Medical Examiner 4-15-22 by Daniel Pearson

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APRIL 15, 2022

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UT TERDESTRUCTION

A week or two ago, how many people had ever heard of aphasia? Courtesy of actor Bruce Willis’ unfortunate diagnosis, the word has been in a thousand recent headlines. Aphasia describes a loss of speech ability that can manifest itself inbound or out: for some patients, they can understand what people are saying just fine, but they have lost the ability to use language to respond. Others have lost the ability to comprehend the meaning of words. In many words starting with “a,” that letter denotes the root word’s opposite, a lack or an absence (as in amoral or atypical), and in the case of aphasia its root words from Greek literally mean “not” (a-) and “speak’ (-phasis). Aphasia can be complete or partial, transient or permanent. Temporary aphasia can result from edema in the brain due to stroke or injury, with speech regained after swelling subsides. In the past, treatment involved speech therapy and protecting the abilities a patient still had. More recent developments under investigation include brain stimulation to restore speech and reverse aphasia as much as possible.

“If most people added just 10 extra minutes of walking (or some other kind of moderate physical activity) every day, as a society we could prevent more than 110,000 deaths each year.” That statement is based on new research published in JAMA Internal Medicine. We’re all busy, but 10 minutes? We can all do that. For walking, that’s just 5 minutes out and 5 minutes back. Done.

The life-saving results the study discovered are based on two words: daily and brisk. It’s important to choose an exercise that we like. Then daily won’t be a chore. Brisk for a teenager is no doubt different than brisk for a 70-year-old. But everyone who does their personal version of brisk, and does it daily, stands to reap benefits. Oh, and bonus points are offered for more than 10 minutes. +

HAIRDIE

You wouldn’t expect the Oscars to bring alopecia to headlines all over the world, but unless you’ve been under a rock lately you know that is exactly what happened. This topic was just covered in this newspaper in “Medicine in the First Person” (see https://issuu.com/medicalexaminer/docs/02.18.22). Alopecia is often thought of as complete baldness, but all those 40- and 50and 60-year-old guys with bald spots (male pattern baldness) have a form of alopecia. It can refer to total or partial hair loss, and sometimes appears as just a normal part of aging. Some people — male and female — embrace baldness, and in fact will shave their heads when their alopecia is only partial. But not everyone: alopecia is what gave the world the comb-over; wigs are another common option. Treatments for alopecia include medications and surgical options like follicle implants. The Greek origins of the word alopecia refer to foxes, presumably because they shed their fur twice a year. +

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PART T OF A 26-PART SERIES

PARENTHOOD by David W. Proefrock, PhD

Your 2-year-old daughter doesn’t seem to like being hugged or cuddled. She is well-behaved and seems to be developing normally in all other ways, but she just doesn’t seem to be affectionate. What should you do? A. Take her to a mental health professional for evaluation. This could be a sign of serious psychological problems. B. Spend a little extra time with her every day reading or interacting with her while you are very close. C. Don’t do anything differently than you have been. Just let her be herself. D. Stop trying to hug or cuddle with her. She will come around when she starts to miss the affection. If you answered: A. While avoiding physical contact is one of the signs of a psychological problem, she is developing normally in every other way. There is no reason at this age to think that there is something wrong with her. B. This won’t hurt anything and it will probably be fun, but there is no reason to change how you have been interacting with her. C. This is the best response. Some children are just naturally more or less affectionate that others. It doesn’t mean that there is anything wrong with her. D. It would be a big mistake to respond to her lack of affection by taking your affection away from her. There is great variability in how children develop. They are more or less active, more or less curious, more or less obedient, and more or less affectionate, as compared to others. It is way too early to think there might be something wrong with her because she is not as affectionate at other children. + Dr. Proefrock is a local retired clinical and forensic child psychologist.

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IS FOR THIRST

ike everything else about the human body, thirst is yet another topic where the deeper you look, the more complex and sophisticated and even mysterious the subject becomes. As the reference work Human Anatomy and Physiology puts it, “the thirst mechanism is poorly understood.” How’s this for starters: although thirst signals are generated at the cellular level, it is quenched as soon as we take a drink, which makes no sense: the fluid hasn’t had time to be absorbed into body tissues yet. That might be part of the reason, as we have all heard a thousand times, that thirst is not a reliable indicator of need. This can be particularly true of athletes, the elderly, and some renal or cardiac patients. The first two groups may not drink enough, while the latter may feel thirsty despite being fluid-overloaded already. The human body is not designed to take a casual approach to fluid levels. The hypothalamus contains what has been labeled the brain’s “thirst center.” From this command post, continuous chemical signals that occur at a molecular level are analyzed

and converted to language that we might understand — if we don’t ignore it — as “get a drink of water.” A healthy body has a remarkable ability to maintain proper body fluids within very narrow limits. A loss of even 1% or 2% in fluid volume can activate thirst signals from the brain, while at the same time releasing anti-diuretic hormones that slow down kidney function to conserve water. The common scene in movies where someone is bleeding from a gunshot or other wound and wants a drink of water is basically an acute version of the same thing we might experience after working outside on a hot

THE SCOOP ON WATER Experts say most of us are chronically dehydrated, and very few of us realize how vitally important drinking enough water is to our overall salubriousness. What’s the solution? At the risk of stating the obvious, water is the solution that is the best solution. Virtually every beverage offers hydration, but some promote weight gain and tooth decay, some make people jittery, others can get you arrested if you’re drinking them and driving. Water is the best, the most readily available, and the least expensive. But how much is enough? There is no one-cup-fits-all answer because one person may sit at a desk all day in air conditioning while another person has a very strenuous outdoor job in hot weather. But some suggest “the half rule” is a good starting point: that is, drink half your body weight (pounds to ounces) in water every day. For example, if you weigh 120 pounds, drink 60 ounces of water over the course of each day. +

day. What causes fluid loss in the first place? In fact, it’s happening right now, 24 hours a day. Breathing causes nearly 30% of our fluid loss, and another 60% is lost going to the bathroom. Sweat (or, in your nicer neighborhoods, perspiration) accounts for another 8% or so on average. The brain constantly monitors hydration levels for a very important reason: variations from the norm can cause huge problems, including death. That might automatically conjure up thoughts of severe dehydration, but the opposite condition — overhydration, (sometimes called water intoxication) — can be just as lethal. Rapidly drinking too much water dilutes electrolytes and leads to metabolic haywire. Left untreated it can cause cellular (especially cerebral) edema (aka swelling), nausea and vomiting, convulsions, coma, and death. Speaking of edema or swelling, another way to describe that condition is highly localized overhydration. What about our opening conundrum: how can our thirst be satisfied as soon as we take a drink, even though the liquid hasn’t come close to accomplishing its purpose? Damping of thirst begins immediately, as sensors and receptors in the mouth, throat, stomach and intestines are all activated and send instant feedback signals to the brain’s thirst center. Thirst is promptly inhibited, which prevents us from drinking far more than we need and overhydrating. Overall, good health requires that water intake (which can vary widely from one person to the next) must equal water loss (see box). +

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APRIL 15, 2022

The

Money Doctor 5 WAYS TO PREPARE FINANCIALLY BEFORE YOU QUIT YOUR JOB It’s hard to turn on the news or open your browser right now without hearing something about the Great Resignation or the Great Rethink. According to CNN, 4.4 million Americans quit their jobs last month, and “in February, US businesses had 11.3 million job openings to fill, slightly more than economists had predicted.” According to the Harvard Business Review, “Unsettled by the pandemic, most people are considering our jobs with fresh perspective. Some are quitting, in what has been dubbed the Great Resignation. But for many, it’s more of a Great Rethink. Do we really like our employers’ culture? Do we feel that we’re fairly treated and have the advancement opportunities we want? Most profoundly, does our work feel as meaningful as we’d like it to? “First, know your personal purpose and then evaluate whether you really need it on the job or can find it in

some other setting. If you first want to evaluate staying, try job-crafting to align your responsibilities with that purpose, and evaluate your boss and employer to make sure they can support you in that endeavor. If after all that you still cannot find meaning, it might be time to consider moving on.” Many people don’t have the luxury financially to quit a job they’re unhappy with without a strong financial footing. If you find yourself in a position where you would like to find your next career move, here are 5 ways to prep your finances before you quit your job. Find another job. The best way to make a job transition less stressful is to already have another job lined up. It is best practice to secure your next job before leaving your current job. That will reduce the financial impact. Take a hard look at your emergency fund or cash reserves. Make sure you have

enough cash to fund living expenses for three to six months. If your cash reserves are low, consider stopping any monthly savings you are doing to build the cash up. This is one of the few times we recommend reducing savings. During the transition, try to avoid pulling money out of retirement accounts before age 59½, which can result in a 10% penalty plus taxes. Having liquidity and access to cash during a job transition is very important. Be sure to have a game plan. Take advantage of all your employee benefits before you leave. Make all those health care appointments with your in-network doctors. If you have a flexible spending account or FSA, make sure you review the rules. It is oftentimes advantageous to use the funds before you leave employment. Review your employer’s policy for vacation days and Please see QUITTING page 6

WHAT ARE CARBOHYDRATES? Broadly speaking, they are practically poison if you are to believe the claims of many fad diets. But whenever an entire food group or a component in most foods is labeled as bad, people with working brains should be suspicious. Consider: carbs are found in fruits, vegetables, milk, nuts, and whole grains. Does that sound unhealthy? Consider also: carbs are found in cookies, candy, cake, table sugar, and sugary drinks. Does that sound healthy? As you can readily see, not all carbs are created equal. People who say carbs are bad might have a point. It all depends on the source of the carbs. And people who say carbs are good might have a point. It all depends on the source of the carbs. If they’re from a good source, carbs are vital to good health. There are three main types of carbohydrates: simple sugars, starch, and fiber. During digestion, sugars and starches are quickly broken down into simple sugars that quickly enter the bloodstream as glucose, the major source of energy for the body. But that can be a problem. The pancreas responds to blood glucose by releasing insulin, which helps deliver glucose into cells as fuel. Logically, lots of sugar means lots of insulin, and lots of insulin can over time lead to cell damage, heart disease, diabetes, and weight gain as the surplus glucose is stored as fat. Imagine the sugar spike from a slab of cake a la mode washed down with a sugary drink. That’s more than can be used, and that will lead to glucose stored as fat. Compare that with so-called complex carbs. While cookies or cake may be made with heavily processed flour (which quickly become simple sugars), consider a sandwich made with bread made from whole grains (which are complex carbs) and that includes fiber-rich fruits and vegetables, . They take longer to digest, meaning that they don’t result in a sugar spike and all of the problems just enumerated above. Fad diet promoters will tell you carbs cause weight gain and low-carb diets are healthier and lead to weight loss. The truth: a diet rich in healthy carbs can result in weight loss. +

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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

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AUGUSTAMEDICALEXAMiNER

#163 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

his amazing woman was not a part of the medical profession, but she certainly deserves her remarkable place on the pages of medical history. Or does she? First, let’s get better acquainted. Her name was Jeanne Louise Calment, born in Arles, France, in February, 1875, a time when the average life expectancy of women in France was 45. Astonishingly, she just died in 1997. Do the math on that and you’ll discover she lived more than 122 years. She is the only person in modern times with a verified lifespan of more than 120 years. Living a life that long, she outlived virtually everyone in her small family. Her husband preceded her in death by some 55 years; she outlived their only daughter by roughly 63 years and her only grandson by almost 35 years. By 1965, at age 90, she had no living heirs left. That same year she sold her spacious apartment in an arrangement similar to a reverse mortgage; the buyer makes a monthly payment to the seller as long as the seller remains in the dwelling, and takes occupancy only after the seller dies or moves out. The buyer was still making payments to Calment at his death; his family was legally obligated to continue paying her for still more years. She finally moved into a nursing home at age 110. It was only supposed to be temporary, but it ended up being a permanent move, and was one of only 4 addresses Calment had ever occupied during her long life. Over the years there have been a number of challenges to Jeanne Calment’s claims of longevity, but despite her detractors, most researchers consider her to be the most extensively documented supercentenarian on record. So why did we question her place on the pages of medical history above? Not because we question the records. We accept the evidence that she lived 122 years, five months and 14 days. But as a medical specimen, she presents quite the anomaly. If she was still alive and was willing to consent to one more interview, she would repeat for the thousandth time her secrets to longevity: chocolate, cigarettes, red meat, cheap wine, skipping breakfast, and olive oil. She wasn’t exactly a model patient or Exhibit #1 in how to live the healthiest lifestyle. Not that she was devoid of healthful habits; she was physically active throughout her life. Even at age 122 she kept to her routine of rising at 6:45 a.m., beginning every day with prayer, followed by arm and leg exercises from her chair. She usually ate braised beef for lunch, followed by a cigarette and a glass of port wine. As often as possible, she slathered her meals in olive oil. Every meal ended with dessert. She ate more than two pounds of chocolate per week. Some gerontologists say that reaching age 80 is largely attributable to lifestyle, but beyond that genetics is your best friend. In Jeanne Calment’s case, her brother lived to the age of 97, her father to 93, and her mother to 86. But this remarkable woman’s life illustrates another fact: there is occasionally some randomness to who lives long and who doesn’t. It’s always best to live the healthiest possible lifestyle, but the payoff is sometimes small and sometimes quite spectacular. +

by Marcia Ribble

Stress has a major impact on health. I was fairly patient when I was young and raising five children, but in my seventies, I am finding that my patience is much diminished. Recently, I had problems with both my phone and my computer, such that I could use neither of them to communicate at all. That alone pushed my patience way past my limit and close to panicking. My nurse arrived and we used her phone to get my phone working, but meanwhile I was very fearful of being without a phone and facing imagined emergencies demanding instant use of a phone to seek help. STRESS! I could feel my heart beating faster. I could feel my blood pressure going up. I was clearly already in fight/flight mode. But where could I run to in my wheelchair? Then, trying to get help even with her phone was crazy making. My cell provider asked me some security questions, which in a less stressed mode would have been easy, but with that much stress, the answers escaped me and I probably sounded as flaky as I felt. “I don’t know,” was my response to most of the questions. Later that evening my daughter came over and she was able to get the computer back to work. But I was still running at hyperspeed internally. It took me a full two days to calm down. And then it was just a couple of days later that I was asked to participate in a phone visit with my doctor. The stress from the computer/phone fiasco was re-ignited, and when this person at the doctor’s office who was supposed to “walk me through it” was on the line and started to demand that I do things I had never done before and didn’t know how to do and couldn’t even imagine were possible, I said “I don’t know how to open settings while I am already on the

phone without hanging up” and she kept firing things at me when I already was beyond my limit, which led to me finally saying, ”I can’t do this, I just can‘t do this, goodbye.” Many folks don’t know that when they are in a situation where they are being severely stressed, it’s fully OK to protect themselves by leaving the situation. None of us owes anyone the right to upset us that much. Unfortunately, she was so focused on getting the phone link set up that she didn’t even register the amount of stress she was inflicting upon me. She said things like, “I have been able to walk people even older than you through this process.” I did not tell her that I am not those other people, that I am just me and I have every right to not feel comfortable with something new for which my prior knowledge was insufficient. She also didn’t think to ask if there was someone who could have come to help me at a later time, or someone who could teach me how to do a face-to-face using a phone. So she didn’t just fail to “walk me through it;” she also made it highly unlikely that I would even consider trying it again in the future. She also failed to have enough sensitivity to my panicking that she could deescalate the situation. My concerns were irrelevant in her expectation that she could, should, and must be in control of the process. But I am not irrelevant and my feelings and needs should have been recognized and respected. It has taken me years to realize that no one has the right to expect that I (or you) conform to their expectations. No one has the right to push me (or you) beyond my (or your) limits. I know now that I am able to say NO and mean it, without being punished for being myself. Helps me to reduce stress to a much more manageable level. +

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age

DEAR READERS

BY J.B. COLLUM

other benefits to my mother, like having her own kitchen where she can feel comfortable cooking meals her way. All those benefits and numerous others are certainly something we’ve been looking forward to, but it reminds me that even though some miles will separate us geographically, I still am obligated out of love and gratitude — to both my mother and my father — to make sure she is looked after. I plan to visit regularly, even though the last two years have made me nearly a hermit, as I have worked from home and even attended my Christian meetings online for over two years. Some of that is changing as well. I am now back to getting dressed up fully and attending worship services at a real building in the midst of real people, and not just sitting in front of a computer with my white shirt and tie on and my pajama bottoms on, out of sight of the cameras. Fortunately, I will still be working from home, and I have the pandemic to thank for that, as it forced my company into re-thinking their stance on the subject, and they now allow it and even encourage it for everyone. Yes, change is in the air, and it is both thrilling and frightening. I’m a nostalgic person by nature and I tend to miss the old ways, the old places, and especially, the old people that are long gone. I have done a better job of embracing change recently, and I can even get a little bit excited about it at times. So many of us say that we “can’t wait for things to get back to normal.” Someone once told me that things never “get back to normal.” They get back to the “new normal” and we must realize that and accept it so that we can move on and still be happy. I’m trying to be that person, but it is hard to teach an old dog new tricks. +

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They say that all good things must come to an end. Logically, one would think that the opposite is true as well. So does that mean that all bad things must come to an end? Or should the opposite be, “all good things must have a beginning?” Oh boy, I’m starting to confuse myself again. Be that as it may, in this case, I am talking about the change in our lives that began almost three years ago when we moved my parents in with us after my father’s Alzheimer’s got too advanced for my mother to deal with by herself. As I write this, she is being moved into her new apartment. It has been seven months since my father passed away, and we knew this moment would eventually arrive. At times it didn’t seem like it would come soon enough for both my mother or me, and probably my wife too. At other times, like now, when it is actually happening, it makes me recall the feeling I had when I realized that Dad couldn’t take care of Mom and couldn’t even take care of himself anymore. I understood that the baton had been passed. I was the patriarch now and I needed to look out for both of them, with a huge heaping dose of help from my wife, without whom I couldn’t have done it. I recall the day my father died, when I knew what he would want me to do, perhaps more than anything else, and that was to take care of his “girlfriend” who, fortunately in this case, is also my mother and his widow. It might have been awkward if it had been someone else. As we are packing things up and getting them ferried over to her new home, I see so many of my father’s possessions being boxed up and moved to her new place because she still can’t bear to part with many of them. It brings the full impact home to me. True, it will be nice to have our home to ourselves and not feel like we need to tell someone where we are going and when we’ll likely be back, and it will be nice, for me anyway, to be able to walk around the house without pants and without the fear of giving my mother a heart attack. And there are the

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The shirt & tie and pajama bottoms world is gradually disappearing.

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

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APRIL 15, 2022

QUITTING… from page 3

sick days. It is important to understand what days you will get paid for if you leave. If you’re thinking of taking the leap to a new career soon, or you want to quit and don’t have the next step in mind, it’s the perfect time to examine your finances. Reviewing your financial situation can help you prepare for unexpected challenges, should they arise — and they usually do. + by Clayton Quamme, a Certified Financial Planner (CFP®) with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

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CLASSICS ARE CLASSICS FOR A REASON

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

GUACAMOLE POTATO SALAD Create a new picnic and party tradition with this delicious Guacamole Potato Salad made with red potatoes and Fresh California Avocados. With only six ingredients it is surprisingly simple to make and taste good with the added bonus of providing 45% of the Daily Recommended Intake of Vitamin C, while being a low sodium dish (less than 140 mg of sodium per serving). Ingredients • 2 pounds small red potatoes, cleaned • 2 ripe, fresh California Avocados, peeled, seeded, and mashed • 2 cloves garlic, minced • 2 green onions, whites only, finely chopped • 1 large Serrano pepper, seeded and minced • ½ teaspoon salt or to taste Instructions Place potatoes in a microwave-safe bowl. Cover with water and microwave on high for 10 minutes. Test for doneness by piercing one

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potato with a fork. The fork should slide in with gentle resistance. Continue cooking if not done, otherwise carefully drain the potatoes and refrigerate them until cold. Cut potatoes in bite-sized pieces (quarter or dice depending on size of potato). Place in a large bowl. Stir in remaining ingredients, adjust salt to taste and serve immediately. Yield: 8 Servings Nutrition Breakdown: Calories 106, Fat 8g (1g saturated fat), Cholesterol 0mg,

Sodium 170mg, Carbohydrate 23g, Fiber 5g, Protein 3g. Serving Suggestion: If made in advance, sprinkle generously with lemon juice and place a layer of plastic wrap right on the surface of the Guacamole Potato Salad and refrigerate. Before serving taste the salad and add additional mashed California Avocado if needed. Recipe provided by California Avocado Commission. For more information please go to: www. californiaavocado.com +

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APRIL 15, 2022

DON’T FORCE THE ISSUE by Ken Wilson Steppingstone to Recovery

About 250 years ago a Scottish poet, Robert Burns, was sitting in church one day behind a lady of high society when he noticed a single louse crawl out of her hair and onto her mink coat! He reached for the paper program and penciled his famous poem “To a Louse” on it: Oh, would some Power give us the gift To see ourselves as others see us. It would from many a blunder free us. Years ago a client of mine was not taking his treatment program seriously – talking out of turn in group, not doing assignments well, and with half hearted participation. I couldn’t bear to let him continue this behavior – after all, his parents had borrowed money and were paying out-of-pocket

for his program and they needed to get their money’s worth. So I contacted significant people in his life – his wife, parents, oldest daughter, and employer – and had each of them write an “impact letter” to him and send them to me (remember postage stamps?). In group meeting the next day I handed him the 5 letters and asked him to read them out loud. He started out being silly and not taking their statements seriously, and ended up crying on the pages to the point of smudging the ink. Things changed after that. He was able to get outside of himself (imagine that) and finally realize how he had hurt the people closest to him with his foolish drug-induced behavior. He was not the first person to crash and burn in group before he got well, nor will he be the last. I felt he might bolt out of the group, but he had tenacity and stayed in there. He didn’t

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thank me for this intervention that day but did years later. The point of assessments as part of patient placement criteria is to determine a client’s readiness to change and to engineer interventions, if needed, to move them to an emotional point of readiness to change. In other words, to help them engage in their recovery versus slip-sliding along just to get a letter of completion for the employer or judge. Treatment does not come in “one size fits all,” as some people do not need such a kick-start to begin getting well. They have had enough pain to be receptive to learning. So the question needs to be asked, What needs to happen here for Person X to learn? For some that might be longer term treatment. For others it might be more intensity. For some, it might mean leaving town for awhile for a work program. For some it might mean get-

ting well in the same town where they became addicted so they’ll have a sober support system after discharge. It takes a seasoned professional to make such recommendations based on research and years of experience. The addicted one does not get to make decisions in health care matters, such as the level of care he or she enrolls in. My doctor certainly doesn’t let me call the shots! I’m sure he’d fire me if I tried to take the reins! Alcohol and drug treatment is a mandated-client business. That’s another way of saying the client is forced into treatment. Very few drive by and see the sign and enroll on the spur of the moment. Usually someone forces the issue – a judge, parent, spouse, employer, or sometimes an attorney. But fret not: research shows that the mandated client does better in treatment than the one who signs up voluntarily!

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional

Who knew?!!! Something about all those smoking guns pointed at them…job, family versus divorce, and not being written out of the family will are all powerful motivators. If you have a family member who has a drug problem, you really don’t need butt-kicking mail from your friends, or even head lice, to move you to action. Just ask yourself, What would it take for me to force the issue? And by the way, I’m interested to know what you come up with. +

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AUGUSTAMEDICALEXAMiNER

PEOPLE NOTICE THINGS Acute Observations from a Lifetime of Near Misses: A good doctor only diagnoses disorders he can cure.

BASED ON A TRUE STORY (most of the time) A series by Flatwoods Frankie

Most people would kill for a Nobel Peace Prize. Borrow money from pessimists -- they don’t expect it back. Half the people you know are below average. 98% of lawyers give the rest a bad name. 82.7% of all statistics are made up on the spot and are uselessly irrelevant. A conscience is what hurts when all your other parts feel so good. A clear conscience is a sure sign of a bad memory. If you want rainbows, you got to put up with rain.

The early bird may get the worm, but the second mouse gets the cheese.

If Barbie is so popular, why do you have to buy her friends? Eagles may soar, but weasels don’t get sucked into jet engines.

I almost had a psychic girlfriend ... But she left me before we met.

What happens if you get scared half to death twice?

Everybody knows the speed of light, but what’s the speed of dark?

My mechanic told me, “I couldn’t repair your brakes, so I made your horn louder.”

How do you tell when you’re out of invisible ink?

Why do psychics have to ask you for your name.

If everything seems to be going well, you have obviously overlooked something.

If at first you don’t succeed, destroy all evidence that you tried. That way no one can call you a failure.

Depression is merely anger without enthusiasm. When everything is coming your way, you’re in the wrong lane. Ambition is a poor excuse for not having enough sense to be lazy.

Everybody who believes in psycho kinesis, raise my hand.

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CRASH

COURSE

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

{

has to perform a hard brake, that action would ay those two words — distracted driving — instantly be detected by the following cars. and we automatically think of cell phones. Instead of each car braking in turn, even the last Fair enough. They are a big part of the recipe car in the line would instantly and automatically for distraction. But they’re far from the whole brake. (Of course, this example presumes that all enchilada. of the cars are new enough to have the technoloThere is quite a lengthy list of distractions gy if and when it starts to appear.) that can affect people while they’re driving. It may sound futuristic, but so do all the crash They might be adjusting the radio; avoidance systems we already reaching for something in the back have that are standard equipApril is seat; putting on makeup; looking ment on new cars. at a navigation screen; talking to But what can you and I do toDistracted Driving (or fighting with) other passengers day to combat distracted driving, Awareness Month especially when you drive a ’91 in the car; eating and drinking; or, for lack of a better term, sightseeCorolla and I drive an ’83 Dodge ing whatever they’re driving past. Dart? It’s a wonder that any of us ever reach our Georgia law makes it illegal to so much as destinations in one piece. Nationally, well over touch a cell phone while driving (except for 3,000 deaths were directly attributed to distractnavigation use). But sit at a red light any day ed driving in one recent year. It affects us all. of the week and as drivers turn left in front of “That’s where you’re wrong, Medical Examyou, notice now many of them are holding and iner. When I drive, it’s hands on the wheel at 10 talking on a cell phone. Sometimes it’s more and 2, eyes on the road, no radio, no cell phone. than half. I have one job and one focus, and that’s driving What can we do about those people? safely.” Nothing? We could lay on the horn as each Well done. Good for you. But what about all one passes in front of our cars. That would be the other drivers around you? What’s to stop ineffective but oh so satisfying. someone from T-boning you at an intersection But here is a strategy that, one person at because they are distracted? a time, will work. We have to make it our Yes, all of us are dependent upon each other personal policy. When you answer your phone — 99.9% total strangers — to reach our destina- and it’s someone you know and love and you tions safely. hear traffic sounds in the background or the There’s nothing we can do about other drivers click click click of their blinker, ask, “Hey, are who are driving distracted. Right? you driving right now?” Actually, there might be a useful strategy or If they say yes, tell them you can’t talk to two. them right now. “I’m going to let you conOn the far horizon (but not necessarily the centrate on your driving. Call me back when way way far horizon), engineers are developing you aren’t driving. Oh, and happy Distracted and testing car-to-car warning systems that will Driving Awareness Month. Buh-bye.” enable vehicles to communicate with each other. You just might save their life. Or someone As one example, if the first driver in a line of cars else’s. And someone else’s. +

WIN A MUG! The Mystery Word Contest winner will be sipping coffee from one of these babies! Additional details on page 14

READ THE EXAMINER ONLINE! www.issuu.com/medicalexaminer

APRIL 15, 2022

PEOPLE… from page 9 The hardness of the butter is proportional to the softness of the bread. To steal ideas from one person is plagiarism; to steal from many is research. The problem with the gene pool is that there is no lifeguard. When an executive takes a dip in the secretarial pool, a divorce quickly follows. The sooner you fall behind, the more time you’ll have to catch up. The colder the x-ray table, the greater the area of your body that will be required to be on it. Everyone has a photographic memory; some just don’t have film. If at first you don’t succeed, skydiving is not for you. If your car could travel at the speed of light, would your headlights work? When being chased by a howling mob of irate fans, a successful college football coach makes it look like he is leading a victory parade. Baldness results from growing too tall for your hair line. Uncertainty is when you have whooping cough and diarrhea at the same time. All treasure maps have one thing in common: They never lead to treasure. +

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From the Bookshelf

the blog spot — posted by Joseph Fennelly, MD, on April 9, 2022

TAKING COURAGE TO HEART AND TO THE HEART OF MEDICINE Few individuals are called upon to be heroes like Ukrainian president Volodymyr Zelenskyy who, in choosing to stay and fight a massive invading army, faces a real possibility of imprisonment and death. This is true courage. Within the medical profession, there are also wars to be fought that require true courage. One thinks of the late Dr. Paul Farmer, who worked tirelessly throughout his career to bring high-quality health care to Haiti, Rwanda, and other resource-poor nations around the world. Even if one does not seek out situations that call for courage, they will knock on one’s front door. Such was the case when I was asked by the Quinlan family, in 1976, to care for their daughter. Karen Ann Quinlan was in a persistent vegetative state, and there had never been a right-to-die case before. Aware of worldwide media coverage, I was uncertain at first, and hesitant. But how could I deny this bereft family the medical support necessary for a more satisfactory palliative outcome? Didn’t I always stop at accidents and offer my help? From a moral standpoint, wasn’t this the same thing? What cemented my willingness to help was that six of my most respected colleagues at Morristown Medical Center unhesitatingly said they would support me. That was nearly a half-century ago. Today, there are many other challenges that also require courage. First and foremost, in my mind, are the gross inequalities of health and health care in America, which have been exposed by the COVID-19 pandemic. In the 1980s, I served as vice-chair of a New Jersey group, Citizens Committee on Biomedical Ethics, that labored in this area. Today, I feel a renewed call to enter the fray of this modern medical civil war and support public groups dedicated to expanding affordable, effective care to all. Another challenge is the way the medical-industrial complex has eroded our ability to serve our patients, the public, and our profession. We must fight to tame the powerful behemoth of high-tech care driven by profit that has contributed to the demise of relational, educational, and preventive areas of patient care. Creating a more proportionate balance between hi-tech and hi-touch will not only improve the quality of care for patients but will also improve career satisfaction for physicians. The doctor-patient relationship is the heart of medicine, and physicians have suffered moral injury from the demise of relational medicine. Restoring this balance will provide us the energy and conviction to improve our charge to society. To paraphrase the poet David Whyte, in an essay on courage appearing in the book Consolations, Courage is the measure of our heartfelt participation with life, with work, with a profession; and yes, with a future. Whyte observes that the word courage originates from couer, or heart. +

We need better balance between hi-tech and hi-touch.

the design of the campaign that eradicated smallpox, the most important global health achievement in history and possibly the greatest feat in any field of international cooperation. — Julio Frenk, M.D, PhD, Dean, Harvard School of Public Health

This would have been a great book to feature in the recent Medical Examiner with our cover story about smallpox. Alas, hindsight is 20/20. But better late than never, we present what a few others have said about Dr. William Foege’s first-hand account of the eradication of smallpox

“A story of courage and risk-taking, House on Fire tells how smallpox, a disease that killed, blinded, and scarred millions over centuries of human history, was completely eradicated in a spectacular triumph of medicine and public health. Part autobiography, part mystery, the story is told by a man who was one of the architects of a radical vaccination scheme that became a key strategy in ending the horrible disease when it was finally contained in India. Rich with the details of everyday life, as well as a few adventures, House on Fire gives an intimate sense of what it is like to work on the ground in some of the world’s most impoverished countries,

and tells what it is like to contribute to programs that really do change the world. — Amazon Reviews

The eradication of a disease has long been the holy grail of global health and Bill Foege found it: more than any other person, he was responsible for the eradication of smallpox from the face of the earth. — Mark Rosenberg, author of Real Collaboration: What It Takes for Global Health to Succeed

House on Fire is a reminder of the importance of preventive medicine and will lead readers to an appreciation of all of the lives that would have otherwise been lost if the challenge to prevent smallpox had not been met. — Journal of the American Medical Association

A fascinating human interest account that is expertly merged with scientific facts. House on Fire is an inspiring story that portrays the remarkable efforts of a courageous physician and public health leader. —Journal of Community Health +

Bill Foege is one of the public health giants of our times. He was responsible for

House on Fire by William Foege; 240 pages, published by University of California Press in 2011

BINGEREAD

Joseph Fennelly is an internal medicine physician.

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The Examiners

APRIL 15, 2022

THE MYSTERY WORD

Well, my sister has been admitted to the hospital.

by Dan Pearson

I will drive you over Thanks for the offer, but I’m going to walk. if you need a ride.

No, she’s in Piedmont.

Oh no! Here at MCG?

The Mystery Word for this issue: SOTBERO

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. Of ankle bones 7. Choose 10. Grand follower? 14. Each 15. Lincoln for example 16. Veinlike deposit 17. C. Daniel lead-in 18. In person medicine (as opposed to, say, laboratory) 20. Open space in a forest 21. Tuscaloosa school 22. Building shape 23. Infers 25. Can in London 28. Former Augusta commissioner Moses 30. Past tense of bid 31. COVID-19 epicenter 33. Run away with a lover 35. Remember Harris ______? 36. To stain or disgrace (poet.) 39. Like Adam, briefly 40. Actually 41. Coin of Lesotho 42. Spiteful 43. Of the ear 44. Bites 48. Humble dwelling 49. Mom and dad 52. Reznor group, for short 53. Elusive 55. Lake in the Sierra Nevada 57. Utopia 59. Location 60. Mid-month day (Ancient Roman calendar) 61. Put on 62. Deer horn 63. Bump 64. 14th letters 65. Assails

20 23

29 33

E X A M I N E R

16 19

24 30

49 53

We’ll announce the winner in our next issue!

S U D O K U

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

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

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

QUOTATIONPUZZLE

35. Med. dissolved in alcohol 36. Missouri landmark 37. Cafe du _____ (old Central Ave eatery) 38. In shreds 39. Fishing net 41. Creek starter? (W. Augusta) 43. Prayer (archaic, poetic) 45. Inspire 46. Ice ax 47. Scoffs 50. Stage whisper 51. Rock 54. Urn 56. Performs 57. Slender metal fastener 58. Fuss 59. Biopsy destination

DOWN 1. Anchor store on 17-A 2. Ono’s first name 3. Indecent 4. Propagative part of a plant 5. Owning much land 6. Permit 7. Close off 8. Royal mansion 9. Clan 10. Slender 11. Native 12. Dental org. 13. Drive-in owner? 19. Just beginning to exist or to show potential 21. Modify 24. Deep, lustrous black 26. Singles 27. Regatta tools 29. Distributed cards 32. Peach State’s Bavaria? 34. Place for a frog to chill?

E F K Y T M C K R N Y T E ’ I V A A U X D O V O D U D I N E O A O A E ’ O R I S E A R D

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

8 9 4 3 2 7 5 1 6

— Rep. Thomas Foley

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

Solution p. 14

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

1 1 2 3 4 K 1 2 1 2 3

O P 2 3 4 5 4

6 8

1 9

3 1

K 5

4 2

1 2 1 2 3 4 S 1 2 3 4 5 6

F 1 2 3 4 5 6 7 8

3 A 1 2

1.DOOFKSPGTFJ 2.OOFRAUNERTH 3.SHRUMOOOEI 4.WENNGEMPT 5.TLLLKR 6.SAEEE 7.ID 8.GN 9.E

SAMPLE:

6 7 2 5 1 9 4 8 3

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MAY 2, 2022

5 3 1 7 9 6 8 4 2

9 4 7 2 8 3 6 5 1

2 6 8 1 5 4 7 3 9

APRIL 15, 2022

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

guy walks into a bar with his dog. He takes a seat and announces, “I’ll bet anybody here a hundred bucks that my dog can talk!” The half dozen people in the bar all take his bet. The guy says, “Speak, spot!” The dog is silent. “Come on, Spot. Say something!” the guy repeats. The dog just sits there. Fuming, the guy grudgingly pays each of the bettors a hundred dollars and leaves the bar. Outside around the corner, the guy turns to the dog and yells, “You set me up, you stupid mutt! Do you know how much money I just lost because of you?” “Relax, boss,” says the dog. “Imagine how much money we’ll make off these suckers tomorrow.”

Moe: How are things going with your girlfriend? Joe: Well, she called me last night and said, “Come on over, nobody’s home.” So I went over. Moe: And? Joe: Just like she said, nobody was home.

A police officer invited a friend of his to go for a ride-along one day while he was on patrol. As they drove along the cop boasted, “I can follow anyone down the road — and I mean anyone — and within a few blocks I can find something to cite them for.” “Prove it,” said said his friend, and pointed to a nearby car at random. “You’re on!” said the officer, and he started following the car. Block after block, nothing happened. The car was being driven perfectly. Finally after more than a mile the officer said, “I can’t believe it. He hasn’t done a single thing wrong. I’m going to pull him over and let him know.” He pulls the guy over, goes up to the driver’s window and says, “Sir, I pulled you over to compliment you. I followed you for more than a mile and not once did you speed, tailgate, change lanes without signaling, or do anything else deserving of a citation. I rarely see this so I wanted to congratulate you for being such a safe driver.” “Thank you officer,” the driver says. “I’m always extra careful when I’m drunk.” A man from the backwoods goes out to dinner at a nice restaurant. He takes along his wife, his girlfriend and his sister. As they walk in the hostess says, “Hey, y’all. Will it be just the two of you tonight?” Moe: Did you hear that the pope has bird flu? Joe: Yeah, it was on the news. Apparently he got it from a cardinal. +

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.

The

13 +

Dear Advice Doctor, For the past two years I have been working from home. It was okay for the first year, but a year ago my sister’s WFH stretch ended and everyone at her job was called back. Since I was still working from home she decided - without asking me - that I was going to be her baby-sitter. Don’t get me wrong: I love her kids, but trying to get work done around here is no picnic. What do you suggest? — WFH (Work. Family. Hate.) Dear WFH, I’m quite sure many others are in the same situation you are. Picnics are on many people’s minds this time of year: winter is over, but the stifling heat and humidity of summer is not yet upon us. It’s really the perfect time for a picnic! There are really two issues I’d like to offer the requested suggestions for. First, it’s natural for people to be a little hesitant about any social gatherings — even small ones involving family members — after spending two years in some degree of isolation. Many of us are not yet accustomed to being around other people, which is understandable. The key is for everyone to ease into “normal” at their own pace. No one should feel pressured to do something they’re not comfortable doing. So if you throw a picnic and some invitees don’t attend, don’t take it personally. They’ll come around eventually. Having said all that, public health experts say that generally speaking we are not at risk from COVID in outdoor settings. As COVID cases continue to recede, the threat will also. Someday soon the World Health Organization may even declare the pandemic to be officially over. That will be the perfect excuse to throw a picnic. In a COVID-free world, the main remaining threat posed by picnicking is food contamination, but that is readily controlled with a few simple, common sense steps. Keep foods covered. Nobody wants flies walking around on their potato salad. Bring plenty of ice. Keep foods that are supposed be cold cold. At the other end of the temperature spectrum, make sure that your grillmaster fully cooks the chicken, burgers, hot dogs and other meats on the menu. Meat thermometers are inexpensive, and it’s easy to look up the recommended safe temperatures for grilled meats. I hope this answered your question. Enjoy your picnic! + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

SUBSCRIBE TO THE MEDICALEXAMINER +

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!

Why read the Medical Examiner: Reason #272 BEFORE READING

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

AFTER READING

+ 14

8 4 2

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

...cleverly hidden on the doctor’s necklace in the p. 2 ad for MEDICAL ASSOCIATES PLUS

THE WINNER: ASHLY WHITE! If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 6. The new Mystery Word is on page 12. Start looking!

THE PUZZLE SOLVED T A R G E T

A P O L L O

A R C H

T E A U

P A I D N O

R I B A L D

S E E D

A C R E D

L E T

E D B E L O T A I N A L L Y T T Y T P A E V A S R A D I E S D D E E

A D A P T O R I S O N

O C C L U D E S T E V E N S

P A L A C E S E I N E

T S L R L O I N I C B A M A E S L C H I T E E T I N L E N T E C N I T S N T A H L O C A A N T L B E S E

A M D E A L O N E S

O A R S

P I O L E T

S N E E R S

SEE PAGE 12

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

...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.

1 5 6 4 8 9 2 7

9 4 3 2 7 5 1 6

7 2 5 1 9 4 8 3

Love to stare at your phone? Visit issuu.com/ medicalexaminer and stare away.

APRIL 15, 2022

AUGUSTAMEDICALEXAMiNER

3 1 7 9 6 8 4 2

4 7 2 8 3 6 5 1

6 8 1 5 4 7 3 9

8 6 4 3 1 2 9 5

5 3 9 6 2 1 7 8

2 9 8 7 5 3 6 4

QuotatioN QUOTATION PUZZLE SOLUTION If you don’t drink, smoke or drive a car you’re a tax evader.

— Rep. Tom Foley (1929-2013)

WORDS BY NUMBER Some people drink from the fountain of knowledge. Others just gargle. — Robert Anthony

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

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APRIL 15, 2022

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

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

DEVELOPMENTAL PEDIATRICS Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com

DRUG REHAB Steppingstones to Recovery 2610 Commons Blvd. Augusta 30909 706-733-1935

YOUR LISTING Floss ‘em or lose ‘em!

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

Augusta Area Healthcare Provider 4321 CSRA Boulevard Augusta 30901 706-555-1234 CALL 706.860.5455 TODAY!

EMF PROTECTION

EMF Safe Homes Sheila Reavill Certified Building Biology Specialist 209-625-8382 (landline) SURVEY•ASSESSMENT•REMEDIATION

IN-HOME CARE 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

YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by thousands of patients every month. Call (706) 860-5455 for all the details!

LONG TERM CARE

WOODY MERRY www.woodymerry.com Long-Term Care Planning I CAN HELP! (706) 733-3190 • 733-5525 (fax)

PHARMACY Parks Pharmacy 437 Georgia Ave. ARKS N. Augusta 29841 HARMACY 803-279-7450 www.parkspharmacy.com

SLEEP MEDICINE Sleep Institute of Augusta Bashir Chaudhary, MD 3685 Wheeler Rd, Suite 101 Augusta 30909 706-868-8555

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AUGUSTAMEDICALEXAMiNER

APRIL 15, 2022

Aiyan Diabetes Center

Augusta’s Advanced Comprehensive Multi-Specialty Diabetes Center • Endocrinology • Endovascular Surgery • Retina Center • Podiatry

• Wound Care • Research • Clinical Trials • Interventional Radiology

• Ophthalmology • Interventional Cardiology • Limb Preservation Center • Obesity Clinic

Exciting News!

• Hyperbaric Oxygen Therapy • Fibroid Treatments • Vein Center

• No more fingersticks! * • The longest-lasting CGM available today! • Exceptional accuracy! • Fully implantable with discreet alerts thru its mobile app! * except for calibration. See doctor for details.

The area’s best team of Board Certified physicians exclusively dedicated to comprehensive diabetes treatment & care, prevention, and research.

Jamie Steinsapir, MD, PhD Endocrinology

Khalil Al Soutary, MD Endocrinology

Kaushal J. Shah, MD Vascular Surgeon

Julian Nussbaum, MD Ophthalmology

Janaki Nadarajah, DPM Podiatry

Diabetes Center

462 FURYS FERRY ROAD • AUGUSTA GA 30907 AIYANDIABETES.COM • FAX: 706-868-3719

706-868-0319

Brandon Sur, MD Interventional Radiologist