen sperm cells, and various other out-of-the-bedroom ways of making babies. Both Louise and Natalie, however, established the fact that IVF babies can grow up to conceive and deliver the oldfashioned way. Natalie, in fact, became the world’s first IVF baby to conceive a child without IVF when she became pregnant in 1999. She went on to have four more children. Louise and her husband have two kids. Edwards, Steptoe and Purdy would have shared the Nobel Prize for their innovation, but by the time the honor came (in 2010) Edwards was the sole survivor (he died in 2013 at age 87), and Nobels are not awarded posthumously. Dr. Steptoe died in 1988 at age 74, and Purdy died in 1985 at age 39 from malignant melanoma. Often ignored for her contributions, Purdy was co-author on 26 papers with Steptoe and Edwards, and 370 IVF children were conceived during her career. +

by Marcia Ribble This afternoon there is a cold drizzle wetting everything making it one of those gloomy days of winter. I have been watching people walk outside my window and find it fascinating to realize how varied walking is for both young and old. On the sidewalk, people are walking with purpose, to get from the parking lot to their apartments, to walk from their apartments to their cars, to get in their 10,000 steps a day, to walk their dogs. But how they walk is almost infinitely varied! I watched as one woman arrived and was slow getting out of her car, or so I thought, before she emerged with four bags of groceries and a dog on a leash. She slowly made sure everything was balanced before taking those first few tentative steps. Gaining confidence, she hurried her pace, but not very much. Each step was measured, deliberate, and controlled. It was clear that at some time she had fallen and was concerned about falling again. Trooper as she was, her bravery kept her both aware and determined to not give up. In contrast, my great-grand twins Silas and Junior turned one recently. I have watched them launch themselves into walking totally without fear, even as they bobble, lurch, and fall, repeatedly. I realize that their short height gives them an advantage. They don’t have as far to fall. They also have nice round bodies, and seem less to fall than to slowly sink into the floor. They giggle, and they get up again. They are even learning to walk while carrying things. I giggle too watching them. Other folks walk with a quick, confident step. They have integrated walking into a mindless, unaware routine, like breathing.

They don’t have to even think about it. The intention to walk is all that is required. They want to go and it is accomplished, automatically. Their bodies get up out of chairs without effort. Carrying packages is automatic behavior without a need to consider balancing. Age doesn’t seem to make a difference once they have acquired the skills Silas and Junior are practicing. I wonder how my body has changed from walking without thought or effort to thinking about walking as an immense challenge. I wake up and think about how my body is feeling, if it is stable enough to walk the few steps from my recliner to my wheelchair, from my walker to the bathroom, from front door to back door. I had not fallen even once since breaking my hip more than two years ago, until I moved here. Then I fell four times in the span of two weeks. That was a few weeks ago. My confidence has been shattered. Every step I take, I worry about falling. I try to limit the amount I walk due to the fear. I don’t know how to explain it to anyone who walks without needing to think about it. Silas and Junior wouldn’t understand. But they can be brave because they haven’t injured themselves. When I fall now it hurts even if I didn’t break any significant body parts. Every part of me aches. I get bruises. My joints creak and complain. I remember the pain of breaking my hip, of the terrible feeling of the shattered hip bones rubbing against one another, of the months of hospitalization and rehab, of now having my right leg two and a half inches shorter than my left leg. What my body used to do without conscious thought, I can no longer trust. So I am asking for prayers to help me regain my confidence, my strength, and the freedom to get up and out of the wheelchair. +

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age BY J.B. COLLUM

coronary artery disease or type 2 diabetes, or one of many other ailments. Or maybe you hit the jackpot like me and were blessed with seversal of these things. You are now a member of the club, and you can’t win. You can’t even quit. Well, you can, but let’s not go there. The problem is that, unlike the 12 albums for a penny deal, you can’t even tell life that you don’t want it. It arrives, and you have to accept it. You add it to your collection, perhaps along with the medicine it takes to mitigate it to a greater or lesser degree. You get used to it and move on. Who knows what next month will bring? I have found myself in this situation ever since my 50th year. I have shared many of my past medical emergencies, ailments, and pains here in this column over the past two years. Everything from a heart attack to diabetes and more. I think I am paying the price for choosing to eat whatever I wanted in whatever quantity I desired, and for taking risks that caused minor injuries when I was young. The mistakes when I was younger have now come back to haunt me in the form of joint pain, hardening of the arteries, diabetes, and the list goes on. I have a new album coming this week. I mean, a new ailment. By the time this is published, I will hopefully be recovering nicely from surgery that will require four weeks of convalescence. I don’t want to go into details, but let’s just say that it involves multiple cuts and stitches in my hind quarters that will have me sitting in a warm bath three times per day for a month and spending the rest of my time resting on my stomach. TMI? Yeah, I know. (And yes, that means the pull-out quote above is more TMI — and lame humor.) At this moment I am able to enjoy a not-so-bad diet, but two days from right now, the day before surgery, I will be subsisting on Jell-O, chicken broth, water, and sports drinks. I enjoy watching survival shows on television. I never thought I’d envy any of the unsavory things they have to eat, but I expect that I will before this particular chapter is over with. And unfortunately, this is just part one of my journey navigating the latest delivery of the Ailment of the Month Club. I hope you will come back around for the next few parts. I hope even more so that I will be around to write them. Like I said, I may not exactly like this club, but I sure don’t want to quit. +

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Do you remember when Columbia House would send you a dozen 8-track tapes of your choice for only one penny? If you are middle aged, you do. I remember those days. I can still remember two of the 8-track tapes we chose, Rumors by Fleetwood Mac, and Boston’s Don’t Look Back. We were overjoyed when our new collection of music arrived. We wore those tapes out. I think I ended up buying both of those albums, among many others, multiple times, across multiple formats from 8-tracks, to cassettes, then to CDs, not to mention replacing at least a few scratched vinyl records over the years. But I digress. It was really nice getting all of those great albums so cheaply and all at once, but we should have remembered the old maxim that there is no free lunch. There isn’t even a one-penny lunch. About a month later, an album showed up that we had no interest in. You see, we were obligated to buy one album a month at the full price and if you didn’t want it, you had to remember to mail back the post cards to tell them that. If you didn’t, too bad, you were stuck listening to Jack and Jill’s Greatest Polka Hits, or whatever they decided to send you. They banked on the fact that enough people would forget to tell them not to send it, and so they could unload a lot of unwanted albums, or albums they wanted to promote and make an insane profit while people began to build collections of albums that just gathered dust. Lately, I have begun to think that life is like a Columbia House 12 for a penny deal. Early in our lives, everything is coming up roses. Most of us get to run and play without the dread of the aches and pains that will follow when we get a little older. Life seems so grand. We get the mistaken impression that it is just going to keep getting better as we get more freedom and make more money and collect more things and experiences. The thing is, you got all the good albums you wanted up front, early on, then when you get to middle age, well, not so much. Middle age is the monthly ailment club. New aches and pains show up. New maladies come to visit and then decide to become permanent residents. You are paying the price for that great deal you got early on in life. Did you enjoy the great fun you had on the football field as a young man? Did you dance the night away as a teenager? Did you eat whatever you wanted without fear of gaining weight or getting some illness that overeating or an unbalanced diet can bring? Well, I hope you made the most of those experiences, because you now probably need a joint replaced (if it hasn’t already been) or you at least have some arthritis in some joints that put you in a sour mood until your medication kicks in. You might have

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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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by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

VEGETABLE LASAGNA

This is delicious and provides 3 servings of vegetables in just one serving of lasagna. Ingredients • 2 teaspoons olive oil • 1 small onion, chopped (about 1 cup) • ½ green bell pepper, chopped (about ½ cup) • 4 cloves garlic • 2 small yellow squash, rough chop (about 2 cups) • 1 (15 oz) container low fat ricotta cheese • ¼ cup grated parmesan • 2 cups part-skim mozzarella cheese, divided use • 2 eggs, beaten • 1/4 cup milk • 2 teaspoons Italian Seasoning • 1 (28 oz) jar “healthy” spaghetti sauce • 1 (14.5 oz) can no-addedsalt tomato sauce • 5 oz raw spinach, chopped (about 4 cups packed) • 9 oz oven ready rolled flat noodles Instructions Preheat oven to 425 degrees. Place a non-stick skillet over medium high heat and add oil. Once the oil is hot add the onion, pepper, squash and garlic. Sauté until the vegetables are soft (~ 6 minutes). Remove from heat and set aside. In a large bowl, combine the low fat ricotta, parmesan, and 1 ½ cup mozzarella cheese with the eggs, milk

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and Italian herbs. Mix well. In a second large bowl, mix together the pasta sauce, spinach and squash mixture. Spread half of the tomato sauce into the bottom of a 9 x 12 inch baking pan. Place one-fourth of the oven-ready lasagna noodles (4 noodles) over the sauce. Spread 1/3 of the cheese mixture over the noodles; top with 1/3rd of the tomato sauce mixture. Repeat layering twice. Top with remaining noodles and last half of the tomato sauce. Wrap the lasagna tightly with a double layer of foil (Spray the layer of foil that comes in contact with the food with vegetable oil cooking spray to keep it from sticking). Bake for 60 minutes. Uncover and top with

the remaining cup of cheese, pop back in the oven for 5 minutes to melt cheese. Remove and allow the lasagna to set for 15-20 minutes. Cut and enjoy! + Yield: 12 Servings Nutrition Breakdown: Calories 270, Fat 8g (4g saturated fat), Cholesterol 50mg, Sodium 140mg, Carbohydrate 32g, Fiber 4g, Protein 16g. Plate Plan: Medium fat meats

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NUTRITION Tammy, a Facebook friend from Greenwood, South Carolina, asks: “February is both Heart Month and Nutrition Month. What are the latest diet and nutrition guidelines for keeping your heart in top shape?”

Tammy, this is currently a very hot topic. Just two months ago (in December 2021) the American Heart Association published its revised dietary and nutrition guidelines. The guidelines had not been updated since 2006. The latest version is a further refinement of what we know about the relationship between diet, food and

heart disease, based on the most up-to-date scientific data. Remember that when we speak about heart disease, we are really speaking about cardiovascular disease, which includes your brain (strokes) and your entire circulatory system (including legs and feet, sometimes called peripheral vascular disease). Foods that are good for your heart are also good for your brain, good for circulation and good for your entire body. Foods that lower your cardiovascular disease risk are the same foods that lower your risk for diabetes and high blood pressure. I thought I’d pick a few of the more important points in the guidelines to mention in today’s column. The first heart guideline I want to discuss focuses on how important it is to be within your reasonable weight range. Health professionals approach your weight as a health and medical issue, not as a cosmetic issue, a social issue, a judgmental issue, a fat-shaming issue or a self-esteem issue. Keep this important distinction in mind when your health professional wants to discuss your weight or your child’s weight. I recently read a mother’s complaint, posted on the web, about how rude a pediatrician was to mention her child’s weight. The mother gave the physician a low evaluation score and said she would never go back to her office again. The doctor was not trying to fat-shame the parent or child. Listen

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to your health professional when they want to discuss your weight or your child’s weight. Don’t get defensive. View this as an opportunity to put together, with your health professional, an action plan to address this important health issue. The updated guidelines also talk about all the heart and brain dietary supplements and special diets advertised on TV, on the web, and elsewhere. Has the advice for these changed? No. The latest heart health guidelines advise you to eat food, not supplements, and to avoid fad foods and fad diets. What foods are heart healthy? Simple foods, such as fruits and veggies, whole grain carbs, low fat dairy, mostly plant-based protein, while avoiding highly processed foods. Your diet should be

FEBRUARY 4, 2022 varied and balanced, which means that it should contain many different types of foods. Most people do vary what they eat for dinner, but tend to get stuck on the same breakfasts and lunches, dayin and day-out. What about dietary supplements? Unless they are prescribed by your physician for a specific medical reason, forget about them. Looking at some other highlights of the latest heart guidelines, the issue of too much dietary salt and sugar is still a big concern. When you eat out or buy all those highly processed, prepared meals, you put someone else in control of the salt and sugar in your diet. Take back control. Also, for the first time the heart guidelines point out that what is good for your heart is also good for the planet. Eating fewer processed and ultra-processed foods and less animal protein are very good things for the health of the planet. Be aware that just because a food is made from a plant rather than an animal does not automatically mean that it’s healthier for you or the planet. Maybe yes, maybe no, especially with regard to all those very highly manufactured and processed artificial plant meats (the burgers and the chicken) that are starting to saturate the market. The recent heart guidelines point out how important it is

for you to focus on your overall eating patterns and take the emphasis away from specific foods. In addition, moving more, more, more, and eating less, less, less, is very heart healthy, especially for the more than 70% of Americans who are overweight or obese. When you do eat, make your meals simpler, healthier, faster and tastier. At your PTA and Board of Education meetings, speak out about the importance of including nutrition education as a part of the school curriculum for all grades, pre-K thru seniors (for the teachers and aides, too). What is the “No-Nonsense Nutrition” advice for February? The most recent scientific evidence on heart health and nutrition re-affirms most of what we already knew. All of a sudden, coconut oils, supplements, butter and fad diets are not “in,” regardless of what you see on the web. Stick to the evidence and stick to the science. If your health professional wants to start a discussion with you about your weight or your child’s weight, don’t get defensive, be open to this idea. The two of you can come up with a good action plan. If you’d like to read the full 2021 American Heart Association nutrition and dietary guidelines, simply search for the guidelines using your web browser. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www. Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to ensure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidencedDr. Karp based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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ON A COVID AND DARWIN’S THEORY BASED TRUE STORY Way back in 1859 Charles Darwin, in his Origin of Species, told us all we need to know about the progression of the COVID virus. The strong and the smart survive and reproduce. The weak and dumb don’t, and they die. The original COVID virus (wherever it came from) attacked human hosts (everyone) and made them critically ill. The deadliest of viruses kill their host and die right alongside the host, and therefore could not reproduce itself. That is dumb. It is never a good plan to bite the hand that feeds you, let alone kill it. A less deadly virus that doesn’t kill the host can and will reproduce and spread. Along the way, viruses naturally mutate. A less-deadly virus will make the host (you) sick, but does not kill it. It can go on to produce wave after wave of offspring. Needless to say, the less deadly (but more host-friendly) viruses that reproduce quickly and rapidly find

more hosts to attack. Meanwhile the deadlier viruses die out due to killing their host. Clearly, we have gotten and will get recurrent waves of mutated viruses that make people sick, but don’t kill them or required extensive hospitalizations. You can see the increased upward curves of new cases, and flattening of hospitalization on TV news each day. How do we survive this COVID onslaught physically, emotionally, and financially? When you survive a COVID infection, you acquire some degree of immunity. Those who get vaccinated acquire some degree of immunity as well. Those who survived infection and got vaccinated and got boosted, have the best available immunity. They are less likely to have extended hospitalization or die from COVID. We may have to adjust to living with COVID the same way we live with flu unless we develop a vaccine that prevents all forms of mutated COVID viruses. We did that

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“If you don’t want the vaccine, that’s okay.” — Charles Darwin with polio and smallpox, but we can’t seem to do that with flu viruses. True herd immunity is when an entire population is immune to a given pathogen (polio, smallpox, measles, mumps, rubella). It works if you can get everyone to vaccinate, but clearly, we can’t do that for political, social, financial, and individual reasons. Everyone can make their own decision regardless of how misguided it might be.

Who bears the cost of failed herd immunity? Let’s say an infected person (vaccinated or unvaccinated) goes to the hospital, runs up a huge bill, and dies. Or survives to go home, but can never pay the hospital bill. It happens every day. Taxpayers get saddled with the bill, usually several hundred thousand dollars per patient. That means higher taxes for the working folks. The income of the work-

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ing folks is damaged by the virus. It may not actually kill the future wealth of the working folks, but it sure makes their bank accounts and retirement accounts sick. Disruptions lead to evolution (for better or worse) in the progress of nature. COVID will gradually weed out the vulnerable while damaging the less vulnerable. And that is not a good thing. We will get still more COVID mutations or variants. The less damaging will proliferate and dominate. The more dangerous strains will kill more people. You can influence your course by the choices you make. Don’t be part of the natural selection process. Unless you want to pay more taxes and higher insurance: Don’t hesitate. Vaccinate. +

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FEBRUARY 4, 2022

CRASH

COURSE

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

five key areas for attention and change: safer people, safer roads, safer vehicles, safer speeds, ack in our Nov. 5, 2021 Crash Course and better post-crash care. column we quoted a press release from It may all sound a bit pie-in-the-sky, but there the US Department of Transportation. They said are places that have already reached the zero “It will take all levels of government, indusgoal. Hoboken, NJ, a town of 60,000 across tries, advocates, engineers, and communities the river from Manhattan, has gone three years across the country working together toward the without a pedestrian fatality. Even more impresday when family members no longer have to sive, Oslo, the capital of Norway, a city with say goodbye to loved ones because of a traffic ten times the population of Hoboken, had zero crash.” pedestrian fatalities in all of 2019. Our comment was, and we quote, “Let’s There is a reason those are significant milebe realistic: that day will never happen.” We thought their use of the phrase “no longer” was stones: while traffic engineers are concerned and dismayed by the sharp rise in US traffic hyperbole, not to be taken literally. As in, even fatalities, especially since the pandemic hit, the USDOT knows it’s hyperbole. pedestrian fatalities are even higher. But we’ll be darned if they haven’t doubled As high as the car crash fatality numbers down on their stated goal. US Department of were in 2020, the numbers for the first six Transportation Secretary Pete Buttigieg released months of 2021 are even worse. They show a his 42-page National Roadway Safety Strategy jump of more than 18 percent compared to the (NRSS) last week with very lofty goals. Exsame period in 2020. That’s bad. But even that tremely lofty goals. Excerpt: “The status quo pales in comparison to pedestrian and bicyclist is unacceptable... Zero is the only acceptable fatalities for the same period. Those numbers number of deaths and serious injuries on our are up nearly 45 percent (compared, in this roadways.” case, to 2010 numbers). That’s really bad. Considering that an average of more than So the US DOT has a tough road ahead. But 38,000 Americans die on our roads each and as you might have noticed, target #1 of NRSS every year and millions more are injured, zero is safer people. That would include the person is a highly ambitious goal. The NRSS outlines writing this article as well as every person who reads it. The Strategy acknowledges that people will always make mistakes. That factor cannot be eliminated. However, without government intervention we can readily eliminate many driving habits that greatly increase accident risks. Starting today we can avoid driving when impaired by alcohol or medication. We can stop our illegal habit of looking at our phones while hurtling down the road in heavy traffic. We can always wear our seat belts, and make sure all of our passengers do too. We can avoid aggressive driving, tailgating, and speeding Although a goal of zero highway fatalities and serious injuries may excessively. We can actually sound unrealistic, this graph from the NRSS illustrates the contrib- stop on yellow lights instead uting factors in fatal crashes that could be reduced or eliminated, of being the second or third leading to survivable crashes — or preventing them in the first place. or fourth car to plow through Starting at the 5 o’clock position and going clockwise: better highway an intersection after the light design could prevent rollovers; improved EMS response times could turns red. It starts with me and you. + get medical treatment started sooner; ignition lockouts could prevent drunk driving; law enforcement could reduce crashes where speed is a factor; greater seatbelt use - both voluntary and through vehicle Editor’s note: the Crash Course subtitle has been updated. It no design - would save lives. (Note: the contributing factor numbers longer says “since 2000.” It now add up to more than 16,261 because more than one was involved says “since 2006.” in some accidents.)

MMORPG, META-HEALTH, AND IMAGINATION Massively multiplayer online role-playing games (MMORPG) could be the precursor to the next evolution in digital healthcare, medicine, and wellness. This month’s Technobabble-Free Zone will explore a new form of emerging technology, the Metaverse. Imagine an immersive online healthcare ecosystem that combines several aspects of 5G, cloud-computing, high-frequency digital twin technology, social media, augmented reality, virtual reality, online gaming, and artificial by Dr. Chuck Cadle intelligence to allow individuals to interact with one another in a virtual world. You have new viewing products (glasses, headsets, projection screens) programmed with either virtual reality, augmented reality, or mixed reality that enable you to experience virtual patient, doctor, and surgical encounters. You can transport your Avatar (digital twin) to a virtual environment to watch surgeries, attend conferences and seminars, or engage with colleagues. In other words, technology has evolved to enable a three-dimensional (3D) imitation of the natural world on a digital platform with little to no latency, which is called a Metaverse. Author Neal Stephenson coined the Metaverse term in his 1992 science-fiction novel “Snow Crash,” which envisioned a virtual reality-based platform. In the novel, individuals use digital avatars {digital twin technology} to live in a digitized version of the real world. Here we are thirty years later, and his thesis is finally becoming a reality. Mark Zuckerberg recently changed Facebook’s name to Meta Platforms. This name change is part of the company’s plan to transition from a social media company to a social platform for digitized products and services in the Metaverse. On November 18, 2021, Nike announced the creation of Nikeland on the Roblox platform, where Nike fans can connect, create, share experiences, compete, and purchase items in a virtual world. This emerging digital ecosystem is an example of what the American economist, Paul Romer, called “endogenous technological change.” His economic theory posited that the search for new ideas by profit-maximizing entrepreneurs and researchers would become drivers of economic growth, which could account for a rise in living standards over time. The Metaverse is a prime example of endogenous technological change. Implementing the myriad of ideas for a Metaverse will transform how the future medical community will service clients, learn, and transact business. On December 22, 2021, Yahoo released a statement from a British non-profit organization, DeHealth, announcing the

The Technobabble-Free Zone

Please see TECHNOBABBLE page 11

FEBRUARY 4, 2022

From the Bookshelf If you noticed the subtitle of this book (“A Funny Book About Horrible Things”) you already understand the contrasts painted by this author. Jenny Lawson, you see, is writing about depression and mental illness. If you would like to read a depressing book about depression, this is not the book for you. In fact, if you’d like to read a G-rated book about depression, keep moving right along. Jenny has what some people might call a potty mouth. She has words, and she’s not afraid to use them. But no one can accuse her of not getting her point across. And it’s a rather important point, since millions of Americans have to deal with chronic depression, severe anxiety, and various mental disorders that range from merely annoying to crippling and life-altering. It probably tells you all you need to know about Jenny Lawson and this book that her readings are a lot like stand-up comedy. But that doesn’t mean she trivializes

this important subject; it just means she isn’t wallowing in despair or living her life curled up in the fetal position in her closet. Depression is giving her a battle, and she’s fighting right back. And making a lot of fair points for all of us, even people who aren’t battling depression. Example: have you ever told someone in the throes of depression to “just cheer up” (or words to that effect)? As defined by this book, you have said the equivalent of telling someone who just had their legs amputated to “just walk it off.” Have you ever told

TECHNOBABBLE… from page 10 creation of their new decentralized health-related Metaverse. According to the announcement, the DeHealth platform will enable millions of doctors and patients to enter a new digital ecosystem where “they can work and interact with each other in full 3D format and earn virtual assets by selling their anonymized medical data.” Transactions for medical products (photos, videos, applications, and audio – also called non-fungible tokens) and services (meetings, prescribed treatments, education) will be enabled by blockchain (digital ledger) technology and create a new type of crypto-economy (crypto meaning a new kind of currency). DeHealth, mentioned above, is also launching a cryptocurrency HLT (health) token as the payment mechanism for transactions in the DeHealth Metaverse. Over the next few years, as the medical Metaverse building blocks combine, many preventive, proactive, and personalized services performed in the hospital, classroom, or outpatient care

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AUGUSTAMEDICALEXAMiNER

center will move to this new digital ecosystem. Cognitive and teaching presence will benefit from the change to a synchronous environment from an asynchronous one, allowing a community of participants to engage and interact in a digital (virtual) environment. It is easy to begin to imagine the benefits of a Metaverse, but we should not ignore the potential disadvantages. Privacy concerns, cybersecurity, the creation of unhealthy and para-social relationships, the costs associated with purchasing and learning new software and hardware, and the possible result of a new generation of haves and have-nots due to lack of access to the necessary network infrastructure are all disadvantages that Metaverse technology developers should consider. Because of the COVID-19 pandemic, millions worldwide are inconvenienced and stymied by immobility. The need for site visits and social/ work-related interactions has fueled a demand for virtual presence. Software like ZOOM, Google Meet, Microsoft Teams, and Cisco Webex is now the

someone who is depressed that they just have “a case of the Mondays”? If so, you’ll get a reminder that mental illnesses are borne of issues a lot more complex than what day of the week it is. Even so, no one should expect to read this book for scientifically-based clinical insights. It might even be slightly comparable to this newspaper: hopefully informative and insightful, but perhaps leaning more in the direction of general knowledge than doctorate level data. And in the case of this book, throw in an almost prescription-level humor and entertainment factor. Add it all up, and without discounting the importance of therapy and medication, it offers a light-hearted cheering section for anyone determined to be, despite their depression, furiously happy. + Furiously Happy: A Funny Book About Horrible Things by Jenny Lawson; 352 pages, published by Flatiron Books in 2017

interface between families, friends, and workers. Still, these video conferencing applications lack the cognitive and social presence associated with personal interactions. The Metaverse could be the solution. Following this premise, cities seek to create a virtual public square. Real estate companies are beginning to use drone mapping software to construct a digital twin of construction projects and buildings to virtually manage construction projects, incident tracking, maintenance, and security in real-time. Healthcare is also beginning to adopt the underpinnings of a Metaverse, as can be seen with the new company DeHealth. As Jonah Lehrer put it in his book Imagine, “our inventions will always be shadowed by uncertainty and contingency, by the sheer serendipity of brain cells making new connections.” Hopefully, this month’s article enlightened you on the Metaverse and demystified the related jargon. One can only imagine where we go from here.

the blog spot — posted by Anthony Fleg, MD, PhD, on January 27, 2022

AS COVID PULLS US APART, WE NEED EACH OTHER EVEN MORE As a family medicine physician, I am not sure about a whole lot as we turn into the third year of pandemic living. I can’t give you a decent prognosis of where Omicron is going to take us or how many it will take from us. I am not even sure of the public health approach at this moment where COVID seems to outsmart us repeatedly. (A reminder that this is not a failure of science, but is rather how science works. Science is an endless search for answers that are rarely definite.) What I do know is that we need each other more than ever. COVID has pulled us apart 6 feet at a time, and connections are disfigured to the point of not being recognizable from what we knew B.C. (before COVID). I also know that it is a human instinct to pull further apart from one another when we are under stress. This might lead us to attack one another and to complain endlessly about COVID restrictions. It also leads us to forget the suffering of our neighbors, our community, and those dealing with COVID. I hope that by recognizing how much we need each other and by also seeing how our fear may manifest in pushing others away, we can overcome the instinct to forget about others and instead reach out to our neighbors to ask if they are OK. Even if we are not 100 percent OK, making that outreach to others is possible. It is good medicine, as much for ourselves as it is for those we are reaching out to. I turn to a speech I recently found on this month of Martin Luther King’s holiday. Not from Dr. King himself, but a speech from Robert Kennedy, who had the difficult task of announcing to the world that Dr. King had been assassinated. What he implored of the crowd that day in April 1968 still rings true 56 (sic) years later: “What we need is not division … is not hatred … is not violence and lawlessness, but is love, and wisdom and compassion toward one another. A feeling of justice toward those who still suffer in our country.” +

Under stress we sometimes forget to be human.

Anthony Fleg is a family physician

Find the Mystery Word yet?

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The Examiners

FEBRUARY 4, 2022

THE MYSTERY WORD

by Dan Pearson

You believe the earth is flat? You’re crazy. The earth’s surface is 70% water.

What does that have to do with it?

That water is not carbonated.

So like I said, the earth is flat.

So?

The Mystery Word for this issue: PITHALOS

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

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. Easy stride 5. Short note 9. Breath sounds 14. Part of the eye 15. Saharan 16. Chicago film critic 17. Almost tailless rodent 18. Home of a noted medical school 19. Robust (Scottish) 20. 1969 bestseller (ending with “-Five”) 23. Character in The Matrix 24. Bottom-row key 25. His donkey spoke 29. A woman, in old movies 31. Just a little drink 34. Unwraps 35. Alpha follower 36. Main ingredient in some casseroles 37. Eye specialist 40. Swing around 41. Threaten, as a crisis 42. Locations 43. Lead-in for 56-D 44. Macon county 45. 2-point football play 46. Tavern 47. There’s a big one in Columbia County 48. Mathematical operation 56. Augusta ________ 57. A month of the Jewish calendar 58. Sports award 59. Bladder liquid 60. Sea eagle 61. On the sheltered side 62. Noted apostle 63. No longer living 64. Monthly expense

E X A M I N E R

46 48

We’ll announce the winner in our next issue!

5 9 4 6

2 5

6 3

4 5

S 5 U D O 1 K 9 3 U

3 9

9 2 1 5

7 6

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

DOWN 1. They can be cyanotic 2. Spoken; verbal 3. Size of type 4. Jacob’s twin 5. He’s in Allstate commercials 6. Muse of lyric poetry 7. 1,760 yards 8. River in central Europe 9. A job for a cobbler 10. Approximately 11. Optical device 12. Scottish Gaelic 13. Pigpen 21. Grind teeth together 22. Brightest star in the Aries constellation 25. Uplift 26. Singer Fiona 27. Tiny island west of Kauai 28. Poker stake 29. Send troops home at war’s end (in brief) 30. It comes from a Greek word meaning indivisible

4 9 7 6 3

QUOTATIONPUZZLE

31. Connected series of rooms 32. A map within a map 33. Nashville’s Cline 35. Early Steve McQueen movie (with The) 36. Week-ending abbreviation 38. Person used as one’s excuse 39. He founded al-Qaeda 44. Local high school 45. _______ Heart 46. Flying vehicle 47. Princess of Wales, 1981-1996 48. Female horse 49. Single entity 50. Piper adjective 51. Small harplike stringed instrument 52. It can precede gas 53. Small piece of land surrounded by water 54. Nasty type of fracture 55. No to Boris 56. It often follows 43-A

4 9 7 6 3 8 9 3 S V R 1 N T C 5 6 2 A A 8E 7 Y 5 4 2 1 — Antisthenes

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.

Solution p. 14

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

C 1

1 2

S 1 2

U 1 2 3 4 5 6

F 1 2 3 4

I 5

— George S. Patton

1 2 3 4 5 6

1.C H O A F L I M 2.SOOONIE 3.LANUN 4.RRUDG 5.EATI 6.NERG 7.GE

SAMPLE:

1. ILB 2. SLO 3. VI 4. NE 5. D =

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, FEB. 14, 2022

2 1 5 7 4 8 6 3 9

5 9 7 1 6 3 4 2 8

3 2 1 4 8 5 9 6 7

8 4 6 2 9 7 3 1 5

FEBRUARY 4, 2022

AUGUSTAMEDICALEXAMiNER

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three-year-old girl asked her mother, “Where does poo come from?” The mother was a little uncomfortable with the subject but decided to give her daughter a straight explanation. So she said, “You just ate breakfast, right?” “Yes,” said the little girl. “Well, the food goes into our tummies, and our bodies take out all the good stuff, and then whatever is left over comes out of our bums when we go to the bathroom, and that’s where poo comes from.” The girl was perplexed and stared at her mother in stunned silence for a few seconds and then asked, “What about Tigger?” Moe: Have you ever tried blindfolded archery? Joe: Uh, that’s a definite no. Moe: You definitely should. You don’t know what you’re missing. How many clickbait articles does it take to change a light bulb? The answer will shock you!

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

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Dear Advice Doctor, I hate to air dirty laundry in public, so the anonymous format you’ve provided here is perfect. My question is about my husband. He’s a quiet man, which I don’t mind at all. But when I want him to talk, it’s like pulling teeth. The man is the poster child for poor communication. How can I get him to open up? — Sounds like the sounds of silence Dear Sounds, You used an apt analogy: it’s not easy to pull teeth. It can be when teeth, gums or bones are abnormal in some way. But pulling a healthy tooth, such as an orthodontist does to make way for realigning teeth, is a bit of a job. Fortunately, anesthesia makes it easy for the patient. In fact, if you do feel pain during a dental procedure like an extraction, don’t be afraid to speak up (if your mouth isn’t full of gauze and cotton balls, that is). There’s no need to be a hero. In various medical settings patients are sometimes told, “You’re going to feel a little pressure.” In many cases they should probably just go ahead and say pain instead of pressure. But in a dental setting pressure is the perfect word. As we have established, the goal is for dental patients to feel little to no pain. But removing a tooth is a rather physical act. The phrase often used, pulling a tooth, as though pulling a knife from its sheath, paints a very inaccurate picture. After all, teeth are solidly embedded in bone, held in place by ligaments. That’s how we can bite into apples and steak and corn on the cob without our teeth coming out. They are very firmly entrenched. Extracting a tooth requires a little wiggle room, and a dentist or oral surgeon will try to provide that as step two (step one being anesthesia). The composition of bone in the jaws is spongy, comparatively speaking, so wiggling a tooth around with special dental tools enlarges the space around the tooth and makes extraction easier. It might be compared to trying to pull a deeply driven tent stake straight out of the ground versus trying to wiggle it around sideways in all directions to loosen the ground’s grip on the stake before pulling it out. That is basically what a dentist is doing prior to extracting a tooth: moving the tent stake — I mean tooth — around to make it easier to remove. It’s pretty physical. It’s the perfect time to say, “You’re going to feel some pressure.” Best wishes! + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

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