Medical Examiner 1-5-24

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JANUARY 5, 2024

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

HABITFORMING This is the time of year when many people try to start good new habits and stop bad old habits. The start of a new year makes it easy to chart progress: Pick a day down the road, any day, and with a quick glance at a calendar you can easily say, “As of today I haven’t eaten a Twinkie in six weeks.” Followed by, “Well, except that one.”

Which raises a question: exactly how long does it take to truly establish a habit, a pattern of behavior that will reliably guide us in the direction of our visions and away from our vices?

It depends.

Variable factors include how difficult a goal is to reach, how motivated the potential habit-former is, how rewarding achievement of the habit will be, and how much support is available.

If those aspects fall short of the ideal, determination may fizzle long before the habit has been etched in, well, sand. Not in stone because, after all, relapses should be expected.

Traditionally, folk wisdom has held that it takes 21 days of focused behavior to establish a habit. Therein lies a key: focused behavior. Put another way, consistency builds strong habits more quickly than inconsistency. Skipping planned exercise days, for instance, isn’t helpful in habit-building, but hits and misses are inevitable. After all, whatever it is isn’t a habit yet. And even when it is, life will sometimes intrude. Accept that after two or three or ten steps forward there will be the occasional step back. Keeping the progress going will keep the habit-forging process on track.

That point illustrates a basic truth about forming habits. Every habit is different, as is every prospective habit builder. There is no magic number that behavioral scientists have discovered that marks the point at which a habit has been formed. But the chances of success are improved by setting realistic, measurable goals that take a slow, step-by-step approach to the ultimate habit aimed for. Just as you have to get to Atlanta before you can reach California, you have to lose 5 lbs before you can lose 50.

It is commendable to set goals whose achievement will result in beneficial new habits. Pat yourself on the back and keep going despite setbacks, and you will form those good new habits. +

AUGUSTARX.COM

6 WAYS TO REDUCE HEALTHCARE COSTS

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verything seems to be going up in cost.

Some increases can be avoided; just don’t use or buy those items. Other things are not optional; they are absolutely essential for life and its enjoyment. Food. Shelter.

Netflix.

Price increases in these areas is known as inflation, of course. But when price hikes affect access to healthcare, the term experts use is salubrinflation, defined by Webster’s (possibly) as “increases in the cost of living a salubrious lifestyle.”

Salubrinflation can force people to make extremely difficult choices, like having to choose between food and medicine. Saying no to either calls to mind another word in Webster’s (definitely): unsalubrious.

While both inflation and salubrinflation may be beyond the control of ordinary citizens, there are strategies anyone can employ to minimize their negative effects and continue to live the most salubrious life possible.

We list a few of them on page 4. +

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AUGUSTAMEDICALEXAMiNER

JANUARY 5, 2024

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 8 year-old son has begun telling lies. He is not lying to get out of trouble, just making up things for no apparent reason. He tells stories about things that haven’t really happened and often falsely accuses other children of various things.

What do you do?

A. Punish him severely any time you discover he has lied.

Lying is one of the worst behaviors he can pick up and it is important to stop it quickly.

B. Have a long talk with him about the importance of being truthful so that he can be trusted. Monitor his lying closely.

C. When you discover he has lied, take something important away from him and give it back when he tells the truth.

D. Let him know that you disapprove of lying and that you fear for his future if he keeps it up, but there’s not much else you can do.

If you answered: A. You are right that his lying can lead to serious problems, but you have to be careful when you punish him. Punishment can lead to even more lying.

B. This may seem inadequate, but it really is the best you can do. With younger children, the story of the boy who cried wolf could help. With older kids who can understand, you can impress on them the importance of mutual trust in relationships.

C. Again, punishment is more likely to lead to more lying rather than less.

D. Unfortunately, this is often the case. However, you should at least try to talk with him about the dangers of lying.

Lying is one of the most difficult behaviors that child therapists have to deal with. Talking about the problem and the possible results of continuing lying is pretty much the best you can do. + Dr. Proefrock is a retired local clinical and forensic child psychologist.

DON’T SAY IT’S QUIET!!!

One of the worst things a person can say in an Emergency Department is any sentence that includes the word “quiet.” As in, “Sure is quiet tonight.” That’s all it takes for a mass casualty event to materialize out of thin air, and heaven help us all if that statement is made when there’s a full moon.

Sometimes people view superstitions in other cultures as evidence of a lack of education or sophistication. “Those primitive people. Bless their hearts!”

Meanwhile back home, the supposedly educated and sophisticated people in our enlightened “first world” environment might believe that things always happen in threes, that the full moon will fill the ER with car crash victims and women in labor, that merely mentioning the name of a “frequent flyer” will somehow magically bring them to the ER on that very shift, and numerous others that vary from region to region.

Scientifically speaking, people who have examined the phenomenon of medical superstitions chalk it up to control: when you work in an

environment with very little control over what happens next — like an ER where no one has the first clue what crisis might roll in the doors 10 seconds from now, and that goes on hour after hour, shift after shift, day after day, night after night — having the means to “control” the chaos, such as by scrupulously avoiding the word “quiet,” offers at least a small feeling of control over what’s happening.

But does it work?

Yes and no.

Observing various rituals may offer the feeling of control, and that has a certain value all its own. It can help ease anxiety and be a mechanism to cope with stress.

A number of superstitions were born during the COVID-19 pandemic, and within that context a 2022 study concluded that “during the pandemic, superstitious beliefs did not act as a coping mechanism that helped individuals reduce their anxiety (as some other studies had previously established).

Instead, superstitious beliefs were positively associated with fear of Covid-19.”

The reality is that whatev-

er is going to happen is still going to happen, and that has been established by several carefully constructed clinical studies, including the one just mentioned.

One British study was carefully designed to find out about the unholy trinity of ER chaos: Friday (and weekend) nights, full moons, and saying that cursed and dreaded word quiet.

The trial was conducted over a period of 61 days: May 1 through June 30, 2019.

That span included two full moons, nine full weekends, 41 weekdays, and one solstice (but unfortunately no Friday the 13ths).

Each day of the study at the start of the shift, an ER staff member secretly opened a sealed envelope that instructed him/her to say where many could hear it, “Today will be a quiet day,” or to refrain from saying quiet. No one was aware of the study, and only the single chosen staff member was aware of the envelopes.

Among the answers researchers were looking for: did the ER’s workload significantly change on any of the traditionally inauspicious days (like full moons and Fridays), and whether announcing that it was quiet or going to be quiet altered the ER’s workload.

Admittedly, 61 days is a short sampling period, but the data showed no meaningful differences in full moon patient volume, and about a 5% difference between “It’s going to be quiet” days (144 patients on average) and quiet avoidance days (139 patients).

So if you’re a fan of evidence-based thinking, you’re safe saying “the Q word.” +

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AUGUSTAMEDICALEXAMiNER

JANUARY 5, 2024

MEDICARE CAN BE CONFUSING. CALL US TO HELP UNDERSTAND YOUR OPTIONS.

TURNING 65?

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Very simply, really. Anyone can go online and check the price offered by GoodRx for a prescription they have. If they like the price, they can print out a free coupon or download it to their phone, take it to their participating pharmacy and reap the savings. How big can the savings be?

The antifungal drug voriconazole has an average retail price of $1,510.58 for 60 200mg tablets. The lowest GoodRx price for the most common version of voriconazole is around $102.58, 93%off average retail. Another example: 30 20mg tablets of Viagra, used to treat erection problems in men as well as pulmonary arterial hypertension, a serious heart and lung condition, have an average retail price of just under $196. The GoodRx price is about $8.00, 95% savings.

Believe it or not, GoodRx offers more 150 billion different prescription pricing data points (for differing dosage and quantity combinations) at its online comparison platform, up from only 1 million when the company launched. Its coupon codes are accepted at more than 70,000 pharmacies across the United States, including Walmart, Kroger, CVS Pharmacy, Walgreens, and many more.

Something is working right: 18 million people access the GoodRx app and website every month, and since its opening day in 2011, GoodRx has saved its customers over $20 billion on prescription costs.

But another aspect of this QA is: how does the company make any money? Don’t worry; they’re doing just fine.

The company is worth more than $21 billion and has made an annual profit for the past 3 years (2018-2020).

Where does all their revenue come from? Some income is generated by advertising on its website, and it has launched a few side ventures, like a telemedicine service. But more than 90 percent of its income is generated by the coupons people like you and I use. If we redeem a GoodRx coupon at our drug store, the store says thank you to GoodRx for bringing them that business. It may be just pennies, but all those pennies add up: GoodRx generated $550.7 million in revenue for the fiscal year 2020. +

Editor’s note: this article previously appeared in our 10/15/21 issue.

MEDICALEXAMINER

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The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2024 PEARSON GRAPHIC 365 INC.

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#204 IN A SERIES

Who is this?

T

his is a face that for many needs no introduction, belonging to a doctor who gained international fame — and infamy — for his beliefs and philosophies.

Jack Kevorkian was born and died in Michigan, graduated from medical school there, and practiced medicine there. But “Dr. Death” is tied inextricably to the state of Georgia. Events here helped formulate his views on death and dying.

In 1972, the U.S. Supreme Court ruled in Furman v. Georgia that the death penalty amounted to cruel and unusual punishment. But that landmark ruling was overturned a mere four years later by another landmark case, Gregg v.

Georgia. (Although the ruling reinstituted the legality of the death penalty, Troy Gregg was never executed. He escaped from Reidsville, the only successful death row escape in Georgia history, and was murdered later that night in a biker bar in North Carolina. But we digress...) Kevorkian seized upon the publicity from the ruling to resurrect an idea he had championed off and on for more than 20 years: using death row inmates for medical experimentation, in his words, “under complete anesthesia at the time appointed for administering the penalty.” As he proposed it, inmates had to approve any such procedures. He also advocated harvesting organs for transplant from inmates after the death penalty was carried out, and he experimented with transfusing blood directly from recently deceased patients into the living. He saw the technique as having battlefield applications, but the Pentagon said no thank you. Likewise, prison medical officials were not interested in medical experiments or creating organ banks from executed felons, and Dr. Kevorkian’s employer at the time, the University of Michigan, opposed his proposals for death row experimentation. He resigned rather than abandon the ideas.

And people wonder where he got the nickname Dr. Death.

But he wasn’t done. In the 1980s he began focusing his attention on euthanasia, a word brought into medicine by none other than Francis Bacon in the 17th century to refer to an easy, painless, happy death, during which it was a “physician’s responsibility to alleviate the ‘physical sufferings’ of the body.”

Kevorkian advertised “death counseling” in Detroit newspapers, and would have been prosecuted for his first assisted suicide except that Michigan had no law prohibiting the practice. The state could only revoke his medical license and forbid him to interact with patients.

His crusade continued, resulting in more prosecutions, all resulting in either acquittals or mistrials, until in late 1998 60 Minutes aired (with Kevorkian’s permission) a videotaped euthanasia Kevorkian performed just a few weeks previously.

That resulted in new charges and a conviction with a 10-25 year sentence, more than eight years of which he served.

Kevorkian remained an advocate for assisted death until his own demise, even for non-terminal patients. “What difference does it make if someone is terminal?” he told Sanjay Gupta in one interview. “We are all terminal.” In his view, suffering was the deciding factor, not imminent death.

While his tactics were sometimes outrageous, Jack Kevorkian fostered a national conversation about the role of physicians in alleviating the suffering of their patients. +

JANUARY 5, 2024

AUGUSTAMEDICALEXAMiNER

Making healthcare more affordable Living salubriously can at times be very expensive. Most of us would agree it’s money well spent. It’s what keeps us alive and functioning. But that doesn’t mean it wouldn’t be nice to cut back a little if we could still get the same (or even better) results for less.

That’s what this article is all about: more salubriousness for less money.

1. Prevention We’ve all heard the old adage that a penny of prevention is worth ten dollars of cure. With salubrinflation at work, these days a penny of prevention could easily be worth thousands of dollars.

The great thing about prevention is how pleasant saving money can be using this strategy: eating good in the neighborhood, going for walks, quitting smoking (what an expensive habit!), finally shedding the pounds you’ve wanted to lose for so long.

It may seem predictable and too easy to start with prevention, going for the proverbial low-hanging fruit, but it really is the crucial starting point for any plan to cut healthcare costs. Living more salubriously reduces trips to doctors, dentists, hospitals, physical therapists, pharmacies, and even funeral homes.

One of the keys to prevention is getting routine health screenings. They are often covered by health insurance, so they’re free — and they can catch potential problems early, before they can get complicated and expensive.

2. Drug dealing Many of us depend on medications to keep us alive. But there are ways to minimize the bite drugs take out of our budget. Some

massively cheaper in time and money than visiting the ER. 4. Go to the right doctor Some insurance plans require their participants to use doctors they have contracted with. Those providers are known as innetwork, and that means they charge lower rates. Going to out-of-network providers is much more expensive, and should be avoided at all costs.

ideas: • provide your doctor with a list of all the drugs you’re currently taking. Ask if any of them can be eliminated or possibly replaced with a less expensive option.

• ask your doctor or pharmacist if generic equivalents of the drugs being prescribed are available.

It does no good to get a prescription you’ll never fill because it’s too expensive.

• utilize options like RxSaver or GoodRx to save money.

• pharmaceutical companies can often help: “if you can’t afford your prescription, AstraZeneca may be able to help” as one example.

3. Get the right care It’s incredibly expensive to go to the emergency room for something routine, like the flu; it’s incredibly dangerous to not go to the emergency room for severe bleeding, trouble breathing, or chest pains. Getting the right care can save a life; it could also save a lot of time and money.

It’s wise to have a family physician as a primary care provider. The second-best option is to get care at a walkin urgent care clinic. Both are

5. Speaking of insurance...

Your health insurance might be provided by your employer, and you have no say in the matter. But for those who can choose their health plan, it’s possible to get coverage tailored to the specific doctors you need to go to, and the drugs you need to take. Check with the insurance reps who advertise here in the Medical Examiner.

Their job is finding the right coverage for people, and their services are usually provided at no cost.

6. Look out for yourself Aside from the advice included earlier in #1, there are other avenues of selfcare. For example, when you get a bill for healthcare services, examine it carefully for errors. Perhaps you’ve been billed for a service that wasn’t rendered, or that you asked about the cost of and the bill is higher than the amount you were quoted. If a bill is 100% legit but huge, it never hurts to call the provider and try to negotiate a lower price or, if that fails, a payment plan you can live with.

These half-dozen ideas only scratch the surface of potential ways to save money on healthcare. Do your own research to look for more. +

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in smaller things this is true. A few days ago, while making my breakfast, I heard our cat meowing loudly at the back door. I knew that it was time to feed her, and it was somewhat cold, so I also wanted to let her into the laundry room and feed her there (she usually still wants to go back outside, but I give her the option). My conscience told me to feed her first, but my hot food beckoned me to the table. My conscience and compassion won out, but then I saw that we were out of cat food.

I knew I could improvise something, but that could take a while and my food would get cold, so I went back to the table and said my prayer over my food. I couldn’t eat though. I felt guilty, so I got up to go feed her. As it turned out, we did have some cat food, but it was canned food, not dry, and she usually turns her nose up at that. I had missed the cans in my initial cursory search. I opened one and put it out for her. I waited to see if she would eat it and she did, but not until she gave me a dirty look. I assured her that we would get her more of her favorite food that day. She didn’t offer any response that looked like gratefulness, but then again, she is a cat.

If you want grateful, you get a dog.

As my little anecdote illustrates, we always have detours in life. Little ones and big ones, and even with the ones that make it seem like we have a choice, sometimes we don’t. Not if we want to live with ourselves. At my house we haven’t given up on reaching some of our destinations. In fact, we almost had plans to go to a concert on New Year’s Eve this year.

But obligations and other considerations got in the way. Our friends Chuck and Vicki tried to help us out and even offered to pay for the concert tickets, but we still couldn’t make it.

I admit to having a little relief about it since my COVID-19 lockdown-warped brain got used to being at home more than ever. But when we do go out and do something fun, I don’t regret it (most of the time), so I will keep trying.

All of that said, the danger to all of this sometimes is not recognizing when it isn’t really your responsibility and when you need to let someone else take care of things. You have to be realistic about what you are capable of. This includes financially, emotionally, and physically. You may not be able to do what your conscience tells you that you must do. Then you have to accept this and re-train that conscience to your new circumstances.

You’re not 25 anymore. At this stage in life, you may be impacting your own health or the health and happiness of the family by taking on too much. Sometimes you have to learn to say no. It doesn’t feel good at first, but if you learn to use it properly, you get used to it. I’m starting to. You should give it a try.

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As of this writing, another year has passed and lots of people gathered together to celebrate the new year while others happily stayed home on the eve of the new year and even went to bed before midnight. Which category do you fall under? I am firmly in the latter category. If anyone ever catches me up past 11 pm on December 31st, it’s because I can’t sleep or because I got up to go to the bathroom, which does happen a few times a night.

I know that this stay-at-home philosophy flies in the face of my previous two articles that talked about dancing our way into our old age like the octogenarian couple we saw at an anniversary party, but hear me out. We plan on being more active than we have, but there have been a few obstacles in our path. Like when the road through Great Smoky Mountains National Park disappears because of ice or a landslide. You can still get to Gatlinburg from Cherokee, but you have to drive around the park on I-40. It takes longer and it isn’t as scenic, but it is less curvy and therefore less nausea-inducing. That’s like life. We will get there eventually, but we are currently on a detour.

My wife has told me numerous times that if I can’t accept and adapt to change, I am doomed to always be disappointed and unhappy. She is right. I do have a problem with change, but I am still mostly a happy person.

The changes in our life over the past five years or so in regard to first, my own health declining, the need for us to care first for my father and now for our grandchildren, and the passing of my father, put us on that detour around our planned route in life. But we are just going to have to make the best of it.

Have you ever had big plans get ruined?

I’m sure you have. If you haven’t, well, it’s like motorcycle riders say. There are two types of riders; those who have dropped their bike, and those who will drop their bike.

The same goes for life. There are those who have had to take major detours in the path to their dreams and those who will have to take them. It is in the nature of being human.

We have far less control over things than we imagine we do.

What do I mean? We get boxed in by circumstances beyond our control. Despite the best efforts to eat healthy and exercise, we can still face serious illness. Despite how good our own health may be, we will likely have loved ones who need help due to their health problems. You have a choice as to how much you help, but that choice is also under subtle control from other factors, like your conscience. Your conscience reminds you of your obligations. There is also compassion to consider. It doesn’t allow you to let someone suffer when you can help. Even when it isn’t humans. Have you ever been moved to help a lost or injured animal? I know I have. Even

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WE HAVE LESS CONTROL THAN WE IMAGINE

Please see MIDDLE AGE page 15

FRONT DESK !

TURE A E F NEW

FOLLIES

...wherein we share amusing medical mis-speakings and misspellings we have overheard, or that have been shared with us.

A patient came in and stated her name. We have three patients in our system with the same name and I could not find her appointment, so I asked for her date of birth.

After a long pause she called someone and asked, “Hey, what’s my date of birth?” + “After he swallowed that cleaner we had + to give him syrup of epitaph.”

READERS: What have you heard? Please share!

EMAIL: Dan@AugustaRx.com or MAIL: PO Box 397, Augusta GA 30903

s tha Les

+

n people can’t be n a millio wron g.

Advertise here

us !

BY J.B. COLLUM

As one year exits the stage and a new one begins, we want to take this opportunity to extend our most sincere thanks to the two groups of people who make this publication possible: our readers and our advertisers. Neither would be possible without the other.

These two groups are both intensely special. Our advertisers are mostly of the long-term variety; most of them have been in this paper for years, in some cases since our very first issue. They are spending some of their hard-earned profits to support this paper. Surely they gain good exposure and hopefully the occasional customer, but they never give us the impression they are on these pages for that reason alone. They are just in the Examiner, period, and their loyalty is tremendously appreciated.

As for our readers, they are a true source of refreshment and encouragement because they are not silent fans. They regularly call, send letters and emails, and offer in-person comments about their enjoyment of the paper when we’re spotted making our many deliveries. As we often say, the word “love” comes up in the vast majority of comments, in expressions like, “We love the Examiner,” or “I love to read it from cover to cover.” In turn, we have to say we love those comments. It’s great to get the feedback, and we welcome any negative comments too: “Praise is nice, but criticism can be a lot more useful.”

Last but not least, we’d like to extend a huge thank-you to David Proefrock, PhD, the esteemed child psychologist who has been spending part of his retirement writing the “Parenthood” column in this paper for the past several years. He is going to re-retire, so this issue contains his final regular column, although we hope he’ll be inspired to send in an occasional guest column whenever he feels inclined. The welcome mat is always out, Dr. Proefrock.

In our next issue we’ll introduce a new contributor to that coveted spot on page 2. Stay tuned.

In the meantime, please keep reading, please keep sending us your feedback, and please keep supporting our advertisers. + Thank you again, and please have a most salubrious 2024.

Call 706.860.5455

panies who already sup port s of com

Middle Age

DEARREADERS

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ADVENTURES IN

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AUGUSTAMEDICALEXAMiNER

JANUARY 5, 2024

HUG YOUR WAY TO BETTER HEALTH The average adult hug lasts 3 seconds. When a hug lasts 20 seconds, there is a physical and mental therapeutic effect. A sincere embrace produces oxytocin, known as the “love hormone.” Oxytocin helps us relax, feel safe, calms our fears and diminishes anxiety. It activates when you hug a person, cradle a child, cherish a dog or a cat, dance with your partner, or simply hold the shoulders of a friend.

Psychotherapist Virginia Satir said, “We need four hugs a day for survival. We need eight hugs a day for maintenance. We need twelve hugs a day for growth.”

While these exact numbers are not scientifically proven, there is a scientific evidence related to the importance of hugs and physical contact.

Here are some reasons why we should hug: 1. STIMULATES OXYTOCIN Oxytocin is a neurotransmitter that acts on the limbic system, the brain’s emotional center, promoting content-

BASED ON A TRUE STORY (most of the time) A series by Bad Billy Laveau

ment, reducing anxiety and stress. It even facilitates monogamy. Oxytocin stimulates the intensity of labor contractions during delivery while at the same time helping mothers tolerate the excruciating pain of delivery.

Research from the University of California suggests oxytocin encourages males to be more affectionate and better at forming relationships and social bonding. Libido and sexual performance were enhanced in test subjects.

Oxytocin, released from the pituitary gland, lowers both heart rates and cortisol levels. Cortisol is the hormone responsible for stress, high blood pressure, and heart disease.

2. CULTIVATES PATIENCE Connections are fostered when people take the time to appreciate and acknowledge one another. A hug is one of the easiest ways to show appreciation and acknowledgement of another person. The world is a busy, hustle-bustle place. Slowing down and taking a moment to offer a sincere hug benefits everyone, and helps foster patience with ourselves.

3. COMMUNICATES SILENTLY Almost 70 percent of communication is nonverbal. Interpretations of body language can be based on a single gesture, and hugging is an excellent method of expressing yourself nonverbally to another human being or animal. Many feel the love and care in your embrace.

4. PREVENTS DISEASE Affection reduces stress, which diminishes many diseases. The Touch Research Institute at the University of Miami School of Medicine

says their studies (more than 100 of them) in touch and feelings demonstrates significant effects, including faster growth in premature babies, reduced pain, decreased autoimmune disease symptoms, lowered glucose levels in children with diabetes, and improved immune systems in cancer patients.

5. SELF-ESTEEM Hugging boosts self-esteem, especially in children.

The tactile sense is all-important in infants. Initially, babies recognize their parents by touch. From the time we are born, family touches show us that we’re loved and special. The associations of self-worth and tactile sensations from our early years are still imbedded in our nervous system as adults. The cuddles we received from our Mom and Dad while growing up remain imprinted in the subconscious for life. Hugs help form self-love.

6. STIMULATES DOPAMINE Hugs stimulate the release of dopamine, the pleasure hormone. Low dopamine levels play a role in the neurodegenerative disease Parkinson’s, as well as mood disorders such as depression.

Dopamine gives us that feelgood snse and motivation.

Dopamine sensors are the areas that many stimulating drugs such as cocaine and methamphetamine target.

Certain dopamine receptors are also associated with sensation-seeking.

7. STIMULATES SEROTONIN Hugging releases endorphins and serotonin. Endor-

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phins and serotonin cause pleasure and negate pain and sadness and decrease the chances of getting heart problems, helps fight excess weight and prolongs life.

Cuddling of pets has a soothing effect that reduces stress levels. That is why we have Therapy Dogs. Hugging for an extended time lifts one’s serotonin levels, elevates mood and creates happiness.

Hugs, among person inclined to invite or desire such closeness, are a good thing.

Uninvited hugs are intrusive and not a good thing. The list of people that I don’t want to hug me is long. Actually, there are few people that I want to invade my personal space, much less hug me.

The Covid disaster has made hugging, kissing, and even hand shaking questionable activities.

But I always want to cuddle my dog, Daisy. She is a rescue dog, 8 pounds of questionable ancestry, who lets me know when rain or bad weather is coming, strange people walk on our side of the street, or when it is time to give her a treat. I’m open to Daisy hugs anytime.

Makes me feel good, and I don’t mind her making me happy and live longer. Having a few dog hairs on my warmup suit is a small price to pay.

A hug a day may not keep the doctor away, but it might improve your disposition. Heck, you might even become a hug-aholic and never seek a cure. Even start a political movement: Hug-a-Thug.com. Create World Peace. Assuming the thug didn’t shoot you, thinking you were picking his pocket. +

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Ingredients • 2 teaspoons canola oil • 1 medium Vidalia onion, finely chopped • 1 10-ounce package frozen spinach, thawed and drained • 6 ounces light cheddar cheese, grated (about 1 ½ cup) • 5 large local farm fresh eggs • ½ cup light cottage cheese • ¼ teaspoon salt • ¼ teaspoon pepper • 1/8 teaspoon grated nutmeg • ¼ teaspoons ground red pepper (cayenne) Directions Preheat oven to 375°.

Coat a 9-inch pie plate with cooking spray and set aside.

Place a nonstick skillet over medium-high heat and add oil. Next add onion and sauté for 5 minutes, or until translucent. Add spinach and stir until moisture has evaporated, about 3 minutes. Sprinkle cheddar cheese evenly in prepared pie plate and add the spinach mixture.

In a medium bowl, whisk together the eggs, cottage cheese, salt, pepper, grated

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ASK DR. KARP

NO NONSENSE

NUTRITION Alexis, a Facebook friend from Statesboro, GA, asks “My New Year’s resolution is to make 2024 spicier, replacing the salt I usually use with spice and herbs.

I don’t know where to begin. Help!”

What a wonderful New Year’s resolution! Yes, add zest and spice to the foods you eat in 2024. This will help you cut down on salt without sacrificing flavor.

When I use the word salt I am really referring to sodium, which is the ingredient listed on the Nutrition Facts Label. Americans eat too much salt. The ideal sodium intake for most adults is less than 1500mg per day, but many Americans consume two or three times that amount.

The average daily sodium intake for Americans is a whopping 3400mg. Finding ways to reduce your sodium intake without reducing the flavor is a very good resolution. Remember, we are not saying that you need to go on a low-salt or salt-free diet.

Most Americans do not need to have such a restrictive salt intake; 1500 mg of sodium per day is plenty of salt to make your foods tasty, especially if you add some complementary herbs and spices.

Let us assume you are totally clueless about using herbs and spices, as many people are. Do not feel intimidated.

There are no “herb-and-spice cops” around. You will not get a ticket if you make a mistake and add too much or too little.

Just adjust the next time.

When I was growing up, the only spices and herbs in our house were salt, pepper and, occasionally, some garlic and paprika. That’s about it. How-

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ever, if you look in my kitchen cabinet today, the spice shelf contains fifty or more different spices and, believe it or not, I use them all. If a guy from Brooklyn can learn to flavor foods with herbs and spices, you can learn, too!

One key with herbs and spices is to begin small. Begin by buying and adding just a few herbs and spices to your food. Then, slowly but surely, become more adventurous and start experimenting with more flavors. In the summer, have a simple herb garden, even if it is just some basil, oregano and parsley growing in a flowerpot on your balcony or under your kitchen grow light. It makes your place smell good, too.

Take the first step and buy some dried oregano, basil, powdered ginger, garlic powder and, perhaps, some sesame oil. Then start changing your mindset. Don’t just cook your food; “imagineer” your food prior to cooking it.

This takes just a minute. For example, one easy way of trying out some new flavors is to add extra herbs and spices to ordinary supermarket foods.

Imagineer that store-bought jar of pasta or spaghetti sauce.

Buy the lower-sodium variety and zip up the flavor by

JANUARY 5, 2024

sprinkling in some oregano and basil. In Augusta and other southern and southwestern cities, rosemary bushes are used as shrubs because they are heat and drought-resistant. Voila! A free source of rosemary. Take a few clippings from the ends of those bushes, put the clippings in a little plastic bag and keep them in the refrigerator veggie bin. Add some diced rosemary to the store-bought sauce, along with the oregano and basil. You can add even more flavor to that pasta sauce by first adding a little olive oil and garlic powder to the saucepan, throwing in some onions, and sautéing prior to adding the sauce from the jar. You will be wowed by the zesty taste of that pasta sauce

with the added onions, garlic, oregano, basil, and rosemary.

Try it.

Another simple way of becoming more familiar with spices is in Asian food. Close your eyes and imagineer.

What simple Asian flavors come to mind? Garlic, ginger, onions, sesame, soy sauce.

What to do with leftover rice after a meal? Refrigerate it and on another day make some stir-fry for dinner. Asian stirfry is simply stirred in a little oil. Just add a little sesame oil to a non-stick pan (sesame oil is very flavorful, so you just need a little), sprinkle garlic powder, ginger, a little salt and add some cut-up onions and celery. Sauté everything until tender. Then throw in Please see NO NONSENSE page 9

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/ AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health.

Dr. Karp You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

Read online: issuu.com/medicalexaminer

JANUARY 5, 2024

SHORTSTORIES ONE NIGHT IN THE ER… A 42 year old lady came in with severe abdominal pain and nausea. She wasn’t vomiting. No other symptoms or problems, except for multiple prior visits to the ER with the same problem.

Many doctors had tried and failed to diagnose and treat her. She had been to all the specialists at all the regional Universities. The famed Cleveland Clinic even took a crack at her.

All the tests were negative including blood work, stool samples, X-rays, scopes in both ends, the camera pill (a camera that the patient swallows which takes pictures as it traverses the gut), and various scans.

She had CT scans, MRIs and various nuclear scans.

There were scans with and without IV contrast and oral contrast. There were scans of her arteries, and scans of

her gallbladder. Her gallbladder was a little weak, so a weak surgeon jerked it out without any benefit.

She had every blood test for cancer known to man.

Multiple biopsies were always negative. I thank God that no tired pathologist ever imagined cancer cells under the microscope. This lady already suffered so much at the hands of her healers.

X-rays were done many times with and without Barium. Some of the X-rays were done as videos. She might have had enough radiation to kill any tumor!

And the scopes! Multiple scopes down the throat and into the stomach and duodenum. Another scope down the throat through which a catheter is passed into the bile duct and pancreas to inject contrast that highlights the ducts for more X-rays.

A urologist even scoped her

NO NONSENSE… from page 8 the rice, cut-up and throw in some leftover chicken or leftover porkchop, add some egg substitute, add some frozen peas and carrots, or some diced red and green pepper. Stir everything until the eggs are cooked. You can add some low sodium soy sauce or grate in a little orange peel for even more flavor if you want. A delicious meal in a few minutes. How much ginger and garlic? Whatever you want. And if you did not add enough in the beginning, you can just sprinkle some more on the cooked stir fry before you eat it. Want even more flavor? Instead of powdered ginger, buy some fresh ginger in the fruit/veggie section of your supermarket and grate it into the stir fry.

Another simple idea: have you ever sprinkled spices and herbs onto chicken prior to baking? Buy a package of cut-up chicken, pull off the skin, put the chicken pieces in your baking dish, spray with a little butter or olive oil spray. Next, liberally sprinkle on garlic and any other herbs and spices. You want Mediterranean chicken? Sprinkle on some cinnamon, pepper, oregano, and rosemary in addition to the garlic. Do you want Asian chicken? Sprinkle on some ginger, curry powder, grated orange peel, and pepper along with the garlic. Bake as usual.

What about those pre-mixed spice blends, like Fajita, Mexican, Greek, Italian, and others. Be careful with those. Check the sodium content. Some pre-mixed spices have a lot of added salt. Some do not. The Mrs. Dash line of herbs and spices has no salt. There is even an extra-spicy Mrs. Dash. If you want to add a little salt to the food too, that is not a problem. Remember, the sodium recommendations are to reduce the salt in the foods you eat, not to eliminate salt completely. One word of caution; be careful with those pepper and tabasco sauces.

Check to see how much sodium they contain and buy the lower sodium ones.

Here are ideas for other foods you can experiment with. A little cinnamon or nutmeg tastes great on your morning cut-up fruit, a little curry powder tastes wonderful in chicken soup.

Liquid smoke adds bacon or fatback flavor to veggies without the fat; tarragon goes with chicken, and dill tastes great in salads (I love dill but tend to overdo it, according to Nancy!)

What is the “No-Nonsense Nutrition” advice about herbs and spices at the beginning of 2024? They are magical for helping you cut down on sodium and adding zest and flavor to your life. By 2025, you will be the “chef du jour!”

Have a happy, healthy, zesty and delicious New Year! +

AUGUSTAMEDICALEXAMiNER

9 +

bladder.

She saw stomach specialists, liver specialists, gastrointestinal surgeons, kidney specialists, urologists, neurologists, and even psychiatrists.

There’s an old saying in medicine, if the only tool you have is a hammer, everything looks like a nail. This poor lady had been beaten with every specialist’s hammer in 3 states.

When they couldn’t

diagnose her, they skipped realize that she would be straight to the cure. She written off as an addict, that failed multiple curative prodoctors stop trying if they cedures and dozens of medithink you just want opioids. cations. There were medicaShe has been put on tions to neutralize acid, coat every dietary restriction, the stomach, decrease acid and treated with every fiber production, anti-spasmodics, supplement. She knew it all anxiolytics, antidepressants, because she had tried it all. antibiotics, anti seizure, antiThe first night I saw her, funguals, and plain old pain I just told her that she had medications. already seen many doctors She learned to refuse the much smarter than me, pain medications, because working in a low-level ER. she was smart enough to Please see SHORT STORY page 11

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behaviors. Accidents will continue, although they might be fewer and of lesser severity.

More and more, institutions like the National Highway Traffic Safety Administration (NHTSA) are striving to convince state and local officials to rely more on changing the physical, social and environmental elements of highway safety.

Issuing tickets for unsafe driving means by definition that the unsafe act has already occurred.

And as NHTSA points out in a new report entitled Countermeasures That Work, enforcement efforts by police have their place, but in city after city such efforts have been applied unequally, in ways that have resulted in inequities and negative interactions with law enforcement.

How much better to attempt to prevent unsafe driving than to punish it after the fact. But how?

Safety has to be proactive, not reactive, says NHTSA. Redundancy is crucial; no single strategy will work.

Taking into account the unchangeable fact that humans make mistakes, a great place to start is with safe road design. Recall that back in the day, even main roads often didn’t have a white line painted along the outside edge of the pavement.

Now, not only is that white line there, but many roads have bump strips to physically and audibly alert drivers who leave their lane in either direction. Countless other road improvements are now routine elements of roadways, and more are coming all the time. The I-20 interchange under construction in Grovetown is a perfect example of innovations in design that improve the safety and efficiency of roads.

Closely connected to roadway design is the matter of setting safe speed limits. The development of progressively safer and safer vehicles is another key.

The current thinking in traffic safety is that death and serious injury are unacceptable outcomes. As you may recall, we have written in this very space about the ambitious goal of U.S. Secretary of Transportation Pete Buttigieg: zero traffic deaths, and the plans to achieve that goal seem realistic, at least on paper.

It’s a goal that would not have been possible even a few decades ago, and it may not be possible now either. But taking the primary responsibility away from traffic cops and individual drivers is part of the new approach. As NHTSA puts it, “Humans make mistakes...responsibility is shared, safety is proactive, and redundancy is crucial. Stakeholders should approach transportation safety proactively with the goal of creating redundancies in the system. The responsibility should be shared across disciplines and include science-based safety interventions.” +

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hink about the challenges you would personally face if your job required you to try to correct unsafe driving habits.

The biggest hurdle you would have to overcome is the unfortunate fact that humans drive cars. There is your #1 problem right there, and it presents a huge obstacle you would have to attempt to overcome.

Consider the typical ho-hum highway safety campaign (or “Crash Course” article in the Medical Examiner). What is it likely to consist of? Messages like “Don’t drive while distracted,” or “Drive safely; pay attention.” Undoubtedly some statistics, facts and figures, and points of reasoning are usually in the ingredients list.

Thankfully, such safety campaigns have limited the death count on U.S. roadways to less than 50,000 people a year.

Or to put it another way, they don’t work.

Consider a few reasons why.

Data compiled by the American Automobile Association (AAA) Foundation for Traffic Safety demonstrates that the overwhelming majority of drivers are fully aware that various behaviors are unsafe and present serious traffic safety issues, yet they do them anyway.

For instance, 96% of those surveyed by AAA in 2020 agreed that using a cell phone to text or email while driving was “very dangerous” or “extremely dangerous.” Yet 37% of the same respondents admitted to talking on the phone during the past 30 days while driving; 34% admitted to reading a text or email while driving; and 23% admitted to having manually typed a text or email message while driving in the preceding month.

Clearly, information alone does not work. What driver is unaware that a red light means stop?

Every driver in the two to five cars that commonly run reds already know the rules. They simply choose to ignore them.

Safety campaigns (and yes, M.E. articles) seem to be based on the notion that people don’t know that practices like speeding, running red lights, and tailgating are unsafe and illegal. Once they’re informed, they’ll stop.

In other words, such safety campaigns are flawed from the outset. They present information of which people are already fully aware, but the information alone is not likely to affect behavior.

What is the answer?

Someday, possibly fairly soon, self-driving cars will advance enough to take flawed human behavior out of the picture to a much greater degree as the technology continues to improve and grow the share of “driverless” cars on the road. When that happens, hands-free cars will replace flawed human behavior with flawed computer driven

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SHORT STORY… from page 9

The blog spot — posted by Joseph Parker, MD on Dec. 21, 2023

MALPRACTICE OR MISCARRIAGE OF JUSTICE? A DOCTOR’S ORDEAL The Drug Enforcement Administration (DEA) often quotes big numbers to reporters, who dutifully throw them into the news without context. In a DOJ press release after a physician’s arrest, it was announced that the doctor had “in the two-year period analyzed… prescribed approximately 1.2 million dosage units of opiates, including oxycodone and hydrocodone, to approximately 1,508 patients (approximately 847 dosage units per patient).”

That sounded like a lot to the public, each of whom was a potential juror, and even to other doctors in the area. When one doctor remarked about the “extreme” prescribing practices to a colleague who happened to be a pain specialist, the pain specialist rejected the argument.

You see, the pain specialist had run the numbers the right way. If a doctor prescribed 1.2 million doses to 1,508 patients, the dosage per patient would have actually been 795.8. This should have cued any reporter with a calculator on their phone to look closer, but sadly, it did not. There would need to be 1,277,276 total doses (an additional 77,000 doses) to result in the breakdown of 847 doses per patient for 1,508 patients. All by itself that was a significant error, but the pain specialist didn’t stop there. This was over a two-year period. Twenty-four months. Divide the 847 total doses per patient by 24 months, and you come out with an average dosing per month per patient of 35.3, well below the 50 monthly doses recommended by the state and far below the CDC’s recommendation of 90.

Why does the DEA report numbers this way? Because they trust that the U.S. media will not bother to fact-check what they are told, and the government is not often disappointed.

Patients will fall on a bell curve and the government will sift through the data, aided by unscrupulous data technicians, to identify a few out of thousands that had extreme problems or were particularly difficult to get on the right track. Out of 36,192 patient visits that would have occurred with that many patients over that period of time, the aforementioned arrested physician was brought to trial on charges for just five visits.

These five allegedly problematic patients were then held up to the jury alone, without context, as indicative of criminal intent from “willful ignorance” of the risk of overdose and addiction.

That doctor was me. I was convicted on four of the five charges. I had begged my attorneys to get a statistician, but they refused, I think because they didn’t understand statistics sufficiently themselves. Many doctors don’t. All those numbers are just too much. We don’t want to confuse a jury with facts, after all. +

THE DOCTOR PRESCRIBED 1.2 MILLION DOSES OF OPIATES

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But I did what I always do in these difficult cases: I sit down and shut up and listen. I talk about weather, sports, hobbies and family; anything but medicine. But mostly I listen and observe. I try to get the patient talking more than I am. It’s an attempt to make a brain-to-brain connection for a two-way flow of truth, engaging the patient’s mind as the powerful problem-solving machine that it is.

Two minds together are more than 1+1=2.

It’s more like 1+1=4. And it doesn’t really matter much that the other mind has limited medical knowledge. In fact, this process can sometimes work better if at least one of the minds is unspoiled by medical dogma.

So there we were, in the middle of a hectic ER night with several people trying to die.

I talked with her for a few minutes until a nurse convinced me that another patient was closer to the next world than this one.

I grabbed the patient’s hand and begged her to be patient. I promised her that if she would wait for me, that I would give her my best shot. She was obviously in pain, but she attempted a smile and closed her eyes as I left to find something easier to do, like saving a trauma victim.

That night was one of those nights that leaves me feeling a bit PTSD. But I have a soft spot for kids. The nurses all say that kids like me, and in fact, I am a pediatrician. I hate to leave a kid at the end of my shift knowing that the next doctor may not feel as comfortable with kids.

At last I picked up the final chart in the rack (this was years ago), and saw that it was a 3-year-old girl with abdominal pain.

She was on the other side of the curtain from my 42-year-old patient (whom I had completely forgotten).

I took a deep breath and switched my brain from high pressure ER doc mode to easy and relaxed pediatrician mode. I walked into the room and quickly recognized a familiar problem. I explained to the worried mother that it was a simple stomach virus, that young children can’t tell the difference between pain and nausea. I explained that I was going to treat her pain with a tablet for nausea called “Zofran” that dissolves in the mouth. I told her that I would be back in a few minutes and I left to give the order to a nurse.

By this time it was well after the end of my shift. The nurse I found said, “There you are! We thought you left! Did you forget about the 42-year-old woman with abdominal pain? She’s been lying in there for hours!”

Of course I had, but I said, “No! Of course not! I promised to spend some time with her if she would wait until the end of my shift!”

At that I returned to my forgotten patient.

She was still in obvious discomfort but was waiting patiently. I walked over and placed my hand on her shoulder. Before I could say a word, she said, “That was great!” I didn’t know what she meant until she said, “You’re so good with kids, you should have been a pediatrician.” I realized she had heard me through the curtain.

She did not seem surprised when I said, “Well, as a matter of fact, I am!”

She joked, “No wonder I’m no better, my doctor is a pediatrician!”

I laughed. She tried to laugh. I poked my head around the curtain and asked the little girl’s mother if it was okay to open the curtain. This violates protocols and is

probably illegal, but I was too tired to care.

I was simply trying to create an atmosphere to promote dialogue, maybe the perfect antidote to the chaotic night this lady witnessed.

So now we had three minds working together. We talked to the little girl. She was smiling and feeling better already and asking for food. We talked about little girl things like toys, birthdays and sisters.

The mother thanked me. The Zofran trick worked wonderfully, despite her doubts.

She looked at my patient and said, “He’s a wonderful doctor; listen to whatever he says.”

And then my patient and the mother began to talk about her case. As soon as the mother realized that it was a case of chronic abdominal pain and nausea, she drew an analogy to her daughter’s simple acute stomach virus.

I shook my head at the absurdity of it and was about to interrupt this conversation that was quickly getting off track. And then I remembered my rule for difficult cases (shut up and listen).

My patient said, “Believe me, I have tried every stomach medication and even some herbs. Zofran does nothing for me.”

But my mind was zipping through all my experiences with chronic pediatric abdominal pain. I thought of the episodic nature of my patient’s condition. I asked her weird questions l usually reserve for pediatric cases like, “What part of the world did your ancestors come from? Any children in your family with health problems? How old is your house? Do either of your parents get migraines?”

She said, “Nobody has ever asked that question. My mother and father have both had migraine headaches their whole life.

My brother gets them too.”

And right then I knew the diagnosis, even though I had assumed it was impossible. There is a condition called “abdominal migraine” that affects young children. I had never heard of an adult case, but for children there is usually at least one parent with migraine headaches. Most of these kids will get relief by age 12. Their abdominal pain just stops. A certain portion will develop migraine headaches about the same time their abdominal migraines go away.

But I had my doubts. Pediatric abdominal migraine is easy to treat with simple medications that had failed to help this lady. But what if I gave her a common adult migraine treatment such as a vasoconstrictor? The pain of migraine is caused by too much blood flow to the head. Medicines that constrict blood vessels can be curative.

These medications work best if given very early in an episode. My patient was hours into this episode. As expected, the first dose in the ER that night did not relieve her pain, but it did do something much better: it gave her hope.

I gave her a prescription and sent her home, still in pain. But she was so grateful and she thanked me profusely. I felt a little anxious that maybe I was giving her false hope, for surely it could not be this simple.

Surely the specialists thought of this.

Several months later she was in the ER with a sick family member. She was beaming and radiant. When she saw me she said, “That’s him! He’s the one who cured me!”

Tears were rolling down both our faces that night. +

+ 12

AUGUSTAMEDICALEXAMiNER

The Examiners +

Why the long face?

This news story is just terrible.

by Dan Pearson

Some kids snuck into a field of cattle and they put a stick of dynamite into a What happened? huge cow’s bum.

It is literally abominable.

That is disgusting.

PUZZLE ACROSS 1. Bacon partner 5. Nearby ville?

9. Like a tachy heartbeat 14. Type of ball 15. Requirement 16. Musical study piece 17. Fixed, as a habit 19. Tone of many 19th century photographs 20. Sticky pine gunk 21. Well-known bacteria 23. Electrically charged atom 24. Downtown street that once crossed the river 26. Grownups 28. Abroad 31. “I’ll ______!”

32. Zilch 33. Part of a foot 37. Small metal spikes 41. Cleveland nine, casually 44. All About...

45. # of faces of 44-A 46. One-time retail giant 47. Type of baseball team 49. Cereal grass 50. Clemson conf.

52. Antelopes 55. Bull of great fame 58. Major nerve 60. Kill Bill star 61. Augusta’s “The _______” 63. Musical composition 67. Russian country house 69. Reconciliation 71. Leading 72. Wife of a rajah 73. Common medical prefix 74. Late people “make” this 75. Paradise 76. Sign type

BY

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We’ll announce the winner in our next issue!

by Daniel R. Pearson © 2024 All rights reserved.

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

by Daniel R. Pearson © 2024 All rights reserved.

36. 2013 sci-fi flick with Scarlett Johansson 38. Anemia preventer 39. Heavy metal 40. Hardens 42. Jennifer’s ex 43. Janet Jackson hit of 1990 48. Encountered 51. Nursing assistant (abbrev.)

53. Liberty partner 54. Shrewdness; good judgment 55. One of the 12 tribes of Israel 56. City in Nebraska 57. Speed contests 58. Group of eight 59. Call 62. Noxious weed 64. Basic unit of heredity 65. Untie; loosen 66. English public school 68. Covering for the head 70. Writer Anaïs

DOWN 1. Islamic chieftain 2. Type of pool 3. Jokes 4. Conflict 5. Black bird 6. Stephen Vincent ______ 7. Nearby Island 8. Root of the taro 9. Medical school graduate practicing under supervision 10. Consumed 11. Student 12. Fool; moron 13. Local bridge?

18. Indigo dye 22. Biopsy destination 25. Fed. med. agency 27. Beehive State 28. Formicary residents 29. Adjective for 28-D 30. Hip bones 34. Field official, in brief 35. Stroke abbreviation

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, DEC. 29, 2023

1 6 E 9 S 5 9 3 7 X 1 4 U A 5 8 2 D M 4 2 I 6 9 8 O N 8 7 K E 2 7 6 1 9 U R 6 5

23

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19 21

29

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8

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W O T E Simply unscramble Uthe letters, then begin exploring D K A our ads. When E you find the correctly spelled word R B N HIDDEN O in one of our ads — enter at AugustaRx.com

Solution p. 14

QUOTATIONPUZZLE I O H L E S A R T N S I E ’ C E S A T N E N T T T I B

by Daniel R. Pearson © 2024 All rights reserved

9 8 6 5 3 1 I T I W H G5 7 D N A N G E8 4 R H I N 1 2 O I N 4 3 2 9 — Henry Wadsworth Longfellow 7 6

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

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

Solution on page 14.

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

W 1 2 3 4 1

1

2

D 3

1 4

’

1 5

2

3

1 1 2 3 4 L 1 2 3 4 1 2 3

S 1

2 1 2 3 Y A 1 1 2 3 4

1 2 3 4 5 6 7 8 9 1

2

3

F 1 2 3 4

1

1.DFBTHAAASSYWIWIWI 2.OAAAAOOHUNIE 3.DLLSSRRREAD 4.FRKPNNN 5.TR 6.I 7.S 8.E 9.D

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

by Daniel R. Pearson © 2024 All rights reserved

WORDS NUMBER

1

S M E THE MYSTERYEBSITE PWORD L ROB The Mystery Word for this issue: IASTNTS

© 2024 Daniel Pearson All rights reserved.

EXAMINER CROSSWORD

JANUARY 5, 2024

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4 9 6 8 7 5 2 3 1

5 3 8 2 1 6 9 7 4

JANUARY 5, 2024

13 +

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

T

he math teacher noticed that Timmy was not paying attention in class. “Timmy!” she said, startling him. “Are you listening to me?”

“Yes ma’am,” he replied.

Doubtful, the teacher asked him, “Then what are 3, 5, 29, and 43?”

“CBS, FOX, ESPN and the Cartoon Network,” he replied.

Moe: I’m going to DisneyWorld!

Joe: With all these flu cases going on?

Moe: You are such a germophobe!

Joe: Well, whatever you do, stay away from Sneezy.

A father sends his teenager to his room for being disrespectful. The kid storms up the stairs and yells, “And Jim Morrison is an over-rated hack!”

The dad yells back, “WHAT DID I TELL YOU ABOUT SLAMMING THE DOORS!!?!”

Moe: The first 4 letters of the alphabet are the hardest to learn.

Joe: Yeah, but the rest are E - Z.

The

Advice Doctor

Moe: How do you like your new car?

Joe: It’s awesome. The modern technology in cars these days is amazing.

Moe: Like what?

Joe: Like when I stop at a red light, the engine automatically cuts off.

Moe: Dude, my car in high school did that.

©

Moe: I had this terrible nightmare that I was super-late for work.

Joe: Did it wake you up?

Moe: Yeah, but as soon as I woke up I totally relaxed: I was already at work.

Joe: I had a nightmare too. I dreamed that I was being surgically attached to a convicted felon.

Moe: That must have been con fusing.

Moe: Are you ever scared that your nightmares will come true?

Joe: No, I’m not really superstitious. Only slightlysticious.

Moe: Have you ever been bullied?

Joe: Sure. When I was little some big kids threw me into a washing machine.

Moe: I bet you were really agitated.

Moe: Name something that would be dead, 100 feet in the air.

Joe: A centipede.

Moe: Do you know anything about laughing gas?

Joe: A little. What do you want to know?

Moe: What does it smell like?

Joe: It smells funny. +

Why subscribe to theMEDICALEXAMINER? Staring at my phone all day has certainly had no Effect on ME!

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

Dear Advice Doctor, My child has always been a bit of a handful, but as he’s grown older I keep expecting him to learn to control his emotions. The other day I told him it was time to stop playing video games and come to the table for dinner. When he ignored me I unplugged the machine.

He threw himself on the floor like a 2-year old and screamed. He was still beside himself more than an hour later, hysterically crying. Is this normal for an 8-year old?

— Patient Mom (about to become a patient!)

Dear Patient Mom, I understand your concern. I think I would be worried too.

One patient I treated several years ago had this affliction, known clinically as “Dissociative Identity Disorder.” It’s a coping mechanism for very stressful situations (like having to stop playing video games, apparently) in which the person literally dissociates himself from something he views as too painful, violent or traumatic to deal with. Some people call it an “out of body experience,” or as you describe it in your son’s case, as being able to be “beside” (or next to) oneself.

While the diagnosis is somewhat controversial and rare, many mental health professionals view it as a real condition.

Patients often have from two to four separate and distinct personalities that serve separate roles in helping the person cope with various challenges in life, a fact that is reminiscent of The Three Faces of Eve, a noted Hollywood film whose true story is based right here in Augusta. Triggers of various kinds can cause sudden and swift transitions from one “alter” or personality to another.

An accurate and official diagnosis of Dissociative Identity Disorder is a complicated and imprecise proposition at best, but the disorder is often accompanied by depression, mood swings, sleep disorders, suicidal tendencies, anxiety attacks and hallucinations, among others. Sometimes these sideline symptoms can be treated more effectively than the central core issue. Best wishes with your son! + 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 be provided only in Examiner issues.

SUBSCRIBE TO THE MEDICALEXAMINER +

+

Why read the Medical Examiner: Reason #170

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 $24 ____ or one year for $42 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

2

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6 5

7 6

1

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THE MYSTERY SOLVED The Mystery Word in our last issue was: STATINS ...cleverly hidden on the roof in the p. 7 ad for OVERHEAD DOOR OF AUGUSTA

THE WINNER: WILMA TSOPANARIAS! If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 3. The new Mystery Word is on page 12. Start looking!

JANUARY 5, 2024

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

SEE PAGE 12

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

...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.

6 3 5 8 1 4 2 7

5 1 7 4 2 3 9 6

2 4 6 9 3 1 8 5

9 6 8 7 5 2 3 1

3 8 2 1 6 9 7 4

1 7 4 3 9 5 6 8

4 9 3 6 7 8 5 2

8 5 9 2 4 7 1 3

QuotatioN QUOTATION PUZZLE SOLUTION The best thing one can do when it’s raining is let it rain.

— Longfellow

WORDS BY NUMBER When I was born I was so surprised I didn’t talk for a year and a half.

— Gracie Allen

7 2 1 5 8 6 4 9

+

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

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

IN-HOME CARE

PHARMACY

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

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.

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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.

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Thank you for supporting our advertisers! advertisers!

JANUARY 5, 2024

MIDDLE AGE… from page 5 I had intended that last paragraph to be the last one for this issue, but as I was proofreading, I got a shocking phone call that reminds me that I missed something in regard to detours and living life. One of my oldest friends, born about a year before me, passed away unexpectedly yesterday despite not being ill as far as anyone knew. She was a very caring and nurturing woman who built her life around her husband and children and was happy to do it. We camped together regularly when we were young. Our families would even spend the entire twoweek winter break together in a cabin at Mistletoe State Park.

We did this too many times for me to recall how many times it was. I would play with my G.I. Joe going on a “mission,” and she would remind me that G.I. Joe needed to come home for supper to his wife Barbie at their dream home when the mission was over. As a little boy, I groaned about it and complained, but I complied. It was good training for married life.

Her unexpected passing told me that I had missed an important point about life’s detours. Sometimes, you don’t make it to your destination. At least not in this present life. Because of that, instead of thinking of the detours as an imposition you have to suffer through, make the most of them. See things you wouldn’t have seen going the other way. Who knows what would have happened if you had taken the path you planned?

Perhaps the road not taken wasn’t even the best way to go. Ask Robert Frost about the road not taken.

Find your happiness on the road you have taken, the socalled detour. Look for the new and the beautiful along the way, in all aspects of life. Do that for yourself and for your loved ones. Happiness can spread from person to person, from smile, to smile. +

15 +

AUGUSTAMEDICALEXAMiNER

OUR NEXT ISSUE DATE: 2024

19

JANUARY

VISIT US IN THE UPTOWN VA

BY THE RETAIL STORE

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

DEAR READERS

IFIF YOU YOU ENJOY ENJOY THIS THIS NEWSPAPER NEWSPAPER

TWO WORDS TO SHARE WITH OUR ADVERTISERS ARE SHOWN ABOVE.

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JANUARY 5, 2024

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Kaushal J. Shah, MD Vascular Surgeon

ARTHRITIS/KNEE PAIN CLINIC Fax Referrals: 706-868-3719

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Vascular Surgeon

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ENDOCRINOLOGISTS

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AIYAN DIABETES CENTER 462 FURYS FERRY RD • AUGUSTA 30907 (706) 868-0319 • AIYANDIABETES.COM FAX: (706) 868-3719