Medical Examiner 2-21-20 by Daniel Pearson

MEDICALEXAMINER

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

FEBRUARY 21, 2020

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BODY PARTS: THE OCCASIONAL SERIES

BLOOD

he heart gets a lot of attention every February. Nine years after he suffered a heart attack, President Lyndon Johnson proclaimed the first American Heart Month in February 1964. Well done, sir. The heart deserves all the credit we could possibly give it and then some. But with all due respect for the heart — we’d promptly die without it — the heart would be nothing without blood. Yes, even though the heart is constantly bathed in blood as it pumps about 1,700 gallons of the stuff a day, it gets no nourishment or benefit from any of that blood. A tanker hauling 10,000 gallons of gasoline down the highway could run out of gas because its engine doesn’t run on gas from its massive tank. In the same way, the heart has to get its sustenance just like any other body part, in the heart’s case, through the aptly labeled coronary arteries. Blood is amazing stuff, and it is everywhere. Cut or even merely prick your skin anywhere on the body and a drop of blood (or more) from the average CSRA adult’s 5-quart supply will appear instantly. We say CSRA because people who live up in high mountains can have up to two extra quarts in circulation. The extra blood can help capture and deliver more oxygen in high altitudes where there is less of it to go around. A low-altitude newborn, by comparison, has only about a cup of blood. Most of us have learned that blood has four components: red blood cells, white blood cells, platelets, and plasma. True. But then, what is hemoglobin? What are corpuscles? What about lymphocytes, erythrocytes and leukocytes? Like everything else in the natural world, the closer blood is examined, the more complex and sophisticated it is discovered to be. According to one source, a single drop of blood can contain four thousand different types of molecules, which is slightly greater than four. So let’s take a quick look at the four major components and see how many of the additional four thousand we can work into this article. [Spoiler alert: we’re

not going to even come close.] Plasma Plasma is the liquid part of blood, the vehicle in which the other elements swim. It’s mostly water, which is a lot like saying blood has four components. Plasma also contains vital proteins like albumin, globulin and fibrinogen, each with key assignments. Albumin keeps plasma in blood vessels; a deficiency can lead to edema as plasma leaks into surrounding tissues. Fibrinogen aids in clotting, and globulin proteins help fight infections, particularly gamma globulin. (There are also alpha and beta globulins; the differences come from their varying reactions to electric fields in the body.) Plasma is also the body’s hormone delivery system, and in addition helps convey both waste materials away from and nutrients to their proper destinations among our roughly 37.2 trillion cells. Red blood cells That word erythrocyte (uh-RITH-ruh-site) from before? That’s a synonym for red blood cell. They are the most common cells circulating in plasma, numbering around 4 to 6 million in each microliter of blood (a microliter is 0.00003 of an ounce), and they are tiny. Remember the old cigarette ads for a brand that said it was “a silly millimeter longer”? That may not have been much, but for comparison’s sake, a red blood cell (RBC) measures about 7 microns in diameter, and a micron is 1/1,000 of a millimeter. To put it another way, that’s 0.0000039 inches. More about size in just a moment. Red blood cells are what we commonly think of when we picture blood. The cells in the image above are RBCs, showing their famous round pillow shape. They are unusual in that, unlike most cells, they don’t have a nucleus. Please see BLOOD page 3

AUGUSTAMEDICALEXAMiNER

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PART 7 OF A SERIES BY JONATHAN MURDICK Editor’s note: Our correctional nurse isn’t quite as fetching as the nurse on the cover of the pulp novel shown. Ours isn’t even a female. But our nurse has at least one exceptional advantage over the nurse in the picture: he’s real.

PARENTHOOD by David W. Proefrock, PhD

You have tried everything you can think of, but can’t get your adolescent children to keep their rooms clean. You realize this is a problem you share with almost every other parent of teenagers, but you are at your wit’s end. You are afraid their rooms will become health risks. What should you do? A. Wait until you can stand it no longer and then clean the rooms yourself. At least you will know the rooms are clean. B. Wait until you can stand it no longer and then force them to clean their rooms by not allowing them to leave the house or to use their phones or computers until the rooms have been cleaned to your satisfaction. C. Wait until you can stand it no longer and then clean the rooms yourself and charge them for maid services. D. Make them keep the doors to their rooms closed and try not to think about how messy they are.

If you answered: A. None of these choices are horrible, but this is probably the worst of them. It teaches them irresponsibility and that they can outwait you to get things done they should be doing themselves. B. This will work, but be prepared for all the conflict that will come with it. C. This choice will also work, but may lead to even more conflict since most teens value their money more than their time. D. This is what most parenting experts would recommend, but as someone who has raised teens, the one least likely to work. Most parents will reach the limit of how much mess and filth they can have around them long before most teens will reach than limit. You end up with one of the other choices anyway. There really aren’t any magic solutions to the clean room problem. Just remember that as a parent, one of your jobs is to teach responsibility. That includes responsibility for your surroundings. However, you must accept that kids are just naturally able to tolerate considerable disorder in their surroundings. + Dr. Proefrock is a retired clinical and forensic child psychologist.

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t was my six-month anniversary since I first walked into the maximum security prison, and I still got butterflies when I checked the daily schedule. Although I had only spent a few weeks working Max, I knew my luck could change at any moment. For the last several months I had been working sick call and really felt like I was making a difference. In Max, I often felt like I was just wasting my time. Inmates would spit their meds at you, refuse them all together, and the really creative ones would find more fiendish ways to say no. When I walked to the schedule board on anniversay day I was relieved! I was again assigned to sick call, however my elation quickly grew into a feeling of unease because a rather unreliable nurse was assigned to Max that day. Those of us who had been working in the prison for more than three months were mostly reliable and preferred to work in the same areas from day to day. Unfortunately, in the medical world staff nurses aren’t always paid well, so they are often in short supply. To address these shortages, staffing agencies were contracted and they would provide temporary help. The nurse assigned to Max today was an agency nurse and as usual...she didn’t show. A few hours later I found myself grudgingly packing up the meds for Max and complaining about it the whole time. I don’t mind admitting I hated going to Max. It would behoove me to sugar coat it and say some team player nonsense, but when it came to Max...it was every man or woman for themselves. I soon found myself standing at the door to Max wearing the

I Was a

Prison Nurse ! SHOCKING TRUE TALES!

50¢ familiar feces- and spit-covered stab-proof vest and face shield. I tightened the straps on my little basket of meds and entered the gauntlet. At cell after cell the standard insults, slurs, threats, penises, and many other revolting things were thrown or shown my way, but I kept my head down and tried desperately to hold onto my last scraps of professionalism and patience. At last I made it around to my final inmate who, instead of taking his medications, demanded I give him several band-aids. Inmates are supposed to ask officers for bandaids since they keep a supply of basic first aid supplies with them, but they are never given without seeing a wound. Inmates in Max utilize band-aids and string from their boxers to pass contraband between cells and love to pester nurses in a hurry to break the rules. It is dangerous to stand at an open window in Max, so no other business is to be conducted as during pill pass. Knowing the rules, and feeling the last shred of my patience let go, I soundly refused and chastised the veteran inmate for wasting my time with antics and moved on. As I left

I was chased with threats, curses, and promises to exact revenge for the perceived slight. I finished my morning pass and went back to the med room to prepare for the afternoon pass. Time passes far too quickly when you are dreading something, and again I found myself repeating the exercise in seeming futility. I made it around to the band-aid requesting inmate’s room once more and with other matters on my mind from previous cells had completely forgotten about the earlier incident. The door opened, a hand came out the window, and as if in slow motion a cup of vile fluid hurtled my direction. Never in my life have I been so thankful for a face shield and vest! There was commotion, shouting, doors slamming, an officer grabbed me, and as if teleported I found myself outside of max washing myself free of an odor I can’t even begin to describe. I had been dashed! Inmates will hide cups of bodily fluids, eggs, or anything stinky they can get their hands on. They wait until the mixture ferments and is especially ripe, then they launch them on whoever is unfortunate enough to be their current adversary. Thankfully exposure to my skin was extremely limited, and thanks to the face shield I wasn’t exposed to any diseases. At the urging of the Captain I filed an incident report on the inmate for assault on a healthcare professional, and figured that would be that. A few weeks later I received notice that the inmate’s sentence had been extended for 5 more years and I felt absolutely sick. Although the inmate was serving several life sentences and could care less, it was a heck of a hullabaloo over a band-aid. +

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BLOOD… from page 1

RBCs are essentially delivery pouches. There’s is the pouch itself, and inside it, hemoglobin and a mixture of chemicals. Hemoglobin is what makes red blood cells red. More importantly, it’s a protein that enables RBCs to carry oxygen. Granted, a hemoglobin molecule can hold only four oxygen molecules, but each and every red blood cell contains about 270 million hemoglobin molecules. Yowza. That’s a ton of oxygen-carrying capacity. But the other key talent hemoglobin possesses is getting rid of oxygen. It picks it up on the fly passing through the lungs and drops it off at the aforementioned 37 trillion body cells. But it doesn’t come back empty-handed. Hemoglobin also carries some of the body’s carbon dioxide waste back to the lungs for another gas exchange. Each round trip through the body takes about 60 seconds. A word about size: as mentioned above, red blood cells measure about 7 microns in diameter. That’s beyond microscopic. But to deliver to cells that live alongside the tiniest, narrowest capillaries, RBCs have to be able to squeeze through openings as small as 1 or 2 microns wide. That gives new meaning to small. Despite that, if all the red blood cells in an average human body were stacked one on top of another, they would reach 31,000 miles into the sky (according to an article in National Geographic). White blood cells Let us state by way of an introduction that covering the subject of white blood cells in anything less than 50,000 words is a huge insult to WBCs everywhere. That was also true of RBCs and plasma. Hopefully none of them read the Examiner.

The Reader’s Digest version is that white blood cells are the body’s marauding defense system, relentlessly searching for invaders and killing or neutralizing any and all they identify. This is a tall order. Some of the soldiers are neutrophils, lymphocytes (of which there are two main types: B cells and T cells), monocytes, macrophages and phagocytes and many, many more. The immune system, of which WBCs are the key element, has been compared to TSA airport screeners. Confronted with a massive and never-ending parade of potential threats, the job of WBCs — and TSA agents — is to ignore what’s not important and go to DefCon-4 on what is. None of us would want that huge responsibility, but they both do an admirable job. Platelets Cuts happen. No matter where, there is going to be blood — temporarily. For the small stuff there’s no need to bring out the big guns, uh plates. Plasma contains everything needed to activate fibrin to stitch things up. Platelets handle the big situations through a highly complex interplay of chemistry and structural engineering. The 50,000-word minimum rule is in play for platelets too. When blood loss is severe, body sensors register not only the reduced volume of blood but also that oxygen delivery capacity is dropping. In response the kidneys release a hormone called erythropoietin which signals manufacturing sites in bone marrow to speed up production of red blood cells. Clearly, we need way more space to cover this subject. But hopefully this brief overview has been enlightening.

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WHAT IS DEATH FROM “NATURAL” CAUSES? Sometimes a death from so-called natural causes seems like the lazy man’s way of saying, “The person was old. What were you expecting? That they would live forever?” True, deaths described as “natural” often strike older people, but dying of old age is, technically, not natural. At least not in our humble opinion here at Medical Examiner world headquarters. In our view, it falls into the same category as the lazy doctor’s explanation to a patient: “Your knee hurts because you’re 90 years old.” To which the patient replies, “My other knee is also 90 years old, and it doesn’t hurt.” So plenty of things may happen to us as we age, but none of them are exactly automatic. Or “natural.” True, some dastardly health issue may strike mainly older people. But it doesn’t strike all older people. Officially, however, a death from “natural” causes means that the death did not result from something that isn’t natural, like a bullet. Or a car crash, suicide, drowning, poisoning, or some other equally unnatural reason. It means that the death was the result of something natural, like an infection, illness, or an internal malfunction of some kind. Although it might not seem like it should be, dying of a heart attack is considered a perfectly natural death. Ditto for lung cancer (or any other cancer), stroke, Alzheimer’s disease, COPD, diabetes, pneumonia, the flu, kidney failure, and a host of other common life shorteners. As you may have surmised, then, the vast majority of all deaths fall into the “natural” category. CDC figures for one recent year put the number of natural deaths at close to 93 percent. The unfortunate 7 percent (it’s better to die naturally than unnaturally, right?) succumbed, in order of frequency, to accidental poisoning, vehicular accidents, falls, suicide, murder, drowning, complications of medical care, and fire. In the U.S. there are but six categories for medical examiners (no relation) to record the manner of death on death certificates: natural, accident, suicide, homicide, undetermined, and pending. Of course, we all want to keep living. That’s natural. +

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FEBRUARY 21, 2020

#109 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

ranted, this isn’t the clearest image we’ve ever used for the subject of one of our profiles. In our defense, this is a man who was born well over 200 years ago, and died more than a century ago. He’s an interesting character because his career was spent in dentistry, yet his legacy is in another branch of medicine altogether. It’s also of note that his last name has become a word, and a very commonly used word at that. If you look him up on Wikipedia you’ll discover the “Known for” line of his profile says “gutta-percha.” It’s a big jump from a term most of us have never heard of to being a household word, but that’s exactly what he pulled off. To back up for just a moment, gutta-percha describes a rubber-like resinous substance made from the latex of certain trees in Malaysia. Back in the day (Charles, our hero, lived from 1807-1885), gutta-percha was used to make dental molds, and despite the Wikipedia reference above, English dentist Edwin Truman (18191905) seems to get the credit for its introduction. But it had its drawbacks. It was flexible enough that it would distort unless it was removed from a patient’s mouth with extreme care. Applied when warm, it would also shrink as it cooled, further compromising the usefulness of the impressions made with it. Charles discovered that by adding talc and stearine to gutta-percha, the stability of the material was significantly improved without interfering with its plasticity, obviously important for taking dental impressions. The substance was an immediate hit among dentists, and Charles and his two sons, also practicing dentists, manufactured and sold the substance under the family name for many years, even long after Charles’ death. World War I and its many ghastly facial injuries marked a new use for the widely-sold family dental compound in reconstructive surgery, most notably by the great Sir Harold Gillies, the father of modern plastic surgery (previously profiled in this series). Pretty soon, the compound was being used in all kinds of applications, and in fact, medical dictionaries describe it as useful in holding skin grafts in place and supporting tubular structures in surgery. Before long, hardly anyone used the product or the word to describe anything related to dentistry. It gradually came to be used almost exclusively in the latter sense above, that is to support tubular structures. An article in American Cardiology (for a dentist?) entitled “When a proper noun becomes a common noun,” noted in 1997 that “The greatest accolade that can be given to any inventor is to have the initial capital letter dropped from his name, for that is recognition that the word is now in the general language.” Oh! Almost forgot! The name of the man pictured above is Charles Stent. +

by Marcia Ribble Back on Super Bowl Sunday I spent the day watching, among other things, puppy, dog, cat and kitten bowls as preludes to the Super Bowl of 2020. I didn’t pay full attention, however, because there was the newspaper to read and meals to prepare and eat and various other absorbing activities, like writing this article. One thing that kept my attention during the actual game was the ads, which were often cute, sometimes totally confusing, and some really unbefitting the world I have grown up in. That was true of the half-time show too. I know how old I am when I can’t understand a word that Shakira and J-Lo were singing, even when it was in English. I found myself absolutely appalled by the nearly naked bodies and the suggestive body movements of them and the other dancers. It does make me laugh, though, recalling how upset my own elders were by all the changes my own generation foisted upon the unwilling world. Life keeps changing regardless of who the changes might upset, so part of aging is the attempt to discover what aspects of aging gracefully we can accept and which ones are simply unacceptable. I’m too old to feel comfortable with displays of female body parts that have been sexualized. Despite that, I am very comfortable with seeing women nurse their babies, at least until the children can ask to be nursed. There are many others, however, who are uncomfortable with it. The U.S. is pretty puritan when it comes to nursing moms compared to other parts of the world where a mother who is well-fed enough to

feed her infants is considered a huge blessing because it often means the children will survive. I do realize that my generation put our parents and grandparents through a lot of trauma. We often refused to accept that children born out of wedlock and their mothers were not to be hidden away as terribly scandalous, even if we might have preferred to see women and men married before they had children. Many of us believed that young men could be patriotic and protest against the war in Vietnam. Many more of us accepted interracial relationships and marriages as OK, and we have often grown tolerant of people who are lesbian, gay, bi-sexual, transgender, non-binary, etc, and of our beloved children who have been brave enough to come out to us. These are major reasons why so many of us have turned away from formal religions which seem to have never understood why Jesus said we have to love everyone without qualifications, and which continue to embrace rules that blame humans for conditions God created and fail to understand that those who are different are still made in “the image and likeness of God.” My generation isn’t unanimous in this kind of belief system, but many more of us now live happily in families which include varieties of people who would have been seen as a disgrace only a generation ago. For instance, growing up I never saw families that had children with Down Syndrome, mixed race kids, mentally ill family members, etc. They were normally sent away to live outside the family. We are far from perfect in accepting and loving those who are “othered,” but continually growing in the ability to love others who would not have fit a generation of so ago. +

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ADVENTURES IN

Middle Age

Sweetheart, you know I didn’t mean to let our subscription to the Medical Examiner expire. It just slipped my mind, but I’ll renew today. That’s a promise, lil’ darlin.

BY J.B. COLLUM

Two weeks ago I said this time I would again for an ID check. I don’t mean the obligwrite in this space about breaking my father atory cursory glance bartenders give the IDs of out of a hospital. This is that story: gray-haired old gentlemen though. Oh no, they When the nurse was looking the other way, took my ID, entered some information into a we made a break for it! Dad’s cane was a blur computer and then got some kind of electronic as we made our way across the lobby toward OK signal. To this day I don’t know what they the exit. We pushed through the doors and checked, but the whole procedure made me were halfway to the car where my son John worry about leaving my car in the parking lot. was sitting at the wheel as our getaway driver. It didn’t seem like a bad area, at least at first He had the car cranked and the doors open glance, but I was told they had instituted this and ready for us. We thought we had made it, strict visitation procedure after some dangerous but then we heard the barking dogs. They had and frightening incidents in the past. us! I jest, of course, but not by much, at least We eventually got in and saw my parents from my point of view. Let me in the emergency room. I won’t start from the beginning. They said I couldn’t. bore you with all of the details, It was late May 2017, about I said “watch me.” but I will give this summary. six months since my father had They were trying to rule out a been in the hospital back home stroke, so they ran some tests in Augusta and had gotten a stent. We felt that while he was in the ER, but then admitted him. things were going well with his health, but our We spent a few days waiting for them to come outlook and our world was about to change. and get him for tests that inevitably got put off At the time I was working on preparing time after time after time. some land we would be moving to about seven After about four days of this, a large hospimonths later. My brother was next door where tal and hotel bill, and zero progress, I decidhe had already moved in. My wife, son, and ed we’d had enough. I gave them a piece of father in law were sitting nearby when my my mind, and it wasn’t the nicest part. I had phone rang. It was my mother. She and dad started giving them deadlines the day before had spent a few weeks with my sister and her and finally when they missed another one on family in Maryland and they were on their Saturday morning, I made good on my promway home, trying to avoid the perils on I-95. ise to take him to another hospital back home Her voice betrayed her distress. My father was despite their saying I wouldn’t be allowed to. arguing with her that when she got back on My mother was concerned but I could tell the interstate, she was going the wrong way, she wanted me to do it. One last time, the staff but she was using her phone as a GPS and she said that we couldn’t do it, but I said, “Hold was sure she was heading south as she should my beer.” No, wait, that wasn’t it. That’s a be. My normally easy-going father, who I can different story where I ended up at a hospital. barely recall ever raising his voice, was in the I actually said, “Watch me.” They then said background working himself up into a lather. we could leave but only if we signed some She couldn’t reason with him. Something simpaperwork. I refused and walked my father ilar had happened a few months earlier when out. I kept expecting someone to stop me, but he was driving and had gotten lost but refused that never happened despite their assertions help. This time was different though. He was that they could and would stop us. I was so furious and his speech seemed slurred so we frustrated and angry, a part of me hoped they feared it might be a stroke. I told my mother to would try. pull over and call 911 because I knew that if it We made a clean getaway and drove him was a stroke, time was of the essence. home and went straight to a hospital here in Once I got off the phone with her, my son Augusta where we got a preliminary diagnosis and I headed home to pack for a quick trip that proved true in the end. It wasn’t a diagnoto where my parents were in North Carolina. sis we welcomed, but it was made within a few At that moment, we didn’t even know where hours and we were home shortly thereafter. they were, but we would later find out it was If I’m ever near Fayetteville and need medical Fayetteville and he ended up at a hospital that care, I think I will drive a little farther to avoid shared part of its name with a famous movie. that hospital. That place was scary. + A thriller set in Cape Fear. In retrospect, that was fitting. J.B. Collum is a local novelist, My son and I arrived at the maximum-secuhumorist and columnist who wants rity prison, wait, I mean the hospital. We stood to be Mark Twain when he grows in a line and entered one by one where we up. He may be reached at johnbcolwere scanned by metal detectors and then wait lum@gmail.com

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OVER AGE 70-1/2? LOOK INTO THIS CHARITABLE GIVING STRATEGY

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One of the topics for conversation we really enjoy having with people is charitable giving. It is truly amazing listening to people share all the different ways they give back to the community. The recent tax law changes have made claiming a tax deduction for your charitable gifts a little harder because the standard deduction is a lot higher now. This means many people are no longer taking itemized deductions, which is where your charitable gifts were being deducted. However, for people over age 70½ with an IRA, the IRS has a great option for you. If you are making gifts to your church or other charitable organizations and you are over age 70½, the IRS

allows you to do something called a Qualified Charitable Distribution or QCD. A QCD lets you take money from an IRA or inherited IRA and give it directly to a charity. If you follow the QCD rules, you will not have to pay taxes on that money. We recommend you talk with a financial advisor and tax preparer when considering this strategy. You must follow all the rules to take advantage of the strategy. Below are a few items your financial advisor and tax preparer will help you consider and discuss before you make a QCD. • Age - you must be over 70½ to make a QCD. You must wait until you actually go six months past your 70th birthday before doing the

QCD. • Taxes – QCDs are a great fit for those who DO NOT take itemized deductions anymore. With the recent tax law changes, we are seeing a lot more people in this situation. If you do use itemized deductions, a QCD may still be a good fit. It will depend on what amount of your itemized deductions are from charitable contributions. • Required Minimum Distributions (RMD) – The recent SECURE act just changed the rules on RMDs. If you must take a “required minimum distribution” (RMD) from your IRA or inherited IRA, you can use a QCD to satisfy the RMD. The key is you must take the QCD before the RMD. This can trip a lot

of people up, and we recommend you talk with a financial advisor and tax preparer to ensure you follow all the QCD and RMD rules. • Account Type – You can only take QCDs from an individual IRA. This is one reason many people should consider consolidating old employer retirement plans into an individual IRA. Consolidation simplifies things and helps you use the QCD option. • Charities – most churches or charities are eligible to receive QCDs. There are a few limitations such as donor-advised funds and private foundations that cannot receive a QCD. If you have the desire to contribute, a QCD can offer an enhanced means to accomplish your goal. + by Clayton Quamme, CFP® a financial planner with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

IT’SYOURTURN! 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 21, 2020

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7 +

GARDENVARIETY

Olive Oil Mashed Potatoes are smooth, creamy with a hint of Tuscan herbs, and so rich no one will miss the dairy. The key to this recipe is using an excellent quality olive oil. When you think of olive oil, have you always felt that it was grown mostly in Europe? It may surprise you that Georgia is not only known for peanuts and peaches, but we are also now known for superb quality olive oil. Olive Orchards of Georgia originated in the summer of 2013 and is a family-owned company that grows and presses arbequina olives for the production of highquality extra virgin olive oil. Not only does their olive oil have outstanding flavor, it also is a healthy oil to add to your diet. Here are just a few of the benefits. An ISRN Pharmacol study suggested that ingredients in extra virgin olive oil may help protect the nervous system and could be useful for treating depression and anxiety. According to a Nutrients study published in 2019, olive oil contains substances that may help prevent colorectal cancer. Lab tests have found evidence that antioxidants in olive oil may help protect the body from inflammation, oxidative damage, and epigenetic changes. According to Olive Wellness Institue, extra virgin olive oil contains over 30 various types of phenolic compounds, which are powerful antioxidants that help protect the body against free radicals. Free radicals are molecules that cause cell damage and contribute to disease and the aging process A PubMed study states olive oil supplements appear to improve inflammatory markers and reduce oxidative stress in individuals with rheumatoid arthritis Olive Oil Mashed Potatoes Ingredients • 4 lbs. Russet potatoes, peeled and cut into 1-inch chunks • 1/2 cup almond milk • 2/3 cup Olive Orchards of

Olive Oil Mashed Potatoes Georgia olive oil, plus more for drizzling • 3 cloves garlic, gently smashed and peeled • 2 sprigs fresh rosemary, about 3 inches each. Stems removed and leaves chopped lightly • 1 teaspoon small strips of lemon zest • 1/4 tsp. crushed red pepper • salt and pepper • 2 tbsp. chopped fresh flatleaf parsley Directions In a large stock pot, add enough cold water to cover the potatoes over an 1 inch. Add 1 tbsp. salt. Bring to a boil and cook until very tender, about 12 to 15 minutes. Meanwhile, in a small saucepan, heat 2/3 cup Olive Orchards of Georgia olive oil on medium heat. Add the garlic, rosemary, lemon zest, crushed red

pepper, and 1/4 tsp. salt, stirring occasionally, for 2 minutes. Drain the potatoes. Push the potatoes through a potato ricer back into the pot, or return the potatoes to the pot and mash with a potato masher. Strain the oil mixture into the potatoes and add 1/2 cup almond milk. Stir well. Add seasoning from oil, salt and pepper to taste. Transfer the potatoes to a bowl, drizzle with oil, and sprinkle with the parsley. by Gina Dickson, an Augusta mom to six and Gigi to ten. Her website, intentionalhospitality. com, celebrates gathering with friends, cooking great healthy meals and sharing life around the table. Also on Instagram @ intentionalhospitality +

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...Continued. For the first 3, see the Jan. 24 issue online at issuu.com/medicalexaminer So, Myth #4 now: “He has underlying issues, that’s why he drinks too much.” Well, maybe maybe not. True, we drink for one reason only: to change the way we feel. The question is, Why do I need to change the way I feel? Is reality not good enough? Truth is, people drink for as many reasons as there are stars in the sky! Sometimes people to drink to escape, sometimes to not feel grief, sometimes to be sociable, and sometimes… For most people most of the time (but not all people all of the time), the progression from social drinking to problem drinking takes years and years and never happens with the thought of escaping grief or other feelings, but just to be convivial with friends and loved ones. Somewhere along the way the body builds up tolerance to alcohol or drugs and more of the chemical is required. Again, not to escape reality but to satiate the brain’s demands…a chemical “need.” An alcoholic, you see, doesn’t necessarily drink because he wants to but because he has to. Often this increase in consumption brings about a myriad of problems that never existed way back when…such as laying out of work, legal problems like DUIs, and marital dysfunction. This brings me to my Myth #5: “If he could find out what these underlying issues are, he’ll stop drinking.” Well again, maybe so and maybe not. Actually, as long as he’s drinking he’ll never find his “issues” to deal with because he’s in an altered state of mind much of the time, either hung over, intoxicated, or “jonesing” (“craving,” for you out there who are never “jonesing!” How did the Jones get such a bad rap?) When I was in college (at age 16 – way too young, don’t you think?) and went to class hung over, high, or craving, I was not in a position to learn anything, much less remember what the professor said. The point I’m making is, the first task for an alcoholic or addict is to be clean and sober for a period of time so they are able to do the introspective work of self-examination. The 12-step programs well understand this and the steps are intelligently ordered to be accomplished one at a time…you don’t start with Step Five, or Seven, until you’ve done numbers 1, 2, & 3. Imagine a poor guy who goes to the Emergency Room in a diabetic coma…the staff has two choices: treat him immediately for his condition, or stand around and ponder, “Is he a diabetic because he has a family history of it or because he just eats too much sugar?!!!” Treatment is paramount, not psychoanalyzing the situation. Another example to illustrate my point is a guy trying to quit smoking cigarettes who goes to a hypnotist to find out why he smokes so much. He discovers while under hypnosis that he smokes because he

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional was weaned from breast feeding too early and still has an oral fixation. Coming out of hypnosis he is told this truth. Does that mean he quits smoking right then & there? Not. Sometimes insight just doesn’t help heal us - at first. The important thing is to quit smoking or drinking through treatment or self help groups and then, in time, go deep inside the soul. Then there’s #6: “He’s bi-polar and that’s why he drinks.” I have seen this at times: people who “self-medicate” their undiagnosed and untreated mental illness. They’re hyper and can’t concentrate so they drink to slow their brain down. But more often than not I’ve seen people who’d rather be bi-polar than be an addict or alcoholic! Once I was in a recovery meeting and someone asked everyone in the room how many had been diagnosed as bi-polar and every person sitting in the circle raised their hand! According to much literature I read, bi-polar is one of the most over-diagnosed illnesses in the field of mental health. The reality is that many are not bi-polar at all. They just have mood swings from alcohol and drug use that make them look like how a layman would expect a bi-polar person to act. An accurate bi-polar diagnosis cannot be made while interviewing a person who is actively dependent on alcohol or drugs. A clearer picture can be made 30-90 days after getting clean/sober, and an even better shot at it comes after 6-12 months clean and sober! Patience, patience, patience. I’ve seen many clients over the years who finally got clean and sober, and as a result were also able to stop taking prescribed psychotropic medications. Most of these medications even have a warning on the bottle, “Do not use alcohol while taking this medication.” Sure, like we listen! Guess we’ll have to finish next month. Or maybe write a book on this subject. Hasn’t somebody already done that? Find out for me please. +

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AUGUSTAMEDICALEXAMiNER

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

To Indulge or Not to Indulge by Jessica Williamson, Dietetic Intern

Please see CHOCOLATE page 10

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our bodies due to its ability to resist cell damage caused by free radicals produced naturally in bodily processes and environmentally by contaminants. Although it would be nice to believe that any and all chocolate is healthy, indulgers must be wary of the type of chocolate eaten. The healthiest choice must contain a certain amount of active flavonoid components for its effects to be beneficial. The flavonoid content of chocolates differs due to the extent of processing of the cocoa. Processing methods include fermentation, alkalization, and roasting. What kind of chocolates offer these science-supported health benefits? It is important to understand how chocolate is made in order to make an educated decision on which chocolate to purchase. Cocoa is the dried and fermented seed of the fruit from the cocoa tree. Cocoa is then ground, roasted and fermented to produce cocoa

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As tempting and forbidden as chocolate may seem, any reason is a good enough reason to indulge in this delicious and decadent confection. When the leftover Valentine’s Day chocolate goes on sale in the grocery stores, pick yourself up a bag because science says certain chocolates, in moderation, aregood for your health. The science linking chocolate and your health is dependent upon the flavonoid compounds found in cocoa powder. Flavanols, a particular type of flavonoid, are responsible for producing the bitter flavor of cocoa typically found in darker chocolates. Multiple steps of processing and a variety of additions to chocolate usually conceal the bitter flavor produced by cocoa. Despite producing an astringent flavor, flavanols also provide the health benefits of chocolate. Flavonoids have been proven to have cardio-protective effects on health due to their antioxidant activity, immunoregulatory properties, and favorable effects on vascular tissue. Flavonoids improve heart health by improving vascular function, reducing blood pressure, improving insulin sensitivity, and reducing the stickiness of blood platelets. Antioxidantrich cocoa is beneficial to

liquor. Cocoa liquor, which is labeled on chocolates as “percent cocoa,” is a paste containing both cocoa solids and cocoa butter. Removing the cocoa butter from the paste leaves only the cocoa solids, thus producing cocoa powder. It is the “percent cocoa” of the product by which the darkness of the chocolate is determined. Dark chocolates must contain at least 35% cocoa. Milk chocolates contain anywhere from 10 to 12% cocoa along with condensed milk. White chocolates are made from only cocoa butter and contain no cocoa solids, thus lacking the beneficial effects of flavonoids. Dark chocolate and cocoa powder are the best sources of the beneficial flavonoids found in cocoa. The average flavonoid content of dark chocolate is five times greater than that of milk chocolate. Cocoa butter is naturally high in fats, such as monounsaturated fats

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined

Law enforcement people... do you know who you are?

This space has been devoted to the life-saving value of wearing seat belts for the past two issues. While cars are getting safer and safer in their design and construction, it’s plain to anyone who drives (or is an observant passenger) that drivers seem to be less and less law-abiding all the time. Exhibit A is the rampant disregard of red lights. The common sight when your light turns green is to see one or more cars cross in front of you who ran the red light on the crossing street. It seems that runners happen more frequently than not. Given the frequency of this dangerous plague, it would not seem like a difficult or time-conF RE E! suming challenge for traffic division officers to enforce the law 9th ANNIVERSARY by citing offenders, but that isn’t something that Examiner 9 Ways to 9 Easy Ways Feel Healthier to Lose Weight researchers around the CSRA have particularly noticed. It’s not like cops would have to sit around for hours waiting for someone to run a red light; it happens constantly, and people have been killed as a result. Remember the red-light runner RiverT watch wreck at Stevens Creek Road that killed three boys? Are area traffic enforcement agencies waiting for more deaths before they act? As long as red light running continues seemingly unabated, anyone who does not wear a seat belt (only about 88 percent of drivers in the Southeast do) is doubly at risk. Exhibit B in our short list of excellent reasons to drive defensively and wear seat belts is the absolutely flagrant disregard for hands-free cell phone laws. Lots of people ignore this law, and they include people who wear badges and are paid to supposedly enforce traffic laws. Aiken County did not write any citations for violations of cell phone laws during 2019. Columbia County wrote a grand total of 38. We wouldn’t be surprised if we could tool around the Aiken-Augusta area and spot more than that many cell phone violations in an hour or two. The gold star goes to Richmond County, where the Sheriff’s Office wrote 435 citations for violations of the hands-free law between July 1, 2018 (when the law went into effect) and Dec. 31, 2018. During all of 2019, a total of 1,188 citations were issued in Richmond County, 657 of which were written by the Sheriff’s Office, with the remainder issued by Georgia State Patrol and public safety officers from Augusta University. Those two agencies also wrote more than 150 citations in the last half of 2018 to go with Richmond County’s 435. Obviously there is a lot of work to be done, and guess where the primary responsibility lies? In the hands of motorists, not police officers. Law enforcement officers can’t be everywhere. They can’t hold the hands of drivers like they’re babies. If we are old enough to legally drive, we are supposed to be mature enough and responsible enough and honest enough to obey the rules of the road — and not just when a cop is in sight. It is high time for every one of us to respect the laws of the land on the subject of safe driving, as well as respect other drivers. It’s high time we drive as though we respect the precious gift of life itself. +

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ISSUE

What is the best way to lose weight? The easiest way. It’s amazing how complicated people sometimes make it. Instead, here are 9 simple strategies. 1. Lose the liquid calories No more mini-buckets of sugary beverages. Try water instead. 2. Stop snacking Get your crunch from carrot celery sticks 3. Eat slowly and stop before you’re full To lose weight, all most people need to do is simply eat less food. Slowing down gives your brain time to register that you’re full when you actually are, not ten bites later. 4. Eat more protein, since protein keeps you fuller for longer, among other benets. 5. Eat more high volume foods Hunger always wins, so eat foods that are higher in volume and that keep you fuller longer, like brous green vegetables, lean protein, low fat dairy, low sugar fruit, potatoes, and other roots. 6. Reduce re ned sugar intake Most people would benet immensely by reducing rened sugar intake. A little here and there is permissible, but not too much. 7. Lift weights A little strength training is a great way to rm up and to burn calories. Baby steps, then bigger steps. 8. Drink caffeine, since it helps suppress appetite. It also can increase your physiological and mental capacity. 9. Have a preset plan to cheat Every diet fails at some point, so plan on it. In fact, create it, perhaps with one guilt-free cheat day/meal per week. One sensible cheat day/meal per week is not going to overpower 6 other days worth of diligent dieting, so don’t self impose unrealistic and unsustainable restrictions. +

The Medical Examiner took its first breath in July of 2006. We thank every single reader and each and every advertiser, past and present, whose support has made this publication “Aiken-Augusta’s Most Salubrious Newspaper” for the past 9 years.

3 boys die on Riverwatch his is not going to be an article about the June 1 accident on Riverwatch Parkway that took the lives of three young boys, one age 9, the other two just 8. It’s actually about you and me. Even so, let’s take just a moment to review what apparently happened. Two adult drivers were approaching the Stevens Creek Road intersection from opposite directions. One was intending to go straight; the other turned left into the path, as it happened, of the straight-through driver. Both drivers have been accused of running the red light; one was allegedly travelling nearly 67 mph in a stretch where the posted speed limit it 45 mph. The accident was a xture in news reports for nearly two weeks and three funerals were held, as accident reconstruction teams investigated exactly what happened, and eventually charges were led against both drivers. The fact that children were killed made the story especially heart-wrenching. Since the basic causes were identied — running the red light and speeding — perhaps a noticeable drop in both of those behaviors would be evident around town, even if temporarily. Have you noticed that? At Medical Examiner world headquarters here in Augusta, we have not. We continue to see aggressive driving well in excess of posted speed limits, both on area interstates and major surface roads. It is also amazingly common to see the light ahead of you change green, and then to see one or two vehicles — sometimes as many as three — zip across the intersection. In any context that is unacceptable driving, but in the aftermath of the Riverwatch accident, that is nothing short of contempt for the lives and safety of others. Here is a suggestion from the Medical Examiner: every single time you approach a trafc signal that turns yellow, dedicate your stop to the memory of three little boys who died as innocent passengers in a terrible wreck. What a tting tribute to their memory. +

And a few extras thrown in at no additional charge. • Make your bed every day • Have fruit smoothie for breakfast • Skip your coffee and have herbal or green tea instead. • Keep anything articial and packed with preservatives and other chemicals out of your diet. • Meditate for at least 5 minutes. • Hug someone. It releases endorphins, the feel-good hormones. • Unplug all your devices for at least one hour. • Spend time in nature: go for a walk in a park or by the river. • Drink plenty of water. • Avoid high sugar/high fat combination foods, such as traditional cookies, ice-cream, milk chocolate, cheesecake, etc. • Eat a side green salad with your lunch and dinner. • Eat your lunch outside in fresh air rather than at your desk near the computer. (See p. 2) • Snack on bre-rich and antioxidant-packed fruit and/or berries. • Watch your posture, especially when you sit. • Get a massage. • Think of 5 things to be grateful about in your life. • Smile at strangers. It will give a positive boost to your mood. • Make someone laugh. • Read a book that inspires you. • Clean up your workspace; it will help you be more focused and productive. • Listen to classical music. Studies show it boosts cognitive function. • Sleep at least 7 to 8 hours a night. +

CHOCOLATE … from page 9

and saturated fats, and cocoa solids are naturally high in fiber, vitamins, and minerals. Highly processed commercial chocolates are usually stripped of these naturally found nutrients and are loaded with added sugars and fats to improve palatability. The more cocoa is processed, the fewer beneficial flavonoid compounds remain. And remember: less is more. Overconsumption of chocolate cancels its benefits. In order to achieve the optimal health benefits from chocolate, eat one ounce of dark chocolate a few times per week. There it is. Your excuse to eat chocolate!

Enjoying a small piece of dark chocolate once in a while is scientifically proven to be good for your health! + Resources: • http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4696435/ • http://my.clevelandclinic.org/services/heart/ prevention/nutrition/food-choices/benefits-ofchocolate • https://newsinhealth.nih.gov/issue/ Aug2011/Feature1 • https://www.cadbury.com.au/AboutChocolate/Harvesting-and-Processing-CocoaBeans.aspx

FEBRUARY 21, 2020

HUMAN BEHAVIOR WHEN YOUR NEIGHBOR IS THE WORST

Leaf blowers at 5:30 a.m. Says, “You don’t mind if we hang out at your pool sometimes, do you?”—then is constantly in your yard. Plants some amazing flowers, but just over the property line into your yard. Regularly by Jeremy Hertza, Psy.D. parks in front of your driveway. Borrows tools and cups of sugar so often that it’s gotten annoying. This is a challenge. You own your house. You like it. You don’t want to move. What do you do when you’re struggling with a neighbor with no boundaries?

Ask Yourself This Question Start by deciding: “What is my goal here?” (And let’s assume your goal is not to be in a constant fight with your neighbor or uncomfortable in your own home, just to prove a point.) For most of us, our goal is to get along with our neighbors - within certain boundaries. First of all, here’s what not to do: • Don’t encourage the behavior. • Don’t escalate or engage in an altercation. • Don’t get nit-picky and annoyed at every little thing your neighbor does. • Don’t assume it’s personal. Your neighbor might not realize that his or her behavior is crossing a line in your personal comfort zone. Here’s What You Can Do When you’re trying to set boundaries, it doesn’t have to be a big conversation where you’re laying out “the neighbor rules.” Boundaries don’t necessarily have to be spelled out that way. Instead, there are ways of asking and doing things that are respectful but still communicate your message. For example: • Leaf blowers at 5:30 a.m. Call your homeowners association if you have one, or the police. Augusta’s noise ordinance, for example, prohibits loud or unusual noises between 11 p.m. and 7 a.m.. • Constantly in your yard: You don’t have to be nice and agree to opening your yard up to everybody. It’s fine to say, “Hey, I’ll get back to you.” If you’ve already said yes, try, “Hi guys, I’m afraid we have to close our pool to outside guests who are here unsupervised; our insurance agent warned us about potential liabilities.” Neighbors still coming onto your property when you’re not there? Try installing a security camera, and make it widely known throughout the neighborhood gossip line. • Puts stuff over the property line. Before any problems, mark your property line with a divider or fence. If they’ve begun the process or have put something on your property, you’ll have to talk. Start with the positives, and don’t be defensive. For example, “A new fence is a great idea, but as soon as I saw it I wanted to tell you: It’s on my property line.” And have the plat or marker so they can see for themselves. Or, “Your new plant looks great, but I was planning to put a flower border right there. When I’m putting that In, I’d be glad to move it over.” • Parks in front of your driveway. Say: “Hi, I’m not sure you realized it, but sometimes when you have friends over, they park in front of my driveway.” • Borrows everything. First, make sure to get all of your stuff back. Then next time try, “I’m sorry, we’re using that,” or “We need to go to the grocery store ourselves. Sorry we can’t help.” In short: Start by thinking creatively about what to do or say. If a conversation has to happen decide who’s the best person to talk to your neighbor, and make your tone calm and positive. Set your boundaries, then stick to your guns (just not literally). + Jeremy Hertza, Psy.D., is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC, in Augusta. Contact him at 706-823-5250 or info@nbageorgia.com.

FEBRUARY 21, 2020

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Suneel Dhand, MD, on Feb. 9, 2020 (Edited for space)

HEALTHCARE IS LIKE LIONS FOR LAMBS I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World War in high school in the UK. Its stories are often eclipsed by the much larger-scale Second World War, but many historians will argue that it was the First World War which was more horrific and shook the world to a greater degree. It was a war that became drawn out because of the sheer arrogance of the leaders. The British lost millions of brave young men, not to mention the millions wounded and maimed. There are monuments all over England, even a large one right in the middle of my small Berkshire village. There’s a famous quote by a German general who was witnessing wave after wave of brave British soldiers being sent over the top of trenches to their certain death, as they were mowed down by machine gunfire. He remarked: “Never before have I seen such lions led by such lambs.” That quote came to represent many of the catastrophic leadership decisions of the British hierarchy, who kept making miscalculations and taking needless risks with human life — all for sometimes gaining just a few feet of enemy territory. That famous quote can be applied in a multitude of different ways today, especially to modern leadership. Leadership is lacking all around us, in so many industries and sectors. And nowhere more so than health care. The consequences are right in front of our eyes: a suboptimal fragmented system, soaring costs, hidden agendas, and a demoralized group of people who work in it. If you have a leader who is not with their frontlines, an earthquake will be felt down the whole chain. As a physician who has worked in dozens of different institutions in different parts of the country, I have sadly seen some terrible examples of leadership. From mid-level managers all the way up to CEO. From what I have seen, the better places are in the minority in the health care world. There is a scene in 1917 when the soldier who is trying to deliver an important message from high command to a senior Colonel, to halt an attack, interacts with a senior British officer, who cleverly tells him: “Make sure there are witnesses when you deliver your message … because some of us just want the fight.” That was a very shrewd thing to say, because there are sadly leaders who will always be more interested in advancing their own agenda, and will gladly sacrifice others to do so. We have all seen it, and I’m sure everyone reading has their own stories. Managers who are all about numbers, targets, and the bottom line. I have personally seen many leaders gladly throw a doctor group or nursing team under the bus, to look good themselves. And all the while the clinicians know that none of them would even last a day if they ever had to do what we do. The frontline workers in health care are heroes. There’s no other word for them. They are lions. The doctors, nurses, and all other professionals. They will always do their duty no matter what. Moreover, their hearts are in the right place. Sadly, that is often taken advantage of. They could be exhausted, understaffed, or being led badly—but they will never neglect that patient in front of them and always go the extra mile. And all of this while their immediate world may be consumed by corporate greed, politics, industrial disputes, and patients who are suffering. Every day across this great nation, frontline clinical staff are let down by their leaders. Whether it’s the administrators or politicians, it’s true in health care too: Rarely will you ever see such lions led by such lambs. +

They wouldn’t last a day in our jobs.

Suneel Dhand is an internal medicine physician

Reading this book calls to mind the famous quote by Stuart Chase: “For those who believe, no proof is necessary. For those who don’t believe, no proof is possible.” We are currently rehashing issues that were hotly debated in the 1700s and even earlier: the first military defeat in American history happened when George Washington vacillated on whether or not to have his troops vaccinated against smallpox. After a forced retreat he made inoculation mandatory. That he was unsure of the safety of vaccines was not an evidence of the thinking of the day. As Eula Biss shows in this slim but well-researched volume, many centuries before George Washington vaccines were the subject of broad acceptance and pockets of entrenched skepticism. The more things change, it seems, the more they stay the same. The debate has little to do with fact, although this book is densely packed with them. Consider a little of the related history Biss reviews: the theory that AIDS is a government plot to kill

segments of the population the government supposedly views as undesirable. As one African man near AIDS’ ground zero remarked, however, wouldn’t it have been simpler to poison their Coca-Cola than to concoct a virulent disease? Another: Cotton Mather, became a proponent of variolation in the early 1700s (coincidentally, not long after losing his wife and three children to measles), and was rewarded by a firebomb thrown through his window. Consider the so-called anti-vaxxers who ignore the mountains of evidence provided by the World Health

Organization, the CDC, and countless independent studies by organizations with impeccable credentials, and instead hitch their wagons to a disgraced doctor and a former Playmate of the Year. Indeed, this debate is really not about facts. It’s about trust: of government, of the medical profession, and of the pharmaceutical industry. As Biss acknowledges, there are plenty of reasons to distrust all three. That does not mean, however, that everything they endorse or recommend is some diabolical plot. If it is, one has to wonder what’s behind government speed limits, healthful suggestions from the medical field (like encouragement to quit smoking), and aspirin tablets made by the pharmaceutical industry. The best idea may be found in the words of Biss herself, who suggests that we should “trust, but in an intelligent, skeptical way.” Her book will help readers do just that. + On Immunity: An Inoculation by Eula Biss, 205 pages, published in January 2014 by Graywolf Press

Research News Possession is 9/10ths... How does that saying go? However it’s worded, here is one of the most amazing discoveries about possession we have ever read here at Medical Examiner world headquarters. This is not about drug possession either. It’s about the exact opposite of drug possession. A study was published in Current Psychology last February which demonstrated the always-amazing power of placebo. But this is even more amazing than normal. In the study, participants were given information about a pain relieving cream. The cream was actually an inert placebo, however. Half of the study participants were given a sample of the cream. Everyone in the study did a cold-pressor test, which involves submersing one hand in ice water for a full minute. It can be quite painful. As it turned out, participants who received the cream but

did not use it reported lower levels of pain intensity during the cold-pressor task than those who did not receive the cream. Study authors say, “Our findings constitute initial evidence that simply possessing a placebo analgesic can reduce pain intensity.” Long hours = high pressure A new study by Canadian researchers published late last year in the journal Hypertension revealed a link between long hours of work and an increased risk for high blood pressure. Working between 41 and 48 hours per week was linked to a 42 percent greater likelihood of having sustained hypertension. Working 49 or more hours each week was linked to a 66 percent greater likelihood of sustained high blood pressure. High blood pressure affects nearly half of all Americans over age 18, and is considered the primary factor in more than 82,000 deaths per year.

Goodie bags that save lives You know that little bag that some dentists give you when you leave their office, the one with a new toothbrush, maybe a sampler tube of toothpaste and a small package of floss? A cancer researcher at the Medical University of South Carolina had an idea sitting in his dentist’s office watching patients leave with their bags. Why not do the same thing for patients who use tobacco? Matthew Carpenter, Ph.D., managed to roll out his idea at 22 clinics across the Palmetto State, reaching nearly 1,250 patients with parting gifts after appointments with their primary care providers. The bags included nicotine patches, lozenges and quitting information. More than a quarter of all participants achieved a full week smoke-free, and 12 percent were completely smoke-free at a 6-month follow-up appointment. +

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AUGUSTAMEDICALEXAMiNER

The Examiners

FEBRUARY 21, 2020

by Dan Pearson

Well, my big toe hurts and I’ve got this crazy itch How are you today? on my elbow, plus...

Hold it! It’s just a greeting. You don’t answer literally.

Let’s try again. This time say something positive about how you feel. Thank you for asking. How are you today? I’m not unwell.

Sorry. I need to work on that.

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. Chew on 5. TV network sports award 9. Polychlorinated biphenyl, in short 12. Orchard beginning 13. Muskogee resident? 14. Noted Lane 16. Disagreeable 18. Common medical prefix 19. ____-line 20. Prepare for publication 21. Entrances 22. Single-handedly 23. Broad Street has one 24. Lindsey’s predecessor 27. Members of the distaff side 28. Football played on 200 ft.long field 29. Raced 31. Greg’s follower 34. Abuse tactic 38. Garden implement 39. Name with Aaron 40. Temporary tattoo ink 41. Governor in Mogul India 44. _______ boy 45. Clothing fastener 47. Eisenhower’s middle name 50. Permit 51. Monetary unit of Iran 52. Beta Kappa intro 55. Type of machine gun 56. Oil rig worker 59. Scottish Gaelic 60. Flyers on scoreboards 61. Rule of ______ (in burns) 62. Donkey 63. Method 64. Feet (slang)

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

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MAR. 2, 2020

We’ll announce the winner in our next issue!

E X A M I N E R

The Mystery Word for this issue: ALECIRO

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S U D 3 O 4 K 9 U

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. ______ pool 2. Back of the neck 3. Knee injury abbrev. 4. Helmsman 5. Reddish dye 6. _______board 7. Slender metal fastener 8. Nevertheless 9. Give pleasure to 10. Dependent on 11. He took over for Cheney 12. Tavern 15. Mediocre 17. Fuss 21. Leg (Dated slang) 22. First-class 23. Conclusion (in music) 24. It might say “Miss Georgia” 25. Group of three persons 26. Persistent; tenacious 27. Masters follower 29. Thrust with a knife 30. As needed, in medicine

32. Sigmund’s youngest child 33. Celebrity 35. Word used when comparing 36. Siam today 37. Blend 42. Makes amends 43. Exclamation of surprise 45. Headquarters 46. Marine introduction 47. Park Avenue starter 48. Passageway between seats 49. Large tank 52. Second half of table tennis? 53. Colors 54. Word often erroneously given an apostrophe 56. Spinning speed (abbrev.) 57. Exclamation of pleased surprise 58. Logical beginning?

Solution p. 14

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— Martin Luther King Jr.

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.

1. 35374 (body part) _____

6. 3668 (body part) ____

2. 2663 (body part) ____

7. 72257 (body part) _____

3. 7546 (body part) ____

8. 847628 (body part) ______

4. 4247 (body part) ____

9. 7227852 (body part) _______

5. 4263 (body part) ____

10. 25284253 (body part) ________

Use keypad letters to convert numbers into the words suggested by the definitions provided. There may be a theme linking all answers. Sample: 742 (body part) = RIB. Answers on page 14.

TEXT

THE MYSTERY WORD

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THEBESTMEDICINE ha... ha...

The

Advice Doctor

Moe: You told me you bought a guitar. Joe: Yeah, I bought one all right. Online. It doesn’t work though. I should have suspected something when the seller said no strings attached.

Moe: What do you call someone who takes care of chickens? Joe: A chicken tender.

oe: How was your heart check-up? Joe: I’m not sure how to answer that. The doctor gave me a diagnosis - in writing - but then admitted it was a lie. Moe: What??? Joe: He wrote that it was a fib! Literally! “Wow,” said the teenager. “That was the worst time I’ve ever had in my entire life.” “How do you mean?” asked his friend. “Well, first I had atherosclerosis, then angina pectoris. After that I got psoriasis, tonsillitis, and finally they gave me appendectomy.” “All that at your age? Your health is terrible!” “What are you talking about? My health is perfect. I’m talking about the hardest spelling test I’ve ever had.” Moe: How’s your new zookeeper job? Joe: I got fired. Moe: Already? What happened? Joe: All the animals either died or got sick. In my defense, every sign in the whole place said “Don’t feed the animals.” Moe: Aren’t you taking guitar lessons? Joe: No, not yet.

Moe: Why did the tofu cross the road? Joe: To prove it wasn’t chicken. Moe: I just watched Jurassic park for the first time. Joe: What did you think? Moe: First, that he should go to driver’s ed. And also that we picked a really stupid name for our son. A woman is sitting at her husband’s funeral when the minister invites any in the chapel who would like to say a word to come forward. A man sitting next to the grieving widow leans over to her and whispers, “Do you mind if I say a word?” “Please, go right ahead” she replies. When the man’s turn comes, he stands at the lectern, clears his throat and says, “Plethora,” and sits back down next to the woman. “Thank you,” the woman says, “that means a lot.” Moe: Help! I lost all my numbers. Can you message or text me? Joe: Here you go: 1, 2, 3, 4, 5, 6, 7, 8, 9, 0. +

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, There is a lady on our street who is always trying to get some save the world project started. One time it’s like a disease awareness thing, the next time it’s collecting money to send to some Third World disaster area, and then she’ll show up with flyers about people in foreign prisons or something. I know her heart is in the right place, but just once I wish it was something local. How can I help her focus on our area once in a while? — Do Right Right Here Dear Do Right, We had to reach deep into the old research files to answer this question! You say her heart is in the right place like there’s no other possibility; like everybody’s heart is in the right place. Well, Virginia, there are no guarantees. In fact, about 0.01 percent of the population has their heart in the wrong place. That might not sound like a lot — 1 person out of every 10,000 — but there are billions of people in the world! That makes it surprisingly common. Please understand, I’m not saying that someone’s heart might be in their left leg. It’s always pretty close to where it should be. In fact, the heart is the least of someone’s worries when they have this problem. Officially the condition is known as situs inversus, or situs transversus. When someone is born this way, the organs normally on their left side are on their right, and vice versa. It can be missed in newborn examinations, so people with situs inversus are sometimes completely unaware of the problem until something comes up later. It can be quite puzzling for doctors. A child is brought in to a pediatrician’s office, for example, with pain in his lower left abdomen and a high white blood cell count. It can’t be appendicitis. It’s on the wrong side. Eventually situs inversus is discovered. The condition can present complications, but more often than not, life is normal and no treatment is needed. Enrique Iglesias and Donny Osmond are among the people you may have heard of who have situs inversus. They seem to have done fairly well. 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 +

Why read the Medical Examiner: Reason #192

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY STATE ZIP Choose six months for $20____ or one year for $36 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

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THE MYSTERY SOLVED The Mystery Word in our last issue was: GLUCOSE ...cleverly hidden by the heart in the p. 15 ad for EVERYDAY ELDER CARE LLC

THE WINNER: BRENDA L’ECUYER! 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 21, 2020

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED G N A W E P E A C H O U N P L E A S B E E E D I A L O N S T R O M A R E N A S S I L E N T T H O E H A N A W A B B U T T O N A L L O W S T E N R O E R S E P H A S S M O

S P Y P K I E L A N T E T G A E C A S W O M E P E D R E A T M N K H E A L D A V I D R I A L U S T A B I L N I D E D O

C O N T I N G E N T

B I D E N

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A N N A

S T A R

P O N G

H I U T E S S

SEE PAGE 12

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

...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 “It does not matter how long you live but how well you do it.” — Martin Luther King Jr.

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How can people lift cars off accident victims and perform other feats of superhuman strength? How do sleepwalkers leave the house and even drive without really being conscious? What causes PTSD, flashbacks, and powerful memories of things that never happened? Guest columnist Wayne Thigpen takes a look at various altered states in this new series.

HYPNOSIS Experience tells us that there are mental states of varying focus, wakefulness or abilities apart from those induced by alcohol or drugs. Our most powerful organ, the brain, can access great reservoirs of concentration. It can remove pain, even withdraw life itself. Perfectly healthy people have come to believe they are supposed to die, get in bed and pass away within weeks; others survive what they are told is a terminal illness because they believe they should live. The brain can detour in self-defense. A dozen or more alternate mental states exist, from sleepwalking to panic attacks, to name just two. What of today’s topic, the hypnotic state? Is it real, and if so, what is it and does it have medical uses? Medical specialists tell me hypnosis is real, not a trick, with centuries of history behind it. Although entertainers and charlatans have abused it for most of the past 250 years, accounts of hypnosis are found in literature from ancient times. More recently its use has ebbed, and for good reason, as it can be dangerous in hands not specifically trained. The process of hypnosis creates a trance-like mental state in which the subject or patient appears partly asleep, but with an increased ability to cooperate with the therapist, right then or later -- suggestibility, in short. A person under hypnosis cannot be persuaded to do things they oppose morally. A therapist cannot and does not “take over” the subject’s mind, cannot make the subject do that which they do not wish to do, much less commit a crime — unless perhaps they are a criminal in the first place! Rather, hypnosis amounts to a temporary partnered power, a potential healing aid. Like the

brain itself, much mystery persists, and the exact neurochemistry eludes exact definition. Essentially, the patient briefly dissociates or disconnects from daily life. We have all experienced driving somewhere and arriving without recalling much of what happened on the way. We were on cruise control. The hypnotic state can be viewed as an extreme form of such disconnection, used to help heal. A person cannot be hypnotized against their will, and not everyone who wishes to can be. According to a local expert, a “good” subject a) has favorable attitudes toward hypnosis, b) is strongly motivated to be hypnotized and c) expects to be hypnotized. Of paramount import, the patient must trust the therapis and believe the therapist can hypnotize them. Profoundly, the expert says, “the behavior of the hypnotic subject, while hypnotized, is a direct function of their altered perception of themselves and of the situation; they are ready, willing and expecting to perceive the therapist’s statements as valid descriptions of what is or is not happening.” For example, decades ago this writer observed a psychiatrist well-trained in hypnosis undertake a group hypnosis of about 40 deer hunters. The physician changed into a coatand-tie, while everyone else remained in hunting garb. Of the 40, maybe 30 decided to participate; and of those nearly all were hypnotized to a degree. The doctor then selected one man about 25 years old as being the most completely “under,” released to the rest back to their normal states, and asked the young man to re-visit his second grade classroom. Most of us likely can name our second grade teacher, and he did. However he amazingly recalled where he sat: the second row. Counting from the wall or the window? The wall. Responding readily, the man

memory or one that recycles ceaselessly. In fact, the memory which recycles may not be the memory that caused the memory to begin recycling. However, a patient may be very greatly relieved to be free of the stress, to be healed of it. Two caveats: the patient must be ready for recollection, for a possible emotional outpouring from recall of a painful memory. And, a therapist must not project onto the patient the therapist’s own ideas, which then can become fabricated “memory” not of the patient. Leading questions which contain the preferred or suggested answer must be avoided, according to another expert. Surprisingly, innumerable surgeries have been performed under hypnosis without anesthesia in years past, including amputations. Pain from natural childbirth, severe burns and malignancies have all been relieved by hypnosis Irritable bowel syndrome (IBS) and tinnitus (ringing in the ears) can be relieved. People can be assisted in efforts to quit smoking, though one therapist remarked that care should be taken: if a therapist suggests that cigarette smoke will make the subject nauseous, second-hand smoke will likely have that same effect. Better to suggest that having a cigarette in one’s mouth will cause nausea. It should be noted that

true addictions with physical withdrawal symptoms, hallucinations and tremors, cannot be effectively dealt with via hypnosis. We might well ask, then, if it’s so great, why isn’t it used more? Part of the answer is that the technique obtained a bad reputation several decades ago from some court cases in which the origins of victims’ or witnesses’ memories were successfully called into question, with attorneys impeaching the witness with the idea that it was the therapist’s memory, not the victim’s. Part of the answer also lies with insurance companies, which prefer to pay therapists for more conventional methods. A hypnotherapist may be able to fight successfully to be paid; however, a local psychiatrist says following insurance company guidelines takes less time and effort. Patients who seek or receive assistance via this method are likely to be self-payers. Liability issues may have also caused disuse, though it may be too easy to simply blame it on the lawyers. Asking medical experts yields the conclusion that hypnosis works as described and can genuinely assist in mental and physical health. It is employed today almost exclusively by psychologists and is mostly a forgotten art among mental health tools. +

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

CALORIE

ALTERED STATES

then named all the students sitting right around him until he was asked who sat behind him. Silence. Did you sit at the end of the row? Yes. When later a remark was made to the doctor about the astonishing level of recall, he smiled, “He was there for nine months; of course he remembers.” (Not long after, the psychiatrist decided hypnosis was not appropriate for entertainment.) On another occasion this writer observed a pediatrician, self-taught in hypnosis and limited in experience, hypnotize a teenager, tell him he was a Revolutionary War soldier, hand the subject a long stick said to be his musket, and to kneel by a tree and shoot at the enemy. The boy knelt, appeared to aim and said, “Pow!” He turned his stick to the ground, reloaded and fired again and again. However, when the amusement ended the doctor could not readily release the boy from his altered state. It took hours, but the boy did finally awaken to normalcy. Danger averted, but there was serious question for awhile as to whether that boy could come back. It has been said that when successful, hypnosis is “the most vivid, effective psychological tool ever devised” by humans. A bold statement. Therefore, of what medical use is it? Hypnosis can be help free someone from a troubling

FEBRUARY 21, 2020

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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