Medical Examiner 2.7.20

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FEBRUARY 7, 2020

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

JUST THE

S FLU?

AUGUSTARX.COM

ome people think the flu is nothing more than the sniffles, maybe a headache and some body aches thrown in. Guess what? Most of the time they’re right.

Even symptoms of the headline-grabbing coronavirus are in most cases nothing that would give you nightmares: runny nose, sore throat, watery eyes, headache, coughing, sneezing (see page 3), mild fever and body aches. Most people with coronavirus think they have nothing more than an ordinary cold.

All of that makes the following figures seem completely illogical: the 2014-2015 flu season killed around 51,000 people in the U.S. alone based WHAT IS CORONAVIRUS? on CDC estimates. 2015-2016 saw The name comes from the surface about 23,000 flu-related deaths, folprojections of the virus that look lowed by 38,000 in 2016-2017. Final data is still pending for the 2017-2018 like a royal crown or solar corona.

The viruses were discovered in the and 2018-2019 flu seasons, but the early numbers are 61,000 and 34,000, 1960s, and were behind previous respectively. That’s well over 200,000 flu outbreaks like SARS and MERS. deaths in the U.S. alone in just the past five flu seasons, an average of more than 41,000 deaths per year.

How does something whose symptoms seem no worse than a common cold end up killing people by the hundreds of thousands?

How flu kills If we put ourselves into the mind of a killer (let’s go with a lion), our target of choice will be the weak and vulnerable. Easy pickings. That is our first clue to how and why flu kills: by preying on the weak. That could be the elderly or the very young, including infants who have yet to be fully inoculated. The same strain that might barely slow down a strong and healthy young adult could have devastating consequences for someone in infancy, in their 80s, or who for whatever reason has a weakened immune system.

Every year, however, people who had been the very picture of health days before die suddenly from the flu. How does that happen?

It should be noted first that, despite the alarming numbers above, death from the flu, even the current coronavirus, is a highly unusual event. Even Please see JUST THE FLU? page 3

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AUGUSTAMEDICALEXAMiNER

FEBRUARY 7, 2020

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD

by David W. Proefrock, PhD

Your 13 year-old son has developed a terrible attitude around the house. He usually does what he is told, but not without complaining and talking back. Everywhere but at home he is a perfect child. He has lots of friends, his grades are good and his teachers love him; he never gets in trouble at school. Other people are forever telling you how polite and helpful he is. What should you do?

A. Get tough with him about the way he is behaving at home. You know he is capable of being as polite at home as he is in public. Start giving him restrictions or taking away priv-

ileges when he talks back.

B. Just ignore him when he talks back. This is normal teenage behavior.

C. This is just him being a teenager. Let him know that his bad attitude is unacceptable, but don’t worry too much about it.

D. Something is wrong when he behaves so well in public and so bad at home. Take him to a mental health professional, preferably a family therapist, for an evaluation of the situation.

If you answered: A. This response is probably an over-reaction. You should let him know his attitude is unacceptable, but don’t lose sight of the fact that he is obediently

doing what he is told despite his attitude.

B. This is normal teenage behavior, but if you ignore his talking back, you are giving him the message that it is okay.

That’s not the message you want to deliver.

C. This is probably the best response in this situation. In every other area of his life, he’s doing well. Let him know that a better attitude is expected, but don’t worry too much at this time.

D. A teenager with a bad attitude at home is not necessarily a sign of an underlying problem, especially when he is doing so well everywhere else.

A mental health professional is probably not necessary.

A bad attitude at home while doing well everywhere else might actually be a positive sign. The teenage years are a time when kids naturally strive for independence, and talking back is one way of doing that.

The good sign is that he feels safe enough at home to do it.

Don’t accept the disrespect while he is expressing independence, but don’t worry too much about it either. + Dr. Proefrock is a retired clinical and forensic child psychologist.

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f you are still reading after the last installment describing toenail removal, I salute you. With that said, I’ll tell you about my second favorite part of sick call: lump and bump day! Inmates would arrive complaining of spider bites, bumps, lumps, tumors, alleged bullets, and many other descriptive adjectives used to affectionately name their skin abnormalities. While some were simply hoping to have a female nurse examine their groin, others were full of a bounty of maladies. In short, lump and bump day was a playground for a nurse with a strong stomach and a desire to see gross stuff.

Our nurse practitioner was extremely skillful and had a knowledge base that rivaled Dr. Pimple Popper. (If you don’t know who that is, Google it and enjoy...You’re welcome!) After inmates presented with their little lumps of wonder we would schedule them for our next “lump and bump day” and wait with

I Was a

Prison Nurse !

SHOCKING TRUE TALES!

50¢ bated breath. Lipomas, cysts, infected pores, and so many more issues were poked, prodded, drained, or excised.

One of my truly favorite cases was an inmate who came in one day complaining of a lump on his shoulder. I had the inmate strip down and saw that there was a baseball-sized evil head growing out of the top of this poor gentleman’s shoulder (ok, not really, but it was huge). A thorough examina-

tion revealed it was unlikely to be a tumor and the inmate was added to the schedule for treatment.

The day of judgment arrived a few days later and after another brief examination the N.P. began her work. Generous amounts of anesthetic were injected and time stood still as she made the first cut. Although I was expecting to see copious amounts of fatty yellow tissue, the geyser that issued forth was far more satisfying! Instead of a lipoma, that baseball-sized head turned out to be huge cyst. I watched with rapt fascination as the N.P. squeezed every ounce of putridness out of the cyst. Thankfully our masterful N.P. was able to remove not only the contents, but also the sack which contained the aforementioned vileness. After a few sutures, the inmate was freed from his companion of the previous 4 years.

I went home that day with a spring in my step. We made a difference in someone’s life... even behind bars. +

JUST THE FLU?… from page 1

though we’ve established that the annual U.S. flu death toll averages about 41,000 people, millions get the flu. For the 2017-2018 flu season, the preliminary unofficial estimate was 45 million. That means that fewer than one-tenth of 1% of people who get the flu die from it.

That is certainly little comfort to the friends and families of those who do, and the doctor or public health official who thinks one-tenth of 1% is an acceptable mortality level probably does not exist.

We’re still left with the question of how flu manages to kill tens of thousands, especially when many are strong and healthy before getting sick.

One of the ways flu becomes lethal is through what we’ll call the wave strategy.

In warfare, initial assaults may fail miserably, but if they keep coming, eventually the enemy can be decimated, exhausted, depleted of ammunition, or all three. In that state, yet another assault can spell victory even if it’s nowhere near as powerful as the initial attacks which failed.

Similarly, in humans the flu may be part of an initial assault which fails, but which softens up the target for some other opportunistic infection that happens along by coincidence, and which in ordinary times would have easily been crushed by our immune system.

Maybe the secondary attack is from a Streptococcus or Staphylococcus infection, which then invades the lungs or wreaks havoc elsewhere.

Or, one of those could be the first wave that weakens us, and before we’ve recovered fully the flu arrives as the secondary wave. At that point, we look just like a lame gazelle does to a hungry lion. It’s game on.

Another way the flu can quickly and unexpectedly transform itself from minor inconvenience to ruthless killer happens when someone’s immune system goes into overdrive, adopting a scorched earth policy of more or less indiscriminate destruction.

How can that happen to our usually trustworthy defenses?

Think of this analogy. You’re in a huge crowd of people, perhaps attending church or a large business conference, sitting quietly and anonymously in row 34. Unexpectedly you hear your name called out from the podium, and you realize you’ve been introduced

as the next speaker. Most of us would go into full-blown panic at the thought of speaking extemporaneously in front of a thousand people. But maybe we would have been perfectly fine with a few days’ or weeks’ notice.

The human immune system can be just like that. Faced with a sudden call to arms against a previously unknown foe, it can start dropping huge bombs where hand grenades and snipers would have been more effective.

There could be a nest of flu virus taking cover in lung tissue, for instance, and the immune system will attack and destroy healthy, uninfected lung tissue in its assault on the virus. The same thing can happen all over the body with disastrous results.

How can we provide our defenses with advance notice of an attack to prevent such an over the top reaction?

That is the job of vaccines. These life-saving inoculations safely expose the immune system to an enemy threat so it is prepared in advance and recognizes the enemy if it later attacks. Since vaccines don’t have active viruses, they are kind of like combat training with blanks for ammunition. Everything is very real, but it’s not going to kill anybody.

In fact, just living can be like an added vaccination — if you’re doing it right. Existing in a sterile bubble would be absolutely lethal if the protective cocoon ever failed. By contrast, kids who grow up climbing trees, scraping their knees, eating candy they dropped on the floor, being licked on the face by their dogs and a million other little events are all training their body’s defense systems to recognize and neutralize invaders.

Researchers say we can sometimes go overboard trying to sterilize our environment.

Limited exposure to the enemy via vaccines and day-to-day living is good for a healthy immune system.

Even against a new enemy like the 2020 novel coronavirus (so-called because it’s a brand new strain), simple, common sense steps like those in the box above can go a long way to prevent the spread of disease.

Follow them! Cover! Don’t spread germs!

Wash your hands often! Avoid contaminating yourself and others! +

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WHY DO SNEEZES ALWAYS COME IN PAIRS? The short answer is they don’t. Not always. But for millions of people, it’s almost never one and rarely three.

Don’t tell that to Donna Griffiths. She holds the record for the longest sneezing fit. It all started on January 13, 1981 and was more or less non-stop for 976 days, until September 16, 1983.

According to news reports at the time, she sneezed an estimated 1 million times in the first 365 days alone. (If you’re wondering, as a rule people do not sneeze while sleeping.)

Sneezing is a very complex process triggered by events not always fully understood. Sometimes it’s easy enough to decipher the cause. Inhaling a foreign body or irritant (like pollen, pepper, or dust) triggers an automatic response that is a very effective defense mechanism. Eviction is forceful and immediate. It’s a little more difficult to figure out why some people sneeze when they look toward the sun or tweeze their eyebrows.

When it comes to the obvious causes, the prevailing theory about twin sneezes is that the job isn’t fully accomplished by the first sneeze. It takes two to expel whatever potential invader has been identified. We’ve probably all seen or read videos or articles that clearly prove the power of a sneeze. Whatever the body is trying to expel can reach speeds of up to 100 miles per hour.

There are several medical myths when it comes to sneezing.

Among them: the heart momentarily stops beating during a sneeze; and that it’s impossible to keep your eyes open during a sneeze, and it’s a good thing because if you could, the force of sneezing would pop your eyes right out of your head.

There is no truth to either belief.

There is one question on the subject of sneezing that is almost impossible to answer: why don’t people cover when they sneeze?

Granted, the vast majority do. But it’s not like sneezes are unexpected. We always know when one (or two) is coming. There is ample time to prepare, to cover, to grab a handkerchief, or even step out of the room. Instead, some people go into a kind of trance waiting for the sneeze, and when it comes they let ’er rip. Here’s a not-so-fun fact: an uncovered sneeze can launch 100,000 germs into the room. That is the opposite of love thy neighbor. +

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.

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: graphicadv@knology.net 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. © 2020 PEARSON GRAPHIC 365 INC.

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AUGUSTAMEDICALEXAMiNER

FEBRUARY 7, 2020

#108 IN A SERIES

Who is this?

ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE

N

obody’s perfect. We’ve all heard it, and we have all seen evidence of its truth. If all humans are imperfect, it logically follows that all human organizations are likewise subject to mistakes and errors in judgment.

We offer these two gentlemen as Exhibits A and B. They are both doctors who were world famous in their day, at the very top of their professions, the elite of the elite. When you are known as “the father” of something in medicine — the father of nuclear medicine or the father of cataract surgery — it’s usually a good thing, a feather in your cap and a badge of honor to be worn proudly.

The doctor above, Egas Moniz, earned the Nobel Prize in Medicine for his accomplishments, and the doctor to the left, Walter Jackson Freeman II, was one of his most devoted acolytes.

There is some irony in the fact that Freeman modified and perfected a technique that he also coined the name for - lobotomy - but it was Moniz who won the 1949 Nobel Prize in Medicine for it. Yes, even though Freeman holds the dubious distinction of The Father of the Lobotomy, it was he who nominated what some histories call his “mentor and idol,” Dr. Moniz, to the Nobel Committee.

Before the two met at a medical conference, Moniz’ research and medical practice in Portugal had focused on abnormalities in the brain. He was the first person to successfully inject radiopaque substances into the brain to precisely locate tumors and vascular abnormalities, and his work advanced the development of angiography. His studies led him to the conclusion that abnormal neural connections in the frontal lobe were the source of many mental illnesses. He pioneered chemical (injecting pure alcohol into the brain) and surgical lobotomies in the mid-1930s with mixed results (of the first 20 patients, Moniz reported seven “cures,” seven improvements, and six unchanged cases). He might have done hundreds more, but he was shot multiple times by a schizophrenic patient in 1939 and was confined to a wheelchair until his death in 1955.

After Freeman met Moniz and learned of his work, Freeman became the high ambassador for the procedure, performing thousands of lobotomies on patients aged 4 and up, including one of his most controversial, Rosemary Kennedy, President Kennedy’s sister. He simplified the procedure to a ridiculous extent, developing a through-the-eye-socket method without anesthesia instead of drilling through the skull as Moniz did, performing the procedure using ice picks while wearing neither gloves nor mask, and taking his lobotomy show on the road to some 23 states, stopping by overcrowded mental institutions unannounced to spread the word, and willingly performing lobotomies upon request for his standard fee of $25.

It has long been the global medical consensus that the 1949 Nobel for Medicine was a mistake. There will be no counterargument here. The best you can say about it is if the choice was limited to one of these two, they probably chose the right guy. +

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

the truly agonizing pain I experienced when I broke my hip so badly. And from There are days when I doubt that I the other falls that seem to increase in will ever be fully back to my old self, number as I get older. In addition, the but they are growing fewer as I practice consequences of falling keep getting the exercises designed to worse as I age. Maybe I need strengthen my legs and to invest in some hypnosis to reduce the pain of moving “The fear is a leftover from block the fear. LOL in now unfamiliar ways. my youngest, Vicki, the truly agonizing pain wasWhen I’m now up to walking born, she did not have a over 200 feet at a time hip socket or ball to keep hip I experienced.” with supervision, but still and leg together. She was hesitant to walk very far on given a sort of soft prosthetic my own, even when using my walker. to wear to keep her hip and leg at a I’m able to stand up from my proper angle from one another. It was the wheelchair very briefly to manage thickness of about a dozen cloth diapers cooking a meal, even though standing and it effectively allowed her to learn to with the walker would likely be much put weight on her leg until the joint grew, easier. With the walker I could manage which took a year and a half. During that getting into rooms I can’t enter with the time other moms remarked how clever wheelchair, allowing me to do things like it was to keep her from hurting herself if take a bath, wash and dry clothes, etc. I she would fall. could even manage to go up and down Maybe that is what I need, a soft the one step to get outside and back bubble type prosthetic to let me fall inside without being in the wheelchair. without hurting myself. I cannot imagine It would be fun to be able to get out by what such a thing might be, nor whether myself, and safer, too, because it would I could wear it without embarrassment. give me safe access to the outside in I do know that if I cannot find a way event of a fire or some other event that beyond the fear to live more freely, I would require evacuation. I’m supposed might just as well confine myself to a to weigh myself daily but haven’t been place like Amara for the rest of my life. able to do that yet.

Right now the difference between there I did walk into my bedroom because and home is the bigger space to live in that’s where my computer is, in order here, the cooking for myself instead of to write this article. I’ll be able to walk being fed three meals a day, and a handy back to my chair when it’s time for that port a potty to allow me to keep clean too. The fear is just so present still and and dry by myself. it does get in my way. I’d love to reach a I believe I’ll find a way. I always have plateau where I feel confident in walking. been able to face and overcome the many I know that the fear is a leftover from challenges of living. +

by Marcia Ribble

The Medical Examiner is what is known as a

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

FEBRUARY 7, 2020

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age

BY J.B. COLLUM

“Come quick, I think maybe your dad had a heart attack!”

Scary words for sure, and this wasn’t the first time I had heard bad news about a parent like this. At fifty, I was much better prepared for this type of situation than I was the first time it happened.

Let’s take a ride in the way back machine.

The year was 1981, so I was only a teenager. Getting off the bus in front of my house I was greeted by a friend of my mother telling me, “Your mom is all right, but she had a heart attack.” My mother was in her mid-thirties at the time, so that was quite a surprise and worrisome. I didn’t feel much better until I actually got to the hospital to see her and she convinced me not to worry. Of course, that’s what moms do.

She did recover though, and I am fortunate that she’s still with us even though it has been a few decades now.

At that time, my previous experience with hospitals had been limited to just brief visits. I didn’t have to worry as much as the adults. Worries about things like the cost or the long-term issues that illness can cause didn’t cross my mind. Although not as important to the big picture, minor yet very annoying things about health care can certainly make the experience less than optimal. What do I mean? Let’s get back to the fall of 2016 when I heard that first sentence up above in a call about my dad, and I’ll put it all together.

I picked my father up and took him to the emergency room where we got excellent care. As I had already learned,

chest pain gets you through triage pretty quickly. My own experiences from about 11 months before, when I went through the same thing and got a stent put in my ticker, served my father well. I was able to inform and reassure and him during the process.

His heart didn’t show much damage, so everything turned out fine, and he also got a nice new stent in one of his arter-

There are similarities between hospitals and prisons. Which one is better though? ies and was sent home with a clean(ish) bill of health. The actual health care, like most of what I have personally experienced as a patient and as a patient advocate for my family, has been mostly excellent.

The thing that I have come to loathe is all of the things related to health care.

What do I mean? Allow me to illustrate with part of my routine if I ever decide to become a stand-up comic.

Imagine this next part with me onstage at a comedy club: I’m not sure what’s worse; going to the hospital or prison.

Sounds crazy, huh? Well, hear me out. There are at least three ways prison might actually be better.

First, when they put you in prison, you know when you are getting out. In fact, you might even get out early for good behavior. At a hospital?

Not so much. Your doctor tells you something like, “You should be all done. Just a little paperwork and you should be out in an hour or so.” That “or

so” part is the key. When you hear that, think of it as like what the cable company tells you and remember how that actually turns out. No matter what the Doc says, you should be aware that it could be a few more hours or even days, or maybe next month.

The second way a prison is better than a hospital is how they starve you. “We’re sorry ma’am, but you might need this test done today, or next week, or maybe in June that requires you to fast, so you can’t eat or drink anything, but you can have some ice chips.” After several hours of this - or even days - and enough ice chips to preserve a prize marlin, you are still starving, and no test is in sight. If a prison tried this, it’d be all over the papers and heads would roll, but not at a hospital. Heck, even bread and water would be better than this.

The third way a prison is better than a hospital should be the most obvious. If you need medical care while incarcerated, that care is free! Or free to you anyway.

Well, that does it for the stand-up comedy. Next time, I will tell you about the time when I had to essentially break my father out of an out-of-state hospital that was much worse than a prison, and how a local hospital saved the day. +

The

Money

Doctor

Because wallets should be healthy too

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IN OUR NEXT ISSUE

SALUBRIE

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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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.

FEBRUARY 7, 2020

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Gut-healthy Fermented Salsa Verde is a quick and easy recipe made with fresh tomatillos, garlic, cilantro, and a kick of jalapenos. Fermented salsa is made fresh then allowed to culture for several days in a closed container on the kitchen counter. This process imparts a uniquely complex flavor with acidic undertones. Fermentation helps preserve the food and makes it more nutrientdense.

It happens when microbes such as yeast and bacteria metabolize the carbohydrates in a food and produce acid, says Jennifer McGruther, author of The Nourished Kitchen cookbook.

Fermented foods like salsa, sauerkraut, kimchi, and certain drinks are a great source of probiotics.

The chemical process to culture a good probiotic sourced food is simple to do.

The probiotics that are created through fermentation are very beneficial for digestive health. Fermenting foods can also change the nutritional content a little bit. It can increase the B vitamins in the food, accoording to Torey Ar mul, a registered dietitian nutritionist in Columbus, Ohio, and a spokesperson for the Academy of Nutrition and Dietetics. “[Fermentation] has been linked to bowel regularity, even improvements in blood pressure, and blood sugar control.” There are a lot of things that happen when a food is fermented – the probiotics, the nutritional value, can all lead to good benefits for a healthy gut.

Here are some tips to help you create great fermented salsa: Look for bubbles. Tiny bubbles should appear at

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Fermented Salsa Verde the surface of your salsa while it ferments. They are a good sign that the beneficial bacteria are doing their job.

Look for color changes. As the salsa ferments, it will become more acidic, and this may cause it to change color from vivid green to a dull green.

Don’t skimp on salt.

Adding salt to the salsa helps keep mold and other microbes that can cause spoilage away, allowing beneficial bacteria to grow.

Fermented Salsa Verde Ingredients: • 14 oz fresh tomatillos, husked and quartered • 3 medium jalapenos, seeded and quartered • 3 medium garlic cloves • 1 cup coarsely chopped fresh cilantro • 1 teaspoon ground coriander

• 1 medium lime, juiced • 2 teaspoons salt • 1/3 cup sweet onion quartered Instructions: Place all ingredents into a food processor. Process for 1-2 minutes until salsa is smooth.

Place in a glass quart jar and seal tightly with lid.

Allow to ferment for 4 days on the counter at room temperature, then place in refrigerator for up to 3 months. I like to write the use-by date on the lid. +

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

This issue and 199 more back issues are available to read online anytime at issuu.com/medicalexaminer

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ASK DR. KARP

NO NONSENSE

NUTRITION Janice from Rotary Club asks: “Which is better, the DASH Diet or the Mediterranean Diet? I’m doing DASH. Should I switch?”

No need to switch diets, Janice. Just pick one and stick to it. They are both, basically, the same diet, and they are both great ways of eating. In fact, forget about using the word diet. Diet always seems to be a temporary concept. You go on a diet and then you go off a diet. Rather, your mindset should focus on a way of eating for life.

It is true that news reports

AUGUSTAMEDICALEXAMiNER and social media like to jerk people around from one diet to another, promoting these “diet wars.” It’s simply good for business and has little to do with science and evidenced-based nutrition.

It’s marketing. It sells products, books, newspapers and magazines. The fact is that diets aren’t in a horse race.

Nutrition scientists from all over the world are in agreement about what constitutes a healthy diet.

Did you know that the DASH diet, The Mediterranean Diet, The American Diabetes Association Diet, The American Heart Association Diet, The Alzheimer’s Diet, The Parkinson’s Diet and many other evidenced-based diets are all basically the same diet? In science, there is no race going on, no competition and no doubt. Stick with the science and your vision becomes pretty clear.

Listen to the ads or what’s on social media and you will be befuddled. Here’s a simple nutrition rule; ignore nutrition claims in ads, in the news or in social media. See how simple that is?

Let’s just quickly review some of the basic principles found in all evidenced-based diets, regardless of their names. First of all, vegetables and fruits are healthy.

Does this surprise you? It shouldn’t. The more veggies

and fruit you eat, the healthier you will be, especially if you are moderating your use of high fat meats, cheeses, fast food and junk food.

Which vegetables and fruits?

All of them. Eat a variety of them. Terms like “superfood,” “organic,” “natural,” “clean,” etc. are marketing and advertising terms. Just buy lots of regular veggies and fruits and eat them. Today, people spend more time talking, thinking and arguing

about veggies and fruit than eating them. Stop talking and start eating Whole wheat and whole grain foods are healthy.

Shocked? Even my grandma, who only made it to the 6th grade, knew this one. So eat whole wheat and whole grain foods. It’s easy. Buy breads and cereals made from whole wheat and eat whole grain foods like corn, oatmeal and brown rice. Avoid high calorie, high sugar cereals, and when you buy whole

FEBRUARY 7, 2020 grain cereals, make sure they are fortified with folic acid and the B vitamins. When you buy whole grain breads, make sure the ingredient label states it is whole grain, not just stone-ground, millground or any of those other “warm and fuzzy” nutritionally meaningless words.

Dairy is healthy, but make sure it is low fat or skim.

Dairy is simply a great source of protein, calcium and Vitamins A and D. Try to remember what dairy actually is. I’ve never seen udders on a soybean or coconut, have you? We really need to change the food labeling laws so that milk is actually milk.

When I go shopping, I buy the store brand skim milk, which is, by far, the cheapest thing in the dairy case. Certain veggies and beans also contain calcium.

Are you with me so far?

Get this. Eggs are healthy and have always been healthy.

They are a great source of protein, which resides in the white part of the egg. Most of the cholesterol and fat are found in the yolk, so if you have to moderate your cholesterol intake, then just cook with the white. And, if you want a whole egg now and then, that is ok, too. Egg advertising hype arrives with terms like “free range” and “enriched with omega fat.”

Ignore all that. Just buy

the cheapest eggs you see. I actually buy egg substitutes because they are convenient and they are pasteurized.

They are a bit more expensive, though.

Peas and beans are healthy, so eat lots of them. Peas and beans are sometimes referred to as “legumes,” but I don’t use that term since most people don’t know what it means. Peas and beans are wonderful sources of fiber and protein. Also, they are cheap, cheap, cheap, especially if you buy the dried beans rather than the canned beans. Just soak the dried beans before you use them.

An inexpensive sack of beans can last a long, long time. If you like the flavor of bacon with your beans, use Liquid Smoke instead. It tastes the same, but has no fat.

Red meat is healthy. Just make it lean and eat way, way less. Did you know that many Americans eat meat twice a day? When I say eat way, way less, I’m talking about eating meat twice a week or less. Fish (not fried) is healthy, especially oily fish like salmon or sardines.

Chicken is healthy. Sometimes the way you prepare meats, chicken, and fish can turn an otherwise healthier meal into a nutrition disaster. That means go easy on the grilling and frying. Bake, Please see KARP page 16

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 insure 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, evidenced-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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Dr. Karp

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FEBRUARY 7, 2020

Ask a Dietitian

PEOPLE LOVE OUR SHOES SO MUCH THEY USUALLY BUY

KIDNEY HEALTH: WHAT EVERYONE SHOULD KNOW

by Christopher R. Nesbitt, MBA, RD, LD, Renal Dietitian

The failure to acknowledge, address, and manage diabetes and high blood pressure may ultimately lead to end-stage renal disease (ESRD), requiring dialysis. Preventing damage to your kidneys is a topic very little discussed.

However, once the damage is done the reactive treatment methods of dialysis and kidney transplants are frequently discussed.

As a renal dietitian I hear “How did I get here?” from patients almost daily. This question is directly related to why the patient needs dialysis. Though I am not a Nephrologist or medical doctor, it is my responsibility to explain the why to the patient. I approach this by referring to the doctor’s diagnosis.

The two most common diagnoses that lead to endstage renal disease requiring dialysis are diabetes and high blood pressure. As a renal dietitian, I explain how diet, exercise, disease management, and medications each play a role in ESRD. This article discusses preventive measures and the numerous actions you can take to preserve your kidney health. You can start your kidney health check-up by taking inventory of the following things first: diet, exercise, primary care physician visits, and medications.

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AUGUSTAMEDICALEXAMiNER

DIET When it comes to protein in the diet more is not always better. Reason being, the

kidneys have to work harder to filter the breakdown of excess protein. If you’re wondering how much protein your body needs, a good rule of thumb is 0.36 grams per pound for a normal body weight. If you are athletic, underweight or overweight, it is best to see a licensed Dietitian to best determine your estimated protein needs.

A diet rich in fruits, vegetables, whole grains, fiber, and lean meat is preferable.

Maintaining healthy weight is also key to kidney health.

The BMI measure for weight classification is not perfect, but it stills serves as a tool to monitor your weight health.

You should look to have your BMI between 18.5-24.9 for a normal weight.

received from exercising has many benefits, including improved blood pressure, blood sugar, and stress level.

Remember that the kidneys are comprised of millions of small blood vessels that filter waste from our blood. In order to keep these vessels working properly we must manage weight, blood pressure, blood sugar, and stress and exercise assists with achieving all of these.

PRIMARY CARE PHYSICIAN VISITS Outside of your spiritual life and family, your primary care doctor should be very close at the top of your relationship list. Reason being, without a health care provider in place it is nearly impossible to take preventative measures for kidney health.

The labs and vitals you should be checking at your annual physical include the following: hemoglobin A1C, blood pressure, creatinine, glomerular filtration rate, and blood urea nitrogen.

Knowing these labs will allow you to better track your kidney health. Your primary care physician should also know if you have any family history of kidney disease or other related issues.

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AUGUSTAMEDICALEXAMiNER

CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined In our last class, Crash Course discussed the wisdom of seat belt use, at least among persons who value life and health. It’s practically suicidal to drive around without being belted in. In addition, it’s illegal.

But a little research prompted by a reader’s comment revealed something we were previously unaware of: some people think airbags have made seat belts redundant and unnecessary. That doesn’t mean they don’t wear seat belts.

They might own a car that requires seat belts to be buckled up before it will start. Or they buckle up just to stop the maddening chimes that won’t stop until they do strap themselves in. But they don’t think it’s necessary for safety.

Unofficial observational research conducted by the Medical Examiner suggests that many back seat passengers don’t buckle up. They probably theorize that in a crash they don’t have to worry about hitting a windshield or dashboard; they’ll hit the upholstered back of the front seats. No worries!

Sometimes front seat passengers can also be a bit lax in seat belt use.

Here’s why both seat belts and airbags together are crucial for occupant safety. As we established in the previous article (read it online at issuu.com/ medicalexaminer/docs/01.24.20), seat belts have a proven decades-long track record of minimizing and preventing serious injury and death.

If seat belts did the job completely, airbags would never have come along.

What would be the point? And if airbags did the job completely, why would car makers continue to install seat belts when they could save millions of dollars every year by discontinuing them?

The way airbags work is actually printed on most dashboards and steering wheels: SRS. We know what you’re thinking: Savannah River Site. Not this time. In vehicles it denotes the presence of a Supplemental Restraint System.

Note that first word. Airbags can’t do it alone. They are supplements to what we’ll call the PRS: the Primary Restraint System, aka seat belts. In fact, without seat belts airbags can be downright lethal.

Consider the mechanics of a crash (once again, see previous issue). Let’s say a vehicle is traveling at 50 mph when it leaves the road and strikes a tree, a very common scenario. The first thing that happens, obviously, is that the vehicle stops. But for a few fractions of a second, everything in the vehicle that isn’t tied down continues traveling forward at 50 mph until each object, in turn, strikes something that stops its forward movement. Without a seat belt in play, one of those objects will be you. And any and all unbelted passengers. Not a good scenario at all.

But it gets worse.

Without a seat belt, the occupant of a vehicle isn’t just going forward at (in this case) 50 mph. Something else is coming toward him at 200 mph!

That something is called an airbag.

Airbags don’t mess around. They can’t afford to. There’s no time. They deploy in milliseconds with tremendous explosive force. Hitting one can be pretty painful even when restrained by a seat belt, but without a belt an airbag is coming at you a lot faster than you’re coming at it. There are cases where unbelted children in front seats have been blasted into the back seat by deploying airbags.

Airbags can’t prevent every death or injury, and they also cause injuries.

Most people would gladly trade a few minor injuries for being able to continue living, or not being a quadriplegic.

All of us have probably heard a friend, relative, neighbor or co-worker’s story of how someone they know was killed (allegedly) because they were wearing a seat belt. Or who walked away from a horrific wreck only because (allegedly) they were not wearing a seat belt.

It’s hard to establish the truth behind such anecdotes, but even if every one of them is true, they are anomalies. In the overwhelming number of accident cases, the combination of airbags and seat belts offers the best available means to avoid death and to prevent or minimize serious injury.

Why are they more important than ever? Tune in next time. +

FEBRUARY 7, 2020

HUMAN BEHAVIOR

How neuroscience works in everyday life

8 THINGS YOU SHOULD ALWAYS DO ON A DATE

On a first date, do you just talk about yourself? Are you playing on your phone constantly?

And do you get miffed if the person doesn’t want to kiss you when you’re saying goodnight?

That’s totally NOT the way to enjoy a good first date—or any date. And that’s not me

by Jeremy Hertza, Psy.D. talking. That’s according to my son Finley, and and Finley Hertza he’s only 9.

Yes, my 9-year-old is already wondering about talking to girls. He’s searching for videos about it on Kids YouTube. And he’s asking me, his dad, a neuropsychologist, about what exactly we should do and say.

No pressure, son.

According to Finley (And Me) When we talked about this, Finley got a lot of it right (major props to Kids YouTube).

What Finley said: “First of all, you shouldn’t talk about yourself unless someone asks you.”

What I said: When we’re uncomfortable or anxious, we tend to prattle on about ourselves to help us feel better. That’s completely the opposite of what we should do on a date. Ask questions instead. And really listen and respond to the answers.

What Finley said: “At the beginning, say hello or something that’s nice.”

What I said: People like hearing their own names. So greet your date with “Hello, [insert name here]!” It’s personal and directs your attention to them.

What Finley said: “Ask how the other person’s doing. Or ask good questions like, ‘What’s your favorite mythical creature and why?’”

What I said: Ask real questions, not superficial questions, about things you legitimately want to know. So instead of, “Where do you work?”, ask “What do you like about your job?” Ask more specific, detailed questions. But don’t make it weird—you don’t want your date feeling like they’re on an interview for the role of your boyfriend/girlfriend.

What Finley said: “Have good eye contact, and don’t play on your phone.”

What I said: It’s all part of body language: Is your date facing you and engaged with you, or staring at the floor? Do their replies to questions seem sincere?

What Finley said: “You might get a kiss, you might not. If not, don’t get upset, back away and blend in.”

What I said: Ditto Dates Can Be Tough Hey, we all know dates can be tough. But here are a few other tips to make it fun—and maybe even develop a real relationship: Pick an interesting location. Sure, a restaurant is fine. But maybe make it one with a cool cuisine you’ve both been wanting to try. Or choose an activity date like a festival or trivia. A first date is easier if there’s something that can help move the conversation along.

Remember, small things matter. If you want to give your date something, take a little effort to find out what he or she likes first. For example, your ex may have loved flowers, but maybe your date is allergic?

Just work the question in naturally as best you can. In the case of a blind date, ask the person who’s setting you up for some ideas.

Finally, one thing a 9-year-old may not be able to express, but probably already knows innately: Honesty and communication are the two main things you need in a strong relationship. There’s no need for games; communicating honestly gives your date—and relationship—the best chance to be successful. + Jeremy Hertza, Psy.D., is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC, in Augusta. Contact him at 706-8235250 or info@nbageorgia.com. His son, Finley, is a clever, kindhearted boy and a unique and creative thinker.

FEBRUARY 7, 2020

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Rabbi Chaya Gusfield on February 10, 2018 (Edited for space)

THINK TWICE BEFORE YOU HUG I’m usually a hugger, but I’ve learned an important lesson about touch through my work as a hospital chaplain. I often ask permission for the many ways that we interact: “May I visit for a while?” “May I sit down?” “May I turn your TV down while we talk?” Asking permission is a way of respecting the person’s autonomy. This is especially important in a hospital where throughout the day nurses, doctors, physical therapists, dietitians, and custodians walk into patient rooms without explicit permission, disturbing or poking the person in the process of delivering care.

It’s important that people know they can say no to me when they are unable to say no to so many other providers. I learned to ask someone if they are hand holders in prayer or whether I can touch them. I rarely offer a hug to patients or family members because they may feel pressured to say yes, but occasionally I sense that a sincere hug at that moment would be appropriate and helpful. In those rare situations, I will ask permission, listen to their words, and watch their body language for the answer.

When my partner was diagnosed with cancer, I learned that unwelcomed touch could be a matter of life and death. She is immune compromised due to her ongoing chemo treatment even when she looks healthy. What may be a simple illness like a bad cold could, for her, become life-threatening pneumonia.

She avoids crowds where sick people might be found. We vet people for their state of health before they are invited over. We insist on people washing their hands before coming into the home. She prefers matinees where there is alternate seating if someone sits next to her who sounds sick. Handshakes are even harder to avoid without feeling rude. Humans feel like walking germ carriers. That is a hard way to think about people, but it is her unfortunate reality.

The matter of touch became very real for me when I broke my elbow. Without a sling signaling to people to be careful, I was scared of being bumped. I tried to keep a safe distance for fear of being jostled. As people approached, I would pull away.

I noticed that some people were very loving and respectful, others puzzled, and still others pushed the boundaries. “I’m not sick.” “Why can’t you hug?”

It was so restful when someone gave a kind look, put their hand on their heart, or bowed without asking any questions.

They assumed there was a good reason I pulled away.

There are other reasons uninvited touch can be harmful to someone: they may have a hidden injury or chronic pain, or they may be an abuse survivor where touch initiated by someone without their permission can be triggering. Recent revelations of widespread sexual harassment and the #MeToo movement have made many people wary of unwelcome touch.

In addition, there are culturally specific norms about touch we may not all be aware of. To be respectful, we need to listen to people’s body language and accept all responses to an offer of physical touch. Everyone gets to control their own body. We don’t need to understand or challenge them.

Sometimes we need a hug. I remember walking home from work one day. I was so sad from the state of the world and had just spent the day serving a large family with a tragic trauma at the hospital. I walked by where my hairdresser works. I knocked. When she came to the door, I just said, “I need a hug.”

She said, “Me too.” We embraced without words, in a moment of mutual understanding, shared permission and deep healing.

I invite us all to find multiple ways to express our warmth to one another. Through our eyes, gestures, words. When invited, through loving hugs, handshakes, or hand-holding. This awareness of each person’s touch-needs requires us to deeply listen to body language as well as their words.

When I say I am not hugging today or during flu season, please know that my heart still joins with yours. +

There are other options.

Chaya Gusfield is a palliative care and acute care chaplain.

Trust us, you don’t want to read this book. Do you really want to discover how many tens or even hundreds of thousands of living things share the apartment you thought you occupied alone?

Well, maybe.

It is fascinating to consider, and the knowledge that we are never really alone — whether at home or anywhere on this planet — is probably a very healthy step to take in the direction of environmental awareness.

The key point about that previous sentence is a word that is also in this book’s title: home.

Humans are leaving the outside world at breakneck speeds.

Consider your own life: many adults recall playing outside all day long all summer long, until the streetlights came on.

The kids of those kids, and their kids, are inside about 93 percent of the time, notes Dunn in one of the book’s opening chapters. And a fair amount of the scant outdoor time people have these days is spent walking from one building directly into another, or walking out of a building and into a car.

So an examination of indoor

spaces is an examination of where we spend the vast majority of our time.

The message of this book is not that cleaning is futile.

But it is.

The most well-scrubbed home (and face, for that matter) is alive with alien creatures that share our space (and face).

Dunn gives credit where credit is due, tracing our knowledge and awareness of all things microscopic through an extensive profile of Anton van Leeuwenhoek, “the father of microbiology” and widely credited as the developer of the microscope as a tool for scientists, doctors and medical

researchers of every kind.

Leeuwenhoek discovered all kinds of microscopic creatures — the Dutch name he gave them translates to “little animals” — in ordinary tap water, something that continues today despite centuries of advancements in water purification. But more surprising, Dunn and other modern researchers have discovered thriving colonies of living things inside water heaters, in thermal vents at places like Yellowstone, home of Old Faithful, and even in boiling lava.

And we think a few spritzes of 409 is going to make our homes sanitized and sterile?

Life is a bit too prolific and tenacious to capitulate so easily.

Incidentally, if this kind of thing appeals to you, Dunn has several other books with this same general focus.

Come to think of it, every pest control company should hand out free copies of this book as a sales tool. + Never Home Alone — From Microbes to Millipedes, Camel Crickets, and Honeybees — the Natural History of Where We Live, by Robb Dunn, 336 pages, published in Nov. 2018 by Basic Books

Research News Zinc and colds Zinc lozenges are advertised as an effective way to shorten the duration of colds and/or reduce their severity. Some clinical studies have borne that out, while others have been unable to find any supporting evidence in favor of “vitamin Z.” That usually means more studies are needed. Why the discrepancy?

An analysis published late last month in BMJ found that some studies with negative findings used lozenges with low zinc content, or which had ingredients that bind to zinc, preventing or slowing its release in the body.

After identifying these flaws, researchers at the University of Helsinki conducted a test of their own in a randomized, double-blind placebo-controlled trial using Helsinki city employees.

All were given a supply of lozenges (or placebos) with instructions to immediately

begin their use as soon as they experienced cold symptoms. If they did, they were instructed to dissolve 6 lozenges per day by mouth for 5 days.

During the period of the trial, 88 workers experienced cold symptoms and used the lozenges. The findings after the study results were analyzed?

No difference in symptoms was observed between participants taking actual zinc lozenges and those taking the placebo. In fact, after the 5-day treatment period it was discovered that the zinc takers recovered from their colds more slowly than placebo takers.

The Finnish researchers did not conclude that zinc is an ineffective treatment. That’s not what researchers do. They recommend further research!

There are studies, after all, which concluded that zinc is effective. So what is the ideal dosage which will make that

happen? What is the optimal length of time to take zinc lozenges for the greatest positive effect?

Stand by. Patiently.

New colonoscopy guidelines You might have missed the news but in 2018 the American Cancer Society lowered its recommended age for an initial screening colonoscopy to age 45. Other major public health agencies still recommend starting at age 50, however.

New research at Tulane University School of Medicine looked at colon cancer incidence rates by year rather than age blocks, like 45 to 49, 50 to 54, etc. In so doing they discovered a strong argument for pre-age 50 screening: at age 49, there are fewer than 35 cases per 100,000 people, but it’s 51 cases per 100,000 among 50-year olds.

Not yet 50? Talk to your doctor. Get started. The life you save could be your own. +

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AUGUSTAMEDICALEXAMiNER

The Examiners

FEBRUARY 7, 2020

+

I think I’m mad at you.

Why?

by Dan Pearson

After we had that argument That is not true. the other day, did you tell I might have called you someone that I’m brainless? anencephalic though.

Oh! Well thank you very much!

THE MYSTERY WORD The Mystery Word for this issue: SCGEOUL

You’re quite welcome. © 2020 Daniel Pearson All rights reserved.

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. Sleep disorder 6. 1975 blockbuster 10. Fed. med. agency 13. Unambiguous 14. Hawaiian island 15. Bar intro?

16. A movie star is often one 18. _____ glass 19. Consume 20. Temple (Archaic) 21. Rugged 23. Shirts and blouses 24. Hot ______ 25. ______-Sinai 28. Furthest back 31. Music hall 32. Tantalize 33. Name for 13 popes 34. R. A. ______ Blvd.

35. Clean and treat a wound 36. Attired 37. Liberty Mutual mascot 38. What flooding rivers do 39. Plants 40. Yellow, crystalline dye 42. Half asleep 43. Thorax, in plain English 44. If you don’t care at all, you don’t give one of these 45. Willows 47. French city on the English Channel 48. Type of mask 51. Wound reminder 52. The act of enrolling 55. Type of bloomer 56. Underwater ridge 57. It leaves the left ventricle 58. Metal-bearing mineral 59. Couch 60. Downtown building

BY

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We’ll announce the winner in our next issue!

E X 3 A M I N E R

S U D O 2 K U

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

4

8

3 5 9 1 8 8 7 2 6

by Daniel R. Pearson © 2020 All rights reserved.

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. Continuous dull pain 2. Court statement 3. Tidy 4. Type of ring 5. Poetry or sculpture, etc.

6. Augusta-born artist Jasper 7. River in central Switzerland 8. Global health org.

9. Secondary category 10. Broad Street restaurant 11. Mr. Barnard 12. Askew 15. Abyss 17. Evening song?

22. Like some steaks 23. Stretched tight 24. Famine’s ironic partner 25. Ancient manuscript in book form 26. Swelling 27. Denounce 28. AU’s Summerville Library 29. Common mall anchor

30. USA _________ 32. The ___ Affair, a diplomatic incident between the US and Britain during the Civil War 35. Items of bedroom furniture 36. It often follows blood 38. She was once married to Gregg Allman 39. ____ assault 41. Monetary unit of Botswana 42. Female deer 44. Seaport in NW Israel 45. Capital of Norway 46. Disfigure 47. Musical symbol 48. Bug 49. Greek temple doorpost 50. The state flags of California, Texas, and North Carolina each have one 53. Nazi beginning?

54. 37-A-like exticnct bird Solution p. 14

QUOTATIONPUZZLE ,

,

E R D W A U E O I I E E F S L P V E D O N O S O Y H S S W O S U H R D E W S N U R W

by Daniel R. Pearson © 2020 All rights reserved

7 1 5 6 3 4 2 5 1P 8 9C 7 8O 9 6 2 4 3

8 2 9 4 6 3 7 5 1

— Annie Dillard

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.

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.

1 2

I 1 2 3 4 5 6

1 2 3 4 5 6 7 8 9

1 2

M 1 2 3 4

1 2 3 4

1

O 1 2 3 4 5 6 L 2 1 2 3 4 5 6

— Lord Chesterfield

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by Daniel R. Pearson © 2020 All rights reserved

WORDS NUMBER

1

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, FEB. 8, 2020

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FEBRUARY 7, 2020

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

M

oe: You know that new janitor lady they hired the other day?

Joe: I think I’ve seen her around. What about her?

Moe: She just asked me if I wanted to go back into the stockroom and smoke some weed with her.

Joe: What did you tell her?

Moe: I told her I can’t deal with high maintenance women.

Taxi Driver: I love this job. I’m my own boss. I get to set my own hours. Nobody tells me what to do. Nobody!

Fare: Turn here.

Moe: You know what the #1 use of leather is worldwide?

Joe: Yes, holding cows together.

A little boy and his father visited a country store, and as they were about to leave the owner of the store offered the little boy some free candy.

“Just reach in the barrel and grab a handful,” the storekeeper said to the boy.

The boy just stood there looking up at his father.

The

Advice Doctor

The owner repeated his invitation. “Go ahead, son. It’s okay. Get a handful!”

Still the boy did not move, continuing to look up into his father’s face.

Finally the father reached into the barrel and pulled out handful of candy for his son.

After they left the store, the father asked his son why he didn’t take the storekeeper’s offer. “I know how much you love candy.

What’s wrong?”

“Nothing, dad,” said the boy. “I just knew your hand is bigger than mine.”

Two fathers from a war-torn Middle Eastern country who haven’t seen each other for some time meet on the street one day.

“How have you been?” asked the first.

“Terrible,” answered his friend. “What about you? How are those two sons of yours?”

“They both became suicide bombers,” he replied.

“Kids. They blow up so fast these days,” lamented his friend.

A man realizes his eyesight has been steadily deteriorating, so he decides to see an eye doctor.

He walks in and says to the receptionist, “I think I need to get my eyes checked.”

“You’re not kidding,” she says. “This is the ladies room.”

The Journal of the American Medical Association reports that nine out of ten doctors agree that one out of ten doctors is an idiot. +

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, I’m in business with another person as equal partners, 50/50, everything right down the middle. As with most fledgling businesses, it has been a struggle. Last week, I found out that my partner has been skimming money off into his own pocket. This is a huge issue involving everything from being able to pay our bills to properly computing and paying our taxes. He claims his fraud just started and he will repay every penny. I want to believe him but my gut tells me it’s over. What do you suggest?

— Feeling the Pain Dear Feeling, Times have certainly changed. You just didn’t hear certain things years ago when I was growing up.

Take your question as an example. It used to be “guts” was considered kind of a crude word. To use it in polite company would be like being at someone’s home for dinner today and asking, “Where’s the can?”

Gone are the days when the only terms used would be “digestive system” or “gastrointestinal.” These days, medical literature is full of references to gut health, like this one from Healthline: “The incredible complexity of the gut and its importance to our overall health is...” Or Time magazine’s comment about “things that will help establish a healthy gut.”

Our grandmothers are spinning in their graves.

But in the spirit of the times, let’s go gut and briefly review what gut health isn’t — and is. Poor gut health can be reflected in constipation, diarrhea, gas, heartburn, nausea, upset stomach, and all things digestive being something of a problem. There are other signs that would seem unrelated, like skin irritations and constant fatigue, which demonstrate the importance of seeking medical attention when there’s a problem of any kind, not just shrugging off some persistent symptom as unimportant. It might not be.

Gut health is improved by things which might not seem particularly gut-relevant, like reducing stress; getting recommended amounts of sleep; staying hydrated; and finally, eating a healthy diet, and eating it slowly and chewing thoroughly.

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 #28

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: SUTURE

...cleverly hidden in the boy’s hair in the p. 8 ad for DANIEL VILLAGE BARBER SHOP

THE WINNER: STEVE MASON! 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!

FEBRUARY 7, 2020

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED A C H E

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C O D E X

E D E M A

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S C A R

N E A J E A R O A R T T H T F A N T O P S D A R S E U M T N T D R U C R E N T H E N C H E S T I E R S A B E N T E R E E S O

A W S A H U R O B E C R F L A R E A R E A S E E S S S T F E D R H O O C A E N L I S T E F A F A L

F R O G H O L C L L O O W T G M E O R A M

C H A S M

D O U G

A W R Y

S E A R S

T O D A Y

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SEE PAGE 12

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

...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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QuotatioN QUOTATION PUZZLE SOLUTION “How we spend our days is, of course, how we spend our lives.”

— Annie Dillard

WORDS

BY NUMBER “An injury is much sooner ­

forgotten than an insult.”

— Lord Chesterfield

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one?

FEBRUARY 7, 2020

IT’S A QUESTION OF CARE How do I address driving safety with my aging loved one?

by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and a Certified Advanced Social Work Case Manager.

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AUGUSTAMEDICALEXAMiNER Family members are often concerned about their loved ones as they age and continue to drive. This can be a concern for the aging one as well as other drivers.

Depending on the relationship you have with your aging family member, you might choose one of a few options to address driving safety and whether your loved one should continue to drive.

• You may choose to tell them outright that you believe it’s unsafe and that they’re no longer going to drive. You might take the keys, or in some instances disable the car. Sometimes this works and sometimes it causes anger, but if your relationship allows it and you can stay firm in your decision because you believe it is for the best, it’s often the best path.

• You might enlist the doctor to tell your loved one that he or she cannot drive and explain to them why that is the case. Perhaps the reason is poor vision, hearing loss and/or mobility issues. Sometimes it’s because they have dementia and they cannot make good judgements or might get lost. The doctor will typically write a letter, and then you can share that letter with your loved one.

This becomes evidence that the doctor has ordered no driving. It can work in some cases because older persons frequently respect that what the doctor says goes no matter what. You can also utilize the services of the doctor and ask him or her to write a letter to the Department of Motor Vehicles, informing the organization that he or she

believes your loved one is unsafe to drive (if the doctor does truly believe that).

This will begin a series of events in which your loved one will have to prove they are safe to drive.

• You can also suggest to your loved one that you believe there is are safety factors involved, and you would like them to have some testing done to determine if they should continue to drive. If they agree, you can find such testing at our larger local medical centers either through their physical therapy or occupational therapy departments. There might be in-lab testing, and there might also be behind-thewheel driving assessments.

No matter your approach, the primary goal is to keep your parent/loved one safe. +

To WILD WING CAFE & SCRUBS OF EVANS They’re the prize sponsors of our Mystery Word Contest.

PROFESSIONAL DIRECTORY +

Dr. Eric Sherrell, DACM, LAC Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707 www.AcuClinicGA.com

ALLERGY Tesneem K. Chaudhary, MD Allergy & Asthma Center 3685 Wheeler Road, Suite 101 Augusta 30909 706-868-8555

CHIROPRACTIC Evans Chiropractic Health Center Dr. William M. Rice 108 SRP Drive, Suite A 706-860-4001 www.evanschiro.net

COUNSELING Resolution Counseling Professionals 3633 Wheeler Rd, Suite 365 Augusta 30909 706-432-6866 www.visitrcp.com

DENTISTRY

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048

IN-HOME CARE

Floss ‘em or lose ‘em!

Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

DERMATOLOGY

GLUCOSE

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Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com

Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE

Georgia Dermatology & WOODY MERRY www.woodymerry.com Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Long-Term Care Planning I CAN HELP! Augusta 30904 (706) 733-3190 • 733-5525 (fax) 706-733-3373 SKIN CANCER CENTER www.GaDerm.com

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TRANSPORTATION AMBULANCE • STRETCHER • WHEELCHAIR

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VEIN CARE Vein Specialists of Augusta G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 706-854-8340 www.VeinsAugusta.com

Karen L. Carter, MD Medical Center West Pharmacy 1303 D’Antignac St, Suite 2100 465 North Belair Road Augusta 30901 Evans 30809 706-396-0600 Your Practice 706-854-2424 www.augustadevelopmentalspecialists.com www.medicalcenterwestpharmacy.com And up to four additional lines of your choosing and, if desired, your logo.

Parks Pharmacy Keep your contact information in this 437 Georgia Ave. ARKS convenient place seen by thousands of HARMACY N. Augusta 29841 patients every month.

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AUGUSTAMEDICALEXAMiNER

FEBRUARY 7, 2020

KARP… from page 8

broil and sautee instead. When you use oils for cooking or on salads, use less. Use oils that are low in saturated fat and high in monounsaturated fat (such as olive oil and canola oil) and polyunsaturated fat, such as soybean oil, corn oil and sunflower oil. This coconut oil fad is pretty silly. Coconut oil is extremely high in saturated fat. Also, I do want to mention something about salt. The typical American diet is way too high in salt and it comes, mainly, from pre-prepared foods and eating out too much.

What’s the “no-nonsense nutrition” advice for today? Don’t worry so much about the name of your diet. The Mediterranean Diet and The DASH Diet both follow very similar dietary principles. Make sure that any diet you follow is an evidenced-based diet from a peer-reviewed scientific source, not from a book, TV ad or what you came across on social media. Actually, the best advice is to eliminate the word diet from your vocabulary. Instead of diet, think of these nutrition guides as the best ways of eating and living your life, every day, for the rest of your life. +

KIDNEY HEALTH… from page 9

MEDICATIONS Not all medications are created equal when it comes to kidney health. Over the counter medications such as ibuprofen can harm kidneys when not taken correctly. If you have kidney disease or a family history of kidney disease please talk with your physician before taking laxatives and antibiotics. There a several prescription medications that can harm your kidneys and it is up to you and your physician to identify these medications and seek alternative treatments. If you are prescribed any medication for diabetes or high blood pressure that you cannot tolerate notify your physician immediately. Do not just stop taking the medication. Not managing your diabetes and high blood pressure is not an option! Work with your physician to discuss your symptoms and let the physician decide on an alternate medication, dosage, or treatment method.

Prevention is always better that treatment, and it is best to practice preventive kidney health methods versus waiting until kidney damage has already happened. Education and behavior change methods are great tools to prevent the continuous increase in end-stage renal disease. Diet, exercise, medical care, and medication management are the key focus areas to help prevent kidney disease. Through my experience as a dietitian in hospital settings and dialysis clinic settings, the methods listed above are the answer to this global public health crisis. +

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

M.D. John Cook,

Pictured above (from left to right), John Cook, MD; Lauren Ploch, MD; Jason Arnold, MD; Caroline Wells, PA-C; Chris Thompson, PA-C

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